ADMINISTERING MEDICINES FROMISLAMIC PERSPECTIVE
FAHMI BIN HASSANPRINCIPAL ASSISTANT DIRECTOR
PHARMACY PRACTICE & DEVELOPMENT DIVISION
MINISTRY OF HEALTH MALAYSIA
HALAL PHARMACEUTICAL FORUM, PULLMAN BANGSAR HOTEL, 29 Sept 2018
TABLE OF CONTENT
Introduction
01Use Of Medicine From Islamic Perspective
02Use Of Medicine Containing Non Halal Ingredients
03Conclusion
04
HALAL PHARMACEUTICALS & PATIENT CARE
The Muslim population was comprised of 1.7 billion people in 2014 and is expected to rise to 2.2 billion by 2030.
Since Islam lays the responsibility to practice the religion on individuals, there are personal and cultural disparities that may lead to difficulties in delivering the medical practice that tailors to all Muslim.
Muslim consumers are more discerning on their purchases of pharmaceuticals and cosmetics, which are absorbed by the body.
Hinduism, Judaism and Christianity also command certain religious restrictions and bindings on their followers in the consumption of foods and drinks
HALAL PHARMACEUTICALS & PATIENT CARE
A drug/medicine is composed of a combination of active ingredients, and excipients. These substances are obtained from a variety of sources; animals, plants or synthetic origin
HCP, in their practice encounter with the patients of different severity of illness, and accordingly their exposure to different categories of medicines will also be different.
In the present age, medicines have become a necessity to maintain our health. Usually there are three players in this context; doctors, pharmacists and consumers. Consumers usually cannot decide which medicine is suitable for them.
This is then the role of the HCP to choose the most suitable medication for his/her patient keeping in mind, the religious beliefs of the patient.
HALAL PHARMACEUTICALS & PATIENT CARE
Close patient-HCP relationship has resulted in consumers to perceive that the advice of HCP is reliable.
Individuals have different views on treatment, including the use of certain inactive ingredients in medications.
However, most patients are unaware of these ingredients being in their medications. Patient has a right to ask information about sources of ingredients in medicines which are prescribed to them.
The clinicians and pharmacists should be proactive and not leave it to the patient to broach the subject. Since patients have the right to make informed decisions about their medical treatment, it is important that health care providers involve the patient when making treatment decisions
“Do you know that it is ethical obligation for a practitioner to take consent from the patient before prescribing any medicine which has any non-Halal content?”
PANDUAN PENGGUNAAN UBAT-UBATAN DARI PERSPEKTIF ISLAM
Published in January 2018 by Program Perkhidmatan Farmasi in collaboration with:-
Bahagian Perancangan dan Penyelidikan JAKIM
Bahagian Regulatori Farmasi Negara (NPRA)
OBJECTIVE
“Garis panduan ini disediakan untuk memberi kefahaman dan penjelasan kepadagolongan profesional kesihatan/perawat kesihatan dan sebagai rujukan kepada
umat Islam mengenai aspek penggunaan ubat-ubatan mengikut hukum syarak, agar tidak timbul keraguan dan kekeliruan”
To provide explanation to health professionals and to serve as reference to Muslims on the aspect of use of medicine according to Islam, so that to avoid doubts and confusion.
BACKGROUND
Purpose of medicine
The importance of seeking treatment
Concept of daruriyyah
Halal and haram from clinical point of view
Halalan Tayyiban
USE OF MEDICINE
Ingredients and Excipients
MSQH & Joint Commission International
Halal gelatin
Ethanol (alcohol)
Psychoactive substances
ADMINISTRATION TIMING
To relate it with prayer time
Once daily – any of the 5 fardh
Twice daily – Subuh & Maghrib
Thrice daily - Subuh, Zuhr & Isya’
Four times daily – Subuh, Zuhur, Maghrib & Isya’
DURING FASTING
PERMISSABLE
Eye drops & ear drops
Nasal drops
Creams, lotions, topical preparations
Bolus injections
Local/regional anesthesia
Sublingual tablets
NOT PERMISSABLE
Oral preparations
Suppositories
Pessaries
Inhalers*
General anesthesia
ADMINISTRATION TIME DURING FASTING
OD – During sahuror during breaking fast
1
BD – During sahur and during breaking fast
2
TDS – During sahur, during breaking fast and midnight
3
ETHICS
Be respectful, kind and ihsan to
the patient
Always maintain good intention
(niat)
Be sincere, patient,
responsible and amanah
Maintain professionalism
Privacy & confidentiality
Maintain good pharmaceutical
care practice (5R)
PANDUAN PENGGUNAAN UBAT-UBATAN YANG MENGANDUNGIUNSUR TIDAK HALAL
Published in January 2018 by Program Perkhidmatan Farmasi
Reviewed by:
Pejabat Mufti WPKL & Putrajaya
Bahagian Perkembangan Perubatan, MoH
Bahagian Pembangunan Kesihatan Keluarga, MoH
DISCUSSION WITH WP MUFTI IN JUNE 2017
1. Use of inhaler during fasting
2. Concept of daruriyah in medicine
3. Use of medicine containing non halal substances
OBJECTIVE
“Garis panduan ini disediakan bagi memberi panduan kepada anggota kesihatanyang terlibat dalam rawatan pesakit yang menggunakan ubat-ubatan mengandungi
sumber-sumber yang tidak halal atau bertentangan dengan syariat Islam”
To guide health professionals who have to treat patients with medicine containing ingredient not permissible in Islam.
USE OF INGREDIENTS DERIVED FROM ANIMALS OR ALCOHOL
HCP should explain that during medicine manufacturing process, substances derived from animals may be used as:
Production of active ingredients (special biotechnology processes such as recombinant DNA)
As excipients or used to produce capsule (gelatine)
As culture medium
For alcohol, HCP should explain that it may be used as diluent, stabilising agent or disinfectants. Medicine containing alcohol for the said purposes is permissible in Islam.
REGULATORY REQUIREMENT
Drug Registration Guidance Document (DRGD) from NPRA stated that all products to be registered should declare all substances derived from animals contained in the finished products.
HCP could explain with confidence to the patients that the would know whether the medicine prescribed contain any unlawful ingredients or not by referring to the labels.
HOW TO START A TREATMENT WITH MEDICINE CONTAINING NON HALAL SUBSTANCES
HCP own’s patient
Treatment is critical or life
saving
No proven alternatives
Duration of treatment as necessary
Proper explanation to
the patient
Get consent before starting
treatment
RESPONSIBILITIES OF PHARMACY DEPARTMENTS
All pharmacy departments in MoH facilities should compile a list of drugs containing animal sources available at the individual facility.
The list will serve as reference to all HCP involved in patients treatment and should be updated from time to time.
In line with the requirement of “Service Standard 18 – Pharmacy Services” MSQH Malaysian Hospitals Accreditation Standards (Standard 18.1.1.8).
CONCLUSION
Diffusion of proper information will result in building positive perception towards medications and an increased treatment outcome which is the aim of the therapy.
Addressing concern associated with Halal and Haram in medication use can be the first step in providing competent and rational healthcare.
HCP opinion becomes an important factor when it comes to the drug decision making process.
A consensus has been made during our discussion with religious authorities. Clinical judgement of the treating doctor to the individual patient is the most important factor to decide whether it is permissible for a drug containing non halal substances to be used.
REFERENCES
1) Al-Bukhari, Abu Abdullah Muhammad bin Ismail, 1400 H, al-Jami` al-Sahih, Muhibbudin al-Khatib (pnyt.), cet. 1, jil. 4, Kaherah: Maktabah al-Salafiah.
2) Al-Zuhayli, Wahbah, 1997, Nazoriyyah al-Dharurah al-Syar`iyyah: Muqaranah Ma` al-Qanun al-Wadh`iy, Beirut: Dar al-Fikr al-Mu’asir.
3) Abu Daud, Sulaiman bin al-Ash`ath al-Sajistani al-Azdi, 2000, ‘Sunan Abi Daud’ dalam Mawsu`ah al-Hadith al-Sharif, Saleh bin Abdul Aziz bin Muhammad (pnyt.), cet. 3, Riyadh: Dar al-Salam.
4) Ibn Majah, al-Hafiz Abu Abdullah Muhammad bin Yazid, 1992, ‘Sunan Ibn Majah’ dalam Mawsu`ah al-Sunnah al-Kutub al-Sittah wa Sharahuha, Muhammad Fuad Abdul Baqi (pytg.), cet. 2, jil. 18, Istanbul: Cagri Yayinlari.
5) Jabatan Kemajuan Islam Malaysia, 2014, Keputusan Muzakarah Jawatankuasa Fatwa Majlis Kebangsaan BagiHal Ehwal Ugama Islam Malaysia, cet. 4, Putrajaya: Jabatan Kemajuan Islam Malaysia.
6) Muslim bin al-Hajjaj, 2000, ‘Sahih Muslim’ dalam Mawsu`ah al-Hadith al-Sharif alKutub al-Sittah, Saleh bin Abdul Aziz bin Muhammad bin Ibrahim (pnyt.), cet. 3, Riyadh: Dar al-Salam.
7) Abd. Latif Muda & Rosmawati Ali @ Mat Zin, Perbahasan Kaedah-kaedah Fiqh, Pustaka Salam Sdn. Bhd, 2000, hlm. 163.
REFERENCES
8) Portal Rasmi Jabatan Kemajuan Islam Malaysia, 2005, Garis Panduan Kawalan Ubat-ubat Dalam Islam, http://www.islam.gov.my/rujukan /garis-panduan/52-garispanduan-bersama-kawalan-ubat-ubat-dalam-islam.
9) Portal Rasmi Jabatan Kemajuan Islam Malaysia, 2013, Panduan Berpuasa bagi Pesakit, http://m.e-muamalat.gov.my/sites/default/files/e-penerbitan/buku_panduan_ puasa_bagi_pesakit.pdf.
10) Garis panduan penggunaan ubat-ubatan sumber haram kepada pesakit Muslim di Pusat Perubatan Universiti Malaya (PPUM).
11) Keputusan Muzakarah Jawatankuasa Majlis Fatwa Kebangsaan (25 Jun 2009).
12) Mohd Zarif et. al (2013). The use of forbidden materials in medicinal products: An Islamic perspective. Middle-East Journal of Scientific Research, 13:05-10.
13) The Evolution and Future of ACC/AHA Clinical Practice Guidelines: A 30-Year Journey. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
14) Malaysian Medical Council Guideline: Consent for Treatment of Patients by Registered Medical Practitioners.
15) Borang Keizinan Pembedahan/Prosedur KKM (PER/CONSENT/2016)
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