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

INTRODUCTION

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?”

AVAILABLE GUIDELINES FROM MOH

PANDUAN PENGGUNAAN UBAT-UBATAN DARI PERSPEKTIF ISLAM

Guideline 1

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)

MULTI ORGANISATION INVOLVEMENT

Working committee

MoH

UKMMC

CUCMS

MinDef

MCPG

MPS

JAKIM

BumiFarma

PANDUAN PENGGUNAAN UBAT-UBATAN DARI PERSPEKTIF ISLAM

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 MENGANDUNGI UNSUR

TIDAK HALAL

Guideline 2

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

PANDUAN PENGGUNAAN UBAT-UBATAN MENGANDUNGI UNSUR TIDAK HALAL

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.

SCOPEMoH

Facilities

Reality

PracticalityPatient

Wellbeing

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.

DRUG REGISTRATION GUIDANCE DOCUMENT

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

WORKFLOW

IN GENERAL SITUATION

WORKFLOW

IN EMERGENCY SITUATION

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).

MSQH 5TH EDITION

“List of medicines with

animal origin”

WHAT SHOULD HCP EXPLAIN

The name of the medicine

Indication

Why it is necessary/preferred

CONSENT FORM

CONCLUSION

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.

DOWNLOAD LINKS

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)

THANK YOU jfahmi_h@moh.gov.my