When Taking Medication May Be a Sin: Dietary Requirements and Food Laws

BJPsych Advances (2015), vol. 21, 425–432 doi: 10.1192/apt.bp.114.012534 When taking medication may be a ARTICLE sin: dietary requirements and food laws in psychotropic prescribing Waqqas A. Khokhar, Simon L. Dein, Mohammed S. Qureshi, Imran Hameed, Mohammed M. Ali, Yasir Abbasi, Hasan Aman & Ruchit Sood In psychiatric practice, it is not uncommon to Waqqas A. Khokhar is a SUMMARY come across patients who refuse any psychiatric consultant psychiatrist with Leicestershire Partnership NHS Religious laws do not usually forbid the use of intervention, placing their faith in a spiritual psychotropic medication, but many do forbid the Trust and an honorary lecturer in recovery enabled by their religious beliefs (Campion the Centre for Ageing and Mental consumption of animal-based derivatives of bovine 1997; Koenig 2001). Although religious laws do Health at Staffordshire University. and/or porcine origin (e.g. gelatin and stearic not usually restrict the taking of psychotropic Simon L. Dein is a senior lecturer acid) such as are found in many medications. at University College London, an Demonstrating awareness of this, combined with medication, many do forbid consumption of the Honorary Clinical Professor at a genuine concern about how it affects the patient, animal derivatives, particularly gelatin and stearic the University of Durham and a may strengthen the doctor–patient relationship acid, that many psychotropics contain. This has consultant psychiatrist with the and avoid non-adherence. In this article, we major implications, for example, for patients who North Essex Partnership University NHS Foundation Trust. Mohammed outline dietary requirements of key religions and follow Judaism, Islam, Hinduism, Buddhism and S. Qureshi is a Foundation Year belief systems that may have a bearing when Seventh Day Adventism (Singsit 2001; Leung One Doctor at United Lincolnshire prescribing medication containing animal-based 2005). There are also over 4 million vegetarians Hospitals, having recently gained an MB ChB degree from ingredients. We identify common psychotropics in the UK and the number is ever growing (Food that contain animal-based derivatives and suggest Leicester Medical School. Imran Standards Agency 2005). alternative prescribing options and approaches to Hameed is a GP registrar with The experience of illness can be akin to a spiritual the East of England GP Rotational dealing with sensitive ethical issues. event for many psychiatric patients. Patients, Training Scheme. He is based LEARNING OBJECTIVES in Peterborough. Mohammed carers and their families may be more likely to M. Ali is a consultant forensic • Gain a basic understanding of religious principles consult religious teachings during times of illness psychiatrist with St Andrew’s governing dietary laws and their influence on (Borras 2007; Chatters 2008). A discussion about Healthcare Service, Northampton. concordance with psychotropic medication the presence of animal products in medications Yasir Abbasi is a consultant addiction psychiatrist with the • Be able to discuss confidently with patients the not only opens the door to a dialogue with people Leeds Addiction Unit, Leeds & York presence of religiously or ethically forbidden for whom the psychiatrist pledges to care but also Partnership NHS Foundation Trust ingredients in medication shows a willingness to acknowledge that their and an honorary senior lecturer in the School of Healthcare, University • Be able to offer alternative strategies to address beliefs are important to the psychiatrist (Huguelet medication non-adherence secondary to of Leeds. Hasan Aman works 2006). Lack of consideration for these matters can with Northumberland, Tyne and religious, ethical or personal beliefs impair the doctor–patient relationship (Khokhar Wear NHS Foundation Trust as a DECLARATION OF INTEREST 2008). Although there has been little research in consultant child and adolescent this area (e.g. Mohr 2004; Sattar 2004b; Dogra psychiatrist in Newcastle upon None Tyne. Ruchit Sood is a consultant 2005), the fostering of patients’ trust through a in general psychiatry with the shared understanding of their illness can improve Betsi Cadwaladr University Medication is probably the most frequently treatment adherence, reduce relapse rates and thus Health Board, Wrexham, Wales. Correspondence Dr Waqqas prescribed treatment in mental healthcare and help to reduce their mental distress (Borras 2007). Ahmad Khokhar, Department of non-adherence has a significant impact on patients’ There is also evidence to suggest that the patients Psychiatry, Maidstone Centre, lives and well-being (Weiden 1995; Patel 2005). of clinicians who respect their perspectives have City Central CMHT, St Peters Although religious beliefs may not markedly improved healthcare outcomes and feel better Health Centre, Sparkenhoe Street, Leicester LE2 0TA, UK. Email: influence medication adherence in patients who understood, respected and valued as partners in [email protected] present to psychiatric services (Dein 2004), their own care (Secker 2002). Williams (1997) non-adherence should prompt a comprehensive argued that, when culture is overlooked, incorrect assessment of the patient’s demographics, social and even harmful decisions may be made. Good circumstances, and cultural and religious beliefs patient care is not only culturally aware, but (Subach 1999; Sattar 2004a). also religiously sensitive. Such care requires 425 Downloaded from https://www.cambridge.org/core. 28 Sep 2021 at 02:13:55, subject to the Cambridge Core terms of use. Khokhar et al commitment, willingness to honour differences and physical well-being of animals. For example, and openness to exploring diversity. It also Exodus 23:5 and Deuteronomy 22:4 both talk requires mental health professionals to be more about relieving animals of their burden, regardless aware of issues of religion and spirituality and of whether their owner is a friend or an enemy. educated about the major teachings of diverse religious groups (Meyer 1988). Jewish dietary laws Kashrut comes from the Hebrew root Kaf-Shin- Dietary requirements and food laws from a Reish, meaning fit, proper or correct. According religious perspective to Jewish dietary laws (Kashrut), only animals The concept of clean and unclean animals that chew the cud (ruminate) and have cloven hooves, for example cows, can be consumed. Pigs Followers of many religions forbid the consumption are forbidden, as they do not chew the cud despite of certain animals, which are commonly referred having cloven hooves. Horses and camels do chew to as ‘unclean’. Some religions also have specific the cud, but do not have cloven hooves. Thus, Jews requirements with regard to the slaughtering of are forbidden to eat pork, as swine are considered animals and the preparation of meat and meat to be unclean (Dresner 1980). products. These issues are prominent in Judaism Meat must be kosher, which is achieved by the and Islam, where pork is not consumed, and they ritual slaughter of the animal (schechita) with are largely used as the basis for identifying ‘taboo’ respect and compassion by a religious Jew who meat proscribed by religious dietary laws. For is trained and licensed. Kosher dietary laws are certain faiths, medicines derived from sources observed all year round, not just during Pesach that are forbidden can present huge problems for (Passover). Any products of a non-kosher animal patients, carers as well as healthcare professionals. are also non-kosher (Heber 1995). Gelatin is Methods for determining what is and is not one such product, and within the past 20 years, acceptable among people of particular religious kosher gelatin has become available: some of this creeds remain a source of discussion by religious is derived from cows or fish and some is derived leaders and scholars (Eriksson 2013). from a plant or seaweed base using agar or pectin. The Abrahamic faiths What does this mean for the Jewish patient? A brief word on the concept of Abrahamic faiths According to Jewish teachings, people who are ill and their common ground will aid the understand- fall into one of three categories: ing of references to non-Abrahamic faiths later in this article. Judaism, Christianity and Islam are • choleh sheyesh bo sakanah: someone who is ill the three religions collectively referred to as the and whose life may be in danger as a result of Abrahamic faiths. All are monotheistic religions the illness; and are unified in their belief that God revealed • choleh she’ain bo sakanah: someone who is ill himself to the Prophet Abraham. Thus, the but whose life is not likely to be in danger; this Prophet Abraham is the common forefather of includes those who are bedridden and those who these faiths, which currently embrace more than are not functioning at normal levels owing to half of the world’s population. According to this pain or illness; trio of religions, God is the Divine Creator and • one who has a michush: someone who is source of all moral law. All other faiths, including uncomfortable but is able to maintain routine the dharmic religions and the Chinese religions of activities despite discomfort, for example those East Asia, are therefore termed non-Abrahamic with a headache or indigestion. faiths. The non-Abrahamic faiths that we discuss in Jewish medical ethics derived from Jewish law this article are Hinduism, Buddhism and Sikhism. (halacha) provide guidance on the use of medicinal substances. All food and dietary additives or Judaism medicines

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