Islamic reasoning and the use of prohibited medicines among Muslim patients: a qualitative study

Abstract

Introduction: Muslim patients may avoid medicines containing ingredients prohibited by their faith (haram), such as alcohol, gelatine, or porcine derivatives. While Islamic law permits exceptions based on necessity (darura) or biotransformation (istihala), the way these principles influence medication adherence and shape patient-healthcare provider (HCP) interaction is underexplored. Aim: To explore how Muslims apply Islamic reasoning to medication adherence decisions involving medicines containing haram ingredients. Method: Thirteen ethnically diverse Muslim adults were purposively sampled for semi-structured interviews. A prior scoping review and mosque-based public and patient involvement (PPI) informed the interview guide. Interview data were analysed using Braun and Clarke's Reflexive Thematic Analysis (RTA), with themes constructed inductively. Data interpretation was guided by the Necessity-Concerns Framework (NCF) and locus of control (LOC) theory. Rigour was supported through member checking, peer debriefing and reflexive journalling. Results: Four themes emerged: (1) Halal as worldview: the halal-haram spectrum functioned as a moral lens for daily behaviour and intake, extending to medication use. (2) Motivations for consumption: halal was linked to perceived health and spiritual benefit, while haram signalled impurity and harm. (3) Minor illness or major disease: darura and istihala were applied flexibly in chronic or life-threatening illness, whereas participants avoided prohibited medicines for minor conditions, favouring complementary remedies. Practical workarounds included switching dosage forms or opening gelatine capsules and discarding the shell to minimise religious harm. Decisions were shaped by perceived severity, symptom burden, financial considerations, and the extent to which HCPs were perceived as trustworthy, culturally competent, and responsive to religious disclosure, all of which influenced adherence. (4) Personalised care: participants valued shared decision-making, transparent disclosure of religiously relevant excipients, and a reasonable degree of religious literacy among HCPs; scepticism about halal certification underscored the need for clearer labelling and guidance. Conclusion: Islamic reasoning influenced how participants engaged with medicines deemed haram. Supporting adherence requires pharmacy practice that incorporates religious literacy and responds to concerns about transparent labelling and faith-sensitive communication. These steps will strengthen patient-centred care by aligning religious and ethical reasoning with treatment decisions, fostering trust, enhancing adherence, and supporting more equitable care for Muslim patients.