title: Should a doctor prescribe hormone replacement therapy which has been manufactured from mare's urine?
abstract: Many clinicians are experiencing consumer resistance to the prescription of equine HRT (that is hormone replacement therapy which has been manufactured from mare's urine). In this paper I consider the ethical implications of prescribing these preparations. I decide that patients should have a right to refuse such treatment but also ask whether a prescribing doctor should choose one preparation over another on moral grounds. I determine that there is prima facie evidence to suggest that mares may suffer and that prescription of equine HRT (instead of synthetic oestrogen-oestriol) would therefore have to be justified in terms of either offering greater benefits to the women or offering greater value for money to the health service. I find that there is no substantial evidence to suggest that equine HRT offers unique advantages over and above oestriol. I conclude that it would be preferable for a doctor to recommend the synthetic oestrogen to women who want relief from the symptoms of the menopause and protection from osteoporosis and cardiovascular disease.
authors.affiliation: Cambridge University Clinical School.
authors.forename: D
authors.initials: D
authors.lastname: Cox
mesh_terms: D017087:Animal Rights; D000818:Animals; D015519:Bone Density / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000517:prevention & control; D003363:Cost Control; D030881:Disclosure; D004964:Estriol / Q000191:economics / Q000494:pharmacology; D015914:Estrogen Replacement Therapy / Q000191:economics; D004966:Estrogens, Conjugated (USP) / Q000191:economics / Q000494:pharmacology; D028663:Ethical Theory; D004992:Ethics, Medical; D005260:Female; D006736:Horses; D006801:Humans; D008593:Menopause / Q000187:drug effects; D028681:Moral Obligations; D009014:Morals; D026684:Personal Autonomy; D018570:Risk Assessment; D013315:Stress, Psychological; D014556:Urine / Q000737:chemistry*
chemical_list: D004966:Estrogens, Conjugated (USP); D004964:Estriol