Sunday, October 7, 2012

Medical Ethics: Why I Wouldn’t Write a Prescription


Medical ethics is woven into the Whistleblower blog. I have presented vignettes exposing ethical controversies in the medical profession. I have pointed out scenarios when patients test the steeliness of our ethical scaffolding. I have admitted when my own ethics can be fairly challenged. Indeed, this blog does not take a ‘holier than thou’ posture, though at times I have been accused of this. I have directed as much criticism at myself as I do elsewhere.

Recently, I received a request to assist someone whom I was told was in dire need of a physician’s assistance. While I am a physician who has taken an oath to heal and comfort, in this case I turned away from a person in need. I present the anecdote not because it will stimulate a discussion of the competing ethical angles of the case. Indeed, the case has no angles and no reader will challenge my decision. I present it as an example of an outrageous and improper request that was made to a doctor. Indeed, while I have received numerous improper requests from patients over the past two decades, which I routinely declined, this request was the ‘mother of all ethical outrages’.


Valtrex Structural Formula

A woman whom I know called me with a medical request. She is not my patient. Her niece, also not my patient, was desperate to receive a prescription for Valtrex, a medication she needed for oral herpes. Her own physician would not refill the prescription. The niece did not want to see another doctor for a prescription, as this would create a paper trail that her husband, who opens the mail at home, might discover. The niece was frightened that her husband would discover this infection, and worried that this would result in a marital strain. The woman who phoned me asked if I would call in a prescription for Valtrex under her name, although the pills would be transferred to her niece.

This case poses no ethical quandary for any physician.

The woman who called me is a wonderful and caring person. I wanted to offer some counsel beyond a rebuke of her request, and I did so.

I am interested in what advice readers would have offered, as well as potential explanations for the niece’s anxiety. Once a discussion has hopefully developed, I will share the advice I rendered, and will look forward to readers’ response to it. I always welcome criticism because I am holier than no one.

3 comments:

Toni Brayer, MD said...

This is surprisingly not uncommon. There are so many reasons patients (or non-patient friends) will ask us to fill prescriptions for others. The stories are elaborate and seem to make total sense to the requester.

Of course the answer in this case has to be no. The request was built on a faulty premise...that a diagnosis of herpes is something to be hidden. If I had the time, I would educate the woman on herpes infection and the latent properties of the virus. I would advise her to always have a supply of Valtrex on hand and if her own personal physician will not refill this essential medication, she needs to find a new doctor.

Filling prescriptions for non-patients is illegal and the risk goes as far as loosing our license to practice medicine. Added to that is the knowledge that this RX would be handed over to yet another person. Huge red flags, which of course, you recognized and dealt with.

LA Morrison, MD said...

This dilemma brings up the "do no harm" ideology, which is paramount to our profession. As we know, millions of Americans and not-yet-official Americans are without health insurance that will cover prescriptions and medical visits. Would it be ethical to advise a non-patient to spend $120 for a clinic visit in order to obtain a $4 antibiotic?

Implications of patient prescriptions also must be considered. An associated diagnosis of asthma, anxiety, migraine headaches, etc. may bar an otherwise-healthy individual from joining the armed forces, obtaining better, non-governmental health insurance, or organ donation.

As a physician, I've balked at the suggestion of writing a prescription under these circumstances. However, I have considered it as a daughter, granddaughter, friend.

Ethical issues are never cut-and-dry, and never static. We do the best we can.

Michael Kirsch, M.D. said...

Agree that ethics are not purely black and white, as you suggest, but there needs to be some bright lines that we don't cross. Clearly, the slippery slope risk of even minor ethical erosion is there and we need to be vigilant.

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