Welcome to Ethics Consult -- an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma in patient care, you vote, and then we present an expert's judgment.
Last week, you voted on the ethics of surreptitiously giving a suicidal cancer patient medications he doesn't want, as requested by the patient's son. Here are the results from nearly 800 votes:
Would you tell the patient his son's plan [to give the rejected medications under the guise of something the patient will accept]?
Yes: 314
No: 457
Is pill switching something you would report to authorities?
Yes: 324
No: 442
And now bioethics scholar Gregory Dolin, MD, JD, weighs in:
The doctors' intuition is correct. Provided that the patient is cognitively able, it is entirely within his right to take or refuse to take medications. Attempting to medicate such a patient against his will would be a classic case of medical battery.
That having been said, if doctors suspect that he is indeed suicidal, they may use involuntary commitment procedures to ensure that the patient is not a threat to self. Of course, merely refusing to take medications and "letting nature run its course" is not in and of itself proof of mental impairment.
It is not clear what doctors can do to stop the son from carrying through with his "pill switching" plan (assuming he is able to get the pills somewhere absent a prescription). It is possible that doctors could inform law enforcement authorities because the son is not the patient and therefore, no physician-patient confidentiality applies. However, the best line of defense is to refuse to prescribe medication without personally evaluating the elderly gentleman who will be the subject of treatment.
Finally, doctors (even if they are themselves not psychiatrists) should attempt to have a conversation with the cancer patient about what he really wants and why he wants it. In such a conversation, options can be explained, the patient can be reassured as to the nature and the likelihood of success of the proposed treatment, and the patient's competency, insight, and support system can all be assessed.
These conversations are always important, but are particularly invaluable with patients who are facing a potentially dire diagnosis and whose decisions may be clouded both by the heavy burden of the medical side of the diagnosis and the concern about the effect such a diagnosis may have on family dynamics, finances, and other similar considerations.
, is associate professor of law and co-director, Center for Medicine and Law at the University of Baltimore, where he also studies biopharmaceutical patent law. His work includes a number of scholarly articles, presentations, amicus briefs, and congressional testimony.
And check out some of our past Ethics Consult cases: OK to Give Babies Experimental Drug Not in Trial?, Deaf Couple Only Wants Deaf Baby, and Critical Patient With DNR Tattoo.