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Medical Ethics: Why I Wouldn’t Write a Prescription

Posted Oct 07 2012 6:00am

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’.

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.

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