Ethical and Legal Implications of Prescribing Drugs

Scenario 2: A friend calls and asks you to prescribe a medication for her. You have this autonomy, but you don’t have your friend’s medical history. You write the prescription anyway.

Many healthcare practitioners will avoid practicing medicine upon friends and family members, except in cases of urgent need, because of the difficulties in upholding ethical standards of conduct in such instances. The above-cited example demonstrates how tempting it can be to use one’s capacity as a nurse practitioner to do a favor for a friend and to act in a manner that is not consistent with ethical standards. In fact, in some states, such as Colorado, it is explicitly grounds for disciplinary action. The Colorado Medical Practice Act reads: “Prescribing, distributing, or giving any controlled substance to oneself or family members, except in an emergency, is considered unprofessional conduct and grounds for disciplinary action” (Zilber, 2016, par.3). In this particular scenario, there is no clear sense of urgency in regards to the need for the patient to be issued a prescription, it is merely convenient to do so.
The fact that the nurse practitioner does not have the patient’s medical history is problematic. First, the patient could have allergies to active or inert ingredients in the medication. The patient could also be taking prescription or non-prescription medication which might be contraindicated. There may even be an issue of an addition to the specified medication. From the point of view of the nurse, this could leave her open to legal liability. The pharmacist cannot give the patient adequate information about dosing, things to watch out for, or other factors associated with taking the medicine, since the provider does not have the patient’s full medical history. The patient is needlessly being put at risk and the patient’s family could have grounds to sue the provider, should anything go amiss regarding the patient’s prescription.
Zilber (2016) states that there are two foundational ethical principles to consider when determining if it is ethically permissible to prescribe a medication to an individual with whom the provider has a personal relationship, “beneficence and fiduciary duty. Beneficence is the familiar principle that our professional actions will benefit the patient. Fiduciary duty is the requirement that physicians consider only the interests of the patient, not the physician’s own interests,” including the interest to avoid a personal conflict with a friend (par.5). In this instance, there is no clear indication the patient will really benefit from the medication. While the nurse is not being compensated, a better strategy would be to create a plan to obtain the medication from an outside, legitimate provider.
Also, the act of prescribing a friend a medication may not be addressing the patient’s real illness. Patients are notorious about self-diagnosing themselves with illnesses, based upon what they have seen on television. There is a reason that patients are required to have a prescription before obtaining medication and for the nurse to look the other way and enable the patient to take advantage of a personal relationship with a health provider is very problematic. Depending on the medication, the patient may have an addiction that is not being addressed and is engaged in doctor-shopping. Or the patient could have a more serious condition that will go overlooked, because only the surface aspects of the patient’s illness are being addressed (Silverman, 2016). Providing advice about seeing a general practitioner or specialist would also be advisable.
Nurse practitioners are often most tempted to issue prescriptions if a friend needs a prescription for a medication he or she takes regularly, such as birth control pills or an allergy medication. But even with regularly-issued prescriptions, the need for a full health workup at periodic intervals should not be overlooked and a patient’s health status can change quickly. If a patient lacks insurance at all, it is also tempting to issue a prescription but ultimately the potential risks to both the provider and the patient outweigh those of any possible benefits.


References
Silverman, M. (2016). Off-script: The dangers of writing off-hand prescriptions for friends and
family. Emergency Physician’s Monthly. Retrieved from:
http://epmonthly.com/article/off-script-the-dangers-of-writing-off-hand-prescriptions-for- friends-and-family/
Zilber, C. (2016). Ethical considerations when prescribing for friends and family. Psychiatry
Online. Retrieved from:
https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2016.3a11