Ethics of Prescribing Medications to Friends and Family

The Ethical Dilemma of Prescribing for Friends

Scenario: A friend calls and asks you to prescribe a medication for her. You have the authority to do so, but you do not have her medical history. You write the prescription anyway.

Many nurse practitioners and other healthcare providers avoid treating friends and family members — except in cases of urgent need — because of the inherent difficulties in upholding ethical standards of conduct in such situations. The scenario above demonstrates how tempting it can be to use one's prescribing authority as a favor to a friend, even when doing so is not consistent with professional ethical standards. In fact, in some states, such as Colorado, this conduct is explicitly grounds for disciplinary action. The Colorado Medical Practice Act states: "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 — the prescription is issued merely out of convenience.

Legal and Liability Concerns

The fact that the nurse practitioner does not have the patient's medical history is deeply problematic. The patient could have allergies to active or inactive ingredients in the medication, or could be taking prescription or non-prescription drugs that are contraindicated. There may also be an issue of dependence or addiction to the specified medication. From the provider's standpoint, this creates significant legal liability. Without the patient's full medical history, neither the provider nor the pharmacist can give adequate guidance on dosing, potential side effects, or other critical factors associated with taking the medicine. The patient is needlessly placed at risk, and the patient's family could have grounds to pursue legal action against the provider should any harm result from the prescription.

Beneficence and Fiduciary Duty

Zilber (2016) identifies two foundational ethical principles relevant to determining whether it is permissible to prescribe medication to someone 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 in avoiding personal conflict with a friend (par. 5). In this scenario, there is no clear indication that the patient will genuinely benefit from the medication. While the nurse is not being financially compensated, the more appropriate course of action would be to help the friend establish care with a legitimate outside provider.

Conclusion

Prescribing medication to a friend without access to that person's medical history violates the core ethical principles of beneficence and fiduciary duty, creates significant legal liability for the provider, and may cause direct harm to the patient. Regardless of the circumstances — whether the medication is routine, the intent is kind, or the patient lacks insurance — the ethically and professionally correct course of action is to refer the friend to a legitimate healthcare provider who can conduct a proper evaluation and prescribe safely.

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