Can My Psychiatrist Deny Me Services Using Medical Marijuanas
The Ethicist
Can a Dr. Refuse to Treat a Patient Who Takes Cannabis?
A friend was recently diagnosed with multiple myeloma, a cancer of a type of white blood cell called plasma cells. There is ofttimes significant pain associated with this condition, and my friend has been treated with high doses of different opioid combinations, in addition to chemotherapy. My friend lives in Colorado, where he has easy access to medical marijuana, and he asked his oncologist if he could add together this to his regimen in hopes of decreasing his dependence on opioids. The oncologist told him that he would refuse to treat my friend if he took any form of cannabis. Given his insurance coverage, my friend does not take the option of changing physicians.
The National Cancer Plant states that cannabis may benefit patients suffering from cancer-related side effects. Cannabis is routinely recommended for cancer patients to improve appetite, decrease nausea and alleviate hurting. The medical literature is fairly consequent on the efficacy and minimal side effects of cannabis, which has specifically been shown to help patients decrease opioid dependence. There are even some reports that cannabis may be a valuable adjunct to chemotherapy in cancer patients.
Is it ethical for the doctor to deny handling based on my friend's taking cannabis? Is it ethical for my friend non to inform his oncologist if he chooses to use cannabis?
D.A. Kinderlehrer, M.D.
Permit me start with your question about the right of doctors to refuse service. Doctors in the United States can be legally required to treat patients in medical emergencies. Otherwise, though, doctors can mostly refuse service — as long as it's consequent with whatever agreements they've made with their health care organizations or provider networks and isn't in violation of anti-discrimination laws. There are shortages of doctors in many places, so clinicians — particularly the ones with the all-time reputations — often truthfully say they simply won't take new patients on board.
While doctors don't take a general obligation to take patients, they do have obligations to patients they accept taken. Yes, doctors sometimes "burn down" patients they observe unpleasant, overly demanding or abusive. But the American Medical Association rightly calls for physicians to ensure "continuity of care" in these cases — which involves making sure that the patient can secure another medico. You say that your friend has access to merely this one oncologist. That's disturbing, if true. In a decent medical organization, the ability to switch doctors is a central chemical element in respecting patient autonomy. A situation in which a md can fire a patient but not the other way around strikes me as insupportable.
Equally a general dominion, what's more, noncompliance is a poor justification for terminating care. If this oncologist has medical reasons for objecting to your friend's employ of cannabis — if he has specific concerns near drug interactions, say — he should explain them. (I'm bold your friend isn't enrolled in an experimental protocol.) If information technology's just that he disapproves of legal marijuana use, that's an abuse of the doctor-patient human relationship. Patients aren't obliged to help their doctors enforce a tyrannical need, so there would be no moral reason your friend should inform him of his cannabis use. Indeed, your friend might want to consider filing a complaint confronting the oncologist for making this threat.
As a medical matter, though, it's not a great idea to take a medico who doesn't know what drugs y'all're taking. Ideally, your friend would enlist the services of a specialist in pain management or palliative intendance who could work with his oncologist. Treating pain involves subjective considerations that make information technology very different from giving chemotherapy, which is why people skilled at the second sometimes falter at the first. And if your friend tin't come up to terms with this oncologist, the oncologist is ethically required to find him another.
I have a friend in a long-term relationship who has always wanted kids but has been putting off getting married to her young man and starting a family. I think it'southward because she'due south ambivalent most him. I'm worried that she is going to lose her fertility window if she doesn't leave him before long and find a better match. I don't want to say anything because I don't want to add to her anxiety, but I don't want to see her miss her chance and later regret it. Is information technology more upstanding to share my business or to stay quiet?
Name Withheld
Everything you say almost your friend's situation is, if true, known to her. What you want her to do is to draw what yous recollect is the obvious conclusion: that she needs to suspension upward with her partner, discover a new one and settle downward to motherhood. Maybe yous think that forcing her to confront reality will become her to snap out of it and take some new course of activity.
If you had reason to be confident that your promptings would guide her to a life every bit a happily married mother, it would certainly be ethical to proceed. You'd be offer a souvenir of friendship. But I suspect you don't have reason to be confident well-nigh this. And y'all've identified the downsides: adding to her anxiety, sparking her resentment. It is an important maxim, widely ignored, that intervention is a good idea only if it is likely to brand things meliorate. Many people think that a mediocre partner is better than no partner at all. And depending on their character and temperament, they may exist right.
At the gym, I often encounter a adult female who appears to be severely underweight; I tin can't help thinking that she may have an eating disorder. I'g non a medical professional person, I don't know her, I don't piece of work at the gym and I don't have any data that isn't plainly visible. I don't want to intrude on her privacy (for all I know, this woman may have some other underlying medical condition and already exist receiving medical intendance for information technology), just at the same fourth dimension, it's difficult for me to come across someone looking so painfully sparse. For what it's worth, I've seen this adult female at the gym for a year or more, which suggests that her weight is relatively stable, albeit very depression.
What is the most upstanding course of activeness? And how would information technology be nigh helpful to appoint with this woman if ethics need that I can't simply be a bystander?
Name Withheld
You know almost nothing about this woman and accept no relationship with her. Unless she's completely friendless, there's almost certainly someone who is better placed than you to approximate whether she's ill and, if so, to help her deal with it. Maybe that has already happened.
You don't have very good reason, in short, to involve yourself hither. And acquit in mind that one feature of eating disorders is a preoccupation with how y'all look to others; being addressed by a stranger in a gym who is worried past your appearance is probable to exacerbate that problem. Shame is part of the psychic brunt of many eating disorders (she may be struggling to recover from it), simply and so is a profound body dysmorphia. Hearing that she's too thin may have the opposite result than what you intend, by making her experience pleased that her behavior has succeeded in making her look the way she wants to wait. Every bit I cautioned in my previous answer, we should intervene only when nosotros're likely to make things amend.
I recently started a new job. During the application process, I was asked if I would be applying to graduate school in the near future, as their intention was to accept the new hire stay on for ii to three years. At the time, I was not intending on applying to graduate school, only this has since changed. Must I inform my new employers of my modify in plans? There is a chance I may non be accepted into a programme or receive enough funding to nourish. I also took on personal chance past moving to the other side of the country when accepting the offer.
Name Withheld
Unless you lot promised your new employers not to apply to graduate school, the truthful answer you lot offered in the interview was what you owed them. You might consider sticking around for a year, though, and then that you lot could give them a practiced chunk of what they'd been hoping for. That yous're not obliged to do then doesn't mean that it wouldn't be a decent thing to exercise.
Can My Psychiatrist Deny Me Services Using Medical Marijuanas,
Source: https://www.nytimes.com/2019/02/05/magazine/can-a-doctor-refuse-to-treat-a-patient-who-takes-cannabis.html
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