Medical Ethics/Ethical question
Hello and thank you for taking the time to read my question. Back in 2011 I was diagnosed with a chronic pain condition...idiopathic neuropathy. Over the course of two years my neurologist and I tried almost every combination of antidepressants, pain killers, creams, acupuncture, etc with no level of good relief. After 2.5 years he referred me to a pain management specialist. He read all of my biopsy results and 2.5 years worth of records from my neurologist. He recommended a medication that would work very well for my pain and I would only have to take it one time a day....that medication was methadone. He put me on 60mg a day along with lyrica and the difference in my life was unreal. I had great quality of life again. I was no longer depresed and was able to get on with my life. Being on pain management you have to follow strict rules. You can't take any other narcotic pain medications without first consulting you pain management Doctor. You have to keep all medications in a safe at home. There are NO early refills for any reason. No problem. About a yeAr ago my doctor mentioned the possibility of implanting wires into my spine to see if with electrical current he could block the pain signals going from my legs to my brain. I am not a huge fan of spinal surgery especially a surgery that he could not guarantee the outcome. A few months went by and nothing was said. Last month, June, he came in to see me and said that if I was not willing to try the spinal surgery he would no longer prescribe the methadone for me. I felt very violated...like he was giving me no choice. Do this surgery or no more medication for you. I said to him, why would you as a physician want to do such an invasive procedure that you can't ever guarantee will work when for 2.5 years we have been doing a therapy that lets me live my life with no surgery so or problems. He gave me no answer. Six days ago I went for my appointment and saw his PA. He wrote my prescriptions and said don't forget to make an appointment for next month. I no sooner got home then there was a voice mail on my answering machine from my doctors secretary. The voice mail said " hello Paul, this is Maria at Dr. So and so's office. He wanted me to call you to let you know he cancelled your appointment for next month. Have a nice day". That was it. I know you don't give legal advice but can a physician who has been prescribing a medication to me such as methadone for over 2.5 years without me breaking one rule just "cut me off" with at much as slowly detoxing me? I find it hard to believe that after being on this medication that my body is now dependent on that my doctor can just say "goodbye". He didn't even have the decency to call me himself. Anyway...I guess I am just looking for an ethical answer. First do no harm....correct. Isn't that part of the Hippocratic oath? I can just imagine what I am in for when I start to run out of this medication. I have already read horror stories. Anyway...sorry this was so long but I wanted you to have as many details as possible. Thanks for your time.
The answer to your question from an ethics standpoint is somewhat complex. Patient abandonment is not ethical. To constitute abandonment, the provider terminates the physician-patient relationship without providing for reasonable alternatives. If you lived in a small community with no other options and your provider did not ensure that you could find a reasonable alternative, it would most likely be patient abandonment. If you live in an area with multiple providers and you can make an appointment to continue treatment, it is most likely not patient abandonment. Another issue is the provider giving you no choice in your treatment or making you feel forced into surgery. This does not honor your autonomy which is you making the best choices for yourself. If the provider believes you to be drug-seeking, then the actions may be justified; however, it does not appear you were showing signs of this type of addiction.
By the way, "Do No Harm" is really not part of the Hippocratic Oath. The principle of non-maleficence has been an ethical consideration for as long as medicine has been practiced.
I hope this has been a useful response. I am sorry you were put through this type of treatment.
Very truly yours,
Paul D. Friedman, M.A., Ph.D., J.D.