LCHM Summer 2018 - 15

L C M E D S O C .O R G

But then I began to consider further what
I was requesting of the participant. Why
avoid prescribing for family? What's wrong
with prescribing a Z-Pak for your teenage
child with bronchitis? What do medical
ethics say about this practice?

occasionally physicians will go farther out on
the limb to prescribe sedatives, antidepressants, and narcotic analgesics.7-9  In another
study, 15 percent of hospital physicians
reported serving as an attending for a loved
one, and 9 percent had performed elective
surgery on a relative.6 It is not surprising
The very first code of medical ethics drafted to me that physicians, an intelligent but
by the American Medical Association (AMA) self-willed and independent group, will
in 1847 recommended against physicians not infrequently choose to go against the
treating family members. Their ethics state grain of ethical recommendations.  Or more
that "the natural anxiety and solicitude which generously, perhaps they are simply unaware
he experiences at the sickness of a wife, a of the ethical guidelines - I don't recall any
child ... tend to obscure his judgement, and training about these issues in medical school
produce timidity and irresolution in his prac- (albeit a long time ago). 
tice".1 This ethical position was reaffirmed
by the AMA in 1993 and continues to the
Here are some of the pitfalls of caring for
present.2 Further, the American College of family and friends: failure to ask sensitive
Physicians recently stated that physicians but important questions, failure to do a
should "usually not enter into the dual complete physical examination, failure
relationship of physician-family member or to keep adequate records of medical care,
physician-friend".3 The American Academy failure to provide alternative plans of treatof Pediatrics position is similar: "Caring for ment, failure to obtain medical consent,
one's children presents significant ethical providing care outside the scope of clinical
issues."4 The exception to this rule is during expertise, failure to communicate with the
emergency situations during which no other physician of record, and failure to obtain
physician is available, and then only for a informed consent in the case of a minor.5 
limited period of time.5
Also, difficult situations may arise in case of
a complication which occurs as the result
Requests to treat family and friends are of a physician treating a friend or family
pervasive, and physicians often feel pressured member, including remorse on the part
and conflicted when asked to do so.  A 1991 of the physician, and anger on the part of
survey reported that 99 percent of physicians the family member or friend, leading to
had received requests from friends or family medical malpractice action or reporting of
for medical advice, diagnosis, or treatment, the physician to his state's Medical Board.5
and 83 percent had prescribed medications Finally, Medicare prohibits payment for
for relatives.6
services ordered or performed by a provider
for a family member.6
Usually, these requests are for minor illness
or injury, and antibiotics, contraceptives, and
After reviewing all of these factors, I feel
analgesics are the most commonly prescribed that I am on solid ethical and practical
classes of drugs in these circumstances. But ground when I ask our participants to eschew

prescribing for their family. This requirement
will not only reinforce the avoidance of
drugs that can trigger a relapse, but will
also help the participants to circumvent
stressful situations which may arise when
they unadvisedly act as a treatment provider
for their family and friends. Recovery is hard
enough without the added pressure.

1. Code of Medical Ethics of the American Medical
Association. Chicago: American Medical Association
Press, 1847
2. The AMA Code of Medical Ethics' Opinion on
physicians treating family members. Virtual Mentor
2012; 14:396-397
3. Americal College of Physicians Ethics Manual,
6th Edition. Ann Intern Med 2012; 156:73-104
4. Committee on Bioethics. Policy statement - pediatrician-family-patient relationships: managing
the boundaries. Pediatrics 2009; 124:1685-1688
5. No Appointment Necessary? Ethical Challenges
in Treating Friends and Family. Gold, K., et al.
NEJM 2014; 371:1254-1258
6. When physicians treat members of their own families: practices in a community hospital. LaPluma,
J., et al. NEJM 1991; 325:1290-1294
7. Self-prescribed and other informal care provided
by physicians: scope, correlations, and implications.
Gendel, M., et al. J Med Ethics 2012; 38:294-298
8. Personal use of medical care and drugs among
Swiss primary care physicians. Schneider, M., et al.
Swiss Med Weekly 2007; 137:121-126
9. Physician patterns in the provision of health care
to their own employees. Sansone, R., et al. Arch
Fam Med 1995; 4:686-689
10. Medicare benefit policy manual: Chapter 15.
Baltimore: Center of Medicare and Medicaid
Services, 2013

The Physicians' Health Program (PHP), a program of The Foundation of the Pennsylvania Medical
Society, the charitable arm of PAMED, provides support and advocacy to physicians struggling with
addiction or physical or mental challenges. The program also offers information and support to the
families of impaired physicians and encourages their involvement in the recovery process. Find out
more at www.foundationpamedsoc.org.

SUMMER 2018 | Lehigh County Health & Medicine 15


http://www.LCMEDSOC.ORG http://www.foundationpamedsoc.org

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