More patients are asking for medical marijuana, but some physicians are ethically conflicted or unsure how to respond. A recent paper offers an ethical guidance to physicians in managing these requests.1

The guidance came about after ethicists at Western Michigan University received a consult request from an outpatient physician. A patient had requested medical marijuana, and the physician was inclined to assist. “He thought that it might be legitimately helpful for the patient,” says Michael J. Redinger, MD, co-chief of the program in medical ethics, humanities, and law at Western Michigan University Homer Stryker M.D. School of Medicine.

The physician asked, “Is this request something I could honor if I wanted to? Would that be ethically permissible?” The doctor asked ethicists if there were any institutional prohibitions against it (there were not). Ethicists explored whether the physician had any personal objections (he did not). The matter was easily resolved, with the physician complying with state requirements to attest that the patient’s condition was one of the qualifying illnesses that meet criteria for a medical marijuana prescription. “But we realized it was a good question,” Redinger notes.

A literature search revealed there were some professional guidelines, but none answered the kind of questions the physician had asked. “There really wasn’t anything out there to help guide an individual physician to respond to those factors,” Redinger reports.

Physicians must weigh the quality of medical evidence for use of medical marijuana for various conditions. “Ethical obligations might be different for somebody who presents with chronic pain as opposed to glaucoma or chemotherapy-induced nausea,” Redinger explains.

Physicians also have to judge whether they have any personal reasons for being uncomfortable with the request, and whether there are any relevant institutional policies. One of the physicians who peer-reviewed the paper commented, “This is something that’s come up in my clinic.”

“It’s something that resonated and felt very practical,” Redinger offers.

Physicians who feel ethically conflicted about medical marijuana are unlikely to call a formal ethics consult over it. The guidance is meant to be a resource to help those doctors sort out the relevant ethical issues. “This is an issue that outpatient physicians are more likely than inpatient physicians to encounter. They may need some tailored education in that setting,” Redinger notes.

Ethicists might consider providing some proactive education on medical marijuana requests. “We often livestream our in-hospital noon-hour ethics education so outpatient physicians and staff can participate. Occasionally, we tailor the topics to better address their needs,” Redinger says.

REFERENCE

  1. Redinger M, Fledderman N, Crutchfield P. An ethical framework to manage patient requests for medical marijuana. J Am Board Fam Med 2020;33:147-151.