Opioid Addiction Treatment: Ethics Help, Please??
Question by ellyrooroo: Ethics Help, please??
Hi there, I just need a little help with 2 scenarios and the questions.
•A Physician assistant in a medical practice with several physicians contacts his professional association, the American Academy of Physician Assistants (AAPA), to report that one of his employing physicians often recommends chiropractic treatment for patients with persistent back pain issues that have resisted medical solutions. The PA knows it is legal to refer a patient for chiropractic treatments, but he adamantly opposes the practice, considering it “bogus medicine.” The physician declines to discuss the matter.
In your opinion, how might the situation be resolved?
Is it ethical for the PA to continue working for the physician when their opinions differ so widely on this issue?
•A registered nurse calls her professional organization’s ethics consultant to ask for resources she can present to her employing medical clinic to support her intention to quit working with a physician she feels is providing sloppy and possibly dangerous care.
What is the most important principle for the nurse to consider here?
In your opinion, are there legal issues inherent in this situation, as well as ethical issues? Explain your answer.
Best answer:
Answer by Bill
As an Associate Professor at a chiropractic college, I will tackle the first question.
The person who is behaving unethically in this situation is not the physician who is referring patients to a chiropractor. The unethical person is the PA who adamantly opposes the practice based on his own prejudice rather than any scientific evidence. There is strong scientific evidence that a chiropractic approach to chronic low back pain is at least as effective as any other medical option. My question for the PA who considers chiropractic treatment “bogus medicine” would be, “what option would be better?” Opioid analgesics that are likely to lead to addiction and won’t help the pain long-term? Spinal surgery that has little evidence of long-term effectiveness and commonly has major complications? Telling the patient “just get over it”?
The ethical approach would be for the PA to educate himself, perhaps by meeting with one of the chiropractors to whom the MD refers patients. This would be a much more constructive approach than “reporting” his employer to the PA Professional Association (who, of course, has no jurisdiction over what the physician does anyway). The ethical approach would be to open one’s mind and get the best care possible for the suffering patients, rather than engaging in professional bigotry.
Bill Lauretti, DC
Associate Professor, New York Chiropractic College
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