When patients ask for a pandemic drug

Ethics Forum. June 5, 2006.

Scenario: How should you handle requests for influenza antiviral medications?

Mr. A comes to your office regularly because of chronic obstructive pulmonary disease with frequent episodes of acute bronchitis. After his current medication is adjusted, he asks you to prescribe a course of oseltamivir (Tamiflu), which he would like to use if and when there's an influenza pandemic.

Ms. B is a patient you have never seen before. She reports that she is healthy and the only reason for her visit is that she would like you to prescribe a course of Tamiflu to be used in case of a pandemic.

Should you provide these patients with the prescriptions?

Reply:

Responding with a simple, unconsidered acceptance or rejection of such patients' requests could be ethically problematic and leave both patient and physician unsatisfied with the encounter. A more nuanced approach is in order. The conflict in this morally complex matter is between the physician's responsibility to his patients and the physician's responsibility for public health.

A physician who accepts a patient for provision of personal health care has primary responsibility to that patient and is expected to act in the patient's best interests.

Moreover, respect for a patient's autonomy requires that the physician support the patient's efforts to contribute to the management of his or her medical condition. This does not mean that physicians have a duty to fulfill every patient's request, but rather that the merit of any explicit request should be examined.