Ethical and Legal Implications of Prescribing Drugs
Prescribing medications is a privilege that not all nurse practitioners (NPs) in every state have. In some states, the prescribing of medications by NPs is heavily regulated. In Maryland, the state where I practice, NPs can prescribe medications with the only restriction being they must have practiced under a physician for 18 months previous to earning the privilege. That means Maryland NPs are autonomous in this regard and must take the responsibility for prescribing medications seriously. Maryland NPs should know the laws that apply to prescribing medications and follow them. One practice, prescribing medications to friends and family, is not illegal in Maryland but any NP anywhere should be cautious about this practice because the prescription legally binds them to the consequences of the medication’s effect on the patient. Such prescriptions can come back to haunt them in the future. The purpose of this paper is to describe the best practice in the scenario of prescribing medications for a friend, the moral obligation to disclose medication errors, and to describe the prescription process.
Ethical and Legal Implications
The NP should not agree to prescribe medications for a friend without first examining the friend and having a look at the friend’s medical history. The state of Maryland, where I live and practice and where my friend presumably lives, allows NPs to be primary care providers and to prescribe Level I-IV medications without supervision or authority from a physician, but only after having practiced under the supervision of a physician for a year and a half (Scope of Practice Policy, 2019). According to the Center for Disease Control and Prevention (CDC) (2015), many states, 41 and the District of Columbia, have laws that say a physical examination must have been performed by a healthcare provider before prescribing any medication. Maryland is one of those states (CDC, 2015).
Strategies to Address Disclosure and Non-Disclosure
When a healthcare provider makes any error when treating a patient, it is probably best to disclose it to the patient. However, some may reason that if the error is not going to cause the patient any harm, there is no purpose in disclosing it except to cause the patient more stress about their health situation. Medication errors should be disclosed for the simple fact that the medication could harm the patient if it was not intended for them. The website, Josie King.org, cites a training video by Dr. Albert Wu that trains healthcare providers in how to disclose a medication error to a patient. Wu and many others believe that all medical errors should be disclosed to patients (Josie King.org, 2016). Ghazal, Saleem, and Amlani (2014) of the Journal of Clinical Research and Bioethics propose using an ethical decision making model based on five steps of ethical decision making process called MORAL (Ghazal, Saleem, & Amlani, 2014, p. 2). This decision making process can help a provider who has to disclose a medication error to his or her patient.
Strategies to Guide Decision-Making
One strategy I would use in the scenario provided is the friend strategy. I would point out to my friend that because she is my friend she would not want me to lose my hard-earned career as an NP. I would suggest to her that if that were true, then she should not ask me to prescribe her medications without me first doing a physical exam and reviewing her patient history. Another strategy I might use would be to ask her who the prescribing provider was and then phoning this provider to ask why my friend might be wanting to have her prescription renewed. If it was an opioid medication, I would not have to make that phone call because I would assume that the friend was either addicted to opioids or was trying to make money from selling them. In either case, I would not write the prescription for her. I would not write the prescription for her in any case without first examining her and reviewing her medical records.
Prescription Writing Process
Depending upon the state in which an NP is prescribing, NPs can prescribe Schedule II-V drugs. Schedule I drugs are not considered medically beneficial and are usually not prescribed anyway. Prescribing some types of medications may not be covered by insurance unless the NP has a DEA number, although it is not required to be able to prescribe medications. Prescribing medications for friends and families is allowed, but usually only in emergency situations. However, regardless of for whom the prescription is written, the medical examination and prescription must be documented in the person’s medical record. Prescriptions can be filled out-of-state, but if the state where the prescription is to be filled has different prescribing laws for NPs, then pharmacies in that state probably will not (and should not) fill the prescription.
Conclusion
Having the practice privilege of prescribing medications for patients is a great responsibility. NPs should not take it for granted or exploit it by writing prescriptions for their friends and family on a whim. In an emergency situation, it may be permissible, but it should be done in accordance with the laws of the state in which the NP practices. When an NP makes a medication error, he or she should disclose the error even though it may be difficult. There is training available to make disclosures easier and so that it can be incorporated into the NP’s practice, but hopefully not used frequently.
References
CDC. (2015, January 29). Prescription Drug Physical Examination. Retrieved from Center for Disease Control and Prevention: https://www.cdc.gov/phlp/docs/...
Ghazal, L., Saleem, Z., & Amlani, G. (2014). A Medical Error: To Disclose or Not to Disclose. Journal of Clinical Research and Bioethics, 5(2), 1-3. Retrieved from https://www.longdom.org/open-a...
Josie King.org. (2016). Maryland Disclosure Program. Retrieved from Josie King.org: http://josieking.org/programs/...
Scope of Practice Policy. (2019). Maryland Scope of Practice Policy: State Profile. Retrieved from Scope of Practie Policy: http://scopeofpracticepolicy.o...
