Article Figures & Data
Tables
- Table 1.
Ethical Requirements of the Physician Depending on Their Assessment of the Scientific Evidence Supporting or Dissuading Medical Marijuana for a Particular Condition and if They Have a Personal Moral Commitment Opposed to Attest or Recommend Medical Marijuana Use
A Four-Box Approach to a Physician's Ethical Obligations Willingness to attest/recommend Science Benefit No Benefit Box A Box B Yes Analogous to the physician's evidence-based decision to prescribe any other medication Analogous to requests for experimental treatments or homeopathic remedies Same ethical obligations: obtain informed consent by educating the patient about potential risks, benefits, and burdens of If science is ambiguous, the physician has additional ethical obligations beyond educating the patient on same topics required for informed consent • The prescribed treatment • Educate the patient about why there is a lack of evidence which may create increased risk • Other treatment options • Declining treatment If the harms seem to clearly outweigh the potential benefit, physician may decline to assist the patient • Assistance would be medically inappropriate Box C Box D No Ethical obligation to be transparent with the patient Ethical obligation to be transparent with the patient May have an obligation to refer the patient to a provider who does not have a moral objection to assisting Inform the patient of both reasons for decision to decline assistance • Institutional/personal objections to assisting • Lack of scientific evidence supporting potential benefit - Table 2.
Summary of Ethically Relevant Best Practices for Physicians Assisting Patients in Accessing Medical Marijuana
Summary of Professional Recommendations Regarding Medical Marijuana Supporting Article or Organization Recommendations AMA, National Academy of Sciences' Institute of Medicine, APA, AAFP, American College of Physicians4,15 More research is needed on therapeutic value of cannabis. AMA, APA, American Society of Addiction Medicine15,16 Do not currently support the use of medical marijuana. FSMB2 Patient–physician relationship should be established and in place before making a recommendation for the patient A documented, in-person medical evaluation must be obtained before a recommendation is made. The physicians should discuss the risks and benefits of marijuana use, and the patient should be advised of the variability and lack of standardization of marijuana preparations. A written treatment agreement should include a review of other measures attempted to ease the patient's symptoms and a specific duration for the authorization to obtain marijuana for a period no longer than 12 months. Recommending marijuana for certain conditions is at the discretion of the physician but should be in accordance with the current standards of practice and in compliance with state laws. The physician should regularly assess the patient's response to the use of marijuana and overall health and level of function. This assessment should include the efficacy of treatment, goals of treatment and progress toward achieving these goals. Physician should consult or refer patients to pain management, psychiatric, addiction, or mental health specialist as needed. Physician should keep accurate and complete medical records throughout the process. Physicians who recommend marijuana should not be associated in any way with a dispensary or cultivation center. Physicians should abstain of the use of marijuana (medical and recreational) while actively engaged in the practice of medicine. AAFP, American Academy of Family Physicians; AMA, American Medical Association; APA, American Psychiatric Association; FSMB, Federation of State Medical Boards.
