Medical Ethics?

[TornadoMan666]

Can a doctor prescribe medication for a patient when the patient OD'd on the same med only 3 yrs earlier?
My brother's partner is a pain doctor. He's prescribing Xanax for my brother even though my brother overdosed on this medication only 3 years earlier. The doctor prescribed it for him then. And he makes no mention of past drug abuse issues on my brother's med records (brother has shared them). Thanks

[kittyluv1]

I am sorry to hear of your situation and I can not imagine how frustrating it must be to not have some control over events that you clearly see as harmful to your brother's health and well-being.  It is a difficult situation.
The problem is made worse by having his significant other assume the role of primary treater, caregiver and partner all at the same time.  While it is not favored to have a medical person provide treatment to a close family member or significant other, there is no legal standing you have unless there is some definitive evidence of abuse, negligence or mistreatment occurring with his interventions.
Your brother is mentally competent to understand his situation (and how he got there!) and apparently has not elected to change his circumstances.  You have done quite well in expressing your concerns and while it will continue to be difficult to stand by and watch this problem, you may not be able to do much else unless your brother's mental status changes and you are convinced that he is subject to potential harm and he is unable to correct this situation himself.
My sincere best wishes to you during this difficult period.

[TornadoMan666]

Thanks for taking the time to share your thoughts on this, I definitely appreciate it.  In answer to your question: "Are you absolutely sure that the past drug abuse isn't listed in his med records?"  Yes absolutely.

The reason my brother needed to take pain medication was because he received a broken neck which occurred during a fight between him and his partner and another guest at the house.  He was pushed or struck and fell back and hit his head on an object in his garage. He's now in a halo.  Our family was not made aware of this assualt until 9 days later.  My brother's job consists of heaving lifting at a home lumber yard store.   He was in pain, in his neck while he worked and his partner shot him with pain blockers and provided him with other muscle relaxers. He continued working and for nine days but did not have an MRI or catscan or xray to determine what was causing the pain.  

I've written his partner/doctor and my brother with a strongly worded letter about the family's concern.  Our family is deeply worried about his well being.  When he told us about the prescribed medication of Xanax...this hightened our concern.  We've searched the internet on medical ethics with physicians treating their family members and there seems to be no firm answer to this question.

We are in contact with our brother and we know they both need counciling but we're also concerned about our brother's health in currently being medically treated by this individual.   Out of frustration I've posted this inquiry to see if someone can give us some advice on how to best deal with this issue.  Thank you again for your help and input.

[marileew]

Short answer: Yes.

Long answer...

Are you absolutely sure that the past drug abuse isn't listed in his med records?

I think that a doctor would prescribe a prescription that a patient had ODed on if the doctor felt that there wasn't a risk of the patient ODing on the drug again OR there was a greater risk of the patient suffering more serious side effects (risk of suicide or death, i guess in this case) without the drug. A doctor is always supposed to weigh the risk of possible side-effect and misuse of the drug against the risks associated with not prescribing the drug.

I have unfortunately taken too much pain medication when out of my mind in pain before, and been completely up front about this with my family doctor AND very hesitate about taking the same medication again and my family doctor has noted it in my chart, and we have worked out strategies to make sure that I am safe when I am in extreme amounts of pain so that I don't accidentally ever overdose or make a suicide attempt when I have "lost it" in pain (I suffer from severe chronic migraines and the pain level often gets bad enough that I become irrational during the very worst moments).

Now... the only odd part of your story is the family connection. I personally don't think that family should be the primary care givers of other family members when ever possible (I understand that for money issues, sometimes this is necessary... but I think if it can be avoided, then at least, from my personal experience, I believe that there are ethical issues that can arise when it is a family member you are having to make medical decisions for...). I do think that family members should support and help and care for other family members though... and help other family members when they can. And, if your brother's partner is a pain doctor and your brother needs medical attention, then it would make sense that your brother's partner would be providing quite a lot of extra home care for your brother. BUT, I am not exactly sure that they should be the prescribing doctor... but, I don't know if they are actually breaking any laws or rules, they probably aren't... and I am sure that lots of people would disagree with me on thinking that there is something wrong with this and maybe I am wrong about thinking that there is something wrong with a family member being the main prescribing doctor... I don't know...

Anyway. I think the most you can do is tell your brother that you are worried about his safety because you care about him and love him... but you understand and trust him too. And, if he ever feels unsafe again (if he ODed on purpose) to please talk to you about it because you will always be there to listen and not judge. And, I think that since they likely aren't breaking any laws (someone, please correct me if I am wrong) then that is really the most you can do since this really is a case of doctor/patient confidentiality and you also don't want to push your brother away. (unless of course this is a situation where you have power of attorney or something like that...)