You can scarcely open a newspaper or medical journal today without confronting a discussion pertaining to an issue involving medical ethics. Yet, despite the intense scrutiny of this subject from both inside and outside the medical profession, a recent paper published in Arthritis Care and Research (AC&R) pointed to a dearth of ethical discourse in the rheumatology literature.1,2 In order to explore the range of ethical challenges facing our professional community and discuss their implications, the ACR Committee on Ethics and Conflict of Interest is collaborating with The Rheumatologist to create a new feature called the “Ethics Forum.” This new quarterly department will foster dialog among rheumatologists and rheumatology health professionals concerning real life ethical issues that they may encounter in medical practice or research.
In each edition of the “Ethics Forum,” a member of the Committee on Ethics and Conflict of Interest will analyze brief clinical vignettes that illustrate ethical dilemmas arising from everyday practice. This discussion will concern the ethical principles involved and provide guidance for resolving the dilemma. The goal of these discussions is to be practical rather than theoretical. If you have an ethics question that you’ve encountered in practice, or if you have questions or comments about an “Ethics Forum” case, write us at [email protected]. We may publish your letter or question in a future “Ethics Forum.” We hope that you enjoy this first ethics case study—and that you write in with your own experiences or to ask a question for an issue that has challenged you.
The Case
You have been contacted by a pharmacy to renew methotrexate for a patient with longstanding rheumatoid arthritis. After realizing that she has not had lab monitoring or an office follow-up for a long time, the patient was contacted. The patient says that she is doing well on the methotrexate but has lost her health insurance coverage so she cannot afford office visits or laboratory studies. Despite a social work referral, the patient has been unable to get the lab test, or at least has not obtained a way of getting the lab testing performed. She says she knows and accepts the risks of taking methotrexate without monitoring and wants you to renew her medications until she obtains health insurance, at which time she will see you and have the testing done.
Ethical problem: What should a physician do when faced with an ethical problem that threatens to disrupt the planning or provision of care for a patient?
