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American College of Legal Medicine

ETHICAL DILEMMAS IN THE POSTMODERN CONDITION: WHEN PATIENTS AND THEIR PHYSICIANS CONFRONT THE CONTROVERSY OF MEDICAL TREATMENT WITH SCHEDULE II CONTROLLED SUBSTANCES


Michael G. Anderson MD, MBA, JD, FAAP, DABLM, FCLM

INTRODUCTION TO THE PROBLEM When prescribing medical treatments identified by federal law as schedule- II controlled substances,1 contemporary physicians may confront challenges associated with concerns widely reported in media headlines and other reports.2 Moreover, as physicians, we may often encounter patients presenting with chief complaints, medical histories, and exam findings that assemble as the qualitative data for a proper clinical diagnosis; commonly without laboratory, radiology, or other such quantitative data. When the medical decision includes treatment with a prescription listed as a schedule-II controlled substance, as physicians we may respond to circumstantial challenges differently, some may include of the following:
1. provide appropriate patient care according by our competency and our historic oath as healers; or
2. defer and refer those patients, regardless of adequate training and competency, to other physicians to evaluate and manage, as motivated to avoid entangling ourselves in apparent controversy and associated challenges.

As some may respond by the latter course, other physicians may withhold criticisms of colleagues, but rather seek to prevent harm and injustice. Hereinafter offers some review of the development of the postmodern condition, along with a few of its effects as challenge physicians’ care for patients, notably those with conditions diagnosed from clinical assessments of qualitative data, and then, if appropriately managed, with Schedule II controlled substances. A review of the literature and historical context validates this framing of the problem, as the philosophical construct of the postmodern condition rejects absolutes in favor of relativism, resulting in an erosion of trust in the establishment, including the medical profession. After illuminating some of the challenges contemporary physicians face and examining the roots of these through the lens of postmodernist philosophy, I conclude by optimistically offering a few practical strategies for further consideration by clinical physicians.3 Turning to an exploration of the historical roots of the contemporary problem, what follows is a summary review of the postmodern condition and the resulting uncertainty in medicine.
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