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Student Blog: Prescription for Paternalism

33 Comments 28 February 2014

Ritalin-SR-20mg-1000x1000

By Jenna Tynan, HLS Class of 2016

Multiple commentators have weighed in on the relative boon or bust of the long-awaited Obamacare implementation.  Both perspectives, however, have shown that any legislation’s impact is determined not only by the text of the act but also by the parties affected.  A recent personal experience at the doctor’s office demonstrates the reactionary impact of legislation.  After determining that I had a common eye infection well treated by oral antibiotics, the physicians chose a different antibiotic regimen, referring to their inability to dispense the antibiotic for fear that I may be pregnant.  I firmly vouched that I was not pregnant, but the physicians responded that they would like to take my word but could not do so.

At first, I thought that antibiotic manufacturers were now taking the paternalistic approach that isotretinoin (acne medication) producers have taken. Isotretinoin producers now require patients, pharmacists, and physicians to join the iPledge program to prevent pregnancy during medication ingestion.  However, my physicians’ prescribing choice was not driven by such a formalized program, but the combination of a labeling restriction promulgated in 2013 and, as I opine, fear of medical malpractice suits.  The particular regulations on their face appear benign: providing for updated labeling requirements. The Act, among other things, requires warnings that highlight increased risks of birth defects for drugs falling in the FDA’s pregnancy categories C,D, and X.  As a side note, the category system weighs the benefits of the drug in each category against potential pregnancy-related risks.  Drugs in Category A have the greatest benefit per risk ratio. Category X drugs, conversely, carry substantial risk per unit of benefit; labels for category X drugs require “contraindication” instructions strongly advising against use if the patient is possibly pregnant.

However, physicians seem to have responded to these labeling restrictions by tightening their own prescribing decisions.  Further, radiologists have either begun or have been recommended to conduct pregnancy tests before administering x-rays.  This anecdote underscores that well-thought-out and even uncontested regulations can produce unsavory effects.  Now, a female of childbearing age seems to have, as Carol Gilligan has put it, “lost her voice” to vouch for her own pregnancy status without independent verification.  Yes, physicians and pharmaceutical producers do have specialized knowledge that average consumers do not, but that knowledge should not impair the patient rights of a particular class of individuals. Car manufacturers could use the same rationale, taken to its extreme, to require pregnant women to occupy only the back seat of a car for fear of miscarriage liability due to faulty airbag deployment.  Though I doubt we’ll ever approach such a result, I do believe that one’s autonomy in health decision-making should not be reduced based on being a female in a particular fertility cohort.  Perhaps this particular reaction will indeed reduce birth complications. However I posit that such reactions are a prescription for paternalism whereas patients would be better served with a double dose of autonomy.

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The views in this blog post are solely the views of the author and not of the Harvard Law School Journal on Legislation.  The article image was taken from http://en.wikipedia.org/wiki/File:Ritalin-SR-20mg-1000×1000.jpg, which indicates that the image is free license.

Your Comments

33 Comments so far

  1. Thomas says:

    As divisive as Obama-care can be the fact is that the majority of person bankruptcies in this country are due to medical expenses. Although this type of legislation is thought by some to be going too far as well.

  2. Ismail N says:

    Maybe the physicians could have a standard written document where the patient declare (and sign) that she was not pregnant, so there’s no need to incur additional costs of doing the pregnancy test?

  3. Car Service says:

    Great it is finally happening the Obamacare is great, This new legislation is a good idea.

  4. dally lo says:

    Maybe the physicians could have a standard written document where the patient declare (and sign) that she was not pregnant, so there’s no need to incur additional costs of doing the pregnancy

  5. I agree that any legislation’s impact is determined not only by the text of the act but also by the parties affected in this case.

  6. I agree with Ismail on a signed document declaring that she is not pregnant.

  7. Abdul Rafay says:

    Great it is finally happening the Obama-care is awesome :-)

  8. result says:

    Obamacare is a new era for legislation. For this reason thanks dear author

  9. Michael G says:

    I’m sure that, signed statement or not, attorneys will find a way to circumvent it and sue anyway.

  10. Thank you for this useful article. Waiting for your next post, i know it will be more exciting, you’re awesome.

  11. SKR says:

    Obama care saved lot of low income people who do not fit between Medicaid and Medicare.

  12. Ted says:

    Obamacare sounds good but isn’t it affecting the US economy? With the Russian military movements that are taking place in Ukraine all NATO and UE countries should invest in international security.

  13. san sinichi says:

    Interesting point of view Thomas on fact of person bankruptcies, :)

  14. motorluv.com says:

    thank info Isotretinoin, I know so many

  15. dany says:

    A Nice Post and Your article is very good and I agree with you.

  16. I think they the pharmacist have to write down a legal statement from the patience that she is not really pregnant. So, it will be always protect her from any extra charge. It have to do before any outlaw act happen.

  17. I like the comparison with car manufacturers. Also agree with others here about a signed document declaration. Obamacare is going to be a bumpy road in the beginning and we will have to have patience. I imagine it will work itself out eventually and hopefully turn into a positive thing for this country.

  18. Nice praise for a consistently impressive magazine. Thanks for sharing

  19. Marcel Louis says:

    Great it is finally happening the Obamacare is great, This new legislation is a good idea.

  20. YobertParai says:

    i really agree for this article :)

  21. There is easy way to get pregnant

  22. mijan says:

    this is a very good educasitional institute

  23. John says:

    There should be some type of declaration document that the patient will acknowledge that she is not pregnant.

  24. deddy says:

    Thank you for this useful article

  25. Nice article about Prescription for Paternalism.

  26. subham says:

    Nice post. is it possible to be pregnant by medicine??????????? if yes it will help lots.

  27. Andrew says:

    Doctors warning against using certain drugs while pregnant is nothing new, but not taking a person’s word on whether they are pregnant or not is. I think that if a woman has any question about whether she is pregnant or not (missed cycles or irregular cycles), a test should be given. However, if she is very certain that she isn’t pregnant, no test should be needed. Doctors should be able to trust patients, at least in my opinion.

  28. Hazel says:

    Nevertheless the criticism of the Obama care, it has proved beneficial for many low income groups.

  29. I think the blog makes a difference too.I agree with others here about a signed document declaration.

  30. I think every person should really sign a document declaration confirming that you are not pregnant. Simple as that!


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