Thank you for the great response to BustedHalo’s third moral dilemma “The Drummer and the Drug Rep.”

After outlining the original dilemma and then adding a twist to it later we are now ready to hear an analysis of the dilemma from an expert in moral theology and ethics. Read the original dilemma. Read the second step in the dilemma.

THE FINAL ANALYSIS

Bravo to the on-line responders! An overwhelming number of you–93% by the time I started writing this–said that Kara is not a physician and therefore is neither competent to diagnose her friend’s mental state nor to prescribe the right course of treatment, whether medication, therapy, or some combination of the two.

Two of the commentators summed it up well:

“Under no circumstances should she give him the medication. She should go and help him try to get back on his feet and get him help from the organizations that are able to help him. Giving him drugs without supervision of a doctor is dangerous and the drugs may not be necessary with proper counseling.”

Add to this:

“I don’t think it is necessarily crossing professional boundaries if Kara simply identifies a doctor who might be willing to see Robert for free and then refers Robert to him or her, rather than asking the doctor for a special favor.”

And many of you who wrote in said much the same thing. Congrats! Distributing powerful mood-enhancing drugs without a prescription is no small matter. For a drug company rep to even consider doing so raises red flags for me. (1) What kind of training did she receive about the ethical, legal, and company policy ramifications of crossing such boundaries? (2) How mature and responsible in her job would she be if, at the first request, she contemplates opening the trunk of her car as a free drive-by pharmacy?

Deeper Concerns

That leads me to a couple deeper concerns. Academically, financially, personally and professionally Kara’s attraction to Robert seems curious, out of sync with where she now is in life and career vs. where he is. I’m not trying to be snobbish here, but am wondering how someone with her talent, gifts, college degree, and responsible position with a major pharmaceutical company, could be so drawn to a lonely, depressed, music-loving Starbuck’s counter jockey. And then, as he pours his heart out on the phone and asks for free drugs from her samples in the trunk, why doesn’t her common sense alarm button go off? I have some concerns about Kara’s maturity and loneliness needs.

One of our respondents suggested something fairly bold:

“Beyond the fact that the US is one of the few first world nations that doesn’t offer universal healthcare, it’s immoral for these drug companies to be charging so much for meds that will save lives . . . as long as you can pay. I know some drug reps and they’re offering free samples to friends all the time”

There are two old maxims: “two wrongs don’t make a right” and “the end justifies the means.” This writer seems to have adopted the second and forsaken the first. I suggest it ought to be the other way around. Yes, there are problems in this country with healthcare access, who pays the bills, and how much some medications cost. As a last resort, particularly in a life-threatening illness, one might feel compelled–as the lesser of two evils–to resort to theft to secure essential life-saving medications. [Ethics text books almost always contain such a case for discussion.] But in this instance we are hardly at the last resort.

Lots of Options

As so many who logged on their comments suggest, Kara has a variety of options to help her “new friend” Robert before she needs to resort to under-the-table drug gifts. Emergency Rooms are duty-bound to accept Robert if he presents himself at their door. Also, Kara has sufficient connections in the medical field to find him a sympathetic physician, who would likely meet with Robert pro bono. Or Kara could foot the bill for at least an initial visit or two. There are also agencies (Catholic Charities, SSI, Medicare, free clinics) that could be tapped either for free medical services or to assist with Robert’s healthcare costs. Robert himself–or Kara as his compatriot and advocate–surely have LOTS of options short of opening the trunk for complimentary drug business.

The respondent does, however, raise a genuine concern and “fact of life” in the pharmaceutical samples business. Physicians and pharmaceutical reps have far too loose an access to a variety of expensive and critical medicines. While I appreciate a physician offering a free short-term supply of a medication either to test a patient’s reaction prior to a full prescription or to tide them over until a full prescription arrives, it is a questionable medical and moral practice for physicians (or pharmaceutical reps) to be supplying patients’ total or long-term drug needs from their samples closet. If a patient needs financial assistance securing regular prescriptions there are more legitimate channels than resorting to ‘free’ under-the-table samples.

Questionable Promise

With regard to the wrinkle, if Kara has promised something illegal, unethical, and against company policy to Robert, she is not now duty-bound to deliver on this questionable promise. The fact that she is being offered a promotion has nothing to do with it. If she now has second thoughts about her prior plan and promise to share drugs with Robert, she should say so “on its own merit,” not because of her potential financial gain. Also, if it is clear in her potential job promotion that she would be duty-bound to police such infractions on the part of others, then it ought to be patently clear that she has no business trafficking in such give-aways in the first place. If her employer knew what she had promised Robert and what she is now contemplating, they would surely think twice about whether she is the right professional for such a promotion.

I genuinely empathize with Robert in his depression, his life experience, and his need for help. However, for Kara to even contemplate being his unlicensed M.D. and his free pharmacy makes me more concerned about Kara’s state of mind and maturity than it does about how to help Robert.

To all those who saw the problem and “red flag” immediately, you can work for my pharmaceutical company anytime. And if you then want to help some new-found friend who is depressed or in need, let’s put our heads together to do so legally, ethically and above board.

Until next dilemma…