Moral Argument Essay #1

To Prescribe or Not to Prescribe

I am presenting two arguments to support my thesis, as the PA it’s ethically justifiable to provide Viagra per patients request. Patients do not always make beneficent decisions, as clinicians we do; while respecting their autonomy. I will use principles of beneficence and autonomy in support of writing the prescription.

Beneficence defined by Yeo et al. is described as the orientation towards the good of the patient, with beneficial intentions and outcomes while preventing or reducing harm[1]. Example of benefit is portrayed as taking medication to fight an infection to get better. As clinicians we act in the patients best interest regarding their health. Health is defined in a variety of ways, the World Health Organization (WHO) defines it as “a state of complete physical, mental, and social well-being.¹” In this prompt, Mr. S, requesting Viagra, is asking to better his health in this broad definition. As the PA I have a duty and genuine care for Mr. S’ health and after exploration, find no contraindications for prescribing Viagra. Beneficence is related to caring, and to care is to have good intentions and good outcomes. My good intentions is to help Mr. S’ psychosocial wellbeing, and since he denies any side effects from antidepressant’s or sexual dysfunction, it’s reasonable that he wants Viagra to increase his sex drive or self-esteem. This in a sense would create a better outcome for him and his partner and possibly his quality of life. In addition writing the prescription can build a better PA-patient relationship and perhaps Mr. S would be accessible about his sex drive in future appointments. This would create a direct benefit to Mr. S and the clinician.

Another component associated with beneficence is nonmaleficence, or to do no harm[2]. Example of harm is when someone physically hurts another person. As his clinician, to control, limit, remove any harms that may arise from Viagra I would give Mr. S a limited quantity and monitor for any side effects, reactions, and adverse events. To remain beneficent I would provide him all the information and directions to ensure proper medication consumption. Also collaborating with the attending physician, we have decreased any potential harm. In so far as prescribing Viagra will benefit him and others while controlling any risk or harm it is justified using the principle of beneficence.

Autonomy defined by Yeo et al. is the patient’s right to accept or refuse care consistent with their values³. I will reference free action and effective deliberation to validate prescribing Viagra. First, free action is associated with one’s liberty, specifically to his health, the ability to voluntarily receive or refuse beneficial treatments consistent with their preferences[3]. It is clear that Mr. S who presents for his annual wellness visit is expressing his free action in wanting Viagra. This capacity of self rule is the strongest argument for autonomy and wanting Viagra. With an unremarkable physical and no change in medical history, there is no obstacle, involuntary decision, or evidence of coercion to his freedom of choice. Example interference of free action is someone who had a stroke and now unable to do the things they once did.

Second, effective deliberation is the patient’s rational thought process in which they identify pros and cons such as benefits and risks to make decisions consistent with their goals[4]. Mr. S presented for his annual wellness visit, provided health information, takes fitness supplements, and requests a prescription for Viagra; all of which displays his autonomy. Effective deliberation can be argued if he had a mental deficit or irrational behavior. However he is not sick or in extreme pain or circumstance that may push him to a point where he can no longer weigh the risk and benefits of his choices. Additionally Mr. S has already spoken about Viagra with a friend and maybe even did some research and is now requesting it. As the clinician by providing him a limited dose, necessary information, expectations and directions for Viagra to make coherent decisions to take it or not, ensures effective deliberation. To not write him the Viagra would be diminishing and interfering with his autonomy and cannot be justified through other components of autonomy.

I provided two arguments in favor of prescribing Viagra to Mr. S, first in following the principles of beneficence and weighing the benefit and harm. Then equating clinician support for free action and patient’s ability for effective deliberation to engage autonomy, I conclude that prescribing Viagra is justified through beneficence and autonomy.

 

¹ Yeo, Michael et al. (2010). Beneficence . In M Yeo et al. (eds.). Concepts and Cases in Nursing Ethics. [3rd edition] Ontario: Broadview Press, pp. 103-116.

 

[2] Yeo, Michael et al. (2010). Beneficence . In M Yeo et al. (eds.). Concepts and Cases in Nursing Ethics. [3rd edition] Ontario: Broadview Press, pp. 103-116.

[3] Yeo, M et al. (2010). Autonomy [selections]. In M Yeo et al. (eds.). Concepts and Cases in Nursing Ethics. [3rd edition] Ontario: Broadview Press, pp. 91-97, 103-109.

[4] Yeo, M et al. (2010). Autonomy [selections]. In M Yeo et al. (eds.). Concepts and Cases in Nursing Ethics. [3rd edition] Ontario: Broadview Press, pp. 91-97, 103-109.