X
June 26, 2009

Should a Physician Prescribe Viagra to Unmarried Men?

Catholic physicians are increasingly encountering requests by patients, including their unmarried male patients, for Viagra and are unsure of how to respond. This FAQ discusses how to approach this issue on sound clinical,  ethical and practical grounds.

Catholic physicians are increasingly encountering requests by patients, including their unmarried male patients, for Viagra and are unsure of how to respond. This FAQ discusses how to approach this issue on sound clinical,  ethical and practical grounds.

What does the Church teach on this issue? – Currently, there is no specific authoritative Church teaching on this issue, perhaps because it is so new. Also, perhaps, because it is covered within the context of other teachings. So, right now, there is not an easy answer to this question in terms of a Church authority that a physician could cite. This takes us to a more substantive ethical analysis.

Essential Question: Is it is immoral for a physician to prescribe, or provide a referral for, Viagra to unmarried men in response to a request to restore or enhance their sexual function? The short answer, in terms of my ethical analysis, is yes, it can be immoral to do either one unless certain conditions apply. It is wrong because, if the Viagra (and other PDE5 drugs, including Levitra, Cialis, and others; here I will refer, for sake of simplicity, to Viagra) is given for no other purpose than to restore or enhance the sexual functioning for an unmarried man, it facilitates the performance of an immoral act. To help facilitate an immoral act directly or by providing another indirect avenue to accomplish it – e.g., referral – is also unethical.

The following distinctions and explanations may be useful in explaining to patients or physician partners what you won’t do and why; what you would do and why, and how this is reasonable (albeit unusual) in today’s world.

Issue of Principle: There is a key issue of principle here – what should guide a physician in prescribing a medication to a patient (or making it possible for a patient to get access to a drug or medication). The primary purpose should be to serve the health of the patient. (It is true that some physicians prescribe antibiotics for children’s earaches, etc., to respond to parents’ requests to do “something” even when they know it will not cure the infection. This is not right, but harm to the patient is unlikely or minimal. Still, with antibiotic resistance growing, the social dimensions of this practice are looming much larger.) However, the ethical limit of providing drugs or medications to patients is reached when a patient will use the drug for a harmful purpose. That is, a physician would not prescribe drugs to a patient knowing that the sole reason that the patient wants the drug is for a nefarious reason. For example, an ethical physician would not prescribe Ketamine to a college age man who had no reason to be taking it. Physicians have to be careful of patients hoarding even drugs legitimately prescribed. If a physician had reason to suspect that a patient was selling prescription drugs for money, an ethical physician would take reasonable steps to investigate and stop the abuse. So there are good grounds for saying that, just because a patient requests a drug and it is not harmful (or that helpful either) it always must be provided.

Now, we should note a certain analogy between Viagra and the oral contraceptives (OC). OCs are unethical to take or prescribe as a contraceptive. Still, there are some therapeutic effects that OCs can achieve (although some good physicians doubt that it is really the best therapeutic approach) – and, the side effects are that it functions as an anovulant. In such cases, where temporary sterility is a side-effect, and not the goal of the treatment, there is reputable moral teaching that it is not unethical to take or prescribe the Pill. There are some reports that Viagra can be helpful in immediate post operative period to facilitate and enhance early return of erectile function in men who have undergone radical prostatectomy; and some early reports of benefit from the Viagra-type drugs on coronary artery disease. If these uses can be justified in terms of clinical effectiveness and safety, then it could be legitimate to give Viagra to unmarried men for these reasons, even if a physician was not sure whether abuse would follow.

Apart from such clinical uses, the same reason that it is unethical to prescribe Viagra on demand provides the reason that it is unethical to provide a referral – that is, a specific aid or assistance in helping a patient to obtain what a physician is unwilling to prescribe. This point is lost on most people today, but if we substitute a different example, I think people would appreciate the point. Again, say a frat boy comes to a physician requesting Ketamine before homecoming. Who would agree that it is ethical for a physician to say, “Well, I won’t prescribe it, but I do know a physician with much lower ethical standards who will do anything for money. Here is a note that will tell him that I authorized you to get it”? Other examples include slavery (a bit historic, but what if a blacksmith in the North said to slave hunters who just captured a slave – “I won’t make handcuffs for him, but if you go down the road, John Smith does blacksmithing work on the side, and he will do it for you.”

Issues of Prudence. Issues of prudence differ from issues of principle. In matters of prudence, where no moral absolute is at stake, there may be several ways to foster legitimate goods or to mitigate harms. That is, there may be occasions to prescribe drugs like Viagra even when this is not the ideal treatment, and legitimate ways to respond to potentially unethical patient demands. Now, many people today might say – “Physicians should just give a patient what he wants – and shouldn’t pry into anyone’s private matters (like marital status) and make judgments!” But this is not adequate. For example, physicians need a patient’s history in order to provide proper care, and marital status is an important factor affecting health, and sound ethical concern/evaluation is an intrinsic part of good clinical judgment. Now, a married patient under stress may request Viagra. His physician might think, “Viagra is probably not the best (clinical) solution for this guy yet there is not a clear ethical issue.” The physician could give him the prescription (but see next section, on good medicine, below). Providing a prescription may not be ideal, but it is not unethical in principle. However, a physician may be treating an unmarried man who has health deficits and complains, among other things, about inability to function sexually. On the principled grounds noted above, a physician should not prescribe Viagra. Yet, it seems to me a good physician can legitimately say, “Your inability to function may be due to some underlying disease, etc.; let’s figure out what’s wrong and improve your health.” A physician can intend and act to restore an unmarried patient’s health, rather than merely facilitate the patient’s sexual function. And a physician can’t be held responsible for what the patient does with his good health (e.g., the patient might become healthy enough to rob a bank, but that is not the physician’s responsibility).

Issues of Good Medical Practice. Hopefully no physician is using Viagra as a cure-all. There are many reasons why men begin to lose sexual function. Often there are underlying health conditions. Whether for married or unmarried men, it is first important to identify and treat what is wrong versus giving a pill that achieves a certain effect. Again, even for married men, it seems to me that Viagra should not be a first option – maybe a second, third or fourth. This could be part of an explanation to an unmarried man when he asks for Viagra – e.g., “Well, Jack, my role as a doctor is to take care of your health. I only prescribe pills when I know they’re really needed. Let’s find out what is really going on with you. Otherwise, we might miss something important, or even mask your real problem with drugs.”

Practical Issues regarding Explanation, Operational Issues and Witness. A couple of points:

     

  • Explanation. Apart from the practical, prudential, and clinical issues noted above, there are business and cultural expectations that shape medical practice today. Physicians serve as “gatekeepers” at times; physicians cover for one another, etc. Patients expect physicians to be ready to help, etc. While I don’t think it is fair for only Catholic (or ethical) physicians to put up a list of do’s and don’ts on the wall, it is probably prudent for physicians to begin to educate their patients about their approach to medicine, and what they will and won’t do. This can be “positive” as noted above. It may have to address specifics such as Viagra, however.
     

  • Operational Issues. While I think it is wrong to provide a referral for Viagra, it is not necessary for a physician to entirely quit group practice. He or she could set up a process by which patients who are requesting Viagra are diverted to other physicians as a matter of policy.
     

  • Witness. I think that, in explaining what one will and won’t do, physicians should take the time to think through the points above and improve on them. Also, think up good examples that colleagues will appreciate about what limits on prescribing medications are. Sex is a neuralgic topic and sexual activity is presumed to be a basic human good. However, we know that is not the case. STDs are rapidly spreading among the elderly. This is not good. I think it is good and important to, as St. Peter says, always to be ready to give a reason for the hope that is in us. That is, be ready to explain, in the best possible terms and manner why you think that your action is good for individual patients and for the medical profession.

John F. Brehany, Ph.D., S.T.L.

Executive Director and Ethicist

November 2008

Categorised in: