Ethics Quiz: Asking Your Doctor to Fool an Insurer

Ethical dilemmas come at us in all kinds of ways, large and small, with a surprising frequency. This week, we’re looking at five “everyday ethics” problems, presenting one each day. Think them over, decide what you believe is the best course of action, and then compare your views with mine, which you’ll find at the bottom of this post. Be sure to comment if you disagree. Here’s today’s problem:

My doctor recently reduced the dosage of a drug I take from 60 to 30 milligrams a day. I asked him to write the prescription for the old dosage because the pills are easily split in half and this would save me a significant amount of money. He hesitated, saying that really wasn’t ethical. I countered with the view that it wasn’t ethical for drug stores or insurance companies to charge the same price for the pill no matter what the strength was. He chuckled and gave me the prescription I wanted. Did we err?

Here’s my view:

This is a tough one and I’d love to hear from some independent experts who can help explain the drug pricing system and whether it is fair and ethical. As a consumer, I can’t understand why my copay is the same no matter the strength of the pill or the number of pills per day. That being said, deception in the marketplace always makes me uneasy, especially when it’s a doctor who is taking the questionable path. Presumably, he had to write instructions to tell you to take the higher dosage and rely on you to ignore them. That seems unethical (and unwise). So I come down on the side of the doctor being wrong. I’m more sympathetic to you. It’s reasonable for you to want to buy in bulk, especially if you do the extra work of splitting the pills in half. But given that you had to persuade the doctor to be unethical, you were probably wrong, too.

Still, I’m far from certain of my answer and look forward to comments from those closer to the problem.

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One thought on “Ethics Quiz: Asking Your Doctor to Fool an Insurer

  1. The doctor will NOT go along with your suggestion because by now his order will also be registered in a computerized medical records system. Should someone rely upon that record, you could accidentally be overdosed.

    But the correct dosage can easily be prescribed in the larger pill size. Instead of “twice a day” it would be “once a day”. Both the doctor and patient are free to use the most economical and practical delivery without deceit.

    So I think this case already has real-world constraints and a real-world solution and does not present an actual dilemma.

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