Case Study: Medical Marijuana

Case Study: Medical Marijuana

Jennifer Green is 15 years old and was recently diagnosed with leukemia. She is currently being treated with chemotherapy. Based on research, there is a very good chance that the leukemia can be cured, but she will have to undergo some form of treatment for 3 years with frequent monitoring in the form of blood tests and other procedures. The oncologist (physician who specializes in cancer treatment) on her healthcare team receives a phone call from Mrs. Green, Jennifer’s mother. Mrs. Green inquiries about the possibility of getting a prescription for medical marijuana for Jennifer. She says that since the last chemotherapy, Jennifer experienced severe nausea with occasional vomiting and is not eating much at all. The anti-nausea medication she has does not seem to work very well. Jennifer also has difficulty sleeping and feels anxious for 2 days after treatment due to the steroids that are administered prior to chemotherapy. The family is distraught seeing Jennifer suffer so much. Jennifer’s aunt Alice Reston brought over brownies she baked that contained marijuana. Ms. Reston said that her friend’s daughter, who also has cancer, got great relief from medical marijuana. Because Jennifer was suffering, they allowed her to have a brownie. It really helped decrease her nausea, increased her appetite, and calmed her. The oncologist explained that medical marijuana is not legal in their state, nor is recreational marijuana. He cautioned against giving Jennifer any more marijuana and said that he will consult the pharmacist to see what legal medications could be prescribed to help Jennifer’s nausea, appetite, and anxiety. Mrs. Green agrees and says she really hopes the team can help Jennifer.

When the healthcare team meets to discuss Jennifer’s case, the oncologist tells them about the phone conversation described previously. The oncologist states that he consulted the pharmacist who recommended dronabinol (Marinol), a legal medication derived from marijuana, that is approved for pediatric use to treat chemotherapy-related nausea and vomiting and is also effective as an appetite stimulant. The oncologist recommends that they try the new medication suggested by the pharmacist.

To the oncologist’s surprise, Sara White, the Greens’ social worker, becomes quite upset. She states that the Greens should be reported to the state child protection service for child endangerment because they gave Jennifer illegal drugs. Reporting the Greens could result in them being declared unfit parents and Jennifer being placed in foster care. Sara also states that the Greens and Alice Reston should be reported to the police for possession of illegal drugs. The rest of the team disagrees, noting that this was a one-time occurrence, and that the Greens have been responsible, caring parents throughout Jennifer’s illness. The nurse points out that Mrs. Green was honest about giving Jennifer a marijuana-laced brownie, and that she agreed not to give her any more, but the nurse disagrees about prescribing the dronabinol because it is derived from marijuana. The nurse fears it may lead to Jennifer using marijuana later on. The physical therapist states that it would be cruel to make the family undergo a child endangerment investigation after all they are going through with Jennifer’s illness. Such an investigation may be emotionally devastating to Jennifer and the Greens, and foster care would not be in her best interest. Sara White insists that it is her legally mandated obligation to report the Greens, and that she will do so anonymously, whether or not the team agrees.

Discussion Questions

1. What is the ethical issue/dilemma facing the team?
2. What actions would serve the best interests of the patient Jennifer Green?
3. How should the team respond to Sara White’s decision to report the Greens to the child protection agency?
4. What evidence is there that the Greens have a trusting relationship with members of the team, and how would reporting them affect this relationship?
5. What evidence is there that the team members have trusting relationships with each other?

1. The ethical issue/dilemma facing the team is whether to prescribe dronabinol (Marinol), a legal medication derived from marijuana, to alleviate Jennifer Green’s chemotherapy-related symptoms (nausea, vomiting, loss of appetite, anxiety) while considering the fact that Jennifer was given a marijuana-laced brownie by her family, which is illegal in their state. Additionally, there is a disagreement within the team regarding whether to report the Greens to child protection services and the police for this one-time incident.
2. Actions that would serve the best interests of the patient, Jennifer Green, would likely involve finding the most effective and legal means to alleviate her suffering while ensuring her safety and well-being. This may include trying dronabinol as recommended by the pharmacist, provided it is deemed safe and appropriate for her condition. It’s important to prioritize Jennifer’s physical and emotional comfort during her cancer treatment.
3. The team should respond to Sara White’s decision to report the Greens to the child protection agency by engaging in open and respectful communication. They should discuss their differing perspectives and concerns. It may be beneficial to involve an ethics committee or consultant to facilitate a discussion that considers the best interests of the patient and the legal and ethical obligations of all parties involved.
4. There is evidence that the Greens have a trusting relationship with members of the team based on Mrs. Green’s honest disclosure about giving Jennifer a marijuana-laced brownie and her willingness to seek medical advice and discontinue its use. Reporting them to child protection services and the police could damage this trust and may lead to Jennifer feeling isolated, betrayed, or unsupported during her cancer treatment. Trust is crucial in the patient-provider relationship and can significantly impact Jennifer’s emotional well-being and cooperation with her medical care.
5. The evidence that team members have trusting relationships with each other is evident in their open dialogue and differing opinions on the situation. They are willing to express their concerns and perspectives, which is a sign of a healthy and respectful team dynamic. However, their trust may be tested by the differing viewpoints on reporting the Greens, and it is essential for them to navigate this disagreement professionally and collaboratively, keeping the patient’s best interests at the forefront of their decision-making process. This situation can serve as a test of their teamwork and ability to find a consensus in a challenging ethical dilemma.