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 help alleviate Jennifer Green’s chemotherapy-related symptoms (nausea, appetite loss, anxiety) despite it being derived from the same substance as the marijuana-laced brownie she consumed. Additionally, there is a conflict between Sara White, the social worker, who believes the Greens should be reported to the child protection agency for child endangerment, and the rest of the team, who disagree with this course of action.
2. The actions that would serve the best interests of the patient, Jennifer Green, involve addressing her immediate medical needs and minimizing her suffering. This includes considering the prescription of dronabinol as recommended by the pharmacist, given its potential effectiveness in managing her symptoms. The team should focus on providing Jennifer with the best medical care and emotional support to help her through her leukemia treatment.
3. The team should respond to Sara White’s decision to report the Greens to the child protection agency by engaging in a thorough discussion and evaluation of the situation. While Sara White has a legal obligation to report child endangerment, it is essential to consider the context and the best interests of the child. The team should explore alternative solutions that prioritize Jennifer’s well-being and minimize the potential harm that could come from an investigation, such as seeking guidance from hospital ethics committees or legal experts. They should also communicate openly with Jennifer’s parents and involve them in the decision-making process.
4. There is evidence that the Greens have a trusting relationship with members of the team. Mrs. Green was open and honest about giving Jennifer a marijuana-laced brownie and expressed a genuine desire to alleviate her suffering. Reporting them to child protection services could damage this trust and make them hesitant to be honest or seek help in the future. It could also create emotional distress for Jennifer, who is already dealing with a challenging medical condition.
5. There is evidence that the team members have trusting relationships with each other, as they engage in open discussions and express their concerns and perspectives. However, Sara White’s disagreement and intention to report the Greens have the potential to strain these relationships. It is crucial for the team to work together, respect each other’s roles and expertise, and collaboratively find a solution that prioritizes Jennifer’s well-being and respects the law. Open communication and seeking guidance from hospital ethics committees can help the team navigate this challenging situation without causing further division among its members.