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 centered around the use of medical marijuana to alleviate Jennifer Green’s chemotherapy-related symptoms, specifically nausea, loss of appetite, anxiety, and difficulty sleeping. While the oncologist has recommended a legal medication derived from marijuana (dronabinol), the disagreement arises due to a one-time instance where Jennifer was given a marijuana-laced brownie by her family. Sara White, the social worker, believes that the family should be reported to the child protection service for child endangerment and to the police for possession of illegal drugs. This raises ethical questions about the balance between providing the best medical care for Jennifer and addressing concerns about the family’s actions regarding marijuana.
2. Actions that would serve the best interests of the patient, Jennifer Green, should prioritize her health, well-being, and comfort. The team should focus on finding effective and legal ways to manage her symptoms, including nausea, appetite loss, anxiety, and sleep problems. This may involve following the oncologist’s recommendation to prescribe dronabinol, a legal medication derived from marijuana, if it is deemed appropriate and safe for Jennifer’s condition. The team should also consider alternative treatments and therapies to ensure Jennifer’s physical and emotional needs are met during her cancer treatment.
3. The team should approach Sara White’s decision to report the Greens to the child protection agency with sensitivity and careful consideration. While Sara has a legal obligation to report child endangerment concerns, the team should have an open and honest discussion with her about the family’s situation. They should emphasize the one-time nature of the marijuana-laced brownie incident, the family’s willingness to cooperate and not repeat the action, and their overall history of responsible caregiving. The team should explore whether there are alternative actions that can be taken to ensure Jennifer’s safety and well-being without involving child protection services, if possible.
4. There is evidence that the Greens have a trusting relationship with members of the healthcare team. Mrs. Green was honest about the one-time marijuana-laced brownie incident, and she has been actively seeking help for her daughter’s symptoms. Jennifer’s aunt, Alice Reston, also tried to provide relief for Jennifer’s suffering. Reporting the family to child protection services could erode this trust and create fear and anxiety within the family. It may hinder their willingness to communicate openly with the healthcare team and seek help when needed, ultimately impacting Jennifer’s care and emotional well-being.
5. There is evidence that the team members have trusting relationships with each other as they engage in open dialogue and express differing opinions on the situation. They are considering Jennifer’s best interests and are willing to discuss the ethical dilemmas surrounding her care. However, they should continue to communicate openly, respecting each other’s expertise and perspectives, while seeking a consensus on the best course of action for Jennifer’s benefit. Maintaining a collaborative and supportive team dynamic is essential in providing the best care for the patient.