Medicine by law

People increasingly use the internet to explore medical issues. That is in general a good thing, provided they are careful about using credible sources for their information and are not too credulous about what they find. Being more knowledgeable about their own health can make for more fruitful conversations with their physicians.

But the old saying ‘a little knowledge is a dangerous thing’ can sometimes kick in and people can decide that they know more than their physician, or indeed the entire medical profession, and demand specific treatments. They especially do this when it comes to ‘off-label’ uses of drugs, when people ask that a drug that has been shown to be effective in treating one condition be used to treat a different condition where its efficacy or even safety has not been established. People sometimes seize upon anecdotes about its use to demand that it be prescribed for them.

This often puts doctors in an awkward spot. If they feel that the drug should not be prescribed and refuse to do so, they may face angry patients. Many refuse to compromise their ethics but now people are actually going to courts to try and get judges to order that the treatments be given, in this case with the animal de-worming drug Ivermectin. And some judges seem willing to do so.

At least two dozen lawsuits have been filed around the U.S., many in recent weeks, by people seeking to force hospitals to give their COVID-stricken loved ones ivermectin, a drug for parasites that has been promoted by conservative commentators as a treatment despite a lack of conclusive evidence that it helps people with the virus.

The lawsuits, several of them filed by the same western New York lawyer, cover similar ground. The families have gotten prescriptions for ivermectin, but hospitals have refused to use it on their loved ones, who are often on ventilators and facing death.

There has been a mix of results in state courts. Some judges have refused to order hospitals to give ivermectin. Others have ordered medical providers to give the medication, despite concerns it could be harmful.

Some lawyers have seized upon the fears of patients to file lawsuits demanding that ivermectin be given. Medical ethicists are appalled at this development.

Hospitals have pushed back, saying their standards of care don’t allow them to give patients a drug that hasn’t been approved for COVID and could potentially cause harm, and that allowing laypeople and judges to overrule medical professionals is a dangerous road to go down.

“The way medicine works is, they are the experts, the doctors and … the hospitals,” said Arthur Caplan, professor of bioethics at New York University’s Grossman School of Medicine. “When you go there, you’re not going to a restaurant. You don’t order your own treatments.”

“You can’t have a medical field that’s subjected to having to practice according to patient demand backed up by court orders. That is positively horrible medicine” Caplan said.

Beck, the drug liability lawyer, said that doctors do have the power to prescribe ivermectin to treat COVID, even though it hasn’t been approved by the FDA for that disease, if they think it has therapeutic value — a so-called “off label” use.

“I have never seen a case before this where the judge was asked to force someone to engage in an off label use,” he said.

While the law does intrude into every area of life, judges should not think that it gives them carte blanche to impose their judgments in every area. For example, on academic matters, students have sometimes sued professors over their grades but judges have tended to defer judgments about academic performance to the professors, since only their have the required expertise, intervening only when professors have acted capriciously and in violation of academic norms. That same principle should hold when it comes to medicine too. Judges invading the professional space of physicians and overturning their judgments is a dangerous trend.


  1. StonedRanger says

    This has been going on for a long time. With medical marijuana in Oregon, law enforcement feels like it should have some input on how/when it can/should be used when no one in law enforcement is medically qualified to make any of those decisions. People in Oregon have been fighting this kind of garbage since 98. Let doctors make medical decisions, not police or judges, its just stupid.

  2. brucegee1962 says

    I’m not sure about this. In general, I’m in favor of medically assisted suicide, for any reason. If people want to kill themselves out of sheer stupidity, rather than, say, a terminal illness, should we allow them to do so?

  3. jenorafeuer says

    You could make that argument if the person demanding the treatment were the only one to suffer for their decision.

    Sadly, they aren’t. Just like with hydroxychloroquine, ivermectin has actual valid uses that it’s prescribed for. (In the case of ivermectin, ‘River Blindness’ is a parasitic infection that is usually treated with it even in humans.) And it has a certain level of production that can’t be ramped up immediately. Large numbers of people demanding the drug often means that it’s no longer available for those who actually need it.

    It doesn’t help that the idiots using it for CoViD treatment are usually overdosing themselves, too, taking more of it than is needed and thus taking more of it away from people who really do need it.

  4. says

    by people seeking to force hospitals to give their COVID-stricken loved ones ivermectin

    This is scary.

    My closest living relative is my mother. If I were unconscious in a hospital bed, I wouldn’t want her to make any medical decisions about me. She is uneducated and utterly incompetent to make any medical decisions. She chose not to get a COVID vaccine, because she “isn’t convinced about its safety and effectiveness.” In other words: she has absolutely no clue what she is doing.

    I disapprove of her decision to play with her own life, but there is nothing I can do about it—that’s her body and she is legally allowed to live as she wants.

    But the idea that doctors could allow a person like her to risk with my life or even kill me due to her stupidity is truly frightening for me.

  5. Jean says

    So doctors in the US can refuse to give some treatments because of their religious belief but they can’t so the same for medical reasons? That’s not fucked up at all… And some judges have no judgment at all.

  6. says

    brucegee1962 @#3

    If people want to kill themselves out of sheer stupidity, rather than, say, a terminal illness, should we allow them to do so?

    I also am in favor of medically assisted suicide being legal, but it requires that patients who have requested it know in advance that this injection for which they have applied will kill them. Here instead we have uneducated people who mistakenly imagine that some substance will make their health better.

    Besides, there is room for abuse. A person who wants to get their inheritance faster can convince their elderly relatives to refuse vaccines and take ivermectin so as to legally kill them and get inheritance sooner.

  7. garnetstar says

    Doctors *must* provide only treatment that, in their best judgment, will benefit the patient. Administering useless treatment (as in, giving antibiotics to treat leukemia) has always been considered unethical and a breach of the law. No judge can make it otherwise, and hospitals/doctores must defy their rulings if need be.

    As in, doctors who practice in women’s health are ethically obliged to perform abortions, as it is necessary medical treatment. I don’t mean that they must, if they have personal convictions against it. But, if you do that treatment, no law can tell you not to care for your patients.

    I think that assisted suicide in the US, in the states where it’s legal, requires that some kind of “proof” be provided that you’re requesting it “for a good reason”. Like, severe, unrelenting depression or merely having no quality of life while not having a terminal illness, are, I believe, not considered good reasons.

    Andreas, are you able to legally designate a medical proxy for you? Sounds like I wouldn’t want your mother to make medical decisions for me either. Of course, you’d have to have someone you trusted. My mother was careful to specify one of her children as her proxy, and to tell the rest of us not to let my christian sisters have her linger in pain until the end.

  8. garnetstar says

    In the US, drug companies make it worse. Ads for every new drug on TV, always ending with “Ask your doctor about (new drug name).

    My sister, a pediatrician, says that parents don’t ask: they hear a drug ad on TV and *demand* that she prescribe it, just because they saw it on TV.

  9. kestrel says

    To me, this is just one more indication of how truly stupid our medical system is. In the hospital where the Partner works, the CEO and other office personnel are trying to run things as though they are a “business” (as opposed to a service) and that the patients are actually “customers” and that what matters most is customer satisfaction… just, NO. That’s not how it is. They are professionals (the doctors, nurses, techs etc) that are providing a service. This isn’t like going to Dairy Queen and asking for rocky road ice cream instead of vanilla. These people have dedicated their lives to helping people in the best medical way possible. They constantly spend extra hours keeping their licensure up to date. They constantly strive to keep on top of the latest procedures and knowledge so they can offer the best care possible. They save people’s lives every day, yet they get complaints about a patient being angry that they hurt the patient’s feelings. This is ridiculous and it has to stop.

    And in no way, shape, or form -- does this involve the lawyers or judges. They need to keep their noses on their face where they belong, and not in the medical profession.

  10. robert79 says

    “In general, I’m in favor of medically assisted suicide, for any reason. If people want to kill themselves out of sheer stupidity, rather than, say, a terminal illness, should we allow them to do so?”

    If these people are:
    -- aware of what they are asking for
    -- of sound mind — specifically no mental illness, impaired judgement or other condition that might make them regret their decision later on (if they live that long)
    then yes, after consultation with a doctor and psychologist to confirm this, I also believe they should be allowed to do this. But neither of those points holds for people choosing to use Ivermectin.

  11. mediagoras says

    These plaintiffs are asking for specific performance, which, as a legal remedy, should be rare and used in only extraordinary circumstances. The circumstances here do not rise to that level. Additionally, to my mind, this would amount to the practice of medicine without a medical license. If the patient (or a person with medical power of attorney) wants to use ivermectin, there is no reason why they can’t do it on their own, without a physician or judge.

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