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Ethics Consult: Prescribe Pills Off-Label for Pilot's Peak Performance?

— You make the call

Last Updated June 3, 2022
MedpageToday
A photo of a mature female pilot at the controls of an airplane in the air.

Welcome to Ethics Consult -- an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true, but anonymized, patient care case. You vote on your decision in the case and, next week, we'll reveal how you all made the call. Bioethicist Jacob M. Appel, MD, JD, will also weigh in with an ethical framework to help you learn and prepare.

The following case is adapted from Appel's 2019 book, .

Lynn Lydgate, MD, is a neurologist in private practice. One of her longtime patients, an airplane pilot named Camille, requests that she prescribe her a stimulant, Big A, that is usually given only to patients with rare sleep disorders and narcolepsy. "All of the other pilots take it," Camille explains. "It helps us concentrate better when we're in the air."

Anecdotally, Lydgate has heard from her colleagues of similar requests, and she knows that stimulants generally can improve short-term focus. Yet the medication has never been approved for this purpose and Camille is not suffering from any known neurological or concentration disorder. In short, she is asking for a medication to enhance her abilities to levels above normal rather than to correct a defect. Lydgate is confident that Camille's risk for addiction is very low and that she is telling her the truth about the reason for her request.

See the results and what an ethics expert has to say.

Jacob M. Appel, MD, JD, is director of ethics education in psychiatry and a member of the institutional review board at the Icahn School of Medicine at Mount Sinai in New York City. He holds an MD from Columbia University, a JD from Harvard Law School, and a bioethics MA from Albany Medical College.

Check out some of our past Ethics Consult cases:

Forced Weigh-Ins for Hospital Workers Fair?

Who Decides if Child Is 'Dead?'

Allow Co-Ed Hospital Room?