The doctor-patient relationship is sacrosanct in modern medicine and forms the foundation of contemporary medical ethics. Universities teach medical students from the beginning, even before they set foot in hospitals, to maintain a professional rapport with patients, uphold patients’ dignity, and respect their privacy. This ideology stems from trying to maintain the most objective outlook by both parties — patient and clinician — in formulating and exercising optimal treatment plans. In fact, many health care professionals and patients claim that this trust and relationship are therapeutic in their own right. Unfortunately, we are increasingly seeing these boundaries crossed, which can compromise patient care and potentially lead to fatal consequences.

Take for instance, Dr. Sandeep Kapoor. He is the Los Angeles physician who reportedly prescribed eight-months-pregnant Anna Nicole Smith methadone under an alias used by Smith. It remains uncertain if this prescription lead to Anna Nicole’s death. Methadone is generally indicated for narcotic withdrawal and dependence, particularly from opium or heroine addiction. In limited circumstances, methadone is prescribed to alleviate chronic pain in, for example, cancer patients. Methadone crosses the fetal placenta barrier and may cause fetal dependence. Irrefutable published works demonstrate that methadone is contraindicated for pregnant mothers, unless there is an established opiate dependence [1]. Moreover, it has several drug interactions and requires close monitoring to prevent withdrawal symptoms (undermedication) and overdose (overmedication).

Aside from the possible impropriety of prescribing a commonly abused controlled substance, Dr. Kapoor had reportedly had ongoing unscrupulous interactions with Smith. TMZ acquired photographs of the two participating in the West Hollywood Gay Pride Parade in 2005, engaging in unprincipled demonstrations. A recent video clip that aired on Fox News Channel (below) reveals a peculiar doctor-patient relationship.

In this roundtable, let’s intensively examine the issue and situation. What are the potential consequences of being treated by a family member, friend, or partner? Could Dr. Kapoor’s relationship with Smith have clouded his judgment with respect to the prescribing of methadone? What are some generally accepted policies among hospitals and medical boards? Should they forbid such relationships with their patients? What should be Dr. Kapoor’s fate?

Reference

1. Anderson IB, Kearney TE. Use of methadone. The Western Journal of Medicine. 2000. 172(1): 43-46.