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Testing the law

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#1
Brash

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Author: John Kron
Date: 12-Oct-2005
Source: Australian Doctor (.com.au)
Copyright: © 2005 Australian Doctor - a division of Reed Business Information Pty Ltd
Article link: testing the law

Testing the law

Breaking the law to treat patients opens an ethical can of worms.
By John Kron.

SOME doctors recommend illegal treatments to patients because they believe the anticipated benefit is worth the legal risk. But is that ethical?

Dr Andrew Katelaris recalls being contacted by a 78-year-old patient soon after Dr Katelaris appeared in an episode of ABC TV’s Catalyst program discussing the medical use of marijuana.

“[The patient] was so desperate for help that she found my name in the White Pages and rang me at home,” says Dr Katelaris, who works in a Sydney private hospital in post-operative care.

The woman had mild polymyositis that appeared to have been exacerbated after a statin was prescribed; she became wheelchair bound and experienced chronic pain. A pain management clinic prescribed morphine, but it caused severe constipation, unsteadiness and confusion.

“She had already tried cannabis in cookies, which had provided benefit but ... she wasn’t able to smoke the herb,” Dr Katelaris says.

“I provided her with a sublingual tincture prepared from carefully selected cannabis [plants]. It led to substantial improvement and she was able to reduce her morphine dosage with its associated side effects.”

However, the prescription landed him in hot water. Dr Katelaris, who has been involved in industrial hemp research and medical cannabis experimentation for 16 years, is currently waiting to hear the outcome of NSW Medical Board charges, including professional misconduct, for prescribing cannabis to the woman and other patients.

He also appeared in court on charges of large-scale production of marijuana after drug squad detectives raided his farm where he was growing half a hectare of what he claims was a very-low-THC-fibre hemp crop. Dr Katelaris says most of the more serious charges, including supply, were dropped when he appeared in court last month, although he will still have to appear in court early next year to face some lesser charges, such as possession.

Asked about the ethical issues raised by breaking the law, Dr Katelaris says: “It is not a matter of ethics, it is about the scientific evidence that overwhelmingly shows that cannabis has a beneficial effect on the symptoms of severe disease including spinal spasticity and MS, HIV and cancer.

“The illegality stems from racist and corrupt laws put in place in the US in the 1930s. The law should serve humans, but instead the cannabis laws cause harm and serve to persecute a most disadvantaged group in society.

“Because of the illegality there is a $5-billion black market with profits mostly going to organised crime. What are the ethics of forcing sick people to go to criminals?”

There is support for doctors who provide illegal treatments when they are acting for the good of patients.

Dr Merle Spriggs, bioethicist at the Murdoch Children’s Research Institute in Melbourne, says breaking the law is “justifiable if the doctor has good ethical reasons and respects the patient’s autonomy to make an informed decision by providing information on the risks, benefits and alternatives”.

Dr Duncan Jefferson, a GP in Floreat, WA, says he wouldn’t recommend medical cannabis as a treatment, but not because of its illegality.

“I am not convinced that the evidence warrants it. But if the science says it is good then it is my role as a doctor to offer best practice, and if the police arrest me then I’d have to deal with that,” he says.

In contrast, Melbourne consultant ethicist Dr Nicholas Tonti-Fillipini says doctors have a powerful ethical obligation to abide by the law.

Breaking the law places the doctor at risk of facing criminal charges that could stain their reputation and make them unavailable for patients, Dr Tonti-Fillipini says.

He says doctors shouldn’t place themselves in a superior position to the community’s representatives responsible for determining the law.

This does not mean illegal actions should never be permitted, but they should be resorted to only in extreme circumstances, Dr Tonti-Fillipini says.

He says society does recognise that defying the law to bring about change is legitimate to test a statute in a court of law. It could be argued that doctors who prescribe an illegal treatment are not just helping the patient in front of them but also trying to convince authorities to change the law for the benefit of all patients.

This was part of the reasoning of doctors who prescribed methadone for heroin addiction in the early 1970s in defiance of health authorities.

However, Dr Tonti-Fillipini is not convinced. “There is no justification to step outside the system over marijuana or any other drug. Respect should be given to the processes already in place for deciding which drug can be legally permitted,” he says.

“If everyone started doing what they think is right the system would fall apart. And personally I prefer to believe the authorities are running those processes because of their expertise and broader perspective, rather than a few outspoken doctors.”

Dr Craig Hassed, a senior lecturer at Monash University’s department of general practice and a Melbourne GP, says another criticism of going outside the system is the negative impact on so-called ‘good’ laws such as the ban on recreational marijuana use.

“As an individual doctor you have an ethical responsibility to the health of the wider community,” Dr Hassed says.

He is particularly concerned that people advocating the use of medical cannabis are using it as the thin edge of the wedge to push for the legalisation of recreational marijuana use.

“It’s a serious concern because of the strong evidence that chronic marijuana use has detrimental health effects, particularly mental health problems such as rebound anxiety and lack of motivation,” he says.

However, there are practical means and ethical arguments that get around such concerns.

Dr Spriggs says marijuana does not have to be smoked in a herbal form but can be recommended as a tablet that should not have an impact on wider use.

“There are examples of many other drugs that have multiple uses and legalities, such as amphetamines, where they are allowed in certain situations and in others they are proscribed.”

There is also the argument that undermining respect for the system that decides the legality of treatments can impact on the wider community use of other drugs, such as alcohol.

“I have seen the downside of marijuana use with younger people, but then again I have also seen this with alcohol,” Dr Jefferson says.

“But if we apply what is known to be current best practice to the care of our patients, then we should avoid the pitfalls of being swayed by whatever is the current trend in the wider society that accepts alcohol usage,” he says.

Dr Katelaris says those who determine drug laws make decisions that “fly in the face of the evidence and the inconsistencies are rife”.

“There is a synthetic version of THC marketed as Marinol [dronabinol] that has passed all the FDA [US Food and Drug Administration] testing on safety. It is legally available but patients consistently indicate that it is not as effective as a natural herb,” he says

As far as Dr Katelaris is concerned, the system is so full of contradictions that the laws don’t deserve to be followed.
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#2
Brash

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I met the patient refered to in this article (we both testified on Dr Katelaris' behalf at his medical board hearing). What a great old lady, despite huge health problems, she still has a vitality often rare in people her age. She has agreed to be the first interviewee for our Potcast project.
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#3
HighRising

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That's a great article, Brash.
Very interesting. :P

Keep us posted how he goes.
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So why not forget about all this revolutionary nonsense and start a garden?


#4
Mushaman

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Thanks for the article Brash -

This was part of the reasoning of doctors who prescribed methadone for heroin addiction in the early 1970s in defiance of health authorities.


these are brave men ... the world needs more like them. Hope to see some future posts on this topic with some positive outcomes for those involved.
:P
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#5
Brash

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My 'letter to the editor' in reply to the above article.

-----------------------------
I was another patient who testified on Dr Katelarlis' behalf at his recent NSW Medical Board hearing. In my case I use cannabis to relieve the symptoms of long-term HIV and the side-effects of antiretroviral treatments.

The decision to use cannabis medicinally is not taken lightly by patients. It often involves participation in a expensive and dangerous blackmarket as well as the ongoing risk of criminal prosecution. So why do many seriously ill patients continue to take these risks? Simply because it works for them.

I wonder if the ethicist, Dr Tonti-Fillipini, would be so dismissive if it was he who was faced with the difficult decision to break the law based on a medical necessity.

Justin Brash
Surry Hills
-----------------------------
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#6
WantDaChronic

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top stuff brash, well except for the doctor getting in trouble, but if enough of them stand up and fight for the use of marijuana as a medicine we might just win :thumbsup

like musha and everyone else, i would dearly like to have a good outcome, my fingers will be croseed :P
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#7
Frazz

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I respect you Justin for the stand you take and wish you well in your current and future battles against a system that apparently has no empathy or compasion for those who suffer.

:P
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We are stardust, we are golden,
We are billion year old carbon,
And we got to get ourselves back to the garden.

#8
Doob

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Just more proof of the beniefts of the herb, and innocent people getting punished for it :P
But its great to know that there are doctors that KNOW of all the healing properties of cannabis and will try and save someone.
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#9
Brash

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This article relates to one of Andrew's earlier hearings. The television program refered to was a TV news segment (back in 2003) in which Dr Katelaris and myself were interviewed by the ABC's health reporter, Sophie Scott.

Screen shot from TV, Brash (left) and Katelarlis (right). see attachment

----------------------------
Author: Chris Pritchard
Date: 5/7/2005
Source: The Medical Post (canada)
Copyright: © 2003 The Medical Post. All rights reserved.
Link: article link

The Medical Post
July 05, 2005 Volume 41 Issue 25
(INTERNATIONAL NEWS)

Australian MD admits he uses, distributes marijuana

By Chris Pritchard

SYDNEY, AUSTRALIA | A Sydney doctor recently admitted sending marijuana to more than 20 people who contacted him after seeing him on a television program.

Family physician Dr. Andrew Katelaris further confirmed to the New South Wales Medical Tribunal that he used marijuana himself "from a batch prepared every month."

But the tribunal hearing was postponed abruptly when Dr. Katelaris, who is representing himself, said he needed to seek further legal advice before continuing.

Medical tribunal hearings in Australia are presided over by a judge. Judge Anthony Puckeridge told the physician "the admissions you have made are of concern to the tribunal."

Dr Katelaris said he had "never sought to cover up" his activities and would be "arguing a defence of medical necessity," and planned to present his research results to the tribunal.

Psychiatrist Dr. Nick O'Connor testified at the tribunal that Dr. Katelaris told him he "doses himself once a day after work" and that he used it to relieve pain.

The hearing was adjourned and will resume this month.

Attached Files


Edited by Brash, 12 October 2005 - 11:00 PM.

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#10
Brash

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Just got off the phone from Andrew. He is pleased with the progress in his cultivation court case - next hearing date sometime in Feburary in Newcastle. His bail money has been returned and he is quietly confident.

Of more concern is the NSW Medical Board which seems determined to deregister him - how dare he assist patients !!
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