This essay is going to illustrate a situation of a Physician Assistant’s dilemma of prescribing or not prescribing Viagra to a man, who is mildly depressed with no significant past medical history of erectile dysfunction. As a Physician Assistant in this scenario, I would further question the patient but support the physician in writing the prescription of Viagra to respect patient’s autonomy and follow the rule of beneficence. 

Beneficence is viewed under the lens of doing good to others and in the medical field, it is highlighted as “obligation” with good intentions and outcomes (Yeo, Michael et al., 2010a). As a Physician Assistant, it is my obligation to provide service to Mr. S by prescribing the medicine with the intention to improve his life function. According to the journal of medicine and philosophy, depression and anti-depressant medications are associated with “both erectile and general sexual dysfunction” (Balon, R. 1998). Since Mr. S is currently suffering from mild depression, this might be causing sexual dysfunction, which he does not feel comfortable sharing with the provider. Based on Marwick’s survey conducted in 1999, a patient feels more comfortable inquiring about a medicine than talking about inadequacy in sexual life and performances (Marwick, C. 1999). Perhaps, Mr. S was more comfortable requesting the medicine rather than sharing about his sexual life.  According to this premise of improving his sexual life, it justifies the action of providing the prescription. Viagra is a low-risk medicine especially if it’s used while being monitored; therefore, the beneficial outcome can overcome the risk. In addition, research has illustrated, a man responsive to Viagra therapy with sexual dysfunction and mild depression can “significantly improve their sexual function and depressive symptom” (Seidman, S. N et al., 2001). Based on this research, Viagra can help Mr. S with his depressive symptom and improve his quality of life. In addition, before prescribing the medicine, I would like to speak to the patient about his desire/need for this treatment. I want the “beneficial outcome” to be identified through collaborating with Mr. S and allowing him to express his point of view through his feelings, thoughts, and emotions (Yeo, Michael et al., 2010a).  Furthermore, the decision to prescribe the medication is a result of clinical collaboration.

Autonomy is the patient’s right to make decisions about their medical treatment without getting influenced by the health care provider (Yeo, M et al. ,2010b). According to the Yeo et al, autonomy is divided into four components: free action, effective deliberation, authenticity, and moral reflection. Free action is the patient’s ability to voluntary ask for a treatment, which will enhance their living condition (Yeo, M et al., 2010b). Based on this free action principle, Mr. S has the right to request for medication, which he believes will improve his life. Mr. S requested for Viagra to feel “more like a man,” so maybe he is currently having difficulty being “more like a man” and this might be interfering with his physical and emotional relationship. However, as a Physician Assistant, I am aware that this might be harmful for his sexual partner due to “stress from unwanted sexual overture” (Eugene, V et al., 2010). Therefore, before giving the prescription, I would explain the risks and benefits of the medication. Also, I will request Mr. S to bring his spouse if the medicine is causing her any discomfort, so we can discuss ways to address her issues. In addition, he can make rational decisions that are consistent with the goal of having a better sexual life with his wife. This rational decision of taking Viagra to enhance sexual life can be categorized as an effective deliberation because his actions match with his desired outcome. The patient should be informed about the possible negative and positive outcomes of the treatment. After they are informed, the patient has the right to choose the course of treatments. Furthermore, his decision to ask for this medicine may be linked with his wife’s sexual satisfaction, so he is considerate of his wife’s needs as well as his. This moral goal of happiness and pleasure in their married life can be categorized under moral reflection and effective deliberation. Prescribing this medicine will honor his autonomy as a human being to make decisions based on his core values, morals, and rational thoughts.

Finally, this essay revealed the reasons behind the Physician Assistant’s decision to prescribe the medicine and was justified using the patient’s autonomy model and the medical code of beneficence.

 

Work Cited

1. Balon, R. 1998. Fluvoxamine-induced erectile dysfunction responding to sildenafil. Journal of Sex and Marital Therapy, 24: 313–317.
2. Eugene, V., Boisaubin B.M and Laurence B.M. 2010. Prescribing viagra in an ethically responsible fashion. Journal of Medicine and philosophy, 29:739-749
3. Marwick, C. 1999. Survey says patients expect little physician help on sex. JAMA, 281: 2173
4. Seidman,  N., Roose, S. P.and Menza, M. A. 2001. Treatment of erectile dysfunction in men with depressive symptoms: Results of a placebo-controlled trial with sildepatil citrate. American Journal of Psychiatry, 158: 1623–1630.

1. Yeo, Michael et al. (2010a). Beneficence . In M Yeo et al. (eds.). Concepts and Cases in Nursing Ethics. [3rd edition] Ontario: Broadview Press, pp. 103-116.
2. Yeo, M et al. (2010b). Autonomy [selections]. In M Yeo et al. (eds.). Concepts and Cases in Nursing Ethics. [3rd edition] Ontario: Broadview Press, pp. 91-97, 103-109.