Ethical dilemmas and legal pitfalls in prescribing for the uninsured indigent patient: Reconciling the irreconcilable

摘要

The following case scenario was submitted by a by a JAAD reader, requesting dermatoethics consultation. A young female child was evaluated by a dermatologist for a widespread pruritic papular eruption. The diagnosis of scabies was confirmed on skin scrapings. There are 4 others in the household: two parents, a sibling, and an aunt. Both parents are itching and have a rash.' Only the affected child has health insurance, in this case, Medicaid, a means-tested federal health insurance program that is administered and jointly funded by the state. The parents have asked the dermatologist to write a prescription in the child's name in a quantity large enough to treat the whole household, as they cannot afford the out-of-pocket cost of the medication and none of them can afford the cost of visiting a primary physician or urgent care clinic.