Crystal said:

<<First - this patient came to me with drug in hand, having done all the
research herself. >>

I think that is great -- and there are many mothers that have the sort of
moxie to do that on their own -- more power to them.

And I think another scenario with which I don't find an ethical problem is
this:  the patient's doc gives her a prescription for (in this case)
domperidone.  She finds out the compounding pharmacy here in the U.S. charges an
exhorbitant amount for it, and wonders if there is any place she can get it less
expensively -- I don't have any qualms about giving her a phone number for a
pharmacy in Canada or whereever.

My ethical question comes (and maybe this is a medico-legal-ethical question)
when the physician refuses to order domperidone for the mother ("I don't
believe in it....").  Can I then ethically give her the website in NZ where she
can bypass her physician and get the medication?

How ethical is it for us to tell her to go to another physician we know that
will prescribe the drug?

What if the drug was Reglan?  Available easily by prescription here in the
U.S., but her doc refuses to order it for her....

I struggle with these questions, just as some others struggle with the
question of whether it is in their jurisdiction to talk to a mother about herbal or
homeopathic remedies (is that "prescribing?").  The herbal and homeopathic
stuff I have settled in my mind....I just am not sure about this other more gray
area, and would love more feedback.

And if you want to chat w/ me off list about it, that's fine.

Jan Barger, RN, MA, IBCLC, RLC
Wheaton, Illinois
www.lactationeducationconsultants.com

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