When Legal Forces Impact Medical Care

Abstract: Too often non-medical factors color medical decision-making. This exciting workshop will cover diverse instances in which legalities impact clinical care: medicinal cannabis, medicinal psychedelics, medical aid in dying (MAiD), and clinical care across state lines. Drs. Braun and Appel will focus on complementary and alternative medicine therapies, in-line with the conference’s overall theme.

Dr. Braun will detail the development/content of the American Society of Clinical Oncology's Cannabis and Cannabinoids Clinical Guidelines (Journal of Clinical Oncology, 2024). The guidelines were generated by an international, multidisciplinary team, co-led by Dr. Braun. Grounded in clinical research and offering practice statements for care pertaining to this stigmatized, federally-illegal substance, the ASCO guidelines articulate that cannabis IS medicinal, a notable assertion for the world’s largest oncologic organization. Dr. Braun will contrast target indications with robust clinical research data and target indications with conflicting, negative, or scant data. She will provide case examples for open discussion and end with a call for the psychiatric community to issue similar cannabis-related clinical guidelines.

Dr. Appel will discuss the distinctive legal structures and historical developments that have shaped research on and clinical access to psychedelics as well as the challenging ethical issues that derive from these structures. The medico-legal landscape is defined by tensions between federal and state law, controversies over the standard of care and the respected minority / two schools of thought doctrine, and lawsuits against existing restrictions that derive from right to try laws. Each of these issues poses significant implications for equity and social justice. Dr. Appel will offer a map of this rapidly evolving topography and offer guidance to practitioners.

Dr. Peteet will discuss clinicians’ roles in responding to inquiries about MAiD in states that have dropped residency requirements. What is legally and ethically appropriate to say to patients about MAiD? Does one’s institution support the availability of information about MAiD? Is there institutional guidance on how (and how much) MAiD information is presented and disseminated? How, and to what extent, can providers opt out of discussing MAiD? How and where can they refer their inquiring patients? Who should be identified as the source of information about MAiD within the institution? How public should this identification be? Dr. Peteet will share guidelines for addressing these questions that were created by a Dana-Farber Cancer Institute task force.

Dr. Tung will provide historical context regarding medical licensure requirements and healthcare across state lines; and review changes by governments and health insurance programs due to the COVID-19 public health emergency. She will discuss ongoing legal/ethical challenges related to caring for out of state patients and offer advice based on guidance from the FSMB and professional organizations. She will comment on proposed policy and regulatory changes. The audience-response system will query participants about their institutional practices and personal opinions. Breakout groups will discuss three complex clinical cases.