South Carolina Considers Taking Patients Hostage

December 27, 2015

The Geneva Conventions prohibit the taking of civilian hostages. Which conventions prohibit the taking of patient hostages? The question gains urgency with the introduction this month into the South Carolina House of Representatives of a bill that would impose new restrictions on access to certain medications. The bill is not meant to improve healthcare delivery for its subjects, patients with erectile dysfunction, but to force political concessions.

Among other things, the bill would require that patients get: a stress test every ninety days after prescription to be sure they are healthy enough for sexual activity; a statement from a partner confirming a symptoms of erectile dysfunction; a report from a sex therapist stating that the erectile dysfunction is not due to a psychological condition alone; and counseling regarding celibacy as an alternative lifestyle. In short, if it passes the bill, then South Carolina will legislate medical practice by physicians it has licensed to practice medicine.

The bill presents many issues. First of all, it almost appears to insert television commercial wisdom at the bedside. For example, the language relating to making "sure your heart is healthy enough for sexual activity" feels borrowed from television pharmaceutical ads, which uniformly end with such legal disclaimers. It at once substitutes legislation and television for doctors and suggests a general ignorance that the risk of heart attacks is low after sexual activity. It also begs questions about stress testing. Yes, erectile dysfunction can be a sentinel warning of heart disease, but this should be evaluated before a prescription is issued. The legislative requirement for a stress test every ninety days after prescription dangerously blurs this very important medical point and reduces evidence based medicine to seemingly arbitrary and wasteful prescriptions.

Secondly, the bill makes life difficult for patients who often are coping with very serious illness; it compounds this by picking also on their partners, who often are also affected by their dysfunction. This it does because erectile dysfunction is commonly found among men with such conditions as diabetes, cancer, and depression; Say it on Surgeo has previously reviewed the challenges facing men with diabetes and erectile dysfunction, including a general lack of education by the professional community. It has also reviewed that in the case of some of the treatments, such as penile implant surgery, this challenge is compounded by lack of insurance coverage, which becomes further compounded by the fact that erectile dysfunction is embarrassing and most men are very reluctant to discuss it publicly. Public attacks on access to treatment for erectile dysfunction make it harder to care for and rehabilitate men with diabetes, cancer, depression and other illnesses associated with erectile dysfunction. They are contrary to the notion of compassion for the ill and hurting. They undermine legitimacy in the fight for access to care.

As with the prohibitions of the Geneva Conventions against the taking of civilian hostages, the proposed bill also begs the question of when, if ever, means justify ends. This is because, according to an article in the Washington Post, the bill's sponsor has acknowledged that the bill she introduced is invasive, intrusive, and unnecessary. Her stated aim is to force opposition legislators to back down on certain positions. She in essence seems to argue that the rules of civilized behavior do not apply to patients, that it is acceptable to hold patients hostage. She seems to imply that given her view of the supremacy of her ideals her proposed bill is justified in remotely imposing medical judgment as relates to the complex and often subtle aspects of the care of individual patients with diabetes, cancer, depression, and other conditions associated with erectile dysfunction. 

The South Carolina legislature is considering taking patients with diabetes, cancer, depression, and other conditions associated with erectile dysfunction hostage. There is one more thing it may consider taking: the Hippocratic Oath.

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