Should a Psychiatrist Prescribe a Nanodrug to Help Parents Monitor a Teen's Adherence?

Abstract

This case explores ethical questions about tracking medication adherence in a 16-year-old patient with schizophrenia. Relevant stakeholders are the teen, the parents, and society. How those stakeholders' interests should be considered is explored here in the context of the psychiatrist's professional care management responsibilities and the burdens each stakeholder must bear over the course of the patient's care. Case Dr S is a child psychiatrist who has been seeing BR, now age 16, for about 2 years. BR has been diagnosed with schizophrenia. Given the stress at home, BR has been forgetting to take prescribed medication and has suffered a psychotic episode that required him to be forcibly sedated and hospitalized for 10 days. Dr S considers prescribing BR a nanodrug that can monitor whether (but not necessarily exactly when) BR has ingested the medication. This would help Dr S's staff monitor BR's adherence to the medication and help prevent acute exacerbations, particularly psychotic episodes. BR's parents support this plan for nanopill-assisted surveillance of their son's medication compliance. However, BR is reluctant, stating, "I want to take the medicine, but I don't want to be monitored." BR clarifies that his usual treatments have worked well for him in the past, and he promises to keep taking his medication. BR's parents are adamant that he be prescribed the nanodrug and reiterate that BR has been forgetful and distracted lately and needs the reminders that the wearable patch, which contains a sensor that detects signals from the nanodrug, would trigger. Amidst this disagreement, Dr S is unsure about how to proceed.