Reconciling Personal Beliefs With Professional Duty

“The personal is political” was a common refrain during the women’s movement in the 1960s. I suggest that the personal is professional. Although I try to maintain tidy professional boundaries, I find that it is impossible to separate completely these two domains of life. I recently encountered a novel intertwining of the personal and professional, one that involved marijuana.

During the Jewish High Holidays, I reflect on at least one relationship that needs repair and one personal area for improvement. This year, I resolved to be more attentive to ways I can assist others, not at work where helpfulness is my professional orientation, but in the rest of my life.

The holiday season had barely begun when my first opportunity called out to me as I walked my dog past the mouth of an alley. A young man I’ve seen around the neighborhood in his electric wheelchair, and to whom I’ve spoken on a few occasions, asked, “Can you help me?”

Although I don’t know his medical history, my best guess is that he has either cerebral palsy or a brain injury. He has spasticity and impaired speech, and he is somewhat disinhibited. On this evening, I immediately noticed that his speech was more dysarthric than usual. I walked over to see how I could be of help. In his hand was a bright blue curved metal object, about three inches long, and a film canister with the top ajar. He said something that I couldn’t decipher. It took me a few seconds to realize that he was asking me to help fill his pipe, and that the film canister likely contained marijuana.

My resolve to be helpful was in conflict with my professional assessment of the situation and my own instinct for self-protection. While it is possible that marijuana may indeed alleviate the spasticity this young man experiences, it is also possible that it was responsible for the deterioration of his speech. Did I want to abet an activity that may further impair his neurological status? Furthermore, in Colorado, where marijuana is legal for both “medical” and recreational purposes, it remains illegal to consume it in public. If I helped him load his pipe, would I be breaking the law? We were half a block in either direction from two busy intersections. It crossed my mind that a patient or a Denver Post reporter might see me engaged in an illegal behavior while enabling someone’s substance use, and I didn’t want to face the resulting embarrassment. I said, “I’m sorry. I can’t help you with that,” and walked on.

Just as I struggled between my overall resolution to be helpful and my immediate reluctance to be helpful in the particular way being requested, it is a challenge for me to manage my personal aversion to marijuana and my professional repudiation of the concept of marijuana as medicine while maintaining a nonjudgmental and scientific stance in my office. One positive result of the legalization of marijuana in Colorado is that my patients are much more likely to tell me about their use of pot and other substances. This allows me to engage in education and motivational interviewing and to help them identify the ways in which marijuana may be contributing to their symptoms. If a patient presents with psychosis and is using marijuana, I can confidently discuss the data about chronic marijuana use and the emergence of psychotic illness. Although I cannot definitively assert that marijuana use is responsible for patients’ depression, anxiety, insomnia, or other ailments, it is easier now to have an extended conversation on the topic because people are less defensive about something that “everyone” is doing. I sometimes recommend Dr. Kevin Hill’s excellent primer for laypeople, Marijuana: The Unbiased Truth About the World’s Most Popular Weed (Hazelden Publishing, 2015). Over time, most patients do cut back; some even agree to a drug-free experiment to find out how they feel after a month or two of abstinence.

The personal is professional. My New Year’s resolution is that the demeanor of helpfulness that I assume in my office will be a more consistent stance in my personal life. In this case, the professional is also personal. I am unwilling to be helpful in a way that conflicts with my professional judgment, even though I was not in my office and this man was not my patient. ■

APA’s Principles of Medical Ethics With Annotations Applicable Especially to Psychiatry and Opinions of the Ethics Committee on the Principles of Medical Ethics can be accessed here.