An Ethical question relating to Libre...

[mike@work]

So here's an alternative approach.

Is it ethical to give the Libre you were prescribed to your T2 friend, at no cost, and for them to gift you an item on an irregular basis for doing so, because you use the Dexcom platform and can help the T2 manage their condition by providing them the Libre?

What if that "gift" were a box of three Dexcom G6 sensors?

I'm not interested in the "letter of the law" - I know what the rules are and they are not necessarily about being "morally right".

Hmm - I'm afraid that all the answers you will get from now on, will be colored of all the thoughts brought up in the first question. The base in this question IS as a matter of fact, not different from the first one. In this case you exchange things directly. In the former case you also exchanged things. Only problem in the former case is, that you wave a red cloth, when you mention the word "sell", which includes money.
The action I would recommend: Do as you thought about doing from the beginning, as this will probably be the end result, in any case

 

[Brunneria]

So here's an alternative approach.

Is it ethical to give the Libre you were prescribed to your T2 friend, at no cost, and for them to gift you an item on an irregular basis for doing so, because you use the Dexcom platform and can help the T2 manage their condition by providing them the Libre?

What if that "gift" were a box of three Dexcom G6 sensors?

I'm not interested in the "letter of the law" - I know what the rules are and they are not necessarily about being "morally right".

If the individual is accepting a prescription for a Libre and not using it themselves, for their own arm, then they are not acting in good faith. If the NHS found out, the prescription would be withdrawn.

The same applies to people who regularly collect prescriptions and let them languish in a drawer, because they are afraid to admit that they don't use the medication (statins, bp pills, creams, pills and potions). Or people who collect a prescription made out to themselves and then pass it on to a friend or loved one.

I can understand why it happens, and I can even see myself doing it, if the circumstance occurred that it seemed to make sense.
But it doesn't make it right. And I would know that it wasn't right.

 

[LooperCat]

If the individual is accepting a prescription for a Libre and not using it themselves, for their own arm, then they are not acting in good faith. If the NHS found out, the prescription would be withdrawn.

The same applies to people who regularly collect prescriptions and let them languish in a drawer, because they are afraid to admit that they don't use the medication (statins, bp pills, creams, pills and potions). Or people who collect a prescription made out to themselves and then pass it on to a friend or loved one.

I can understand why it happens, and I can even see myself doing it, if the circumstance occurred that it seemed to make sense.
But it doesn't make it right. And I would know that it wasn't right.

That then brings up the issue of passing unneeded insulin on to someone in need. It’s prescribed to you, you have extra, and another T1 has run out and can’t get any...

 

[slip]

Now I'm beginning to think Tims asking on behalf of a "friend"............

As already mentioned, if you are prescribed something it is for a reason and for your sole use. Not using/taking said item yourself is wrong.

 

[slip]

That then brings up the issue of passing unneeded insulin on to someone in need. It’s prescribed to you, you have extra, and another T1 has run out and can’t get any...

Swapsies Mel, you're only lending some until they can get some more and will 'pay' you back - similar to getting an emergency script from the pharmacist..........

 

[KK123]

In answer to the original post, this is fraud whichever way you look at it. Imagine a person obtaining ANYTHING on a prescription with the intention of selling it to someone else whether as a one off or on a regular basis. In response to the second scenario (what if you already had one and then decided to give it away), well yes, that is different. Imagine if we all decided to get extra boxes of test strips on our prescriptions with the intent of selling them off?

 

[tim2000s]

I'd been discussing it with someone who is an occasional Libre user and balks at the cost. Ethically I see no issue with it whatsoever as "morally", both PWDs end up with better care and better outcomes.

Legally it's a different case.

If, on the other hand, I was to convince my surgery to put the Libre money they would pay out towards Dexcom sensors, that would be within the rules, but would only result in better outcomes for me. Morally, as far as I'm concerned, that's not right. I think it would be an interesting conversation to have with the GP's surgery regarding the process.

It raises the interesting question of how you view "Right" in terms of outcomes, people and the law.

 

[Brunneria]

That then brings up the issue of passing unneeded insulin on to someone in need. It’s prescribed to you, you have extra, and another T1 has run out and can’t get any...

Yes. And especially since some drugs - including insulin - can be lethal in the wrong hands.

Its a minefield.

 

[kev-w]

25 years ago my mates dog was on Humilin I same as me my mate struggled with the cost so I gave him my bottles with around a quarter left in, the dog got that but I'd have been throwing the bottle away at that point anyway, his kids got another couple of years from the dog and my waste wasn't wasted...

The original question? legally wrong, potential of losing the script, too complicated for me, but ethically/morally wrong? No not at all, just creative thinking

 

[DCUKMod]

So here's an alternative approach.

Is it ethical to give the Libre you were prescribed to your T2 friend, at no cost, and for them to gift you an item on an irregular basis for doing so, because you use the Dexcom platform and can help the T2 manage their condition by providing them the Libre?

What if that "gift" were a box of three Dexcom G6 sensors?

I'm not interested in the "letter of the law" - I know what the rules are and they are not necessarily about being "morally right".

Nope. I'd say no change in my view, or how I feel "officialdom" could view it.

Prescriptions are for our personal use, not our chosen method of disposal.

 

[tim2000s]

Nope. I'd say no change in my view, or how I feel "officialdom" could view it.

Prescriptions are for our personal use, not our chosen method of disposal.

So what's your view on the question about giving insulin to someone who hadn't got any and was in need of it until they could get an emergency prescription? I would assume it is the same?

 

[DCUKMod]

So what's your view on the question about giving insulin to someone who hadn't got any and was in need of it until they could get an emergency prescription? I would assume it is the same?

That feels a bit different, but I would probably be suggesting they go to A&E or such.

Of course, as someone who has only recently started taking a medication regularly, I haven't found myself to be in a jam such as you describe.

 

[urbanracer]

That then brings up the issue of passing unneeded insulin on to someone in need. It’s prescribed to you, you have extra, and another T1 has run out and can’t get any...

Personally I don't see the parallel. What you're describing here is a potentially life saving situation, no?

So T1 to T1 ( meaning the receiver knows how to use the insulin sensibly) I would gladly help out without a second thought.

 

[mike@work]

Personally I don't see the parallel. What you're describing here is a potentially life saving situation, no?

But that could be the situation for this Type 2 also...at least in the long run...
Difficult questions don't have easy answers...

 

[porl69]

no, I got the libre on prescription a month ago and bought a Miao Miao and using xDrip+ (still can't figure out how to get the readings on my pc though) and so long as I calibrate it twice a day its as close to the G6 I had and far more accurate than the libre readings from the Abbott reader, so Miao Miao £164 libre on prescription = real life CGM

Trying to figure out how to do the same......wanting to print out reports for my upcoming pump Dr consultation

 

[NicoleC1971]

Purely hypothetical.

It's nuts though, if you think about it. The letter of the rules state"improved outcomes" as a key measure. If you get better outcomes with RT-CGM, and provide a better outcome for the T2 involved by using flash, then you sure as hell save the NHS money.

If the user were selling the Libre on purely to make money, and not to fund a better therapeutic model, then yes, I'd say it was unethical.

Given the NHS reticence to provide better therapeutic models where technology is involved, I don't see it as unethical. Especially as it is effectively improving the model for both people. Ethically I think it is sounder than prescribing Libre to T1s and not prescribing Libre or test strips to T2s.

I don't consider whether it breaks the arbitrary guidance an ethical question.

I don't think it matters that you are using your theoretical profits for a good cause. The ends would not justify the means even if the end as you point out, is improving the health of 2 people. It is still a lie.
Type 1s have the greatest need for the Libre and type 2s should get test strips or the libre in an ideal world too. This would be on the basis that they are using the libre to monitor how their diet/exercise impacts on their blood sugar levels whereas type 1s are using it to calculate basal and bolus doses. At present there are plenty of clinicians who do not treat with diet/lifestyle in any meaningful way thus it would not be helpful for those patients to get libre/test strips.

 

[tim2000s]

So T1 to T1 ( meaning the receiver knows how to use the insulin sensibly) I would gladly help out without a second thought.

This demonstrates that where we draw the lines matters. If you are receiving insulin on prescription, for yourself, by nature of the model, giving it to someone else (let's face it, it's a lethal drug), whether they know how to use it or not, or whether they have their own prescription for it, breaks the stated point that:

Moderator edit to point out that this quote has been significantly changed by @tim2000s from talking about the Libre, to talking about insulin - which was not @Brunneria's intention, or context.

If the individual is accepting a prescription for Insulin and not using it themselves, [deletion] then they are not acting in good faith.

Then on the second point:

Personally I don't see the parallel. What you're describing here is a potentially life saving situation, no?

Just because the situation is a short term one, does that mean that the ethics/morals of the situation change? Especially if the Libre changes the way the person with T2 lives and results in them living longer at less cost to the country and allows them to be more productive?

 

[KK123]

This demonstrates that where we draw the lines matters. If you are receiving insulin on prescription, for yourself, by nature of the model, giving it to someone else (let's face it, it's a lethal drug), whether they know how to use it or not, or whether they have their own prescription for it, breaks the stated point that:



Then on the second point:



Just because the situation is a short term one, does that mean that the ethics/morals of the situation change? Especially if the Libre changes the way the person with T2 lives and results in them living longer at less cost to the country and allows them to be more productive?

Tim, what you have described there is entirely different. If you are asking are there EVER circumstances in which people would break the Law ethically or otherwise, of course there are. If there is an emergency or a set of circumstances where there is a life or death issue, then literally anything can be justified. That is hardly the same as what you asked in your original post and I personally don't think that just because you might act in a certain way in an emergency that somehow you are being hypocritical by calling obtaining something by deception and giving it to someone else ethically wrong.

 

[Miguelg]

I don't think there is an ethical question here, if you can provide someone with a devise that will improve his health, so the opposite, not provide it will be the question.
I'm type 2 and manage to to maintain a perfect glucose level and stop injection insuline (for 10 months already) just by dieting and monitoring my sugar with FreeStyle Libre

 

[LooperCat]

Personally I don't see the parallel. What you're describing here is a potentially life saving situation, no?

So T1 to T1 ( meaning the receiver knows how to use the insulin sensibly) I would gladly help out without a second thought.

Absolutely. I’ve still got basal insulin in date that I don’t need in my fridge just in case someone else in need does. If I return it to the pharmacy it’ll just be destroyed anyway. Part of my post Brexit survival plan! I imagine we’ll be seeing a lot of “pay it forward” groups springing up on Facebook like our American friends rely on if there are distribution issues.