Practicing outside the scope of practice is limited by federal and state laws yet it has psychological and economic benefits: Prescribing in the US.

Introduction

Graduates from the medical-health education institutions in the US have enviable and high calibre qualifications with nationally certified standards and competencies. It is the federal and state-to-state variations that limit their scope of practice but not their skills and competencies.? Practicing within or outside the scope of practice is premised on avoiding risks, liability, litigation, negligence and eventual death of health seekers. Practicing can mean prescribing medicines or offering a health opinion within ethical and legal instruments. However, these same ethical and legal instruments make the practice of medicine vulnerable to manipulation. Manipulation in turn leads to ways that become barriers or enablers to access; to care; availability; acceptability; affordability; and quality of services. Practicing outside the scope of practice has permutations. For some it is lauded as serving far, above and beyond the call of duty, e.g., social medicine. While to others it is a liability or dismissed as motivated by profiteering interests. With such sentiments, it sets the grounds for ambivalent ethical, legal and professional outcomes. On the one hand it enables some doctors, nurses, pharmacists, midwives and physician assistants to promote their cultural, personal or religious beliefs despite of the duty to do no harm. While at the same time it also allows other practitioners to continue providing a service however controversial it may be, e.g., abortion, tubal ligation and vasectomy. These are grounds for tensions within the professions. It may be an enabler or barrier to innovative approaches, diversity and heterogeneity in the health services’ space especially since it is curtailed by statutes like the ones rolling back sexual reproductive health services, the use of medical devices, food supplements and abortion-related care. A cursory look into prescribing, elicits a physical activity and sequence of events leading to the prescriber going through the motions of ordering for medications or medicines which are eventually provided to the health seeker. But prescribing has attendant events which go beyond mere giving of medicines due to the wider context with many stakeholders playing key roles. The actors suggest, provide advice, certification, play oversight roles and have the influence which can impact the outcomes of healthcare services. Health care is complex so different institutions such as the Food and Drug Administration (FDA) and professions contribute to these outcomes (ACHE,2016; Alexander, J.T., n.d; AMA, n.d; ANA, n.d; APHA, 2019; Demarinis, 2020; Leslie, et al., 2021; ?Mackenzie, et al., 2019; Muench, et al., 2021;Pozgar, 2020; Thind, et al., 2020).

The Ethical Principles to Consider

The health professional regulatory regimes ensure the highest quality of care and influence values and standards. These include, protecting the public health; safeguards against harm; enforcement of professional labelling; education about the new medications and specialty drugs on the market; understanding drug interactions and possible side effects; assure that appropriate information is communicated to health care professionals and consumers; ensuring safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices; ensuring the safety of the food supply, cosmetics, and products that emit radiation; judicious resource allocation; continuity of care; workplaces where speaking against unfair treatment is okay; cultural sensitivity to competing values; respect refusal of treatment, hospitalization or treatment during an emergency by patients; doing good (beneficence); being truthful or seeking the truth beyond one’s comfort zone (veracity); ensure that no harm comes out of an action (non-maleficence); regarding the patient as someone capable of free choice as well as according them the freedom to choose freely, when they are able (autonomy); engage in action that will bring about the best outcomes (optimisation); provide best services (maximisation); giving services according to need (proportionality); ?maintaining certification levels (capacity); establishing contexts for safe information storage (confidentiality); seeking permission in anticipation of intrusion (consent); protecting patient information (patient privacy and confidentiality; mitigating disease risks and spread, ensure business continuity, stopping viral spread and protecting employees (guard against transmission of diseases); avoiding inappropriate relationships, avoiding sexual harassment and misconduct (defining relationship levels/fraternizing/sororitizing levels); follow medical directives; maintain employment rights; specific wishes under end-of-life directives; and prioritizing social determinants for health and their intersection within a diversity of actors (ACHE,2016; Alexander, J.T., n.d; AMA, n.d; ANA, n.d; APHA, 2019; Demarinis, 2020; duq.edu, 2020; Legan, 2015; Mackenzie, et al., 2019; McVean, 2019; Mellinger,, 2006; Meredith, et al., 2023; Morens, et al., 2021; Philip, et al., 2020; Pinheiro, 2022; Pozgar, 2020; & Rivière-Cinnamond, et al., 2018).

The Legal Implications

Ethics and laws set the contexts minimising negligence, error, risks, vulnerabilities and harmful effects; and amelioration to ensure errors do not happen. There are executive steps to follow and these include evaluating and defining a health seeker’s problem; determining the therapeutic objective of drug therapy; selecting an appropriate medication; providing patients with information, warnings, and instructions; monitoring the health seeker regularly; considering drug costs when prescribing; use of appropriate tools, such as prescribing software and electronic drug references, to reduce prescription errors;? seeking and preparing for referral in case of such a need; and the protection of information. These steps are catalytic to quality prescription and service delivery. Without quality prescription it is hard to expect better health outcomes (ACHE,2016; Alexander, J.T., n.d; Alsan, et al., 2018; AMA, n.d; ANA, n.d; APHA, 2019; CDC [Center for Disease Control and Prevention], 2023; Demarinis, 2020; Legan, 2015; Mackenzie, et al., 2019; McVean, 2019; Mellinger,, 2006; Meredith, et al., 2023; Morens, et al., 2021; NAMI [National Alliance on Mental Illness], 2024; ?Philip, et al., 2020; Pinheiro, 2022; Pozgar, 2020; & Rivière-Cinnamond, et al., 2018; Seo, et al., 2023; Smith, et al., 2019; Sweeney, 2020; & Taylor et al., 2023).

My stand

There are fears and some are justified but practicing outside one’s scope of practice is beneficial. It is also unavoidable since there are several exigent factors that may call for one to provide or offer a service or intervention. Translating and scaling the aspirations of public health through service provision ensures life promoting lifestyles and better health outcomes (ACHE,2016; Alexander, J.T., n.d; Alsan, et al., 2018; AMA, n.d; ANA, n.d; APHA, 2019; ; CDC, 2023; Demarinis, 2020; Legan, 2015; Mackenzie, et al., 2019; McVean, 2019; Mellinger,, 2006; Meredith, et al., 2023; Morens, et al., 2021; Muench, et al., 2021; NAMI, 2024; Philip, et al., 2020; Pinheiro, 2022; Pozgar, 2020; Rivière-Cinnamond, et al., 2018; Seo, et al., 2023; Smith, et al., 2019; Sweeney, 2020; Taylor et al., 2023; & Thind, et al., 2020.

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