Volume 16, Number 1, Spring 2005

Urine Trouble: Practical, Legal, and Ethical Issues Surrounding Mandated Drug Testing of Physicians


Martin Donohoe


The Journal of Clinical Ethics 16, no. 1 (Spring 2005): 85-96.


Healthcare organizations and medical schools have increasingly adopted mandatory pre-employment and random, not-for-cause drug-testing programs for physicians. This article discusses the history of drug testing in the United States, the recommendations of policy-making bodies, the prevalence of substance use and abuse among physicians, and the data on the costs and benefits of such drug-testing programs. When used appropriately, random and for-cause drug testing of physicians who have been rehabilitated of a substance-abuse disorder have been successful in maintaining abstinence and preserving doctorsí careers.


However, mandatory pre-employment and random, not-for-cause testing programs are based on poor science, are financially wasteful, and are unlikely to meet the programsí implicit goals of creating a safer clinical environment and diminishing errors while improving the quality of patient care. These programs usually ignore alcohol and tobacco (the major deleterious substances affecting performance and health), are often not designed to help those few doctors who abuse other substances get appropriate treatment, can create dissent among staff, and may inhibit an organizationís ability to hire individuals who are unwilling to compromise their personal ethics by capitulating to what they consider to be an unjust policy.


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