1). Of course, anyone who recalls the popularity of cocaine and opium during the late nineteenth-century knows that the historical use of a drug is not, in itself, a testament to that drug's safety or efficacy, but this long legacy of marijuana use for medicinal purposes is important due to the relative absence of clinical studies. The three important treatments that marijuana can offer cancer patients is pain relief, appetite stimulation, and mood elevation. The first treatment is perhaps the most obvious, because cancer and the radiation treatments that frequently accompany it are extremely painful and force patients to live in near-constant pain. Marijuana offers an important response to this pain because it has the ability to relieve pain without the serious side-effects that accompany other pain relievers, and particularly those based in barbiturates. Furthermore, marijuana has a much lower potential for addiction compared to painkillers like codeine or morphine, which is important for someone suffering from the chronic pain that accompanies cancer (Martin, 2002, p. 5). The treatment for catastrophic diseases like cancer often has to be as dramatic and extreme as the disease itself, so there is an urgent need for pain medications that do not carry dangerous side-effects, and in the case of cancer, marijuana can be one such medication.

In addition to chronic pain, the treatments that frequently accompany cancer often result in nausea and a loss of appetite, a problem that can exacerbate cancer's ill effects by preventing the patient from receiving important nutrients. Once again, marijuana can counter these symptoms by simultaneously reducing nausea while increasing the appetite, thus reducing the unpleasant side-effects of cancer treatments while helping the patient maintain a relatively normal nutritional schedule (Martin, 2002, p. 5). This use of marijuana is important because it directly counters the side effects that arise from cancer treatments, meaning that the patient can reap the benefit of preexisting treatments like radiation while being able to maintain a much higher quality of life than has been previously possible.

Lastly, marijuana has the potential to decrease anxiety and elevate a patient's mood, something that is extremely important when dealing with something like cancer. It is important to point out that this is not the same as saying that positive thinking and a "fighting spirit" will help someone survive cancer, because these ideas have not been substantiated by the data (Coyne & Tennen, 2010, p. 17; Harris et. al., 2007, p. 4). To say that marijuana has the potential to elevate a patient's mood cuts to something far more fundamental than the silly idea of a "triumph of character and attitude over biology" (Coyne & Tennen, 2010, p. 17). Instead, marijuana's mood-altering effects can be seen as part of a larger program of healthy coping, because the psychological effects of cancer can be as debilitating as the physical effects.

Marijuana's mood altering effects can help patients cope with their cancer psychologically, because it encourages modes of thinking that step outside the usual "repression/blunting vs. sensitization/monitoring" dichotomy that can emerge (Livneh, 2000, p. 41). Specifically, when faced with something like cancer, many people either attempt to avoid the issue or else focus on it excessively, and in both cases the patient's psychological state deteriorates as a result. Marijuana can intervene in this process because the lateral thinking and changes in mood brought on by marijuana can encourage patients to consider their disease in new or different ways outside of their regular patterns of thinking (Cohen, 2006, p. 20). In this case, the point of prescribing marijuana is not based on the assumption that a positive attitude will increase a patient's chance of survival, but rather is based on a desire to simply improve the patient's quality of life.

This last point is crucial to reiterate, because it helps explain why a physician would be ethically justified in prescribing marijuana even in the face of legal, and in some cases medical, opposition. In the case of cancer, marijuana's potential to increase the efficacy of cancer treatments, or even to serve as a cancer treatment itself, is not the reason for its prescription. Even though reduced pain, anxiety, nausea, and an increased appetite may have demonstrable effects on the outcome of a cancer treatment program, this is not the primary ethical justification for prescribing marijuana. Instead, the justification for prescribing marijuana stems directly from the physician's responsibility to the well-being and quality of life of his or her patient.

That is to say, if marijuana has the potential to make a cancer patient's life even slightly more...

Of course, one can only make this case confidently after appreciating the relative low risks associated with marijuana use, because the ethical obligation only exists wherever the treatment is not worse than the symptom it treats. Because marijuana does not have substantial negative side-effects, however, one can confidently say that if it has the potential to improve the life of a patient and there are not better options, the physician has a responsibility to prescribe it.
In fact, in the case of terminal patients, a physician could be comfortable proscribing marijuana for smoking, because if the goal is an improved quality of life rather than cancer treatment, smoking might be more enjoyable for the patient. Recognizing this cuts to the core of the patient-physician relationship, because it suggests a situation where the quality of life is deemed more important than the length of that life. Deciding whether to value quality over longevity is a decision that can only be made by a patient in consultation with his or her physician, but the current legal regime surrounding marijuana essentially inserts the federal government into this equation in a way that most people likely never imagined or intended. The idea of government intervention in end-of-life decisions is already anathema to many people, but the fact is that the government currently circumscribes end-of-life decisions within a fairly strict set of rules, to the point that it is still illegal for people in the United States to willingly take their own lives or have a physician assist them in doing so.

While there is obviously a substantial gap between prescribing marijuana to a cancer patient and assisted suicide, the comparison is useful for understanding how the prescription of marijuana, though an ostensibly simple idea, actually forces one to consider the nature of the patient-physician relationship as a whole. Specifically, it forces one to evaluate how society values life and whether it is more important to enjoy life or live a long time. While this debate feels abstract and almost philosophical, it is all too real for those suffering from cancer and seeking relief in the form of marijuana, because their ability to dictate the quality of their own life through alternative medications is being constrained by a society that implicitly values longevity over quality.

In addition, examining this topic forces one to consider how the current legal framework controls and constrains that relationship, and whether there is anything that could be done in order to make this relationship freer and more open to alternative options such as marijuana. This is particularly true of patients with cancer or other terminal or chronic diseases, because the physician's responsibility to the patient's well-being and quality of life is being directly constrained by an existing legal framework that seems not to care about the patient's potential suffering. In this case, ethics and the law come into conflict, because the physician has an obligation to prescribe whatever medicines have the potential to improve the patient's life, even if they do not improve their life expectancy.

Understanding what makes it acceptable to prescribe marijuana to cancer patients requires examining the legal, medical, and cultural arguments against medical marijuana as well as the potential benefits offered by it. While there is an obvious legal argument against prescribing marijuana due to the federal government's prohibition, this simply means that there is a conflict between ethics and the law, and it is the physician's duty to choose ethics. The medical argument against marijuana is unconvincing because the potential risks associated with marijuana use are overwhelmingly outweighed by the benefits. Furthermore, the cultural argument falls flat because the problem it describes, of doctors essentially becoming gray-market drug dealers, is a product of the law and not the drug. In contrast, the arguments in favor of prescribing marijuana to cancer patients are overwhelming, because marijuana has the potential to combat some of the most painful and upsetting side-effects of cancer treatment. In particular, marijuana has the potential to reduce pain and nausea, increase appetite, and elevate mood, all things that go a long way towards increasing the quality of life of someone suffering from cancer. With this in mind, it becomes clear that not only is it acceptable to prescribe marijuana to cancer patients, even in violation of the law, but that in some cases one could argue that a…