Physicians are also prosecuted under the theory of willful blindness, which erodes trust in the physician-patient relationship by forcing physicians to suspect patients of diverting, misusing, or abusing prescribed drugs. Prosecuting physicians for willful blindness criminalizes the traditional doctor-patient trust relationship, and contributes to physician opiophobia. Physicians may rightly trust their patients with chronic pain because of the vulnerability these patients have - both from the chronic pain and from the difficulty in demonstrating or verifying the fact of their pain to their healthcare providers. Although doctors' beliefs should be formed with an aim toward discovering the truth, a doctor's obligation to his or her pain patient should slant the doctor in favor of interpretations that favor the patient. Examples of the criminalization of the physician-patient relationship are the cases of Dr. Ronald McIver, who was sentenced to thirty years, and Dr. William Hurwitz, who was sentenced to fifty-seven months, after the doctors were found willfully blind to their patients' diversion of opioid medications. Professor Deborah Hellman posits that willful blindness is morally justified in the setting of a doctor-patient relationship because of the need for doctors to trust their vulnerable patients. Professor Hellman states that the moral justification for willful blindness should be taken into account in determining a physician's culpability. While a physician may be morally justified in willful blindness in some circumstances, if the circumstances permit, the physician should verify their patients' reports, especially in a situation where drug diversion is potentially at stake.
Although the doctor-patient relationship is one traditionally based upon mutual trust, because of the dangers of opioid abuse, misuse, and diversion, the physician should verify and solidify their trust of their patients' reports with quantitative urine toxicology screening, electronic prescription monitoring, and patient-physician opioid contracting. The use of sensory nerve conduction studies, for example, may also objectively determine the location of chronic neck or back pain, reducing the reliance on patient trust. As structural and functional diagnostic modalities for chronic neck and back pain (such as office sensory nerve conduction diagnostic testing) gain wider use, the reliance on a patient's word will be lessened.
These strategies of verifying patients' reports should not be detrimental to the honest physician-patient relationship because the honest patient should continue to have confidence in their physician. Although the honest patient may be annoyed at the scrutiny he or she is subjected to in the physician's office, that patient is usually pleased that the physician is operating in a manner least likely to cause the office to come under DEA scrutiny. The dishonest patient, however, may be likely to become angered and leave the physician's practice in search of another physician who will not verify symptom reports. There will be situations in which the patient's pain symptoms cannot be objectively verified. In those situations, reliance on doctor-patient trust will continue to be of prime importance.