Background: To explore the ethical and policy implications of produce prescription (Rx) programs, PubMed, Embase, and Scopus databases were searched for peer-reviewed literature on existing Rx programs in February 2018. Methods: A review of the literature identified 19 articles published on produce Rx programs; all were included in the review. Inclusion criteria were interactions between a medical professional and patient in a health care setting where a prescription for the consumption of fruits and vegetables was provided. Programs were further classified by whether patients were recruited based on eligibility criteria such as low socioeconomic status, diet-related condition, and the type of referring physician. An ethical matrix was then used to evaluate well-being, autonomy, and fairness from the perspectives of adult and child patients, patient families, participating local farmers, physicians, and government assistance programs. Results: Patients with low income were subjects of 14 articles; 13 studies identified populations with diet-related health conditions such as diabetes or hypertension. Only 9 studies examined both health conditions and low socioeconomic status. An ethical analysis indicated that despite reducing financial burdens and increasing food choice, Rx programs might have unintended psychosocial consequences on participants with low income. Health care professionals benefit from employing a partnership model of care, building trust, and emotional intelligence. Participating farmers benefit from an enlarged customer base but might experience greater financial burdens. Some produce Rx programs could use existing government assistance programs (ie, Medicaid in medically underserved areas or the Supplemental Nutrition Assistance Program, or SNAP, in food deserts), although disbursement may be cost inefficient and disorganized without policy cohesion at all levels of government. Conclusions: Future research must test a variety of produce Rx program designs to ameliorate tradeoffs between well-being, fairness, and autonomy. As pilots grow in scale, produce Rx programs must acknowledge the critical roles and perspectives of health care professionals and local participating farmers. Programs must also determine whether Rx incentives will use the existing government assistance programs to identify patients with low income, with diet-related health conditions, or with both.
Swartz, H. (2018). Produce RX programs for diet-based chronic disease prevention. AMA Journal of Ethics, 20(10), 960–973. https://doi.org/10.1001/amajethics.2018.960