Ethical Dilemmas and Decision Making

Question 1

Ethical Dilemmas:

Answer 1

• Ethical issues always involve people
• Ethical values may conflict with each other e.g. autonomy and beneficence
• Pharmacy situations may include professional, clinical and ethical issues all the same time

Question 2

Ethical dilemmas could involve;

Answer 2

• Relationship with clients
• Relationship with colleagues
• Responsibility to public/community
• Maintaining knowledge/skills
• Personal behaviour and health
• Professional advertising and publicity
• Maintaining the standing and reputation of the profession

Question 3

Issues that are not normally ethical dilemmas ON THEIR OWN

Answer 3

• Issues of medical etiquette
• Inappropriate indications/treatment/discussion of treatment options
• Problems of communication
• Breakdown in relationships
• Assessment of decision-making capacity
• Obtaining informed consent

Question 4

Determination of the ethical issue:

Answer 4

• If the answer to one of these is yes, it is likely that an ethical issue is involved
– Is this unfair? To whom?
– Does this break a promise?
– Will this be harmful? To whom?
– Will this threaten existing or future relationships? With whom?
– Will I be compromising someone’s rights? Including my own?
– Will this benefit the patient, from the patient’s perspective?
– Is this disrespectful? To whom?

Question 5

Medical/Healthcare law and ethics. Ethical dilemmas increased frequency & difficulty due to:

Answer 5

– increased technology
• life-saving/life-sustaining procedures/treatments
• Reproductive medicine
– changing relationship between healthcare professionals and patients
• beneficence+paternalism → autonomy+justice+rights
– changing relationships between different healthcare professionals
• professional roles; specialisation; team care; shared-decision making

Question 6

Ethical principles when dealing with dilemmas:

Answer 6

• respect for autonomy of the patient (self-determination)
• beneficence (do good and prevent harm)
• non-maleficence (do no harm)
• justice (equitable distribution of benefits/burdens)
• fidelity (keeping promises; truthfulness and confidentiality)

Question 7

Ethical decision-making process:

Answer 7

1. Identify the problem
• Review the situation 
• Determination of ethical issue
o Is this an ethical issue?
o Why is this an ethical issue?
• Identify 
o type of ethical problem(s) faced 
o decision(s) to be made

2. Gather relevant information
   • Gather as much relevant information about the situation as possible in order to get the facts clear
   • Establish the facts of the situation and identify
   o what you don’t know and can find out e.g. by asking
   o all the relevant parties involved
   o expectations and responsibilities
   • Consider the context of the decision-making
   o Clinical or pharmacological issues
   o patient preferences
   o quality of life/death social issues
   o legal and professional aspects
3. Identify values
   • Ethical principles
   o respect for autonomy of the patient (self-determination)
   o beneficence (do good)
   o non-maleficence (do no harm)
   o fidelity (truthfulness and confidentiality)
   o justice (equitable distribution of benefits/burdens)
   • Professional standards
   o Standards for pharmacy professionals
   o Other standards
4. Identify options
   • Weigh up each option
   • identify the anticipated outcome of the various possible solutions
   • be fair and open-minded (be aware of own value-system)
   • apply critical thinking and logically valid argument
   • look for best consequences overall
   • consider the impact of each option on those involved, including society as a whole
   • consider what if everyone in similar circumstances did the same
5. Choose an option and justify the chosen action
   • Chose the option which you feel is the right thing to do
   • Are you comfortable with the decision?
   • Justify the decision (explain and support decision)
   • Why this decision and not another?
   • Anticipate criticisms and formulate responses
6. If appropriate, record decision/evaluate for CPD
   • If significant, record the decision and your reasons
   • Assess the outcomes as the processes go forward
   • Evaluate and reconsider; continue to seek new insights into the situation
   • Consider its relevance for a wider range of situations and concerns
   • Use this situation as a foundation from which to grow and develop
   • Consider
   o What you have learned that will be useful in the future
   o What you would do in another similar situation
   o What would you change

Question 8

• You are a community pharmacist. A regular customer and friend tells you in confidence that she suspects her 18-year-old daughter may be suffering from anorexia nervosa. The next day, the daughter (whom you know) arrives at the pharmacy and asks for some laxatives. You know that laxatives can be misused by people with anorexia as they think they will help them lose weight.
• Should you make the sale of the laxative?

Answer 8

What do you know
• Mother suspects daughter is anorexic
• Request for sale of laxatives to daughter following day
• Laxatives are used by anorexics
• Mother is a regular customer and friend

What do you not know
• That the daughter is anorexic
• That the daughter is buying laxatives to lose weight
• Why the daughter is buying laxatives

If you sell
• Ethical principles
– respect for autonomy of the patient (self-determination)
– fidelity (truthfulness and confidentiality)
– justice (equitable distribution of benefits/burdens)

if you refuse to sell
• Ethical principles
– beneficence (do good)
– non-maleficence (do no harm)