Lec 1.5: Ethical Decision Making in Pharmacy

Question 1

Classical Ethical Theories (2)

Answer 1

• Deontological (AKA Duty ethics)
• Utilitarianism
  .
  These theories provide a comprehensive framework for making ethical decisions.

Question 2

Deontological (AKA Duty ethics) - talk about it

Answer 2

‣ AKA “Idealist” (means and ends oriented)
‣ Both the outcome of the action and how you get
there matters
‣ Certain acts may be wrong, therefore unethical,
regardless of outcome
‣ Acts that violate our duties to others should not be
undertaken, no matter what the outcome.

Question 3

Utilitarianism - talk about it

Answer 3

‣ Consequentialist (ends oriented)
‣ Achievement of goals are the primary source of
happiness
‣ Only the final outcome matters, you can use any
means necessary to get there.
.
The correct ethical choice is the one that leads
to the greatest amount of good for the greatest number of people.

Question 4

What are ethical principles?

Answer 4

The common goals that each theory tries to achieve in
order to be successful
.
◦ Beneficence
◦ Nonmaleficence
◦ Autonomy
◦ Justice
◦ Confidentiality
◦ Veracity
◦ Promise-keeping

Question 5

What are the ethical principles used by both idealist and consequentialist? and what are additional principles used by idealists?

Answer 5

Used by both!
◦ Beneficence
◦ Nonmaleficence
◦ Autonomy
◦ Justice
.
Additional principles used by idealists
◦ Confidentiality
◦ Veracity
◦ Promise-keeping

Question 6

Define Beneficence

Answer 6

• Do anything you can to help the patient
• Requires action that has a positive effect
  ◦ Prevent bad outcome
  ◦ Remove something bad
  ◦ Promote good
• Acts of omission violates the principle

Question 7

Define Nonmaleficence

Answer 7

• Do no harm
• No problem with not acting (Omission)
• Acting could cause a problem
  ◦ Deliberate harmful acts
  ◦ Unintentional acts

Question 8

Define Autonomy

Answer 8

• Respect for person/patient - Treat patients
  who are competent as independent decisionmakers
• Person/Patient should make own decisions if it
  affects them - Freedom to choose, respect their
  choices
• Each person has their own unique view and should be able to act on their views
• Even if action is foolish or unwise
• Decisions that infringe upon the rights of others do not need to be respected

Question 9

Define Justice

Answer 9

• Fairness and equity
  ◦ Equals are treated equally
• Pharmacy services should be available to all and equally provided to all
• Do pharmacy services meet the ethical standard of
  justice?
  ◦ Patients without insurance?
  ◦ Patients with socially-unacceptable diseases?
  ◦ The homeless, health disparities

Question 10

Additional principles considered by Idealists when making ethical choices

Answer 10

• Confidentiality
• Veracity
• Promise keeping

Question 11

idealist principle: Define Confidentiality

Answer 11

• Health information is confidential
• Patients do not give up their rights in this respect
• Health Insurance Portability and Accountability Act (HIPAA) of 1996
  ◦ Can share information in the context of job function
  ◦ Legal implications of not maintaining confidentiality
  —– Civil - $100 per failure, up to $25,000
  —– Criminal – Fine plus imprisonment ($50,000 + 1 year,
  and up)
  —– Employer actions-termination

Question 12

idealist principle: Define Veracity (truthfulness)

Answer 12

• Patient’s right to know
• Telling the truth about all aspects of medical
  treatment, including potential outcomes and side effects
• Full disclosure
  ….Why is veracity a idealist principle, but not a
  consequentialist principle?

Question 13

idealist principle: Define Promise Keeping

Answer 13

• Pharmacists should keep their promises to patients
• Classification as a professional = promise to society

Question 14

Duties of pharmacist … technical role and professional status

Answer 14

• Technical role
  ◦ Filling the prescription correctly with drugs that are
  of appropriate quality
  ◦ Guardian of nation’s drug supply
  .
• Professional status
  ◦ Societal right and duty = rational and efficient drug therapy
  ◦ Individualized rather than mass-produced
  ◦ Altruism – benefit to others at self-expense

Question 15

Pharmacist’s duties: Promotion of Rational Drug Therapy

Answer 15

• Assure drug therapy is correct
• Encourage compliance with doctor’s orders
• Assure that the patient has enough information to make a decision

Question 16

Pharmacist’s duties: Patient Advocacy

Answer 16

◦ Show interest in patient
◦ Do what is best for the patient
◦ Patient has a right to make health care decisions for self

Question 17

Pharmacist’s Duties toward Patients??? Towards society?

Answer 17

Towards patient
 Autonomy
 Confidentiality
 Honesty
 Avoiding harm
.
Towards society
 Confidentiality
 Justice
 Public health

Question 18

Pharmacist’s Duties toward Colleagues

Answer 18

• Territorial rights (roles)
• Cooperation
• Fair competition
• Reporting malfeasance
• Monitoring Colleagues
• Preventing unauthorized practice

Question 19

List of barriers to ethical practice

Answer 19

• Temptation to do nothing
• Business versus professional standards
• Subservient posture to the physician
• Lack of knowledge of ethical decision making
• Complexity of health care = High difficulty of ethical decisions hard to know what will be the benefit

Question 20

Steps of Ethical Problem Solving in Pharmacy

Answer 20