Ethics in pharmacy practice

Practice of pharmacy–governed by series of laws, regulations, and rules enforced by federal, state, local government; institutions and pharmacy management Technician–needs to understand these laws for employment

The relation between the patient and the pharmacist is covenant or promise ,and this professional covenant is similar to a legal contract , in which each party makes certain promises. In this case , the pharmacist agrees to provide pharmaceutical care to the patient and the patient agrees to provide payment and any needed information to the pharmacist.

Implicit in this covenant is the idea that the pharmacist has certain moral obligations to the patient, specially to provide quality pharmaceutical care, that provision responsible on improving patient well-being.

What happens if the patient doesn't want to take the drug even though the pharmacist knows the patient may suffer or even die as a result? What if the patient needs the drug but has no many to pay the pharmacist for it? What if the drug for aids and the pharmacist know that the patient wife unaware of her husband's condition? Each of these situations represent an ethical dilemma requiring choices that pharmacist must make.

The moralistic basis of biomedical ethics the APha code tend to take the position of nonconsequentialists, which is based on the following principles: Autonomy: An action is right if it respects the autonomy, or independent choice, of the others. Veracity: telling the truth is right. Fidelity: keeping promises, commitments, contracts, and covenants is right. Avoiding killing: Taking of human life is wrong. Justice: fair distribution of goods and harms is right.

The other major school of though, Consequentialist, general considers an actions to be right when they have beneficial outcomes for the people involved and wrong if they have detrimental consequence.   Beneficence: the principle that guides the actions and behaviors of practitioners toward beneficial patient outcomes.

Non-malificence: the principle that urges practitioners to avoid actions and behaviors that might bring harm to their patients.   These two principle is embodied from the Hippocratic oath:"As to disease , make habit of two things –to help, or at least to do no harm."

Utilitarian theories of justice: justice is merely a form of the most paramount and stringent form of utility, so the system for evaluating risks, benefits, and costs must balance the private and public benefits, risks, and cost.

Ethical Framework Nonconsequentialist: Autonomy Veracity Fidelity Justice (utility, libertarianism, egalitarianism) Privacy/Confidentiality Consequentialist: Utilitarianism Beneficence Nonmalificence

It is difficult to maintain a separation between beneficence and non-maleficence, because no action or procedure is completely safe or completely effective , thus the line can be blur between doing good and not doing harm, for in doing good one can inadvertently doing harm

Medical ethics is derived from a combination of the above elements, but the subject can be discussed by looking at four principles that embody all of the above concepts: Respect for patient autonomy Non-maleficence Beneficence justice

Code of Ethics for Pharmacists PREAMBLE Pharmacists are health professionals who assist individuals in making the best use of medications. This Code, prepared and supported by pharmacists, is intended to state publicly the principles that form the fundamental basis of the roles and responsibilities of pharmacists. These principles, based on moral obligations and virtues, are established to guide pharmacists in relationships with patients, health professionals, and society.

Adopted by APhA in 1994 Endorsed by ASHP in 1996 Actually read by very few practicing pharmacists!

I. A pharmacist respects the covenantal relationship between the patient and pharmacist. Considering the patient-pharmacist relationship as a covenant means that a pharmacist has moral obligations in response to the gift of trust received from society. In return for this gift, a pharmacist promises to help individuals achieve optimum benefit from their medications, to be committed to their welfare, and to maintain their trust. II. A pharmacist promotes the good of every patient in a caring, compassionate, and confidential manner. A pharmacist places concern for the well-being of the patient at the center of professional practice. In doing so, a pharmacist considers needs stated by the patient as well as those defined by health science. A pharmacist is dedicated to protecting the dignity of the patient. With a caring attitude and a compassionate spirit, a pharmacist focuses on serving the patient in a private and confidential manner.

III. A pharmacist respects the autonomy and dignity of each patient. A pharmacist promotes the right of self-determination and recognizes individual self-worth by encouraging patients to participate in decisions about their health. A pharmacist communicates with patients in terms that are understandable. In all cases, a pharmacist respects personal and cultural differences among patients. IV. A pharmacist acts with honesty and integrity in professional relationships. A pharmacist has a duty to tell the truth and to act with conviction of conscience. A pharmacist avoids discriminatory practices, behavior or work conditions that impair professional judgment, and actions that compromise dedication to the best interests of patients.

V. A pharmacist maintains professional competence. A pharmacist has a duty to maintain knowledge and abilities as new medications, devices, and technologies become available and as health information advances. VI. A pharmacist respects the values and abilities of colleagues and other health professionals. When appropriate, a pharmacist asks for the consultation of colleagues or other health professionals or refers the patient. A pharmacist acknowledges that colleagues and other health professionals may differ in the beliefs and values they apply to the care of the patient.

VII. A pharmacist serves individual, community, and societal needs. The primary obligation of a pharmacist is to individual patients. However, the obligations of a pharmacist may at times extend beyond the individual to the community and society. In these situations, the pharmacist recognizes the responsibilities that accompany these obligations and acts accordingly. VIII. A pharmacist seeks justice in the distribution of health resources. When health resources are allocated, a pharmacist is fair and equitable, balancing the needs of patients and society.

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