ETHICS OF PHARMACIST IN COMMUNITY PHARMACY

PRESENTED BY:

NAILA WAHEED
M.PHIL (E) Pharmacology

WHAT IS COMMUNITY PHARMACY

A community pharmacy is the place where most pharmacists practice the profession of pharmacy. Community pharmacies usually consist of a retail storefront with a dispensary where medications are stored and dispensed.

It is the community pharmacy where the dichotomy of the profession existshealth professionals who are also retailers.
9/29/2013 copyright (your organization) 2003 2

INTERACTION OF PHARMACIST WITH PEOPLE

A community pharmacist works according to legal and ethical guidelines to ensure the correct and safe supply of medical products to the general public. They are involved in maintaining and improving people's health by providing advice and information as well as supplying prescription medicines.
9/29/2013 copyright (your organization) 2003 3

 They also sell over-the-counter medical products and instruct patients on the use of medicines and medical appliances.
They also offer specialist health checks, such as blood pressure monitoring and diabetes screening, weight reduction programs and are able to prescribe alternatives as well as dispense medicines.

advice and information to patients regarding the dosage of medications.

9/29/2013 4

WHAT IS ETHICS
Ethics refers to well-founded standards of right and wrong that describe what humans ought to do, usually in terms of rights, obligations, benefits to society, fairness, or specific virtues.

Ethical standards also include those that enjoin virtues of honesty, compassion, and loyalty. Moreover, standards relating to rights, such as the right to life, the right to freedom from injury, and the right to privacy.
9/29/2013 copyright (your organization) 2003 5

 Professional Values and Ethics are a set of moral principles and standards of conduct, supporting the moral prestige of professional groups in society. Ethics is designed to educate people, to help them to behave properly with other, to communicate at work place. The tasks of professional ethics are to identify moral standards and assessments, judgments and concepts, characterizing people as representative of particular profession.

9/29/2013

copyright (your organization) 2003

ETHICS IN PHARMACY PRACTICE

Code of Ethics Statements:

These

statements

regarding

professional

behavior are often written as formal documents and

provide language to aid in the decision-making

process when ethical dilemmas present themselves in pharmacy practice.

PHARMACIST CODE OF ETHICS

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.

9/29/2013

copyright (your organization) 2003

1. A pharmacist respects the covenantal relationship between the patient and pharmacist. 2. A pharmacist promotes the good of every patient in a caring, compassionate, and confidential manner 3. A pharmacist respects the autonomy and dignity of each patient. 4. A pharmacist acts with honesty and integrity in professional relationships. 5. A pharmacist maintains professional competence.
9/29/2013 copyright (your organization) 2003 9

6. A pharmacist respects the values and abilities of colleagues and other health professionals. 7. A pharmacist serves individual, community, and societal needs. 8. A pharmacist seeks justice in the distribution of health resources.

9/29/2013

copyright (your organization) 2003

10

ETHICAL PRINCIPLES & MORAL RULES

Pharmacist have an ethical obligation to care for their patients. Moral rules and ethical principles are used by pharmacist on daily basis as they face ethical situations.

9/29/2013

copyright (your organization) 2003

11

PRINCIPLES IN MEDICAL ETHICS

1. 2. 3. 4. 5. 6. 7. Automomy Informed Consent Confidentiality Beneficence/ Non-Maleficence Fidelity Veracity Distributive Justice

9/29/2013

copyright (your organization) 2003

12

1. AUTONOMY
right to information and self determination free and informed consent free will and accord - intentional participation in treatment respect and dignity maintained

9/29/2013

copyright (your organization) 2003

13

2. INFORMED CONSENT
Individual participation in clinical research & surgery Right to make autonomous decision

Directs that patients must be fully informed about

benefits and risks in clinical trials

Dispensing a medication: risk and benefits of the

drug.
9/29/2013 copyright (your organization) 2003 14

EXAMPLE: A physician may not desire that a patient be informed of the side effects from chemotherapy because of traditional paternalistic attitude that this information may harm the patient by his or her refusal to take a drug with certain side effects.

9/29/2013

15

ELEMENTS OF INFORMED CONSENT

1. Disclosure 2. Understanding 3. Voluntariness 4. Competence 5. Consent

9/29/2013

copyright (your organization) 2003

16

3. CONFIDENTIALITY
Based on loyalty and trust

Maintain the confidentiality of all personal,

medical and treatment information

Information to be revealed with consent and for

the benefit of the patient Except when ethically and legally required Disclosure should not be beyond what is required
9/29/2013 copyright (your organization) 2003 17

EXAMPLE:

This occurs when a pharmacist is asked to identify drugs found in the possession of children or to reveal that a daughter is on birth control pills.

9/29/2013

copyright (your organization) 2003

18

4. BENEFICENCE/ NON-MALEFICENCE
do only that which benefits the patient patients welfare as the first consideration care consideration competence

Taking due care avoiding harm Prevention of harm & removal of harmful conditions calculated risk or risk benefit

9/29/2013

copyright (your organization) 2003

19

EXAMPLE: Pharmacists may be asked to dispense drugs used as abortifacients such as diethylstilbestrol, the "morning after pill." Can a pharmacist conscientiously object to dispense these medications

9/29/2013

copyright (your organization) 2003

20

5. FIDELITY
Pharmacist act in such a way as to demonstrate loyalty to their patients. To do what is in best interest of the patients.

9/29/2013

copyright (your organization) 2003

21

6. VERACITY
Truth telling Obligation to full and honest disclosure To be honest in their dealings with patients EXAMPLE: This occurs when pharmacists are called to provide drug information to be used for

questionable purposes.
9/29/2013 copyright (your organization) 2003 22

7. DISTRIBUTIVE JUSTICE
Actions are consistent, accountable and transparent not to discriminate on age, sex, religion, race, position or rank Provide equal quality of care to affording and non-affording patients Provide equivalent amount of care equity and distribution of burden & benefits

9/29/2013

copyright (your organization) 2003

23

EXAMPLE: Pharmacists are being asked to ration the use of certain high cost drugs in an era of cost containment and limited resources. The question is how do we morally justify the use of new expensive drugs.

9/29/2013

copyright (your organization) 2003

24

ETHICAL-DECISION MAKING
Ethical-decision making situation in pharmacy can be divided into two broad categories. 1. MACRO SITUATION Issues that are not specific to a given pharmacist, but rather addressed by all pharmacist & society. Abortion Assisted suicide In-Vitro Fertilization Organ transplantation

9/29/2013

25

2. MICRO SITUATIONS Those issues that may conflict individual pharmacist in the course of their daily practice. Use of placebos Patients confidentiality Informed consent

9/29/2013

copyright (your organization) 2003

26

ETHICAL PROBLEMS RELATING TO DISPENSING MEDICINES

9/29/2013

copyright (your organization) 2003

27

 Dilemmas and Questions Facing Healthcare Professionals: Deciding what action to take when faced with an ethical dilemma in the pharmacy requires consideration of the circumstances, choosing an action, and justifying the action. This is done by asking questions like What is the dilemma? What pharmaceutical alternatives apply? and What is the best alternative, and can it be justified on moral grounds?

9/29/2013

28

1. CONTROLLED DRUGS
The most commonly cited ethical concern for pharmacists involved situations in which a decision had to be made by the pharmacist as to whether to supply a controlled drug where, for a variety of reasons, doing so would not be legal. Controlled drugs are those medicines that possess an abuse potential and several categories are defined in legislation ranging from specialized drugs such as LSD, opioid analgesics and benzodiazepines.
9/29/2013 copyright (your organization) 2003 29

 A pharmacist may also feel that in dispensing an addictive narcotic, they are introducing the patient to substance abuse, detrimental to the patients mental and physical health. In this situation the pharmacist may feel they are violating the principle of non-maleficence.

9/29/2013

copyright (your organization) 2003

30

2. EMERGENCY SUPPLIES
Ethical problems arose for several pharmacists with respect to emergency supplies of medicines to patients.

These involved circumstances where a prescription was not available and a patient was without their regular medicines and had asked the pharmacist to provide that medicine.

9/29/2013

copyright (your organization) 2003

31

3. CHALLENGEING PRESCRIBING
Ethical concerns in relation to whether to challenge a prescriber with respect to a clinical problem in their prescribing.

Often the pharmacist had identified a problem on a prescription presented to them that they believed would not be appropriate for the patient, either in terms of a dose or an interaction or alternative.

9/29/2013

copyright (your organization) 2003

32

4. EMERGENCY HORMONAL CONTRACEPTION

There is the ethical issue of whether a pharmacist should have the right to refuse to dispense ABORTIFACIENTS based on the principle of conscientious objection, due to moral or religious beliefs. Abortifacients are substances that induce abortion. EXAMPLE: High doses of estrogen cause a rapid shedding of the endometrium in the uterus, which significantly decreases the chance of the fertilized egg attaching to the uterine wall.
9/29/2013 33

5. ASSISTED SUICIDE
Pharmacists may object to filling prescriptions is in physician-assisted suicide. Physician-assisted suicide occurs when a physician facilitates a patient's death by providing the necessary means and/or information to enable the patient to perform the life-ending act. The issue is that, whether a pharmacist should be able to refuse to dispense or endorse the medications used in these practices is an ethical issue.
9/29/2013 copyright (your organization) 2003 34

6. RE-DISPENSING
Requests from patients or other health care professionals for the pharmacist to make-up a redispensing or re-fill medication there was no prescription available and the request was for the pharmacist to re-fill existing medication for the patient. Its being ethically problematic for pharmacist since it was not good practice to use medicines that could not be verified in terms of either the original prescribing instructions or details of the medicine itself.
9/29/2013 copyright (your organization) 2003 35

7. DRUG FORMULARY
Pharmacists as a member of a Pharmacy and Therapeutics Committee is involved in making decisions on what drugs to include on a formulary and to set guidelines on what drugs are used in a hospital setting. Pharmacists have an active role in this clinical decision-making process.

9/29/2013

copyright (your organization) 2003

36

 A potential conflict of interest could arise when a decision on a status of a drug must be made when there is personal interest.

9/29/2013

copyright (your organization) 2003

37