Lecture 4: Legal and ethical

aspect of drug information

practice
Naschmil Abdulla
MSc Clinical Pharmacy Practice
naschmil.abdulla@komar.edu.iq
Learning outcome
• Understand legal aspect of drug informatics
• Consider professionalism and professional judgement in terms of
drug informatics
• Utilize skills to exercise professional judgement when solving ethical
dilemma
• Discuss ethical dilemma using principles of solving medical ethical
dilemma
Legal aspect
An understanding of the legal aspects of drug information (DI) helps practitioners in day-to-day
practice, as well as provide some possible ways to protect himself or herself in the legal system.

Legal issues cross over a number of traditional legal specialties, including:

• computer law: countries have created legislation about the use of computers and data;
concerning protecting people’s data; hacking computer systems, protecting copyright
• advertising law: advertising is the act/practice of attracting public notice and attention
Legal aspect
• privacy law: deals with the regulation, storing, and using of personally identifiable information,
personal healthcare information
• intellectual property law: refer to specific, private information that is important to a business
because it gives the business a competitive advantage
• telecommunications law: telephone network, the radio broadcasting system, computer networks
and the Internet
• tort law: is a civil wrong that causes a claimant to suffer loss or harm, include intentional
infliction of emotional distress, negligence, financial losses, injuries, invasion of privacy
Professionalism and professional judgement
Pharmacy is a profession and pharmacists are professionals exercising
professionalism and professional judgement on a day-to-day basis.
A profession can be described as:
• An occupation that is recognized by the public as a profession
• An occupation that has a recognized representative professional body
• An occupation that benefit from professional standards and codes of conduct
• An occupation that is regulated to ensure the maintenance of standards and
codes of conducts
Professionalism and professional judgement
A professional can be described as:
• A member of a profession
• A member of a professional body
• An individual who:
Behaves and acts professionally
Exercises professionalism and professional judgement
Has professional values, attitudes and behaviors
Professionalism and professional judgement
Pharmacy professionalism can be defined as a set of values, behaviors and
relationships that underpin the trust the public has in pharmacists
Examples of these are:
• Altruism
• Appropriate accountability
• Compassion
• Duty
• Excellence and continuous development
• Honour and integrity
• Professional judgment
Professionalism and professional judgement
Examples of these are:
• Respect for patient, colleagues and other healthcare professionals
• Working in partnership with patients, doctors, and wider healthcare team
• Work within competency
• Place patients at the center of all decision making
• Being honest about scope of practice
• Knowing when to seek support
Professionalism and professional judgement
Professional judgement:
• Can be described as the use of accumulated knowledge and experience, critical
reasoning, to make an informed professional decision
• Useful to solve a problem presented by, or in relation to , a patient or policies
and procedures affecting patients
• Takes into account, law, ethical consideration, relevant standards and factors
affecting surrounding circumstances
Exercising professional judgment

1. Identify the ethical dilemma or professional issue

2. Gather relevant information
3. Identify the possible options
4. Weigh up the benefits and risks of each options
5. Choose an option
6. Record
Principles of medical ethical dilemma
• Nonmaleficence: encompasses the duty to do no harm
• Beneficence: expresses the duty to promote good
• Respecting the patient-professional relationship: A moral rule, often referring to respect for the
physician-patient relationship, but also applicable to other professional-patient relationships
• Respect for autonomy—A principle is founded on a belief in the right of the individual to self-rule
Principles of medical ethical dilemma
• Consent: A moral rule related to the principle of autonomy which states that the client/patient
has a right to be informed and to freely choose a course of action
• Confidentiality: A moral rule, also related to the principle of autonomy, which specifically
addresses the individual client’s/patient’s right to give or refuse consent relative to release of
privileged information
• Privacy: Another rule within the principle of autonomy, more generally relating to the right of the
individual to control his or her own affairs without interference from or knowledge of outside
parties
• Respect for persons: A principle expressing duty to the welfare of the individual
Principles of medical ethical dilemma
• Veracity: addresses the obligation to truth telling or honesty
• Fidelity: addresses the responsibility to be trustworthy and keep promises
• Justice: this concept has been presented within various principles that relate to
fairness and tendering what is due; providing that to which the individual is
entitled
Major medical ethical challenges
• Patient right and confidentiality
• Patient safety
• Conflict of interests
• Ethics of privatization
• Informed consent
• Dealing with the opposite sex
Types of ethical dilemmas
1. Third party enquiries
These are enquiries from a member of the public about someone else. Examples
could include:

Case studies
A. I'd like you to identify these tablets I found in my 18-year-old son’s jacket.
B. My neighbor is taking tamoxifen. What’s that for?
Types of ethical dilemma
2. Enquiries involving illicit drugs
• It is desirable to answer enquiries about street drugs if the enquirer is clearly
seeking help to avoid self-harm (e.g. interactions between street drugs and
medication)
• Do not answer enquiries which might help clients extend their range of abuse
behavior or assist them to break the law or deceive a healthcare professional
• Know how to refer to local and national substance misuse services when
appropriate
Types of ethical dilemma

3. Enquiries involving the police

• Apart from enquiries from the public, other ethical dilemmas can involve
enquiries from the police
• Only supply information that it is legitimate for the police to ask for in the course
of solving a crime and it is reasonable to ask for this to be confirmed in writing
• Enquiries from legal representatives or the media can also sometimes be
problematic: follow your employer’s policy in dealing with these
Types of ethical dilemma
4. Enquiries involving telemedicine and cybermedicine
• Telemedicine uses telecommunications and interactive video technology to
provide health care services to patients who are at a distance
• Cybermedicine includes the marketing, relationship creation, advice, prescribing,
and selling pharmaceuticals and devices in cyberspace
Advantage of digital clinical communication:
 increases patient empowerment and autonomy
patient decides over timing and style of the communication
reduce the power differential between patient and clinician
Types of ethical dilemma
Disadvantage of digital clinical communication
• Impersonal communication
• reducing trust between patient and healthcare professional
• Inherent lack of non-verbal communication can lead to misunderstanding
• May be used inappropriately for urgent issues requiring immediate clinical
attention, resulting serious harm
Case studies
1.A pharmacist providing clinical advice to patients over the internet
and phone. She receives text messages and gets involved in
conversations that are a bit more friendly and receives kisses at the
end of the text messages and emails.

2.A patient decided to put text messages that she had been sent by a
male pharmacist on social media about a health related issue.

3.A pharmacist receives email from a patient in the middle of the night
say [the patient] was going to kill herself.
Case study

A very young man in his start twenties comes to the counter and asks
to speak to you. The man reveals to have had unprotected sexual
relations and is now concerned about his wife becoming pregnant. His
wife told him that there is an agent available that he can buy it from
pharmacies to prevent pregnancy.
Case study
A patient is in the last stages of breast cancer and is in terrible pain. She
asked the doctor to increase her dose of pain-killer medicine. The
patient is already taking the maximum safe dose recommended for this
medication, and the doctor is hesitant to increase the dose any further
since it would likely hasten her death. The patient understands the risk,
but prefer to be comfortable for the short remaining of her life. The
doctor asks for your advice.
Any questions