Professional Documents
Culture Documents
(Phar 4173)
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7. The Health Professional–Patient Relationship
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7.1. Consumerism Versus Paternalism
In the Past
• When patients were instructed by their health care professionals they did so
without question.
– physician or pharmacist to have an operation, go for a laboratory test, or take a
medication
• Medical paternalism: the belief that the health care professional knew best
– Was accepted as standard practice by most health care professionals and their
patients.
• The medical rights of patients were not as widely recognized as other rights
(such as suffrage or due process).
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7.1. Consumerism Versus Paternalism
Nowadays
• Patients have become true consumers of medical care.
• Patients wish—and have a right—to be informed and to be asked for their
consent.
• To do otherwise would be
– Patients both unprofessional and unethical
– not to mention the potential legal ramifications.
• expect a certain level of service, as with sellers of other goods and services
• Health professionals who fail to meet the demands of health care consumers
– may lose customers or
– experience legal problems.
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7.2. Patients’ Rights
• When patients seek the care of health care providers,
– what rights do they have?
– What can they reasonably expect from health care providers?
• Patients can expect that clinicians will employ their knowledge and experience
in caring for them.
• As autonomous individuals, patients can expect that health care providers will
respond to their wishes about their treatment.
• At first glance, health care system seems fundamentally based upon ensuring
the rights of patients.
• Patients generally choose their own physician, pharmacy, and hospital.
• Patients are allowed to choose from multiple options for treatment when they
exist (such as surgery versus drug therapy).
• Patients must give their approval, through the process of informed consent,
prior to the initiation of care.
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7.2. Patients’ Rights
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7.3. Moral Rights Versus Legal Rights to Health Care
• More recently, society have grappled with the question of health care as a
moral right.
– For example, Citizens with lowest economic status
• As one might expect, moral rights and legal rights may be in conflict.
– There is disagreement over whether issues like abortion involve moral rights or legal rights.
• The question of the right to die has been played out in the media.
– Dr. Jack Kevorkian and his so-called suicide machine have forced this society to deal with a
moral question in legal terms.
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7.4. Legal Responsibility Versus Moral Obligation
• Moral obligation of health care professionals to there patients referred from
Hippocratic oath Medicine
• Hippocratic oath states that
– “medical professionals have an obligation to do whatever is necessary to relieve the pain
and suffering of their patients”.
• All pharmacists practice under the practical constraints of law that may limit
their doing whatever is necessary.
• Consequently, although they have a moral obligation to care for their patients,
this obligation is constrained by law.
• Thus, patient rights and practitioner responsibility may sometimes be in
conflict, not on ethical grounds but on legal ones.
• Directing a pharmacist to assume an individualistic approach and take an
illegal, yet ethical, action for a patient despite legal consequences is asking the
pharmacist to subjugate his or her own interests to that of the patient.
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7.4. Health care practitioners’ duty to their patients
• What is the responsibility of medical practitioners?
• Some might argue that health care providers have a Hippocratic responsibility to their patients,
– and that this responsibility focuses solely on what is best for the patient, irrespective of the consequences to others.
• This view is supported by the Code of Ethics of the Pharmaceutical Association, which
states in part that
“A pharmacist promotes the good of every patient in a caring, compassionate, and confidential manner”
• Therefore, how far does a pharmacist’s or another health care professional’s duty to
his or her patients go?
• Is it the health care professional’s moral obligation to care for patients without
exception?
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7.6. Ethical Responsibility
• In traditional pharmacy practice,
– both the legal and ethical obligations of pharmacists centered around
• ensuring that the proper medication as ordered by the prescriber was delivered to the patient.
– Physicians, not pharmacists, were the health care professionals who held ultimate
responsibility
• for monitoring the progress of a patient and ensuring that the desired outcome was achieved.
• The concept of "pharmaceutical care," however,
– directs that this responsibility is to be a shared obligation between the prescriber and the pharmacist.
• The mission of pharmacy practice is to render pharmaceutical care.
• Pharmaceutical care focuses
– pharmacists' attitudes, behaviors, commitments, concerns, ethics, functions, knowledge,
responsibilities, and skills on the provision of drug therapy with the goal of achieving
definite outcomes toward the improvement of the quality of life of the patient.
• Pharmaceutical care forces pharmacy practitioners to change their focus,
broaden their professional responsibility.
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