Medical Ethics

Lec. 1

Code of Ethics for Pharmacists

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.
Principle 1 - Make Patients Your First Concern

The care, well-being and safety of patients are at the heart of

professional practice.
Patients must always be your first concern. Even if you do not have
direct contact with patients your decisions or behavior can still affect
patients care and safety
Pharmacists must:
1. Ensure the product and services provided are safe and of
acceptable quality.
2. Take appropriate action to protect the interest and well-being of
patients.
3. Gather the information required to assess a patient’s needs to
provide the appropriate treatment and care.
4. Inform and educate patients or their caregivers about health and
how to use and store their medicines in a correct manner.
Principle 2 - Use Professional Judgement in the
Interests of Patients and the Public
A pharmacist is expected to use his professional judgement to deliver safe and
effective care. Professional judgement may include balancing the needs of patients
and public and at the same time, managing legal and professional responsibilities in
order to decide the best option for the patient.
Pharmacists must:
1. Ensure that professional judgement is not influenced by personal or
organizational interests, financial interests, incentives, targets or similar measures.
2. Consult and take advice from colleagues and other healthcare professionals
when necessary.
3. In an emergency, consider all available options and weigh the benefits and risks
to the provision of best care of patients and the public.
4. Make best use of the resources available for you.
Principle 3 - Show Respect for Others

This includes patients, their careers, pharmacy colleagues and other healthcare providers
you come into contact with.
Pharmacists must:
1. Treat people politely.
2. develop and maintain effective, professional relationships with colleagues and other
healthcare providers.
3. Recognize and respect the cultural differences, beliefs and values of others and ensure
those individuals receive services appropriate to their needs and which optimize the health
outcomes of all cultural, religious, social and ethnic groups.
4. Take appropriate steps to ensure people with disabilities receive services appropriate to
their needs and in a way that respects and acknowledges their cultural values and beliefs.
5. Respect and protect people’s dignity, privacy and confidentiality. Take all reasonable
actions to prevent accidental disclosure or unauthorized access to confidential information
Principle 4 - Encourage Patients and the Public to
Participate in Decisions about Their Care
Patients and the public are encouraged to be involved in decisions
about their treatment and care.
Pharmacists must:
1. Work together in partnership with patients and the public, their
caregivers and other healthcare providers to manage their
treatment and care.
2. Ensure that information is properly shared with other health and
social care providers involved in the care of the patient.
3. Provide information on the medicine including the risks and benefits,
to help patients improve their compliance.
4. Explain the options available to patients
Principle 5 - Develop Your Professional Knowledge
and Competence
Development of knowledge, skills and professional behavior must
continue throughout a pharmacist’s working life which involves keeping
knowledge and skills up to date.
Pharmacists must:
1. Apply knowledge and skills properly to their practice.
2. Keep their knowledge and skills up to date and relevant to maintain
and improve the quality of practice.
Principle 6 - Be Ethical, Honest and Trustworthy

Pharmacists must:
1. Act with honesty, integrity and do not compromise or abuse their
position to secure and maintain public trust and confidence in their
profession.
2. Ensure accurate information for publication, teaching or providing
services.
3. Not discredit other healthcare professionals during their professional
service.
4. Uphold the sanctity of human life in any pharmaceutical research
carried out on human beings.
Principle 7 - Be Responsible of Your Working
Practices
Pharmacists must:
1. Practice only if they are fit to do so.
2. Actively participate and contribute to the development, education
and training of colleagues and students, and share their skills,
knowledge and expertise.
3. Obey the laws, regulations, standards and policies of the profession.
4. Demonstrate leadership, teamwork and compassion in workplace.
 Pharmacy Ethics
Lec. 2

Common Ethical Considerations in Pharmaceutical Care Practice

Pharmacist has a professional commitment to the care of their
patients. There are a number of ethical principles that are
applicable to healthcare professionals.
Beneficence – The duty to do good
Nonmaleficence – Preventing harm
Autonomy – Right of determination
Beneficence
The principle of beneficence can be described as “doing good” or
working in the best interest of the patient.
Helping patients in achieving the best outcome from their medications,
promoting health and wellness in community .

Case
Smith, a RPh, had a very hectic day due to absence of pharmacy
technician and is just about to close the pharmacy. At the same time,
Marry brings a narcotic prescription for her son who had an accident
and he is in extreme pain. She didn’t take any medicine for her son
from this pharmacy before. Smith is alone today and this prescription
order may take another 15-20 minutes.
Analysis
Smith has a number of choices available to him. He can simply tell
Marry that order won’t be ready until next day morning or he can work
to resolve the issue in a timely manner. Working for the best outcome
of the patient would suggest that Smith should not close pharmacy and
dispense medicines in order to help Marry’s son who is in extreme
pain. By this action, Smith is keeping the best interest of the patient.
Nonmaleficence
The principle of Nonmaleficence is that of preventing harm,
Nonmaleficence overlap beneficence but here it prevents harm.
Checking for drug interaction, checking for overdoses, checking for
harmful side effects are the examples of activities that prevent harm to
patients.
Medication safety is one of the cornerstone activities of this principle.
Case
Dr. Robert has called the pharmacy to say that the wrong medicine was dispensed
to one of his patients. A prescription for a Amiloride 5mg, with the direction to
“take three (15mg) tablets per day” was dispensed with Amlodipine 5mg tablet.
The patient took the wrong medication for 1 day before the error was detected.
Aside from dizziness and headache, the patient suffered no other ill effects. The
RPh pulled the original prescription from files and confirmed that Amlodipine was
dispensed instead of Amiloride.

Analysis
The RPh in this case has already taken the first step in preventing further harm by
admitting that he dispensed the incorrect medication. Disclosing the error to the
patient, following up with the doctor would be reasonable first steps to managing
this incident. Upholding the principle of Nonmaleficence would guide the
pharmacist to investigate what went wrong and determine if procedures could be
put in place that would prevent this and other similar errors from happening in the
future. Documentation of their findings is essential and sharing this information
with other members of the healthcare team will help to develop an atmosphere of
patient safety.
Autonomy
Autonomy is described as the ability to make decision for ourselves: self-determination. A
patient can decide to take a medication (or not), to have surgery (or not), or to try
alternative treatments.
Autonomous decision must be made voluntarily as patient should not be forced into a
decision that they are not comfortable with.
Infants and comatose, are examples. Many people possess some limited capacity to make
their own choices. Small children, the mentally retarded, the mentally ill, and the senile all
may be able to make limited choices based on their own beliefs and values.
Respecting autonomy of a patient is sometimes difficult, especially when the health
professional does not agree with the patient’s decision. For example, a patient may decide
not to take medication because of fear of side effects and if the patient has been given all
the information to make this decision then the health professional must respect that.
The key is that the patient must be given all the necessary information in order to make an
autonomous choice. The best way to achieve this is through patient counselling. The
pharmacist can play a key role in facilitating the dialogue with a patient so that the patient
receives all the necessary information to make that choice. When counselling is completed
effectively, the patient usually sees the benefits of a medication and is much more likely to
make well-informed decision about their health care.
Case
Mrs. Green has been a loyal patient at her local community pharmacy for the
past ten years. Today she presents a prescription for Metronidazole
prescribed by Dr.Mark, her family practitioner, to George, a Registered
Pharmacist. As Gerogre begins to gather the relevant information Mrs. Green
says, “My doctor was really rushed today so he didn’t have time to tell me
what this prescription for.”

Analysis
Mrs. Green has not been given enough information to make an informed,
autonomous choice about her health care. George must recognize this
deficiency and provide the effective counselling. In this way, Mrs. Green will
be able to participate in the choice surrounding her health care and George
will be respecting the patient’s autonomy to participate in these decisions.
Pharmacy Ethics 3th Stage

Common Ethical Considerations in

Pharmaceutical Care Practice
Continue ….

• Fidelity – Best interest of patient

• Veracity – Honesty without deception
• Confidentiality - the state of keeping or being kept secret or private
• Justice – Equality with everyone

Fidelity

• Fidelity refers to the concept of keeping promise or a commitment. The

principle of fidelity requires that healthcare provider (i.e., doctor,
pharmacist, nurse) be faithful to their patients and provide services that
are in the patient’s best interest. In other words: Fidelity is the right of a
patient to have health professional provide services that promote patient
interest rather than their own.

• Example of infidelity are: recommending vitamins that patients don’t

need, failing to confront a doctor with an inappropriate prescription due
to fear that the doctor will direct his/her patients elsewhere.

Veracity
• This principle expresses the concept that pharmacist have a duty to act
with honesty without deception: telling the truth and being honest.
• When working with patient, pharmacist have an obligation to be open
and truthful about the information they providing. In so doing, pharmacist
can build the trust with patients and patients will come to rely on their
pharmacist as a valuable healthcare resource.
• Under this principle, the pharmacist’s primary obligation include
respecting the position of trust inherent in the physician-patient, nurse-
Pharmacy Ethics 3th Stage

patient, and other healthcare provider-patient relationships,

communicating truthfully and without deception, and maintaining
intellectual integrity.
• Honesty can sometimes prove to be difficult. How much information
has to be disclosed. Does the patient need to know everything? This is
where professional judgement plays a role and consultation and
collaboration with the pharmacist will be essential

Case
Patricia is an elderly, frail patient who is staying in long term care facility
and who relies on nurse for assistance with her medication. Patricia’s
nurse has presented a prescription to the pharmacist to be filled and she
asks that print-out for the medication not be shown to Patricia as the side
effects often frighten her to the point where she refuses to take her
medication.

Analysis
The pharmacists have an obligation to the patient to be truthful and
honest about the medication that has been prescribed. Health
professionals have a duty to make sure that patients are adequately
informed so they can make autonomous choices about treatment options.
But how much information is enough? The pharmacist is in a better
position to determine how to present the information during counselling
in such a way so as not to alarm the patient. For example, the pharmacist
may indeed forgo giving the patient information sheet and discuss the
information verbally with Patricia. In this way, the pharmacist can be
truthful and honest and yet still address issues that the patient may need
to know in the event of a side effect. At the same time, the principle of
autonomy will be respected as the patient will be given appropriate
information about her medication.

Confidentiality

• Confidentiality in healthcare is essential for healthcare providers to

achieve effective treatment and provide the best possible outcomes for a
patient. Patient may not be willing to disclose sensitive personal
information if they feel that their information is not protected.
Pharmacy Ethics 3th Stage

• Essentially, patients demand and expect that their personal health

information will be respected and only used for treatment purposes. Any
use or disclosure outside the workplace would be considered a violation
of this principle.

Case
Over the past year, Andrew Turner, owner of pharmacy, has enjoyed the
friendship of Pamela Hicks, a medical service representative for a large
pharmaceutical firm. Andrew and Pamela are frequent golfing partners
and served together on committees of their local pharmaceutical
association. Today, Pamela drops in for a cup of coffee and mentioned
that she has been trying to introduce a new prescription specialty to area
physician without much success. Although her company provides her
with sales figure on the new drug, she would like to identify prescribing
patterns of the physicians in her area, and thus be able to target her
marketing efforts. “Can i flip through your new scripts, Andrew?” Pamela
asks casually.

Analysis
Andrew is in an awkward position of having access to personal health
information and feeling a pressure from a friend to disclose this
information. Andrew must quickly recognize that disclosure of this
information would violet the principle of confidentiality.
Andrew has an obligation to let Pamela know that all the prescription
which contains personal health information of all his clients cannot be
shown unless all clients agree to it. Andrew must refuse to show all
scripts to Pamela and preserve the confidentiality of all scripts and related
health information.

Justice

• A general principle of justice requires that we act in ways that treat

people equitably and fairly. Actions that discriminate against individuals
Pharmacy Ethics 3th Stage

or a class of people arbitrarily or without a justifiable basis would violate

this basic principle.
• The principle of equality requires that all benefits and burdens be
distributed equally. The advantage to this conception of justice is that
everyone is entitled to an equal share of resources; however the principle
becomes problematic when not everyone is perceived as equally
deserving of an equal share.

Good Luck and Success for All