New Ethical Dilemmas with Evolving Pharmacists' Role

Health-system pharmacists are facing inevitable challenges to ethics and autonomy embedded in their evolving everyday practice.

In a session at the American Society of Health-System Pharmacists (ASHP) 2015 Summer Meetings and Exposition in Denver, Herdley Paolini, PhD, a licensed psychologist and founder of The Institute for Physician Integration, facilitated a discussion on how pharmacists can “stand in the gap” between real-world expectations and the ideals of the profession.

The objective of the session was to help health-system pharmacists in attendance recognize the ethical challenges they face in practice and identify self-development tools to best manage these dilemmas.

Engaging in a reflective process is the key to addressing challenges in the workplace, as pharmacists are not always aware of the unconscious factors that motivate their actions and decisions, Dr. Paolini said.

“Ethics, leadership, and emotional well-being have one thing in common: self-awareness,” she explained. “Ethics is about uniting who we are with what we do.”

Certain ethical dilemmas embedded in health-system pharmacists’ everyday practice include competing interests, limited resources, and an evolving care delivery system in which their role has shifted from dispensing medications to actively participating in direct patient care. The latter has created room for not only new professional dynamics, but also competing ethical viewpoints.

Dr. Paolini described a 4-step process for effectively addressing and managing each of these challenges.

First, pharmacists must “own” their actions and decisions.

“We have to debunk the myth that institutions are external to us,” she said, noting pharmacists can take ownership and have a stake in institutional dynamics. “It should be ‘us’ rather than ‘them.’”

The second step is to apply “emotional intelligence” and recognize patterns in behavior that may be negatively affecting patients, caregivers, or other health care professionals.

“We have to examine our own shadows,” Dr. Paolini explained.

Step 3 is to “convene” with the care team. With health-system pharmacists becoming increasingly integrated care team members, it is essential for them to create communities of trust that encourage their colleagues to assert core professional values and actively listen to one another.

The final step is to strike a balance between blind optimism and crippling cynicism in order to set realistic professional objectives.

To do this, Dr. Paolini recommends that pharmacists ask themselves, “How do I stay close to the passions and commitments that took me into this work [while] challenging myself, my colleagues, and my institution to keep faith with the professions’ deepest values?”

Toward the end of the session, attendees were asked to share some ethical dilemmas they have faced and how they may have used some of these guidelines to manage the issues at the time.

One pharmacist participant described a situation in which a patient should have, in his opinion, received a test that would have better determined a treatment regimen for a cardiac condition. The pharmacist’s physician coworker disagreed, citing the potential for a high-cost, low-benefit outcome for the patient.

Another pharmacist responded that the best way to manage limited resources is to have nonemotional conversations with those who oversee the budget while emphasizing that the ultimate goal is to provide high-quality patient care.