Ethics and Pharmacy Advocacy

"We live in a time of unlimited needs and limitedresources." This observation is attributed to aleader of the University of North Carolina Hospital who isconcerned about the commitment to uncompensated careprovided by the hospital. This past year the retail pharmacystaff dispensed almost $8 million worth of prescriptiondrugs to the pharmaceuticallyindigent enrolled in theindigent access program.Over the past 3 years, thehospital has instituted a varietyof changes in this programin an effort to eliminatewaste and fraud and hasreduced unreimbursed drugexpense by at least 50%.Nevertheless, growing unemployment,the aging of thepopulation, increasing utilization,and increases in theprices of newer pharmaceuticalsensure that unreimbursedexpenses will continueto rise.

I have come to realize thatthis hospital's challenge representsa microcosm of thesocietal predicament thenation faces. As scientistsand providers discover newways to cure disease andimprove the quality of life ofthe infirm, patients will expect these new treatment modalities.The one reality everyone knows is that health carespending will rise.

We as pharmacists, as well as our health care colleagues,are inculcated from the beginning of our professional educationand training that our responsibility is to provide the bestcare available. Like the patients we serve, we individuallyprefer to ignore the cost implications of our decisions.Regrettably, health care costs will eventually threaten thevery existence of hospitals, insurers, and governmental agenciesthat are at risk for health care resource consumption.

It seems inevitable that health care will have to berationed at some level, unless members of the public arewilling to pay higher taxes for government health care coverage? and I personally doubt that they will. Therefore,"somebody" will have to decide where the line will bedrawn—a daunting notion. Obviously, individuals will notbe comfortable or willing tomake these decisions on apatient-by-patient basis.

We as pharmacists willneed to be patient advocatesand contribute expertise topharmacotherapy-related rationingdebates. Each one ofus has personal opinions onthe topic, but our involvementneeds to be evidenced-based.Perhaps even moreimportantly, those mostinvolved in these debatesneed to develop expertiseand experience with thetools and strategies related toethical decision making thatcan help in applying the evidence.I suspect that, as aprofession, we are not yetprepared to contribute tothese debates with consistencyand reliability, much lesstake a firm stand.

This issue is so complicated,personal, and gut-wrenching. Yet it seems as if a fantasticopportunity exists for educational institutions, professionalassociations, and pharmacists to collaborate andeventually speak with one voice. We need continuing educationprograms on ethical decision making. We need tocreate forums for debates within the profession. Most of all,we need to begin thinking about the issue and assumingresponsibility for joining the debate. This is one importantissue we cannot, and must not, let be decided by otherswithout our input.

Are we ready?