Bending the Rules to Improve Patient Care

A new study examines how pharmacists are coping with the daily ethical dilemmas of pharmacy practice.

Every pharmacist has encountered them—the pleading patient who, fresh out of refills, cannot possibly make it through the weekend; the 15-year-old asking for Plan B; or the potential addict with a legitimate prescription for opioids.

These patients present a constant ethical challenge for pharmacists, who must decide which is more important—adhering to regulations or acting in the patient’s best interest. In cases where those priorities are clearly defined and mutually exclusive, pharmacists are often willing to bend the rules, a recent study confirms.

Lead author Zuzana Deans, PhD, teaching and research associate at the Centre for Ethics in Medicine at the University of Bristol, conducted the analysis using data gathered from focus groups and surveys of pharmacists from community and hospital settings in the United Kingdom. She found that a majority ranked patient’s health interests as “the most important factor to consider in ethical decision making.” Regulations ranked second, with reputation and risk of termination also playing important roles.

“The research indicated that pharmacists tend to be dutiful in regard to institutional rules, but are sometimes willing to break them when the interests of the patient are considered to outweigh the possible negative consequences of breaking the law,” Dr. Deans said.

Although the study was conducted in the UK, the examples of ethical dilemmas faced by pharmacists in the focus groups span cultures. Likewise, many of the principles participants used to justify their choices are outlined in the Pharmacist Code of Ethics—a creed officially adopted in 1994 by the American Pharmacists Association.

Pharmacy law professor Joy Wingfield, of the University of Nottingham, interpreted the research as “heartening” evidence that “common sense ethical values embedded in pharmacy practice” continue to permeate daily problem-solving by pharmacists. In order to strengthen this ethical framework, however, more formal training may be necessary.

“To meet the moral challenges of future health care, pharmacists will need an even more firm grasp of ethical principles, rational decision making, and ethical literacy to keep pace,” she said.

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For other articles in this issue, see:

• Record Drug Shortages Prompt Emergency Action
• Medicare Clarifies DME Exemption as Deadline Looms