Ethical Dilemmas for Health-System Pharmacists Projected to Intensify

Health-system pharmacists will inevitably face growing ethical challenges as their roles in patient care continue to evolve.

The Pharmacy Forecast 2016-2020 published by the American Society of Health-System Pharmacists (ASHP) Foundation surveyed qualified pharmacists to analyze pharmacy trends and provide strategies for health-system pharmacies to grow and keep pace with the evolving scope of their practice.

Although the majority of the domains have been components of this report for years—including health care delivery changes, enhanced health-related data, patient empowerment, and shifting pharmaceutical marketplace dynamics—ethics is newly recognized as a factor in the changing landscape of health-system pharmacy.

The particular ethical dilemmas embedded in health-system pharmacists’ everyday practice include competing interests, limited resources due to drug shortages, and an evolving health care delivery system that has shifted their role 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.

James Hoffman, PharmD, MS, FASHP, an advisory board member for the Pharmacy Forecast 2016-2020, told Pharmacy Times that pharmacists will play a key role in managing ethical dilemmas going forward, so including a pharmacist’s voice on ethics committees is imperative.

“The pharmacist expertise is really unique within a health system and within these ethical dilemmas, and as more and more dilemmas come up that involve medications…a pharmacist can be a big part of those efforts,” he explained.

One of the hot-button ethics issues in pharmacy currently is the trend of skyrocketing prescription costs and the lack of transparency in drug pricing decisions. Extremely high prices and lagging reimbursement may preclude health-systems from providing necessary medications to all patients who would otherwise benefit.

“Patient welfare is at risk when the ethical perspective in health care is smothered by business and financial perspectives,” William Zellmer, BS, PharmD, MPH, president of the American Institute of the History of Pharmacy, wrote in the Pharmacy Forecast. “Patient well-being often hinges on the ability of health professionals to heed the ethical precepts of their calling.”

In light of its ethical forecast, the ASHP Foundation has offered the following strategic recommendations for health-system pharmacy practice leaders:

1. Designate a small team of pharmacists to take the lead in studying emerging ethical issues and represent the pharmacist perspective in system-wide deliberations and policy development on ethical issues.

2. Advocate for development of a proactively ethically sound health-system policy for rationing essential medicines that are in short supply.

3. Foster discussion of any pricing of medicines that is out of line with patient benefits.

4. Discuss with all health care professionals the potential compromises of ethical principles and professional autonomy in the workplace.

5. Encourage pharmacy organizations to give more attention to issues related to ethics and professional autonomy.

Proper management of ethical considerations is of paramount importance to pharmacists in particular. Pharmacists are currently vying to gain support for an expanded role in patient care in the form of provider status, which will likely be more easily garnered if they are perceived as being on the side of patient care rather than the side of business interests.