Tip of the Week: Making Ethical Decisions

Ethical dilemmas have always been prevalent in practice. One could argue that the number and complexity of these dilemmas continue to increase as society evolves, opinions become more polarized, professional organizations take political stances, and technology brings about possibilities not thought possible years ago, such as cloning, genetically modified consumables, tests that might discover abnormalities in fetuses prior to birth, and so on.

An issue that pharmacists might increasingly encounter deals with medical assistance in dying (MAiD), where patients seek medical assistance to end their lives. In this case, the medical ethics tenets of nonmaleficence versus patient autonomy seemingly clash.

In an review published in the Journal of Pain and Symptom Management, the authors examined health care providers’ perspectives of their involvement with MAiD, specifically to address the roles of diverse health care professionals and the challenges that arise when confronted with MAiD requests. The authors evaluated 33 articles in their review, which included perspectives of pharmacists, nurses, physicians, mental health providers, social workers, and medical examiners.

Professional roles documented in the review included consulting/supporting patients and/or other staff members with requests, assessing eligibility, administering/dispensing lethal drugs, providing aftercare to bereaved relatives, and regulatory oversight. Challenges included lack of clear guidelines/protocols, role ambiguity, evaluating capacity/consent, conscientious objection, and lack of interprofessional collaboration.

Evidence from various jurisdictions highlighted a need for clear guidelines and protocols that define each profession's role, scope of practice, and legal boundaries for MAiD. The authors found that comprehensive models of care that incorporate multidisciplinary teams alongside improved clinician education may be effective to support MAiD implementation.

The authors’ review did not provide an ‘answer’ to the question of authority, responsibility, obligations or proper judgment, and it was not meant to. Pharmacy managers should advocate for clear company/employer policy for guidance on pharmacist rights and responsibilities for MAiD, conscientious objection, and other dilemmas. Role ambiguity must be minimized.

Pharmacy managers have to balance regulations with employee preferences, even though the latter might be entirely obviated by law and by company policy. Ethical judgment comes into play even more routinely during everyday practice, for example, when patients seek refills for important medications on weekends or after-hours when the prescriber might be unavailable.

Ethical decision making is another learned set of behaviors pharmacists must seek to acquire.

Additional information about medication therapy management and management functions can be found in Pharmacy Management: Essentials for All Practice Settings, 5e. You or your institution can subscribe to AccessPharmacy to access the textbook.

Shane P. Desselle, RPh, PhD, FAPhA, is Professor of Social/Behavioral Pharmacy at Touro University California. He is author of Chapter 1: The “Management” in Medication Therapy Management and Management Functions in the textbook Pharmacy Management: Essentials for All Practice Settings, 5e.

REFERENCE

Fujioka JK, Mirza RM, McDonald PL, Klinger CA. Implementation of medical assistance in dying: A scoping review of health care providers’ perspectives. J Pain Symptom Manage. 2018;55:1564-1576.