Tip of the Week: Relying on Ethics to Lead the Way

Pharmacists face moral dilemmas every day in their practices. Role conflicts are inherent to the job, as we seek to simultaneously please supervisors, individual customers and patients, peers, other health professionals, regulators, and professional organizations.

Pharmacists must develop professional behavior and a common professional identity that goes beyond their personal values and self-interests. The professional values of pharmacists are critical to effective practice. Moral dilemmas arise when the wants or needs of 2 or more of the aforementioned parties are in contrast.

The authors of an analysis published in the International Journal of Pharmacy Practice examined the professional core values inherent to moral dilemmas faced by community pharmacists.¹ During an ethics training course, students and pharmacists wrote about a moral dilemma they had experienced in practice, and they described their own ethical stances and values explicit in adjudication of those dilemmas. Examples of dilemmas included a patient presenting too early for a refill of pain medication and another with a patient overusing a laxative, with the pharmacist refusing to sell her additional doses, and yet another with a patient presenting with a legitimate refill prescription in spite of the drug doing her harm and masking a more serious condition.

The investigators coded the responses into 4 broad categories as follows:

• Commitment to the patient’s well-being, but inclusive of the patient’s right to self-determination.
• Pharmaceutical expertise, emanating from basic pharmaceutical sciences, therapeutics, and health psychology.
• Reliability and care, thus developing trust and respecting the patient’s confidentiality.
• Social responsibility, where the pharmacist is responsible for the societal implications of their actions and for guaranteeing access to and continuity for pharmaceutical care.

Previous studies have shown pharmacists to be caring but not necessarily operating on the same level of cognitive moral development as other health professionals. The management of medication therapy says much about doing the right thing in myriad situations even while holding consistently to a set of principal, core values. Every decision has consequences, and many decisions have negative consequences that might be outweighed by the greater good.

Pharmacy managers cannot be a part of each decision made by every employee; however, effective managers have carefully weighed the various mandates, policies, and societal influences to create an environment for—and even encourage—self-development and ethical decision-making training among all pharmacy personnel.

Additional information about Ethical Decision-Making and The “Management” in Medication Therapy Management can be found in Pharmacy Management: Essentials for All Practice Settings, 5e.

Shane P. Desselle, RPh, PhD, FAPhA, Professor of Social/Behavioral Pharmacy at Touro University California.

REFERENCE

Kruijtbosch M, Gottgens-Jansen W, Floor-Schreudering A. Moral dilemmas reflect professional core values of pharmacists in community pharmacy. Int J Pharm Pract. 2019;27(2):140-148.