Ethics in practice and ethical dilemmas
Introduction
As pharmacists, we are faced and deal with ethical dilemmas every day. Much of the time, we do not recognize them as dilemmas – just a situation that needs to be dealt with.
This chapter will build on the ethical principles described in Chapter 7 and help you ponder on what you need to consider as the best course of action in a given situation.
Code of conduct, ethics and performance
The GPhC publishes ‘Standards of conduct, ethics and performance’ that pharmacy professionals must follow. The GPhC is clear in this document that pharmacy professionals are registered pharmacists and pharmacy technicians (see Ch. 5). The standards of conduct has seven principles.
As a pharmacy professional, you must:
What is an ethical dilemma?
As professionals, every time we make a decision or take an action, we face a potential ethical dilemma. Often the situation is not dramatic and we do not always think in the moment that we have faced a dilemma. It is likely that many situations involving a person(s) has an ethical element and if there is more than one way to deal with the issue, then it is in effect an ethical dilemma.
It is also important to remember that we are pharmacists all day every day. We will sometimes be faced with a decision when we are not working, which because we are pharmacists, will have an ethical element to it, which may not need to be considered by others.
Example of an ethical dilemma
You are attending a party and several people at the party are drunk. You become aware that one of them is planning to drive home. As a non-pharmacist you will choose whether or not you want to get involved in the situation or ignore it.
If the driver is then involved in an accident, unless you were in the car with them, there is unlikely to be any personal consequence of your inaction.
As a pharmacist however, if you chose to ignore the drunken driver you may be in breach of the second principle of the standards of conduct, as you are not protecting the interests of the public and have not done your best to reduce risks to the public – this could mean that you are referred to the GPhC’s FtP committee (see Ch. 5).
A legal issue or an ethical dilemma?
Scenario 1
You are working as a pharmacist and are presented with a prescription for a schedule 2 controlled drug; it is 4 pm on a Saturday afternoon. The prescription is not written correctly – there is no quantity on it. You have tried to get hold of the doctor as you have his mobile phone number but he is not answering. You are very clear that you cannot legally dispense this prescription. When you inform the woman who brought in the prescription, she tells you that it is for her mother who is terminally ill and does not have any of her painkillers left to take that night.
Scenario 2
It is Saturday morning, you are working in a small village pharmacy where the only other shops are the local grocers and the post-office. The village has been cut off by flooding and so your delivery has not arrived and won’t be arriving before Monday. You have a number of drug-user clients who collect daily and you were relying on the delivery to ensure you had enough sugar-free methadone mixture to make up their daily doses. All you have left in the CD cupboard is methadone mixture DTF. You know that in law, the different methadone mixtures are different products legally and so substitution is illegal.
Considerations
Both of these situations have started as legal issues. However, if you leave either scenario at this point and choose not to supply anything for either patient, you are probably not complying with the first principle of the standards of conduct – make patients your first concern.
The law is very straightforward in pharmacy issues – you can either take certain actions under certain circumstances or you cannot. However, as a pharmacist you are also bound by the standards of conduct and so situations that are legally clear become ethical dilemmas when your compliance with the law is in conflict with the standards of conduct.
This is not to say that compliance with the standards of conduct is an excuse for breaking the law; it may, however, be an explanation of why you have made a certain choice in a particular set of circumstances.
Ethical decision-making processes
In many situations, you will make a decision without consciously working through a framework. However, in a more complicated or difficult situation, you may need to follow a structure to help you make the best possible decision. As an individual professional, it is inevitable that your process will be unique to you and will develop and change with time and with increased experience.
Your process should include the following:
Define the problem
What do you believe the problem to be?
Does anybody else involved in the situation have an opinion about the problem?
If these two are different, what else do you need to know to truly identify the problem?
Who else is potentially involved in the situation?
Reflect on values, conflicts of interest and if this is an ethical dilemma
You need to identify the values involved in the situation so that you can check whether your own innate values may influence your thought process
Does anyone involved in the process, including yourself, have a conflict of interest with anyone else in the process or with any elements of the process and what is the conflict?
If values, ethics and beliefs are not involved in the situation it is unlikely to be an ethical dilemma.
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