Bioethical Principles and Professional Responsibilities

The pharmacy profession is unique because it blends professional responsibilities with business aspects. Nowadays, there's a noticeable shift towards more patient-centered care, focusing on what's best for the patient and their autonomy, all within the realm of 'bioethics.'

Pharmacists face ethical dilemmas every day in any pharmacy setting. As their roles expand, they'll encounter dilemmas similar to those seen by other healthcare professionals, which can lead to more moral distress. To manage these new challenges, pharmacists rely not just on their own morals but also on the ethical rules and principles of their profession. Sometimes, a pharmacist's personal morals might clash with professional ethics, or multiple ethical principles might apply, creating a dilemma.

These real dilemmas are complex and involve both cognitive and emotional aspects. Moral or ethical values might conflict, and there's no clear right or wrong answer. So, pharmacists have to weigh and prioritize different moral or ethical options when making decisions. This moral reasoning is crucial, especially since it can involve life-and-death decisions, and it's a key part of the moral development of pharmacy students and professionals.

Learning to deal with these ethical dilemmas starts with understanding the ethical principles of the pharmacy profession. Pharmacy students need exposure to ethical dilemmas early in their training to develop their moral reasoning. Many pharmacy schools include ethics courses, often alongside pharmacy law courses. Students also encounter ethical dilemmas during their practice experiences. The aim is to make students aware of the ethical challenges pharmacists face and to develop skills for handling them.

Bioethical Principles

Ethics are a set of standards of behavior adopted by a group. For pharmacists, these are outlined in the American Pharmacists Association’s Code of Ethics. The Code is based on key bioethical principles: autonomy, beneficence, non-maleficence, justice, veracity, fidelity, and confidentiality. These principles guide pharmacists but don't provide clear answers for every situation. So, how does a pharmacist decide what to do when faced with an ethical dilemma?

The principle of autonomy means an individual's right to make their own choices. In healthcare, this often relates to a patient’s right to consent to or refuse treatment. Sometimes, a patient’s ability to consent is questioned due to a lack of competence, which healthcare providers must assess.

Autonomy also includes the pharmacist’s rights. They might choose to follow the law rather than "bend" it for a patient’s benefit. Or they might prioritize the patient’s rights over pharmacy regulations.

Beneficence encourages pharmacists to act in the patient's best interest. This means not just avoiding harm but also removing harm and promoting good. It involves positive acts like kindness and charity. In healthcare, it often requires balancing risks and benefits. Nonmaleficence, based on "first, do no harm," can sometimes overlap with beneficence, especially in end-of-life care where quality of life is a concern.

Justice relates to fairness and equality, particularly in distributing scarce resources. Healthcare providers must consider who gets treatment when resources are limited, often influenced by the ability to pay for care.

While autonomy, beneficence, nonmaleficence, and justice are primary bioethical principles, veracity, confidentiality, and fidelity are also key to the pharmacist-patient relationship. Veracity means telling the truth and not deceiving patients. This is crucial for informed consent and maintaining trust. The Health Insurance Portability and Accountability Act (HIPAA) has emphasized the importance of confidentiality. Fidelity, from the Latin for faithfulness, refers to the trust and promise-keeping between pharmacists and patients.

There are studies on how pharmacists and students handle ethical dilemmas, but none compare the two groups. Studies show pharmacists prioritize respect for medicines and the patient's best interest. For example, a study by Hibbert et al. found community pharmacists often deal with dilemmas involving autonomy, beneficence, and nonmaleficence. When choosing between ethical principles and legal requirements, they usually follow the Code of Ethics. This differs from Lowenthal's findings, which showed pharmacists prioritize patient care despite economic or legal conflicts.

Ethics in Pharmacy

Pharmacists are crucial members of the healthcare team, ensuring safe and effective use of medicines. However, community pharmacy sits between health and retail, as profits come from selling medications. This creates ethical challenges and a need for guidelines based on moral obligations and virtues.

Ethical Principles

The code of conduct for pharmacists varies by country and professional body but generally includes responsibilities to the consumer, community, profession, business, and healthcare team.

Responsibilities to the consumer include prioritizing their health and wellbeing, respecting their autonomy and rights, and helping them make informed decisions. This involves respecting their dignity, privacy, and individuality.

Responsibilities to the community include maintaining the profession's reputation and trust and recognizing their role in controlling and supplying pharmaceutical goods for optimal health outcomes.

Responsibilities to the profession include contributing to its development through training, teaching, mentoring, participating in initiatives, and maintaining professional competence through lifelong learning.

Responsibilities to business practices include conducting business ethically and professionally, with the consumer’s best interest in mind.

Responsibilities to other health professionals include cooperating and collaborating to achieve the best health outcomes for consumers.

Ethics in Pharmacy Practice

Pharmacists must always uphold their professional integrity and provide the best service to patients. This means staying updated on new knowledge and using the profession's trust to promote public health.

Ethical guidelines should underpin every action a pharmacist takes, making ethical decision-making second nature and ensuring consistent, optimal decisions.

CONCLUSION

Pharmacy ethics, concerning both the individual pharmacist and the pharmaceutical company, is evolving. Advances in pharmaceutical innovation and technology have shaped the industry and the need for strong ethics. Ethical principles should be embedded in pharmacists, forming a highly ethical pharmaceutical organization. Pharmacy ethics must adapt to a changing environment.

REFERENCES:

1. Book: Professional ethics in pharmacy: the Australian experience, Volume13, Issue3 September 2005 Pages 195-204
2. https://onlinelibrary.wiley.com/doi/epdf/10.1211/ijpp.13.3.0005
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4100952/
4. Social Science & Medicine, Volume 98, December 2013, Pages 319-329
5. https://www.news-medical.net/health/Ethics-in-Pharmacy.aspx
6. https://www.researchgate.net/publication/221927642_Ethics_in_Pharmaceutical_Issues