Transcript 1 Principles of Pharmacy Ethics

PRINCIPLES OF PHARMACY
ETHICS
Basic biomedical ethical responsibilities
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benefiting the patient,
supporting a patient’s right to selfdetermination/autonomy,
refraining from harming the patient,
assisting and advocating on behalf of the patient to
ensure effective and safe healthcare,
protecting the patient’s medical privacy,
maintaining professional competency and knowledge
The ethical conflicts in pharmacy practice
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allocation of time between dispensing and clinical
services;
patient advocacy responsibilities;
social, moral, or religious objections to certain drug
uses;
conflicts of interest with pharmaceutical companies;
drug diversion and abuse;
healthcare resource stewardship.
Why is pharmacy ethics important?
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A pharmacist’s primary responsibility is to benefit
patients and prevent harm by dispensing the right
drug in the right amount and with complete use
information. Failure to fulfill these responsibilities
can lead to loss of disease control, disability,
and/or death.
Adherence to both professional standards and a
code of ethics is imperative if these problems are to
be avoided.
Conflicts between dispensing and clinical services
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Dispensing pharmacists spend much of their professional time
interpreting, filling, and dispensing prescriptions. These
functions require that the pharmacist reviews the prescription
for proper drug use and dosage.
For all of dispensing services, pharmacists receive a fee, and
the number of prescriptions filled becomes the primary
measure of the pharmacist’s income, especially in a chain drug
store setting.
When patients perceive a benefit from medication counseling,
they can more easily tolerate disruptions in dispensing services.
Patient advocacy
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Training and specialized knowledge should be put to use to
determine if the prescription is valid, beneficial, and safe.
A pharmacist also lacks the medical information that the
physician has about the patient, and pharmacists often
cannot take the time to inquire about the prescribing choices
of a busy physician who may, in turn, resent the interference.
Two guiding principles may help the pharmacist in cases such
as this: (i) the more severe the potential harm to the patient,
the more the pharmacist should be motivated to intervene,
and (ii) informing patients of any concern and advising them
to seek further advice from their physician is always
advisable.
Refusal to fill a prescription on the basis of social,
moral, or religious objections
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Pharmacists can have moral objections to the use of medications
in many circumstances. The use of drugs for physician-assisted
suicide is one such circumstance, and debates exist about
whether pharmacists should fill these prescriptions, both in
jurisdictions where the practice is legal and those in which it is
not.
What is not condoned in most countries is a pharmacist refusing
to return the prescription to the patient or telling a patient that
it is morally forbidden to use the medication for the intended
purpose.
The patient–pharmacist relationship: a patient’s autonomy and
right to treatment and the duty of the pharmacist to benefit the
patient and to refrain from harming someone seeking
medication
Using prescription records to assist the marketing
activity of pharmaceutical companies
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Some large pharmaceutical companies pay US pharmacies to
mail material or call patients about company drugs or competing
products. The materials and messages urge patients to do such
things as continue taking a currently prescribed drug, switch to a
new form of the drug, or switch from a competitor’s drug.
Is there a conflict of interest when pharmacists are paid to urge
patients to take a particular brand of drug?
Pharmacists who are approached to participate in these
programs need to place primary emphasis on protecting patients’
privacy interests and should only convey information clearly
intended to promote health interests.
Drug diversion and abuse
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Pharmacists increasingly suspect that when a patient presents a
prescription for a controlled drug, it is for the purpose of diversion or
abuse. Professional responsibilities in such a case often conflict.
Pharmacists have a duty to dispense opioid analgesics when the drug
has been legally prescribed and is therapeutically appropriate for
the patient. Alternatively, filling a narcotic prescription that is used
abusively increases the risk of harm to the patient and perpetuates a
dangerous threat to the public health.
Since most pharmacists will face this kind of challenge, all should
receive training that focuses equally on decision-making skills to
detect drug abuse and diversion and also on the recognition of valid
and appropriate prescriptions for controlled substances.
Medical resource stewardship
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No system of healthcare is free of the burdens of cost
and the fair and rational allocation of constrained
resources. Pharmacists play a central role in these matters
since they control or manage institutional drug formularies,
which are systems designed to limit the choice of drugs
that can be prescribed based on cost-effectiveness
determinations.
A typical drug formulary decision involves selecting the
least expensive among a class of drugs that provide the
same or similar therapeutic benefit and risk. At times,
however, the decision can involve whether or not to stock a
particularly expensive drug.
Data collection must respect the right to privacy
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Assuring a patient’ s privacy when clarifying prescription
details requires management of the risk of inadvertently
being overheard by other customers during this process.
This can happen if working from a computer screen
removed from the area where prescriptions are received,
unless specific efforts are made to avoid being
overheard.
Risk management would identify that when a patient is
collecting his/her prescription the pharmacist should ask
the patient to state his/her address.
Data recording must be accurate
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While it is critical that pharmacists document
interventions and advice, commentary must be
factually accurate and free from any accusation of
innuendo or slander.
With the advent of advanced services, recording
templates must direct the nature of information
gathered by pharmacists. In addition, confirmation of
the length of time for which records will be kept must
be included in the process of collecting data.
Storage of data must be secure
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Pharmacists are obliged to make sure personal data
is not accessible to anyone other than employees (who
will have signed confidentiality clauses) or to others
involved in the patient’s care.
As with any organisation, pharmacies must ensure that
back-up disks, laptops, fax rolls, printer ribbons,
video tapes and all forms of CCTV must be destroyed
appropriately before being included in regular
waste.
Code of Ethics of Pharmacists of Ukraine
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The purpose of the Ethics Code of Pharmacists of Ukraine
(hereinafter – the Code) is a declaration of fundamental
principles of the profession, which is based on moral
obligations and values.
The Code defines ethical standards of professional
conduct and responsibility, which have to become
exemplary guide for pharmacists in their relationships
with society under conditions of market relationships, when
the role and significance of the pharmaceutical profession
increases.
Pharmacist in modern society
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The main objective of the professional pharmaceutical activity of
the area specialist is prevention of diseases, preservation and
strengthening of human health.
Pharmacists in his practice on the matters of drugs and medical
products promoting must comply with the legislation of Ukraine
about advertising of drugs, medical equipment, methods of
prevention, diagnostics, treatment and rehabilitation.
To promote development of health sphere, including
pharmaceutical sector, and also improving of the profession
image, pharmacists should actively participate in the activities of
national and international civic and professional organizations .
Relations between pharmacist and patient
Pharmacist must:
• treat each patient with respect from meaning individual approach
showing no preference or dislike;
• have psychological communication skills to be able to achieve
confidence and mutual understanding between him and the patient;
• to act openly, honestly and objectively, without using in personal or
their institution’s benefit lack of information and ignorance of the
patient about drugs and medical products, not to place pressure on
the patient (in whatever form) for their purchase.
Relationships between pharmacist and doctor
Pharmacist as a specialist of this sphere shall:
• inform the doctor about drugs and medical products, their
availability, distinctions of pharmacotherapy and use of
analogues;
• provide the doctor with complete information about the new
preventive and diagnostic drugs and medical products;
• require from the physician to precisely follow the established
regulations of writing drugs prescriptions;
• detect errors in drugs prescription and discuss them with the
doctor.
Relationships between pharmacist and his colleagues
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Pharmacist must build relationships with colleagues
based on mutual respect, trust, abide by professional
ethics.
Pharmacist should create and maintain favorable
moral and psychological climate in the team.
Pharmacist must criticize incompetence and
unprofessional actions of colleagues that may harm
health of the population.
Pharmacist and scientific progress
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Pharmacist must raise his professional level and skills.
Pharmacist should contribute to conducting of various
studies aimed at increasing efficiency and accessibility of
rendering pharmaceutical care.
When creating preclinical, clinical trials of drugs,
registration, manufacture and their sales pharmacist must
follow the requirements of international standards.
Clinical trials of new drugs should be carried out
according to bioethical principles.
Pharmaceutical Information
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Providing of pharmaceutical information in professional and
public publications, any media, speeches of pharmacists at
scientific conferences in the conditions of professional and
practical activity should be subject to ethical rules and
regulations, avoiding demonstration of advertising, selfpromotion and unfair competition.
Pharmacist must give the patient comprehensive and
accessible information on application, contraindications, side
effects of drugs and medical products, even against his own or
commercial interests of the institution.
New Pharmaceutical Technologies
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Actions of pharmacists while developing of new drugs and
medical products with use of the latest pharmaceutical
technologies with interference into the human genome, at the
cellular level should be determined by ethical and legal and
legislative acts of Ukraine, recommendations and requirements
of the WHO, Bioethics Committee of UNESCO, Commission on
Bioethics, the requirements of good pharmacy practice: GLP,
GCP, GMP, GPP and others.
Clinical trials of new drugs developed on the basis of new
pharmaceutical technologies should be conducted in
accordance with ethical principles of the Helsinki Declaration,
GCP rules and relevant regulatory requirements.
Respect for the profession of pharmacist
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The principle of respect for his profession must be
maintained in all areas of pharmacist’s activity:
professional, social, scientific, educational and any other
and fully supported by every pharmacist. Unacceptable
from a professional and ethical point of view is disrespect
and negative statements about pharmaceutical profession.
Life position, the whole career, any activity of pharmacist
should contribute to the prestige of the profession,
preservation and increase of its best traditions.
The action of the Ethics Code of pharmacist
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Pharmacist is responsible for the violation of norms and
principles of professional ethics and deontology in front of the
pharmaceutical community as well as of the current legislation of
Ukraine, if the violation also related to its norms.
Revision, amendments and supplements to the Code must be
carried out at congresses and conferences held by Health
Organization of Ukraine, pharmaceutical community and
pharmaceutical associations.
Community Council of representatives of professional public
organizations and executive bodies shall monitor the way a
pharmacist follows the Ethics Code.