This document discusses ethics in pharmaceutical care. It notes that ethical issues often arise from interactions between individuals with differing values and from limited resources in healthcare. It emphasizes the importance of identifying and resolving ethical problems by first addressing any clinical or legal issues. The document also discusses the differences and overlaps between law, ethics and professional codes of conduct. It provides examples of common ethical dilemmas that can occur in patient-practitioner interactions or at an institutional level around issues like resource allocation, competency and protecting standards.

2.  the study of the rightness or wrongness of human
conduct.
 In any situation involving two or more individuals,
values may come into conflict and ethical issues may
develop.
 This is especially true in the case of health care where
pain and suffering are involved, and limited resources
exist.
 Patient care involves applied ethics in that it consists of
the practical application of moral standards to specific
ends

3.  Pharmaceutical care is dependent upon human
interactions.
 These interactions include patients, family
members, pharmaceutical care practitioners,
other clinicians, support personnel, managers,
and administrators.
 These individuals are likely to have different
values, beliefs, and preferences.

4.  Whenever two people with different value
systems interact, there is the potential for an
ethical problem to develop.
 Because ethical problems are common in
practice it is important that practitioners know
how to identify and resolve them when they
arise
 Identifying and addressing ethical problems
would be easier if they were not so often
confused with clinical and legal issues.

5.  These three issues—clinical, legal, and ethical—
can be so closely associated that they appear to
be the same problem.
 It will be helpful if the three issues can be
separated, when possible, because a successful
resolution to each issue is arrived at slightly
differently
 . Each situation requires different knowledge
for its recognition and a somewhat different
process for its resolution

6.  Although each patient situation is unique, as a
general rule, clinical problems should be
identified and resolved first, followed by legal
issues, and if an ethical problem remains, it can
then be resolved effectively.
 Thinking in this order will make the
identification and resolution of the ethical
problem more manageable.

7.  Pharmacy law consists of rules, regulations,
and actions that are promulgated by
governments and are binding on its
constituents.
 Law and ethics, while in most cases clearly
demarcated, often overlap and sometimes
appear contradictory

8.  Example Should a pharmacist, based on her
clinical judgment at the time of an emergency,
provide a patient with a life-saving drug not
authorized by a physician's prescription, when
technically she is breaking the law, but is
arguably acting ethically?

9.  Legal issues often have explicit statutes that
provide a solution.
 In pharmacy, there are many laws that
govern what practitioners may and may not
do with prescription drug products.
 professional standards require practitioners
to both know and follow the law.
 In those relatively few situations where the
law is not clear regarding what can and
cannot be done, practitioners should always
follow the professional and ethical mandate
to do no harm and when it is possible, to do
good for the patient

10.  Example Is it ethical to knowingly dose a
patient with an amount of drug that is so
small it has little or no chance of
successfully treating the medical problem?
If the pharmacist's clinical judgment is
that the patient's drug therapy problem is
that the dosage is too low, then it is legally
necessary to obtain the consent of the
prescriber in order to increase the dose.

11.  Being an active moral agent can conflict
with the law and often does.
 It should go without saying that
practitioners have a duty to know the law
and act accordingly.
 The law prescribes codes of conduct that
are usually reasonable, clear, and direct.

12.  Thus, we divide actions into two classes:
legal and illegal.
 Ethical analysis requires critical
examination of actions and their
consequences and are not so easily
differentiated as appropriate and
inappropriate.

13.  The standards for professional behavior
and the code of ethics provide even more
guidance for the practitioner.
 no code of ethics can contain all the
necessary detail to address all issues that
arise on a daily basis.

14. Code of ethics
 A public pledge to meet certain
responsibilities and perform duties for
those who do not share the knowledge,
expertise, or professional mandate.
 a public pledge to adhere to the standards
and ideals of conduct and to enforce them
through mechanisms that will punish
those who violate the essentials of the
pledge

15.  Pharmacists are health professionals who
assist individuals in making the best use
of medications.
 prepared and supported by pharmacists,
is intended to state publicly the principles
that form the fundamental basis of the
roles and responsibilities of pharmacists.
 These principles, based on moral
obligations and virtues, are established to
guide pharmacists in relationships with
patients, health professionals, and society

18.  Conduct that contravenes the content of the
code can have consequences that are equal to,
or greater than, some legally binding
expectations of performance.
 it is important to study the standards for
professional behavior and the standards of care
with the intent to apply them in the case of
each patient and prevent as many ethical
problems from occurring as possible.

19.  The most common situations that involved
ethical issues
 those which consist of privacy and confidentiality,
conflict of interest, respect for patient autonomy,
duty to warn, and value conflicts and which occur
daily during the patient/practitioner interaction
 those which involve the allocation of resources,
rationing, justice, and competency, are more episodic
and patient-specific, and occur in the institutional
context.

20. Common Ethical Dilemmas in Pharmaceutical Care Practice
Patient-practitioner interaction Institutional context
Patient confidentiality and privacy issues Allocation of resources and rationing
Conflicts of interest Personal competency, colleague competency
Respect for patient autonomy Protection of standards
Duty to warn
Patient/practitioner conflicts in values

21.  It would be considered unethical to discuss or
disclose personal health-related information
about your patient with one of your friends or
family members who is not a health care
provider and who is not involved in the care of
that patient.