Towards he end of the 1 9005 to the present, pharmacists have focused on responding to manage care and new concerns about the quality of patient care (Alai, Tract Lovely, 2013). Moral and ethics have always had a special place in the practices of these health care providers as they are looked up to as the trusted members of societies. There are always some ‘black sheep’ who bend the rules and bring a bad name to this noble profession (Unbroken, 2014).
Breaking the confidentiality of the patient, marking up the price of medication for a difficult patient or selling too much codeine, are practices that no harmonist would do if they were ethically and morally sane (Unbroken, 2014). The different ethical issues faced by the pharmacist can be categorized into confidentiality, justice, veracity, non-maleficent and autonomy. Autonomy is one of the most common issues faced by pharmacists every day (Christmas, 2015). They have to create a balance between the patients’ right for information and protecting them from harm (Rays, 2007).
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Consequences may occur if full disclosure of the side effects of the therapy is revealed to the patient and they back out from the treatment. Also it can result in interference in the physician-patient relation, therefore when providing information to the patient about the therapy the pharmacist must exercise caution (Rays, 2007). The second ethical issue a pharmacist is faced with is confidentiality. Confidentiality is especially important when there is a situation involving children (Porkier, 2003).
Parents have the right to know which drugs are being prescribed. It requires moral and ethical decision making skills to decide when he should and should not, reveal personal information of the patient (Porkier, 2003). Confidentiality comes in contrast to racist where sometimes it is very important for the pharmacist to tell the truth and provide drug information whereas at times the whole truth is not important to be told and should not be disclosed (Porkier, 2003). The third ethical issue pharmacists are faced with is justice (Nordic, 2012).
Justice is becoming the major ethical dilemma in today’s society, pharmacists are involved in choosing the drugs in the formula and in the hospital setting and this decision should not reflect personal interests or gains (Nordic, 2012). Pharmacists have to choose the most economical drug that can improve the quality of life. Justice should prevail among all patients, for example, factors such as age, social standing and economic stability should not influence the drug therapy chosen for the patient (Nordic, 2012).
Non- maleficent is defined as “to cause no harm”, meaning that if the pharmacist thinks dispensing of a particular drug can harm his patient than he has an ethical right to say refuse to dispense (Rays, 2007). Pharmacists can refuse both abortiveness (substances that induce abortion), as well as certain drugs that can be used for the purpose of suicide (Porkier, 2003). Every religion let alone humanity, guides us to differentiate between right and wrong. Non- maleficent is often used with the term beneficence, which means, “to do good” to another while non-maleficent is ‘to do no harm’ (Porkier, 2003).
Both non-maleficent and beneficence are terms used complementary to each other. Non-maleficent is sometimes used more broadly to prevent harmful condition and harm to other individuals so we can put it under the umbrella of beneficence (Porkier, 2003). To further explain the concept of non-maleficent and beneficence, the example of an old woman crossing the dad can be used. If the car stops to allow her to cross, this can be termed maleficent; to get out of the car to help her cross the street is an example of beneficence.
In the health care setting, if a pharmacist detects a drug interaction and refuses to fill it, this would be called non-maleficent because harm is being prevented (McCarthy, Chafferer, Place, 2012). Furthermore, if the pharmacists detects the interaction and calls the practitioner and discuses an alternative drug this would be an example of beneficence (McCarthy, Chafferer, place, 2012). A pharmacist, who wishes o practice his ethical duty of non-maleficent and refuses to dispense a certain drug, should be very clear about his position legally. It is recommended that they have a conscience clause (Pope, 201 1).
A conscience clause protects pharmacists’ right and it is a proactive approach to minimize the severity of the problems that may occur caused by ethical and moral dilemmas (Pope, 201 1 This clause can be the conscientious objection to the issue raised and will determine the position of the pharmacist on that specific issue thus minimizing the conflicts, so that more focus can be put on welfare f the patients (Pope, 201 1). Legislation was passed recently, which gives patient a right to take their own life, the right to use of narcotics for pain management, and the right to use abortiveness (Rays, 2007).
It has been said that it is becoming increasingly common that a physician writes a drug prescription that a pharmacist may not think is ethical to dispense based on his ethics and beliefs. The pharmacy laws allow the pharmacist dispensing of a drug can cause harm, if the prescription does not seem valid but to refuse in terms of personal belief and ethics is not clearly covered in the laws until gently and would makes him responsible for the decision he takes (Harvey, n. D).
Cases as an Example In Order to understand the moral and ethical principles explained, three cases will be presented to explain situations a pharmacist may come across. Case 1: A young student 18 years old presents a drug prescription used as a contraceptive (Porkier, 2003, Rays, 2007). The direction in the prescription indicates that the drug will be used for the emergency contraception only (Rays, 2007). The pharmacist in-charge refuses to fill the prescription based on his beliefs and ethics ‘to do no harm’. Although the patient is in distraught, the pharmacist provides her insight into his beliefs (Rays, 2007).
According to scriptures in the Bible, physical harm of the innocent is forbidden thus abortion is morally wrong because it is the killing of a human being and IS an act of selfishness in contrast to faith and love which most of the religion preach (Porkier, 2003). Case 2: An old patient comes to the pharmacy on a regular basis and submits a prescription for narcotic pain reliever (Porkier, 2003). After talking to the patient the pharmacist concludes the patient is pressed and may not use the drugs appropriately (Porkier, 2003).
The patient is suffering from cancer and the narcotic is to relieve pain (Porkier, 2003). The patient also talks about the unbearable pain and the prospect of reuniting with his dead wife, which shows that he means harm to himself. The pharmacist refuses to dispense the drug (Porkier, 2003). Case 3: A patient is prescribed a prescription drug in a lethal dose (Rays, 2007). She demands the pharmacist directions on how to use the drug (Rays, 2007). In this particular state, it is legal for the physician to prescribe a mentally ill patient a lethal SSE of a drug (Rays, 2007).
The pharmacist refuses to be a part of this act (Rays, 2007). As described in the situations above, pharmacist’s moral and ethical values did not allow him to dispense the drugs, but the important questions to ask are: Is it his right to refuse? And if he refuses, what should he do for the patient? How is the pharmacist protected legally if he refuses? And what will be the involvement of the other members of the society including the patient and the employer? Most of the US states allow pharmacists to refuse to dispense based on their judgment and therefore at this time there re no court cases.
In 1998 the first conscience clause was passed by a state that protected the liability of the pharmacist when dispensing of a drug is refused (Pope, 2011). According to the clause, the refusal can be under three circumstances: If the medicine is used to kill an unborn child, to abort the child, or to assist suicide of any individual (Kirsches, 2006, Pope, 2011 The bill also protects the pharmacist from any actions or the patient makes that result from refusing to dispense a drug (Kirsches, 2006). Policy of American Pharmacists Association (Papa)
In 1 998, the American Pharmacists Association (Papa) took their position on the conscience clause. The Papa clarified their policies by considering pharmacist’s values as well as the patient’s needs (Hinkler & Gang, 2006). According to their policy pharmacists have the right to refuse to dispense but also have the responsibility to ensure the patient gets access to the required drugs (Hinkler & Gang, 2006). In every situation the decision in terms of ethics can be different based on the particulars.
The pharmacist should get all the information regarding the case before taking the decision and should insider all the options and their outcomes. No one set of rules presents itself for every situation and it solely depends on the pharmacist’s skill to take the right decision. Right to Refuse and Duty to Patient To answer the question that asks, if the pharmacist has the right to refuse to dispense a certain drug and if they refuse then their duty to the patient, one must understand the principles of the pharmacy practice.
Confidentiality of the patient’s profile is one of the main principles in order to maintain the relationship of trust and is only used for the benefit of the patient (Daniels, n. D. ). The patient in return then trusts the pharmacist in believing him to be non-maleficent, share their personal information, which is used by the pharmacist to provide the best therapy and care to the patient (Daniels, n. D. ).
A pharmacist based on their knowledge can refuse to fill a prescription if it is harmful to the patient unnecessarily, it can be an error in the dose or an interaction with the drug or if he thinks that the prescription is not valid (Daniels, n. D. , Rays, 2007). When a prescription is presented to the pharmacist that according to his judgment will cause harm to the patient, he should look or other options based on all the information about the patient and the knowledge gained through experience (Daniels, n. D. , Rays, 2007).
It becomes difficult if no other options are available and the issue is not resolved. If the pharmacist fills the prescription then it means that he means harm to the patient if he doesn’t then he is practicing beneficence that ‘is to do good’, but the patient also has the right to autonomy (Daniels, n. D. , Rays, 2007). The pharmacist has the duty to inform the patient about all the necessary information in regards to the harm of the therapy (Daniels, n. D. ). The patient has the right to make an informed decision however wrong it may appear to the pharmacist (Daniels, n. D. . After making sure that the patient has the full understanding of the treatment and its consequences, the pharmacist is expected to assist the patient and provide access to the drug in respect to right to autonomy of the patient (Daniels, n. D. ). Legal Protection Based on the information provided, the question is: Is the pharmacist legally protected to refuse to dispense? The Code of Federal Regulation supports the right of the pharmacist to refuse by the Drug Enforcement Administration lull, if a drug is not used for a normal course of treatment (Temple University, 1999).
South Dakota is the only state that has passed the clause to protect the pharmacists (NCSC Denver, 2012). However, there is no state has a law indicating the pharmacist must to dispense to a patient when his personal beliefs are against it (NCSC Denver, 2012). Pharmacists are not to face any action as long as they remain honest and provide health care to the patient and when does not feel morally fit to dispense a drug contact the physician and refer the patient to another pharmacist (Harvey, n. . ). Ethical Theories There are three alternatives for every situation.
The first situation is to oblige pharmacists to fill the prescription; personal, ethical and moral values should not stop him from fulfilling his duty (Daniels, n. D. ). The second alternative is to give the pharmacist the right to refuse to fill a prescription on the moral and ethical grounds (Daniels, n. D. ). Thirdly, the alternative is to permit the pharmacist to refuse to fill the prescription only if the employer agrees furthermore directing the patient to another pharmacy (Daniels, n. D. ). The iris alternative is backed by the Kantian theory (Christmas, 2015).
The Kantian theory states that the people should be treated with respect and should be given equal right to autonomy (Christmas, 2015). According to Kantian theory a pharmacist is bound to dispense any drug the patient needs as the patient has their own freedom to live how they want (Daniels, n. D. ). According to the classical model of social responsibility and utilitarianism the pharmacist should play a role in maximizing the profit, if it’s within the laws, thus by refusing to dispense a certain drug the pharmacist may decrease the refit of the drug manufacturer and his employer (Daniels, n. D. ).
Finally, the utilitarian theories states that the action of the pharmacist should be able to maximize the overall good, so if he dispenses then he satisfies the patient, makes his employer happy and also give profit to the manufacturer of the drug (Discarding, 2006, p. 30). For the second alternative the pharmacist’s morals are hurt, but if the employer refuses then he has no choice. Laws have yet to pass that protects the pharmacist (Daniels, n. D. ). As for the third alternative, if the company or the employer takes up the responsibility for aging the decision then it becomes easy for the pharmacist to practice (Daniels, n. If the pharmacist does not agree with the terms of the employer then he is free to go to another employer who does practice the refusal (Daniels, n. D. ). Conclusion In the future pharmacists and society should work together to conduct discussions about such situations, pass the conscience clause in every state that protects the pharmacist, and develop a good and healthy relationship between the pharmacist and the physician so that the patient may enjoy the best health care without hindrance. The pharmacist should also take the accessibility to take a proactive approach so that issues of such severity are reduced.