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Ethical principles and codes of ethics
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In terms of the nonmaleficence, we commonly will discuss withholding treatment or withdrawing treatment. Withholding treatment is when we want to treat the person if the person is a normal situation, we should start using medicine or using any treatment modality to start to relieve the patient’s suffering or disease. But at certain circumstances, we withhold the treatment, we do not give the appropriate treatment in certain situation to the certain patient. And we need to consider the ethical dilemma. Withdraw treatment means when a patient is receiving appropriate treatment but at certain time point or because of certain consideration, we want to stop the treatment, so, this withdrawal.
And there’s a lot of discussion about like hospice patient, the patient is already in the terminal stage whether the patient need to continue to receive antibiotics or not, continue to receive blood transfusion or not. Ok, so these are the problems when we facing withhold or withdraw treatment. And also, we could very common issue about nonmaleficence is a physician is to treat the patient but if it is possible or it is ethical to kill the patient or to do assistance suicide to a patient that he or she suffering severe pain or severe discomfort. Could we a physician or a healthcare professional to let patient die without any intervention? It could be ethical or possible in some circumstances.
Or you use a treatment you have foreseen but unintended effects, for example, you use high dose morphine try to sedate to make the patient sleep but actually, the drug could cause death but also, it could have intended effect. But these are pretty critical if you increase a little bit dose, it could cause the patients harm, but you want to actually do good to the patient. So, in this area, benefit and risk assessment is always the discussion and also controversial. For the third principle beneficence, which means you want to do good to the patient.
Okay in the old time when the physician want to do good to the patient, and he the physician may think okay the person doesn’t understand the real medical reasoning behind so, the physician will say okay what I do to you is all correct and all benefit to you, so, you don’t need to make your own decision, so, this is a physician of paternalism. A physician may want to make every decision for the patient. And, this is actually the physician wants to do good to the patient but actually sacrificed patient’s autonomy. And so for beneficence, risk and benefit assessment is always there you need to balance each other and it’s very hard.
Also, beneficence when the treatment costs a lot of money even though it’s good for the patient but the patient doesn’t have the financial ability to pay for it, what should be done? This is a very difficult question. And, also quality of life assessment and evaluation, a person could spend a very high price of medication, but the medication may cost a lot of quality of problem in quality of life, So, is it doing beneficence to the patient? Patient could probably suffer severe side effects and gain certain month of survival, is it worthy? So, these are all the ethical issue related to beneficence. The last principle is justice. Justice refers to for the public benefit.
So, if a health care resource is limited, we have limited blood, we have limited medication, we have limited vaccine. In those time or area that have limited resource, who should have the medication or who should receive the treatment that become an important ethical issue. So, the health care resource allocation is always a very important issue especially in those area like Taiwan, we have national health insurance, the total budget is always limited but if the insurance want to pay for a lot of difference severe or mild disease, then this will become a struggle. Equity means does every patient receive the same quality of the treatment. Okay fairness, does everybody could have the chance to receive the treatment they wish?
Okay these are all related to the resource allocation, and these are the modern national insurance need to face the ethical problem of justice. Though previous section we discussed about the basic principle of bioethics. So, the four basic bioethical principle could guide us to analyze the ethical problem. According to these ethical principles, different profession they could come up with their own code of ethics. And code of ethics is a formal statement by a group especially a professional group that establish and prescribe moral and nonmoral standards and behaviors for members of the group.
So not only medical profession, any profession they could gather together and have a group of people and they have a formal discussion and put up a formal statement about what is the standards or behaviors they expect the profession to conduct or to express. So, the code of ethics for pharmacists are the ethics that expected by the profession also probably by the public to this profession. And currently the most widely accepted code of ethics for pharmacists in United States was developed by the American Pharmacists Association and accepted by its member on October 27th, 1994.
The 1994 version is not the original, the first version, and also hopefully it’s not the final version because I think the technology, the pharmacists will start keep evolve itself and according to the technology, according to advance of the pharmacy knowledge. The pharmacy code of ethics. There are many many countries in the world they have their own pharmacy code of ethics, the most popular one is the American Pharmacists Association published. The first one in 1852 and the most updated one is 1994. The American Pharmacist Association’s pharmacy code of ethics is not in detail. Okay there are two different type of code of ethics of pharmacy in the world.
One type is principle, they put up a principle show the pharmacist or to the public that this is the principle that the profession need to be done, need to do.
The Royal Pharmaceutical Society of Great Britain they published a pharmacy code of ethics, originally the first version in 1944, and the most recent one is in 2007. And, they are different types of code of ethics from American Pharmacist Association’s code of ethics. Royal Pharmaceutical Society of Great Britain
they published the code of ethics in a very detail format, it’s different from the American style. American style I just said is an outline of the code of ethics and they only have eight items. The Royal Pharmaceutical Society of Great Britain, they put up a very detailed instruction especially they focus on certain area that are controversial in the pharmacy practice. So later we will look at the two different code of ethics. And FIP have published a code of ethics in 1997. FAPA which is the Federation of Asian Pharmaceutical Associations they have a code of ethics for Asian countries in 2002. Taiwan has its own code of ethics, it is published by Taiwan Pharmacist Association in 1995.
Chiang finishes the remaining 3 ethical principles, before covering the code of ethics.
Key points
Issues related to nonmaleficence:
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Withholding or withdrawing treatment.
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Assisting suicide or leaving patients to die.
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Foreseen but unintended effects.
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Benefit and risk assessment.
Issues related to beneficence:
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Paternalism vs patient autonomy.
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Benefit-risk assessments.
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Cost of treatments.
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Quality of life assessment.
Issues related to justice:
- Health care resource allocation.
Using these ethical principles, different healthcare profession can establish unique codes of ethics.
Usually enforced by a professional group:
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American Pharmacists (Pharmaceutical) Association
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Royal Pharmaceutical Society of Great Britain
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The International Pharmaceutical Federation (FIP)
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Federation of Asian Pharmaceutical Associations (FAPA)
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Taiwan Pharmacist Association
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Which organization sets the codes of ethics in your country/hospital?
This article is from the online course:
Good Pharmacy Practice: Pharmaceutical Services
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Good Pharmacy Practice: Pharmaceutical Services
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