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Widely accepted codes of ethics
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Let’s look at the most famous and accepted pharmacy code of ethics that published by American Pharmaceutical Association. They have eight items, this is the version of 1994, the most updated version. The first one of pharmacist respects the covenantal relationship between the patient and pharmacist. Considering the patient-pharmacist relationship as a covenant means that a pharmacist has moral obligations in response to the gift of trust received from society. So, this sentence explained the covenantal relationship. Covenantal relationship is a religious concept, it’s different from contract relationship. Covenantal relationship usually referred to a relationship cannot be written or cannot be expressed in word or in writing. The best example in the human life for the covenantal relationship is the wife and husband.
So, for a couple, there is no written document that says who should do something and who should not do something. But they are a relationship, a very solid relationship between two person. So, this is a very good example for the covenantal relationship, So, the pharmacist and the patient they have this kind of covenantal relationship. There is no obvious written document said who should do what and who should not do what but this relationship is there. Because it’s a gift of trust. So, in return to this gift, a pharmacist promises to help individuals achieve optimum benefit from their medications, and to be committed to their welfare, and to maintain their trust.
The second code is a pharmacist promote the good of every patient in a caring, compassionate, and confidential manner. So, a pharmacist place concern for the well-being of the patient at the center of professional practice. In doing so, a pharmacist considers needs stated by the patient as well as those defined by health science. A pharmacist is dedicated to protecting the dignity of the patient. With a caring attitude and a compassionate spirit, a pharmacist focuses on serving the patient in a private and confidential manner. Number three, a pharmacist respects the autonomy and dignity of each patient. A pharmacist promote the right of self-determination and recognizes individual self-worth by encouraging patients to participate in decisions about their health.
A pharmacist communicates with patients in terms that are understandable. In all cases, a pharmacist respects personal and cultural differences among patients. Number four, a pharmacist acts with honesty and integrity in professional relationships. So, a pharmacist has a duty to tell the truth and to act with conviction of conscience. A pharmacist avoids discriminatory practices, behavior or work conditions that impair professional judgment, and actions that compromise dedication to the best interests of patients. Number five, a pharmacist maintains professional competence. So, under this code, a pharmacist has a duty to maintain knowledge and abilities as new medications, devices, and technologies become available and as health information advances. Number six, a pharmacist respects the value and abilities of colleagues and other health professionals.
When appropriate, a pharmacist asks for the consultation of colleagues or other health professionals or refers the patient. A pharmacist acknowledges that colleagues and other health professionals may differ in the beliefs and values they apply to the care of the patient. Number seven, a pharmacist serves individual, community, and societal needs. The primary obligation of a pharmacist is to individual patients. However, the obligations of a pharmacist may at times extend beyond the individual to the community and society. In these situations, the pharmacist recognizes the responsibilities that accompany these obligations and acts accordingly. The last one number eight, a pharmacist seeks justice in the distribution of health resources.
So, when health resources are allocated, a pharmacist is fair and equitable, balancing the needs of patients and society. When we know all these four principles of bioethics, the autonomy, the beneficence, nonmaleficence, and justice. We use the four principles of bioethics to judge or to study an ethical problem. And then we have the code of ethics published by pharmacist association. So, how do we use these principles and how do we use these code of ethics to resolve our daily practice that in the daily practice we face ethical question frequently. In the Royal Pharmaceutical Society Code of ethics published in 2004, there is a paragraph that introduces the way or the method to resolve an ethical problem.
And, it has very simple concise form in five points. The first point is to recognize that a problem needs to be overcame or a difficult choice made. So, the first one is to recognize where is the problem and what is the problem. And usually when we try to discuss the problem, usually because the ethical problem or ethical question is itself that contradict among two or more than two bioethical principles. For example, there is conflict between autonomy and nonmaleficence or there is a conflict between nonmaleficence and justice. So, whenever we face the ethical problem, we need to recognize it and we also we need to dissect it.
So, this will come with the second point: identifies the possible course of actions. So, when we know the word the dilemma is and then we could have many different way of resolving the problem. So, we could identify there are more than one action that could possibly resolve the question. But this is the real life, you cannot do more than one way to resolve the problem, you have to pick one. So, finally you need to choose one of them, after you choose one of them then you take it. Take it means you choose it and you will be responsible for it. And finally you accept the responsibility.
When you accept the responsibility, that means you need to explain why you choose this solution to resolve the problem and you need to explain it to your colleagues, another pharmacists. You need to explain why you make this final decision and also you need to provide the explanation to your boss,
okay because your boss probably need to report to higher level of management.
And, also you sometimes you need to explain why you pick this solution to the government officer. Even sometime someday this become a case in the court then you need to go to the court. You need to explain why you made the decision to the judges. And also you could have intern pharmacists working with, you could have a pharmacy student working with you, you also need to provide explanation to these people. So, this is a very useful methodology that you recognize the problem and you dissect it, you find the dilemma and then you identify all the possible course of actions. And probably you need to figure out the pros and cons for each possible courses or each possible solution.
But you need to choose one of them only and then you take it as your responsibility. And you prepare the explanation to any person that you need to explain to. And how you’re gonna to explain it? How you need to justify your decision? My best recommendation is you go back to look for the sentence and then wording in the code of ethics that published by these pharmaceutical societies. And these words, these nomenclature, these wording from the code of ethics could be a very useful and very effective support to explain to provide the explanation for your decision. Finally, we come to the conclusion. Ethics is a subject that deals with what we should or should not do.
I still want to emphasize it’s a subject. It’s a subject so we need to learn it. And we need to study it. Ethic doesn’t provide a standard for you but we need to discuss what is the appropriate not the best answer for the ethical questions. And pharmacist has become one of the health care professionals. They need to face the patients, they need to face the physicians, colleagues, government, and students. And whenever you need to face these people, pharmacists need to explain why they was a reason they make the decision. And this is a sign of responsibility. So, pharmacists need to know how to deal with ethical problems in a systematic ways.
In this way, the pharmacist could protect himself and also protect the patient or protect the person that supervise him or her. And this will really combine the professional knowledge and human behavior together, they harmonize the professional knowledge and technology with the human behavior or the human side of the profession.
To better illustrate how to implement the principles into codes, Chiang will be using the codes established by various different associations.
8 codes of the American Pharmaceutical Association:
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A pharmacist respects the covenantal relationship between the patient and pharmacist.
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A pharmacist promotes the good of every patient in a caring, compassionate, and confidential manner.
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A pharmacist respects the autonomy and dignity of each patient.
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A pharmacist acts with honesty and integrity in professional relationships.
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A pharmacist maintains professional competence.
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A pharmacist respects the value and abilities of colleagues and other health professionals.
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A pharmacist serves individual, community, and societal needs.
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A pharmacist seeks justice in the distribution of health resources.
Royal Pharmaceutical Society Code of ethics, pharmacists should:
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Recognize the problem that needs to be overcome or the difficult choice that had to be made.
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Identifies the possible course of actions.
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Choose one action.
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Accept the responsibility.
Though there is fixed answer in ethical debates, a pharmacist need to know how to approach the problem in a systemic manner.
Share and learn
Does your country/hospital adopt foreign ethical codes?
If yes, are there any modifications made to accommodate for difference in culture?
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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