Patient-centered pharmacy practice involves increased pharmacist engagement in patient care. This increased involvement can sometimes require diverse decision-making when handling various situations, ranging from simple matters to major ethical dilemmas. There is literature about pharmacy ethics in developed Western countries. However, little is known about pharmacists’ practices in many developing countries. For example, there is a paucity of research conducted in the area of pharmacy ethics in Jordan. This study aimed to explore the manner in which ethical (...) dilemmas were handled by Jordanian pharmacists, the resources used and their attitudes towards them. Semi-structured, face to face interviews were carried out with 30 Jordanian registered pharmacists. The transcribed interviews were thematically analysed for emerging themes. Four major themes were identified: legal practice; familiarity with the code of ethics; personal judgement, cultural and religious values; and Experience. Findings showed that ethical decision-making in pharmacy practice in Jordan was decisively influenced by pharmacists’ personal moral values, legal requirements and managed by exercising common sense and experience. This pointed to gaps in Jordanian pharmacists’ understanding and application of basic principles of pharmacy ethics and highlighted the need for professional ethics training, incorporating pharmacy ethics courses in pharmacy undergraduate curricula, as well as professional development courses. This study highlighted that paternalism, personal values and legal obligations were major drivers influencing decision-making processes of Jordanian pharmacists. Findings also highlighted an inclination towards lack of respect for patient autonomy. This illuminated the need for increasing pharmacists’ literacy in professional ethics. (shrink)

Pharmacy Ethics: A Foundation for Professional Practice provides a model for examining and resolving ethical dilemmas, thereby helping student pharmacists understand the ethical decision-making process in professional practice.

Many problems that arise when providing pharmacy services may contain some ethical components and the aims of this study were to develop and validate a scale that could assess difficulties of ethical issues, as well as the frequency of those occurrences in everyday practice of community pharmacists. Development and validation of the scale was conducted in three phases: generating items for the initial survey instrument after qualitative analysis; defining the design and format of the instrument; validation of the instrument. (...) The constructed Ethical Issue scale for community pharmacy setting has two parts containing the same 16 items for assessing the difficulty and frequency thereof. The results of the 171 completely filled out scales were analyzed. The Cronbach’s α value of the part of the instrument that examines difficulties of the ethical situations was 0.83 and for the part of the instrument that examined frequency of the ethical situations was 0.84. Test–retest reliability for both parts of the instrument was satisfactory with all Interclass correlation coefficient values above 0.6,. The 16-item scale, as a self assessment tool, demonstrated a high degree of content, criterion, and construct validity and test–retest reliability. The results support its use as a research tool to asses difficulty and frequency of ethical issues in community pharmacy setting. The validated scale needs to be further employed on a larger sample of pharmacists. (shrink)

There is a great deal of support for the contention that the ethical cognition of health care professionals are of consequence to the level of patient care provided. The present study examines the ethical cognition of what has traditionally been deemed a profession of incomplete or marginal status: the retail, or community, pharmacy setting. An empirical examination of ethical cognition compares a systematic random sample of retail pharmacists with pharmacy students. Additional comparisons are made with a baseline of (...) ethical cognition abilities of other health care professionals, such as physicians and nurses.Based on cognitive-developmental theory and using a well-known measure of ethical reasoning, two hypotheses are explored regarding the ethical reasoning skills of retail pharmacy practitioners and pharmacy students. Results indicate that, contrary to cognitive moral development theory, students possess greater ethical reasoning skills than do their practitioner counterparts. In addition, baseline comparisons with other health professional groups reflect unfavorably on the retail pharmacists. It is suggested that the selection-socialization processes inherent in the retail pharmacy setting may result in one or more of the following outcomes: 1) the selection of lower ethical reasoners to the community pharmacy setting, 2) the exodus to other pharmacy settings of higher reasoners, and 3) a possible retrogression in the ethical cognition of community practitioners. Implications for retail practice and limitations are discussed. (shrink)

Results of surveys in which pharmacy students and pharmacists responded to ethical dilemmas are discussed. Respondents indicated a high level of concern about patient welfare and patient rights in dilemmas involving conflicts with socio-economic issues, and with peers and physicians. Conflicts that might arise as the roles of pharmacists change and the health-care systems evolve are also discussed.

The past decade has witnessed a shift in the ambitions of pharmacists away from the core role of dispensing medicines towards more interesting and rewarding relationships and responsibilities with other healthcare providers and patients. The patient-centred role of pharmacists has allowed ethical issues experienced in medical practice to surface in pharmacy practice, resulting in an increase in the number and variety of ethical dilemmas that pharmacists face in their routine pharmacy practice. Pharmacy education prepares pharmacy students (...) for practice and must be in tune with the professional dynamics. Many countries that provide patient-centered pharmacy services have redesigned pharmacy ethics education while others are in various stages of revision of their curriculum in order to adequately equip future pharmacists with the rudiments required to handle ethical issues in clinical pharmacy practice. In contrast, in Nigeria, little or no pharmacy ethics is taught to pharmacy students and the challenge lies with the curriculum design and method of teaching. (shrink)

Background There is a need for clearer guidance for pharmacists regarding their responsibilities when selling complementary medicines. A recently published ethical framework provides guidance regarding the specific responsibilities that pharmacists need to meet in order to fulfil their professional obligations and make a positive contribution to health outcomes when selling complementary medicines. Objective Evaluate the acceptability and feasibility of a new ethical framework for the sale of complementary medicines in community pharmacy. Methods Australian community pharmacists were invited to participate (...) in online focus groups and interviews. Participants were recruited via multiple methods, including social media and the professional networks of pharmacy groups. Participants were provided the ethical framework prior to the discussion. Discussions were transcribed verbatim and analysed using thematic analysis. Results Seventeen community pharmacists participated in the study. There was good representation among participants in terms of gender, years of practice, pharmacy location and script volume. Participants differed in how proactive they were in relation to selling and providing advice on complementary medicines, how they interpreted evidence in relation to complementary medicines, and how they navigated their practice within the retail environment of community pharmacy. The majority of participants found the framework was acceptable for practice and was feasible for implementation with targeted support. Participants identified two important areas for targeted support in implementing the framework: improved access to evidence-based information resources on complementary medicines and independent evidence-based education and training on complementary medicine for pharmacists and pharmacy support staff. Conclusion The ethical framework addresses an important gap in providing specific professional guidance to pharmacists when selling complementary medicines. The results of the study suggest that the framework may be acceptable to community pharmacists and be feasible to implement with targeted support. (shrink)

This textbook offers a unique and accessible approach to ethical decision-making for practicing pharmacists and student pharmacists. Unlike other texts, it gives clear guidance based on the fundamental principles of moral philosophy, explaining them in simple language and illustrating them with abundant clinical examples and case studies. The strength of this text is in its emphasis on normative ethics and critical thinking, and that there is truly a best answer in the vast majority of cases, no matter how complex. The (...) authors place high trust in a pharmacist’s moral judgment. This teaches the reader how to think, based on ethical principles, not necessarily what to think. This means navigating between the two extremes of overly theoretical and excessively prescriptive. The cogent framework given in this text uses the language of competing duties, identifying the moral principles at stake that create duties for the pharmacist. This is the balancing act of normative ethics, and of deciding which duties should prevail in a given clinical situation. This work presents a clear-cut pathway for resolving ethical dilemmas encountered by pharmacists, based on foundational principles and critical thinking. Presents a clear-cut pathway for resolving the ethical dilemmas encountered by pharmacists, based on foundational principles and critical thinking. Jon E. Sprague, RPh, PhD, Director of Science and Research for the Ohio Attorney General. (shrink)

– Pharmacy sales of over‐the‐counter medicines in the UK represent an economically significant and important mechanism by which customers self‐medicate. Sales are supervised in pharmacies, but this paper seeks to question whether patients' electronic health records – due to be introduced nationally – could be used, ethically, by pharmacists to ensure safe medicines sales., – Using theoretical arguments, three areas of ethical concern are identified and explored in relation to pharmacists' access to EHRs‐consequentialsim, analogies and confidentiality/privacy., – Consequentialist arguments (...) include positive benefits to customer's welfare and control of medicine of abuse, but negative economic healthcare burdens and consequences due to potentially increased or paradoxically, decreased presentation of patients to doctors. Socially accepted analogous practices – credit checks, existing pharmacy access to information and hospital treatment – are then argued to be ethically relevant and supportive of access. Privacy and confidentiality are then considered as reasons not to allow EHR access. A contrasting view is that pharmacy access to EHRs is another form of surveillance and hence the question of pharmacists' assess to EHRs may be answered negatively by empirical research that locates pharmacy customers as expert users and identifies confidentiality and privacy concerns about information technology in healthcare more generally., – This paper offers a unique and valuable contribution to the debate about healthcare professionals' role‐based access to patients' medical records and offers a reflection on the ethical concerns surrounding patient information and the rival concerns of patient qua customer autonomy and safety. (shrink)

Every pharmacist, aware or not, is constantly making ethical choices. Sometimes these choices are dramatic, life-and-death decisions, but often they will be more subtle, less conspicuous choices that are nonetheless important. Assisted suicide, conscientious refusal, pain management, equitable and efficacious distribution of drug resources within institutions and managed care plans, confidentiality, and alternative and non-traditional therapies are among the issues that are of unique concern to pharmacists. One way of seeing the implications of such issues and the moral choices they (...) pose is to look at the experiences of practitioners and the kinds of choices they have had to make in situations typically faced by pharmacists. This book is a collection of those situations based on the real experiences of practicing pharmacists. The use of case studies in health care ethics is not new, but in pharmacy it is. This text is an important teaching tool that will help pharmacy students and pharmacists address the increasing number of ethical problems arising in their profession. It is not merely a compilation of cases, but rather is organized for the systematic study of applied ethics. Part I shows how to distinguish ethical problems from other kinds of evaluative judgments and examines the sources of values in pharmacy, posing basic questions about the meaning and justification of ethical claims. Part II explores the basic principles of ethics as they have an impact on pharmacy. Specific cases from clinical settings present in a systematic way the various questions raised by each of the major ethical principles -- benefiting the patient, distributing resources justly, respecting autonomy, dealing honestly with patients, keeping promises of confidentiality, and avoiding harm. Part II examines some of the special problems of contemporary pharmacy such as the linkages between pharmaceutical care and professional practice, human experimentation, reproductive issues, genetic technology, death and dying, and mental health. (shrink)

Background: Increasing interest in empirical ethics has enhanced understanding of healthcare professionals’ ethical problems and attendant decision-making. A four-stage decision-making model involving ethical attention, reasoning, intention and action offers further insights into how more than reasoning alone may contribute to decision-making.Aims: To explore how the four-stage model can increase understanding of decision-making in healthcare and describe the decision-making of an under-researched professional group.Methods: 23 purposively sampled UK community pharmacists were asked, in semi-structured interviews, to describe ethical problems in their work (...) and how they were resolved. Framework analysis of transcribed interviews utilised the four decision-making stages, together with constant comparative methods and deviant-case analysis.Results: Pharmacists were often inattentive and constructed problems in legal terms. Ethical reasoning was limited, but examples of appeals to consequences, the golden rule, religious faith and common-sense experience emerged. Ethical intention was compromised by frequent concern about legal prosecution. Ethical inaction was common, typified by pharmacists’ failure to report healthcare professionals’ bad practices, and ethical passivity emerged to describe these negative examples of the four decision-making stages. Pharmacists occasionally described more ethically active decision-making, but this often involved ethical uncertainty.Discussion: The four decision-making stages are a useful tool in considering how healthcare professionals try to resolve ethical problems in practice. They reveal processes often ignored in normative theories, and their recognition and the emergence of ethical passivity indicates the complexity of decision-making in practice. Ethical passivity may be deleterious to patients’ welfare, and concerns emerge about improving pharmacists’ ethical training and promoting ethical awareness and responsibility. (shrink)

BackgroundAs opioid use disorder (OUD) incidence and its associated deaths continue to persist at elevated rates, the development of novel treatment modalities is warranted. Recent strides in this therapeutic area include novel anti-opioid vaccine approaches. This work compares logistical and ethical considerations surrounding currently available interventions for opioid use disorder with an anti-opioid vaccine approach.MethodsThe opinions of student pharmacists and practicing pharmacists assessing knowledge, perceptions, and attitudes toward current and future OUD management strategies were characterized using a staged, multi-modal research (...) approach incorporating a focus group, pilot survey development and refinement, and final survey deployment. Survey responses were assessed using one- and two-way parametric and non-parametric analyses where appropriate, and multi-dimensional matrix profiles were compared using z-tests following an exhaustive combinatorial sum of differences calculation between items within each compared matrix.ResultsFocus group content analysis revealed a high level of agreeableness among participants regarding anti-opioid vaccine technology and a sense of shared ownership regarding solutions to the opioid epidemic at large. Pilot survey results demonstrated subject ability to consider both pragmatic and ethical considerations related to current therapeutics and novel interventions in a single instrument, with high endurance amongst engaged subjects. Access inequality was the most concerning ethical consideration identified for anti-opioid vaccines. Support for anti-opioid vaccine implementation across various clinical scenarios was strongest for voluntary use amongst individuals in recovery, and lowest for mandatory use in at-risk individuals.ConclusionsEthical and logistical concerns surrounding anti-opioid vaccines were largely similar to those for current OUD therapeutics overall. Anti-opioid vaccines were endorsed as helpful potential additions to current OUD therapeutic approaches, particularly for voluntary use in the later stages of clinical progression. (shrink)

Despite the potential value of graduate-level research ethics training, most Middle East countries, including Jordan, do not routinely offer formal research ethics training. In students enrolled in Jordanian master’s level graduate program in pharmacy, the current study assessed: 1- differences in pre- and post-enrollment exposure to research ethics core themes, 2- whether this exposure was through a formal course or in an informal setting, and 3- student attitudes towards research ethics education and the need for integrating a dedicated research (...) ethics course into pharmacy graduate programs. A 12-item on-line survey was developed by the authors and disseminated to a convenience sample of current and former master-level pharmacy students in Jordan. A total of 61 eligible respondents completed the survey. A minority of respondents (38%) acknowledged receiving research ethics training prior to enrollment into a postgraduate pharmacy program with nearly half (16%) describing this training as informal. In comparison, a larger percentage of the total respondents (56%) had received research ethics training during their postgraduate program enrollment, with nearly half of those (25%) indicating that this training was informal. A majority of respondents reported a strong need for integrating a formal research ethics course into postgraduate pharmacy curriculum (90%) to support their research training and thesis writing (89%). Overall, the study revealed a notable lack of research ethics education for graduate-level pharmacy students in Jordan. (shrink)

Patient counseling is a cornerstone of ethical pharmacy practice and high quality pharmaceutical care. Counseling promotes patient compliance with prescription regimens and prevents dangerous drug interactions and medication errors. Counseling also promotes informed consent and protects pharmacists against legal risks. However, economic, social, and technological changes in pharmacy practice often force community pharmacists to choose between their professional obligations to counsel patients and business objectives. State and federal legislatures have enacted laws that require pharmacists to counsel patients, but (...) these laws have had mixed results. This essay argues that community pharmacy's patient counseling conundrum can be solved through additional moral education and moral persuasion, not through additional legal mandates. (shrink)

Introduction There is a paramount need for moral development for pharmacists and pharmacy students to practice the patient-centered profession. We aimed to explore the current situational judgment utilizing ethical reasoning among undergraduate pharmacy students. Methods A set of ten ethical dilemmas, representing potential real-life situations that the students come across in the university and may face in the future as a pharmacist were developed by a team of students, academic staff, and stakeholders. These ethical dilemmas were validated, checked (...) for accuracy, and piloted. An online questionnaire was created consisting of these ten scenarios as open-ended questions and administered to fourth year and fifth year PharmD students in a public university located at the city of Mecca, Saudi Arabia, asking them how they would react in that situation. Responses of the participants were analyzed using thematic analysis independently by four researchers and inter-rater agreement were achieved through consensus. Results Out of 205, 186 students completed the questionnaire with a response rate of 90.7%. Analysis and resulted in the generation of 32 codes, which were then categorized into seven overarching themes: student engagement, social and professional responsibility, academic integrity, legal obligation, moral obligation, signposting, and moral engagement and patient safety. Conclusions Undergraduate pharmacy students experience complex state of mind in connection with ethical reasoning. The participants’ situational judgment were driven by cultural norm, authority, and responsibility. Student engagement is also affected by the state of mind and feelings of mutual trust, perceived cultural influence and peer pressure. The students were prone to seek help from university administrators or teachers when faced with situations in which they were helpless. (shrink)

This article addresses a set of exploratory questions related to emergency contraception and the right to refuse to dispense such drugs. The paper first address the roles of the pharmacist in American society, i.e., as professional, employee, and business owner, and the pharmacists's identity and belief system; second, the paper reviews the status of state law and proposed legislation concerning patient/consumer access to emergency contraceptives; third, it offers an in-depth stakeholder analysis of the ethical and legal responsibilities of pharmacies to (...) stakeholders; and fourth, the paper provides overview of the salient ethical and legal issues concerning patient/customer access to emergency contraceptives relevant to management. The conclusions discuss questions for further research as well as strategic/human policy recommendations that balances the economic, legal, and ethical concerns of all primary stakeholders of the company/business, such as designing a management system which refers customers in a timely fashion; recognizing "conscience clauses," while ensuring that pharmacists "do no harm" to the consumer; and disseminating management "best practices" on "conscience clauses" through joint professional/industry sponsorship. (shrink)

BackgroundPharmacists as the trustee of pharmacy services must adhere to ethical principles and evaluate their professionalism. Pharmacists may sometimes show different unethical behaviors in their interactions, so it is essential to understand these behaviors. The present study aimed to determine the challenges of ethical behaviors based on a principles-based approach in the area of drug supply in pharmacies.MethodsThis qualitative content analysis was conducted in Kerman in 2018. A number of key players in the field of medication supply were selected (...) using snowball sampling to interview. An effort was made to select samples with maximum variation. Exclusion criteria include having less than 3 years of work experience in pharmacy and supervision, not willing to participate in the interview, and not participating in the interview for 3 times. The participants in this study consisted of pharmacy technicians, patients, pharmacists, inspectors of insurance companies, and inspectors of food and drug administration. Data were analyzed using directed content analysis by Maxqda software version 10. The principles of “Beauchamp and Childress Ethics” theory including autonomy, beneficence, non-maleficence, and justice were selected as the main principles.ResultsAfter data analysis, 8 main categories and 26 subcategories were obtained. The main categories include patient privacy, patient independence, communication principles, patient-centered services, drug supplier, patient harm avoidance, supervision, and distributive, procedural, and interactional justice. The subcategories include increasing patient awareness, culturizing prescription, and rational drug use, confidentiality and privacy, and pharmacist-patient relationship/communication, which were the main ethical challenges in the area of drug supply at pharmacies.ConclusionsAccording to a principle-based approach, the greatest challenges were related to two principles of autonomy and beneficence. The policymakers in the healthcare system should emphasize patient independence, patient privacy, and patient-centered services. The results of this study can be used as a tool to introduce ethical challenges to policymakers and develop educational contents, the chart of professional ethics in pharmacies, and accreditation measures of pharmacies. (shrink)

Empirical ethics research is increasingly valued in bioethics and healthcare more generally, but there remain as yet under-researched areas such as pharmacy, despite the increasingly visible attempts by the profession to embrace additional roles beyond the supply of medicines. A descriptive and critical review of the extant empirical pharmacy ethics literature is provided here. A chronological change from quantitative to qualitative approaches is highlighted in this review, as well as differing theoretical approaches such as cognitive moral development and (...) the four principles of biomedical ethics. Research with pharmacy student cohorts is common, as is representation from American pharmacists. Many examples of ethical problems are identified, as well as commercial and legal influences on ethical understanding and decision making. In this paper, it is argued that as pharmacy seeks to develop additional roles with concomitant ethical responsibilities, a new prescription is needed for empirical ethics research in pharmacy—one that embraces an agenda of systematic research using a plurality of methodological and theoretical approaches to better explore this under-researched discipline. (shrink)

Pharmacy Benefit Managers (PBM) induce drug manufacturers to offer rebates to insurers and employers by denying coverage through formulary exclusions, impeding physician prescription through prior authorization, and reducing patient drug use through cost sharing. As they tighten these access obstacles, PBMs reduce the net prices received by the manufacturers.

: This paper examines the obligations of pharmacy licensees and pharmacists in the context of conscience-based objections to filling lawful prescriptions for certain types of medications—e.g., standard and emergency contraceptives. Claims of conscience are analyzed as means to preserve or maintain an individual's moral integrity. It is argued that pharmacy licensees have an obligation to dispense prescription medications that satisfy the health needs of the populations they serve, and this obligation can override claims of conscience. Although efforts should (...) be made to respect the moral integrity of pharmacists and accommodate their claims of conscience, it is argued that the health needs of patients and the professional obligations of pharmacists limit the extent to which pharmacists may refuse to assist patients who have lawful prescriptions for medically indicated drugs. (shrink)

Do UK community pharmacists encounter the high drama dilemmas of the medical ethics literature or is a 'morality of the mundane' more appropriate? This paper presents the findings of a qualitative study that asked a sample of UK pharmacists to describe their ethical issues and to establish whether these were ethical dilemmas as understood philosophically or ethical problems of a more legal or emotional nature. It emerged that although many pharmacists referred to 'dilemmas', these were often problems involving a conflict (...) between an ethical value and a legal or procedural issue and often arose in the routine minutiae of dispensing prescriptions and selling medicines. Such ethical problems remained of concern for pharmacists and the commercial environment, corporate pharmacy ownership and pharmacists' subordination to doctors, all precipitated ethical problems. Law and ethics appeared to be understood synonymously but this may reflect a modernity that increasingly brackets out ethical experiences by encouraging reliance upon law and procedure. (shrink)

One of the key learning objectives in any health professional course is to develop ethical and judicious practice. Therefore, it is important to address how medical and pharmacy students respond to, and deal with, ethical dilemmas in their clinical environments. In this paper, we examined how students communicated their resolution of ethical dilemmas and the alignment between these communications and the four principles developed by Beauchamp and Childress. Three hundred and fifty-seven pharmacy and medical students (overall response rate=63%) (...) completed a questionnaire containing four clinical case scenarios with an ethical dilemma. Data were analysed using multiple methods. The findings revealed that 73% of the qualitative responses could be exclusively coded to one of the ‘four principles’ determined by the Beauchamp and Childress' framework. Additionally, 14% of responses overlapped between the four principles (multiple codes) and 13% of responses could not be coded using the framework. The subsequent subgroup analysis revealed different response patterns depending on the case being reviewed. The findings showed that when students are faced with challenging ethical dilemmas their responses can be aligned with the Beauchamp and Childress framework, although more contentious dilemmas involving issues of law are less easily categorised. The differences between year and discipline groups show students are developing ethical frames of reference that may be linked with their teaching environments and their levels of understanding. Analysis of these response patterns provides insight into the way students will likely respond in ‘real’ settings and this information may help educators prepare students for these clinical ethical dilemmas. (shrink)

This article presents the development, validation and application of an instrument to measure everyday moral distress in different health care settings. The concept of moral distress has been discussed and developed over 20 years. A few instruments have been developed to measure it, predominantly in nursing. The instrument presented here consists of two factors: level of moral distress, and tolerance/openness towards moral dilemmas. It was tested in four medical departments and three pharmacies, where 259 staff members completed a questionnaire. The (...) two factors were found to be reliable. Differences in levels of moral distress were found between pharmacies and clinical departments, and between the youngest and oldest age groups; departmental staff and the youngest group experienced higher levels of moral distress. Departments reported less tolerance/openness towards moral dilemmas than pharmacies. The instrument needs to be tested further, but its strengths are the focus on everyday ethical dilemmas and its usefulness in different health care settings. (shrink)

Researching ethical problems and their frequency could give us a complex picture and greater insight into the types of ethical issues that pharmacists face in providing health care. The overall aim of this study was to assess the pharmacist’s perception of difficulty and frequency of selected ethical issues encountered by the community pharmacists in their everyday practice. A quantitative cross sectional multicenter study was performed using a validated survey instrument - Ethical Issue Scale for Community Pharmacy. The results of (...) the analysis of 690 completely filled out instruments showed the difference between the ethical issues which always occurred, and the ones that pharmacists found most difficult. The majority of respondents were familiar with the Code of Ethics but the correlation between the familiarity and the perceived usefulness of the code in resolving problems in everyday practice was negative. Results showed that patients’ well-being had a high influence on pharmacists’ behavior. The results provided quantitative data by the examination of specific ethical issues and their occurrence. Further empirical research is recommended in order to systematically identify the ethical issues faced by community pharmacists. (shrink)

Industry analysts estimate that Internet pharmacies will generate $1.4 billion in prescription drug sales by 2001 and over $15 billion by 2004. The recent rush by traditional brick and mortar pharmacies either to partner with existing Internet pharmacies or to create their own web counterparts illustrates the increasing importance of business on the Internet. Last summer, retail pharmacy giant CVS acquired the Internet pharmacy soma.com and changed its name to reflect the new ownership. Early this year, in another (...) key industry move, Walgreen's launched an upgraded, full-service Internet pharmacy in order to compete more successfully in the pharmacy industry. (shrink)

Industry analysts estimate that Internet pharmacies will generate $1.4 billion in prescription drug sales by 2001 and over $15 billion by 2004. The recent rush by traditional brick and mortar pharmacies either to partner with existing Internet pharmacies or to create their own web counterparts illustrates the increasing importance of business on the Internet. Last summer, retail pharmacy giant CVS acquired the Internet pharmacy soma.com and changed its name to reflect the new ownership. Early this year, in another (...) key industry move, Walgreen's launched an upgraded, full-service Internet pharmacy in order to compete more successfully in the pharmacy industry. (shrink)

Pharmacists who refuse to provide certain services or treatment for reasons of conscience have been criticized for failing to fulfil their professional obligations. Currently, individual pharmacists in Great Britain can withhold services or treatment for moral or religious reasons, provided they refer the patient to an alternative source. The most high-profile cases have concerned the refusal to supply emergency hormonal contraception, which will serve as an example in this article.I propose that the pharmacy profession's policy on conscientious objections should (...) be altered slightly. Building on the work of Brock and Wicclair, I argue that conscientious refusals should be acceptable provided that the patient is informed of the service, the patient is redirected to an alternative source, the refusal does not cause an unreasonable burden to the patient, and the reasons for the refusal are based on the core values of the profession. Finally, I argue that a principled categorical refusal by an individual pharmacist is not morally permissible. I claim that, contrary to current practice, a pharmacist cannot legitimately claim universal exemption from providing a standard service, even if that service is available elsewhere. (shrink)

Jessica Flanigan argues that individuals have the right to self-medicate. Flanigan presents two arguments in defense of this right. The first she calls the epistemic argument and the second she calls the rights-based argument. I argue that the right to self-medicate hangs and falls on the rights-based argument. This is because for the epistemic argument to be sound agents must be assumed to be epistemically competent. But, Flanigan’s argument for a constitutionally mandated right to self-medicate models agents as epistemically incompetent. (...) For Flanigan, agents are different at the pharmacy than they are at the polls. I identify this behavioral asymmetry and advocate a symmetric and realistic behavioral postulate for both arguments. The result, however, is that the success of the epistemic argument becomes contingent which fails to justify a constitutionally mandated right. I proceed to raise skepticism about the rights-based argument as well. I conclude that there is reason to be skeptical that these arguments can justify a constitutionally mandated right to self-medicate. Ultimately, a bottom-up approach to pharmaceutical ethics is preferable. (shrink)

This article addresses a set of exploratory questions related to emergency contraception and the right to refuse to dispense such drugs. The paper first addresses the roles of the pharmacist in American society, i.e., as professional, employee, and business owner, and the pharmacists’s identity and belief system; second, the paper reviews the status of state law and proposed legislation concerning patient/consumer access to emergency contraceptives; third, it offers an in-depth stakeholder analysis of the ethical and legal responsibilities of pharmacies to (...) stakeholders; and fourth, the paper provides overview of the salient ethical and legal issues concerning patient/customer access to emergency contraceptives relevant to management. The conclusions discuss questionsfor further research as well as strategic/human resource management policy recommendations that balances the economic, legal, and ethical concerns of all primary stakeholders of the company/business, such as designing a management system which refers customers in a timely fashion; recognizing “conscience clauses,” while ensuring that pharmacists “do no harm” to the consumer; and disseminating management “best practices” on “conscience clauses” through joint professional/industry sponsorship. (shrink)

It is widely accepted in the pharmacy profession that pharmacists have the right to conscientiously refuse to participate in certain practices on grounds of conscience. This is allowed in recognition of differences in moral and religious views and out of respect for moral integrity. However, the “conscience clause” does not necessarily sit easily in a professional code of ethics owing to the potential tensions between a professional’s personal moral integrity and her professional obligations. At the heart of these tensions (...) are philosophical questions about the nature of conscience and integrity.These in turn lead to important practical ethical questions about the adequacy of a conscience clause to protect integrity and patient’s rights and guard against wrongdoing, whether conscientious refusals should be publicly announced in advance and what the acceptable bases of a conscientious refusal might be. Such questions apply not just to the professional, but also to pharmacy students, who may hold conscientious objections to some aspects of their training.It is concluded that the conventional compromise that is commonly in place in the pharmacy profession is a workable but imperfect solution and that better understanding of the concepts and competing obligations may be achieved by learning more about conscientious decision-making by pharmacists in practice. (shrink)

General practice (community) pharmacy as a healthcare profession is largely devoted to therapeutic treatment of individual patients whether in dispensing medically authorised prescriptions or by providing members of the public with over-the-counter advice and service for a variety of common ailments. Recently, community pharmacy has been identified as an untapped resource available to undertake important aspects of public health and in particular health promotion. In contrast to therapeutic treatment, public health primarily concerns the health of the entire population, (...) rather than the health of individuals (Childress et al. in J Law Med Ethics 30:170–178, 2002). Thus, an important question for the profession is whether those moral and professional values that are appropriate to the therapeutic care of individual patients are relevant and adequate to support the additional public health role. (shrink)

This article explores the patient consent process in modern community pharmacy practice and discusses the related ethical dilemmas in this environment. The myth of appropriately informed consent, and irrefutable evidence as to a pharmacist’s intentions when advising a patient, are core issues for discussion. The objective is to clarify where such dilemmas may exist in the consent process and to ultimately form a framework against which ethical guidelines might facilitate resolution of the dilemma faced by the pharmacist who is (...) expected to simultaneously maintain legal and duty of care responsibilities in the patient consent process. (shrink)

This publication features the stories and experiences of pharmacy professionals who identify as members of historically underrepresented groups. This collection of personal essays presents significant events in the lives of those in the pharmacy community whose experiences have been shaped by their race, ethnicity, gender or gender presentation, sexual orientation, ability, language, mental health, or other factors. The perspectives from the narratives highlight the importance of diversity, equity, and inclusion in the healthcare sector. The authors of the narratives (...) also reflect on their experience to consider what they wish would have happened in the experience, to offer advice for others that may be faced with similar situations. Access to these stories will deepen the collective understanding among pharmacy colleagues, patients, and society of the experiences that individuals from historically underrepresented groups within pharmacy have experienced. (shrink)

This article describes the development, implementation, and evaluation of a complex methotrexate ethics case used in teaching a Pharmacy Law and Ethics course. Qualitative analysis of student reflective writings provided useful insight into the students’ experience and comfort level with the final ethics case in the course. These data demonstrate a greater student appreciation of different perspectives, the potential for conflict in communicating about such cases, and the importance of patient autonomy. Faculty lessons learned are also described, facilitating adoption (...) of this methotrexate ethics case by other healthcare profession educators. (shrink)

This book inquires into the swarm of ontological, epistemological, and ethical questions provoked by psychedelic experience in the context of global ecological crisis. Richard M. Doyle is professor of English and science, technology, and society at Pennsylvania State University. He is the author of On Beyond Living and Wetwares.

The technological advances of the 20th century resulted in the creation of the Internet and its introduction into everyday life on a global scale. The Internet provides access to information and the sale and purchase of goods. Medications are also subject to trade. Their sale is conducted by online pharmacies and their global turnover amounts to hundreds of billions of dollars. Medications ordered over the Internet are sent by mail all over the world. Considering the events of recent years, we (...) cannot exclude the risk of a terrorist attack through online pharmacies. Terrorists can establish such companies, legally or illegally, or acquire ones already existing. Parcels, which are highly trusted by the customers of online pharmacies, can, for example, be contaminated with dangerous materials. The sale of online medications in the international system is potentially dangerous and requires international regulation. (shrink)

Innovation is fundamental to the pharmaceutical industry and a key to improvements in healthcare. Its effectiveness depends on huge, constant investments in research. This innovative industry directly affects the course of studies in healthcare and medicine. Its efforts translate directly into the length and quality of our lives. For several years now, the progress underway in pharmaceutical industry has produced measurable benefits. Doctors have new pharmaceuticals at their disposal, including many types of antibiotics and anti-viral drugs, vaccines and a wide (...) range of drugs which save lives or make them more comfortable. In the near future, ever more efficient cures for neoplastic, rheumatic, neurological, psychic, metabolic, circulatory or respiratory diseases can be expected. (shrink)

Recently, Congress has focused on reforms to address pharmacy benefit managers’ (PBMs) role in high drug prices for patients. Congress must not excessively restrict PBMs’ ability to negotiate with manufacturers; alternatively, reforms could be paired with other policies that address the high prices of brand-name drugs.

The claim is made in the book, Applied Ethics, published under the auspices of the Australian Association for Professional and Applied Ethics (AAPAE), that it can strengthen ethical behaviour. That claim, embodied in the subtitle, is based on more than a half dozen practices set out in the book. In total, they are drawn from an examination of ethical practices across fourteen different disciplines. The purpose of this paper is to outline and support that claim, drawing primarily on chapters of (...) the book, but also drawing on a small amount of additional information. The research on the ethical issues in each of these disciplines, and the writing of the chapters, were undertaken by members and associates of AAPAE. The fourteen disciplines were Marketing, Business, Accounting, Pharmacy, Nursing, Medicine, Veterinary & Animal Ethics, Engineering, Information and Communications Technology (ICT), Journalism, Policing, Politics, the Law and the Sciences. The findings have significance for the teaching of ethics by moral philosophers, for not all ethics classes follow the practices suggested by these findings. A few of the practices are even rejected by some moral philosophers. That the practices will improve ethical behaviour is the principal position taken by this paper. -/- . (shrink)