Ethics in pharmacy practice : a practical guide

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 Foreword 5 Preface 7 References 9 Contents 10 Chapter 1: Introduction 14 The Approach to Ethics in This Text 16 A Short History of Ethics in Pharmacy Practice 17 A Preview of Topics 19 References 21 Chapter 2: Basic Ethical Theory 22 Introductory Concepts 22 Organizing Ethical Theories 24 Ethical Theories Based on Human Reason 26 Kantian Ethics 26 Natural Law Ethics 28 Ethical Theories Based on Tradition 29 Divine Command Theory 29 Medical Principlism 32 Ethical Theories Based on Relationships 33 Classical Utilitarianism 33 Situation Ethics 35 Virtue Ethics 35 Summary 36 References 37 Chapter 3: Human Value and Human Dignity 39 Human Personhood 39 Human Dignity 44 References 46 Chapter 4: Clinical Ethics in Historical Context, Part I 48 Medical Principlism and the Hippocratic Tradition 48 Informed Consent and Decision-Making Capacity 53 Truth Telling in Healthcare 55 Pediatric Consent and Assent 56 References 58 Chapter 5: Clinical Ethics in Historical Context, Part II 60 The Eugenics Era and Its Influence on Modern Healthcare Ethics 60 The Era of Nazi Medicine 65 References 71 Chapter 6: Clinical Ethics in Historical Context, Part III 73 Human Research Ethics: The Tuskegee Syphilis Study 73 The Willowbrook Hepatitis Studies 77 Human Subjects Research in the Belmont Era 78 Key Ethical Provisions of the Belmont Report 79 The Institutional Review Board 80 References 83 Chapter 7: Pharmacy Professionalism 84 The Ethics Code of Pharmacists 84 Virtue as the Foundation of Pharmacy Professionalism 88 Health and Wellness Promotion 89 Everyday Professionalism 90 Recent Developments 90 Pharmacy Professionalism and the Law 91 Conclusion 93 References 94 Chapter 8: Reproductive Ethics 96 Contraception 96 Abortion 100 Abortion Ethics 103 Assisted Reproductive Technologies 104 ART and Surrogacy 109 Conclusion 111 References 113 Chapter 9: Ethics at the End of Life – Part I 117 Introduction 117 Case Study 119 Defining Death 121 The Persistent Vegetative State 124 Advance Directives 126 Conclusion 129 References 130 Chapter 10: Ethics at the End of Life – Part II 132 The Assisted Suicide Debate 132 Current Legal Context in the United States 133 Ethical Arguments Against Assisted Suicide 135 Ethical Arguments in Favor of Assisted Suicide 139 Pharmacist Participation in Lethal Injection 142 Conclusion 146 References 147 Chapter 11: Rights of Conscience 148 References 156 Chapter 12: Vaccines, Resource Allocation, and Unproven Treatments 158 The Ethics of Vaccines 158 Ethics During a Pandemic 165 The Ethics of Unproven Treatments 169 Pandemic Update 171 Conclusion 176 References 178 Chapter 13: Case Studies and Policy Scenarios 182 Clinical Ethics Analysis: Key Steps 182 What Are the Medical Facts? 183 What Is the Central Ethical Question? 183 What Are the Legal and Situational Constraints? 183 Who Are the Stakeholders, and Who Decides? 183 What Is the Patient’s Quality of Life? 184 What Religious, Moral, or Cultural Factors Influence the Outcome? 184 What Ethical Principles Have a Bearing on the Case? 184 Based on these Principles, What Ethical Duties Conflict, and What Is Their Best Resolution? 184 What Is the Ethical Conclusion? 185 Clinical Case Studies 185 Case Study #1: Dealing with a Difficult Patient 186 Case Study #2: Dealing with Cultural Beliefs 188 Case Study #3: The Ethics of Palliative Care 191 Case Study #4: End-of-Life Decision Making 191 Case Study #5: Abortion and Malignancy 192 Case Study #6: Neglect in an 8-Year-Old Boy 193 Case Study #7: Helping a Patient with Substance Abuse Disorder 194 Case Study #8: A Patient with a Massive Head Injury 195 Case Study #9: Should the Pharmacist Dispense this Medication? 197 Case Study #10: Should This Patient Have Emergency Heart Surgery? 197 Case Study #11: Medical Marijuana for Chronic Pain 198 Case Study #12: A Forged Prescription 199 Case Study #13: Drug Scarcity During a Crisis 199 Case Study #14: Dispensing a Recalled Medication 200 Case Study #15: Who Gets the Insulin? 201 Case Study #16: When Should We Stop? 201 Case Study #17: A Handshake Arrangement 202 Case Study #18: Discontinuing an ICD 203 Policy Scenarios 204 Policy Case Study #1: Should the Pharmacist Support This Law? 204 Policy Case Study #2: Midazolam for Lethal Injection 205 Policy Case Study #3: Should We Use Nazi Research Data? 206 Policy Case #4: Rights of Conscience 207 Policy Case #5: Non-Medical Exemptions from a Vaccine Mandate 208 Policy Case #6: Testing a New Drug 209 Policy Case #7: A Grant-Funded Diabetes Study 209 References 210 Chapter 14: Genetic Ethics and Other Cutting-Edge Issues 212 The Genetic Frontier 212 Gene Editing 213 Three-Person Embryos 215 Genetic Information: Testing and Privacy Issues 217 Precision Medicine 219 Additional Challenges in Genetic Ethics 221 Other Cutting-Edge Issues 221 Machine Learning and Artificial Intelligence (AI) 221 The Rise of Telehealth and Telemedicine 222 The Ethics of Pharmacy Benefit Managers (PBMs) 222 Mandatory Preventative Treatments and Health Behaviors 222 The Continued Opioid Crisis 223 Conclusion 223 References 224 Glossary 227 Index 237 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. -- back cover