Ethics

Code of Ethics purpose

Intended to state publicly the principles that form the fundamental basis of the roles and responsibilities of pharmacists

Code of Ethics basis

Based on moral obligations and virtues, established to guide pharmacists in relationships with patients, health professionals, and society

Principle I

A pharmacist respects the covenantal relationship between the patient and pharmacist

Covenantal relationship

A pharmacist has moral obligations in response to the gift of trust received from society; promises to help individuals achieve optimum benefit from their medications, be committed to their welfare, and maintain their trust

Principle II

A pharmacist promotes the good of every patient in a caring, compassionate, and confidential manner

Principle II focus

Places concern for the well-being of the patient at the center of professional practice; considers needs stated by the patient and those defined by health science; dedicated to protecting the dignity of the patient

Principle III

A pharmacist respects the autonomy and dignity of each patient

Principle III function

Promotes the right of self-determination and recognizes individual self-worth by encouraging patients to participate in decisions about their health; communicates in terms that are understandable; respects personal and cultural differences

Principle IV

A pharmacist acts with honesty and integrity in professional relationships

Principle IV duties

Duty to tell the truth and act with conviction of conscience; avoids discriminatory practices, behavior or work conditions that impair professional judgment, and actions that compromise dedication to the best interests of patients

Principle V

A pharmacist maintains professional competence

Principle V duty

Duty to maintain knowledge and abilities as new medications, devices, and technologies become available and as health information advances

Principle VI

A pharmacist respects the values and abilities of colleagues and other health professionals

Principle VI function

When appropriate, asks for consultation or refers the patient; acknowledges that colleagues and other health professionals may differ in beliefs and values

Principle VII

A pharmacist serves individual, community, and societal needs

Principle VII primary obligation

Primary obligation is to individual patients; obligations may extend beyond the individual to the community and society

Principle VIII

A pharmacist seeks justice in the distribution of health resources

Principle VIII function

When health resources are allocated, a pharmacist is fair and equitable, balancing the needs of patients and society

Medical indications

Diagnosis, nature of disease, condition of the patient, treatment options

Patient preferences

Values, goals, desires, adequately informed, coerced

Quality of life

Personal, subjective, multidimensional: general, physical, psychological, social, cognitive, spiritual

Contextual features

Cultural, legal, financial, institutional, societal

Autonomy definition

Ability to self-rule

Nonmaleficence definition

Do no harm

Beneficence definition

Bring about a good; typically requires some effort on our part

Justice definition

Distribution of benefits and burdens; treating patients fairly

Generalizations helpful one

Are used consciously and analytically

Generalizations helpful two

Are descriptive and flexible

Generalizations helpful three

Seek to be accurate

Generalizations helpful four

Are an attempt to capture similarities and principles

Generalizations helpful five

Are constantly modified by new input

Generalizations process

When we make a generalization, we are attempting to look at the behavior of many people and note similarities; we focus on being descriptive and not judgmental; we are able to modify this broad view if we encounter new examples which disprove the description

Stereotypes harmful one

Are used unconsciously and reactively

Stereotypes harmful two

Are judgmental and rigid

Stereotypes harmful three

Seek to be simple

Stereotypes harmful four

Are an attempt to limit and pigeonhole

Stereotypes harmful five

Are fixed and not open to revisiting

Stereotypes process

Stereotypes tend to lock people into categories with the idea of limiting that group; seek to make judgments rather than to describe; once made, reluctant to modify them

PAS definition

Physician-assisted suicide: when a patient requests and is given a prescription for a lethal medication; the patient then takes the medication him/herself to end that person's life

Oregon PAS

Death with Dignity Act originally passed in 1994; re-vote in late 1997; passed and enacted

Washington PAS

Death with Dignity Act: 2009

Montana PAS

State Supreme Court ruling: 2009; nothing in state law prohibits a physician from prescribing medication to hasten death; defense against prosecution

Vermont PAS

Patient Choice and Control Act End of Life Act: 2013

California PAS

End-of-Life Option Act: 2016

Colorado PAS

End-of-Life Options Act: 2016

Hawaii PAS

Our Care, Our Choice Act: 2019

New Jersey PAS

Aid in Dying for the Terminally Ill Act: 2019

Maine PAS

Death with Dignity Act: 2019

New Mexico PAS

Elizabeth Whitefield End-of-Life Options Act: 2021

Delaware PAS

Ron Silverio/Heather Block Delaware End-of-Life Options Act: January 2026

New York PAS

Medical Aid in Dying Act will take effect August 2026

Illinois PAS

Deb's Law will take effect September 2026

Brittany Maynard

29-year-old California woman with terminal brain cancer, moved to Oregon and died in November 2014 as a result of PAS

Active euthanasia definition

When a physician injects a lethal medication into a patient with the primary intention to end that person's life

Active euthanasia legality

NOWHERE in the United States

Right to refuse to dispense abortifacient

Mifeprex (mifepristone) RU-486

Mifepristone approval

Approved in 2006 for medical termination of intrauterine pregnancy through 10 days' pregnancy

Mifepristone directions

Day 1: Mifeprex 200 mg; Day 2-3: Cytotec (misoprostol) 800 mcg buccally; Day 7-14: Provider visit follow-up

Mifepristone 2000 availability

Only available at clinics or through physicians; in-person consultations only

Mifepristone December 2021

FDA approved discussions via telehealth; mifepristone could be delivered through mail

Roe v Wade overturned

June 2022: U.S. Supreme Court overturned Roe v. Wade; now up to states about abortion

Mifepristone January 2023

FDA states pharmacists can now dispense mifepristone in certified pharmacies; new REMS

Plan B approval

Approved as dual-label status product in 2006

Plan B dose

0.75 mg levonorgestrel

Plan B directions

Take one tablet as soon as possible within 72 hours after unprotected sex and another tablet in 12 hours

Plan B access

Became behind-the-counter for those 18 and over and Rx for under 18

Plan B One-Step approval

Approved in 2009

Plan B One-Step dose

1.5 mg levonorgestrel

Plan B One-Step directions

Take one tablet as soon as possible within 72 hours after unprotected sex

Plan B One-Step access

Was BTC for those 18, then 17, then 15 and over and Rx for those under; NOW truly OTC for all

Other emergency contraceptives

Next Choice ONE DOSE, Take Action, My Way, AfterPill (available online only)

Emergency contraception endorsements

Endorsed by APhA, AMA, ACOG

2000 APhA statement

Plan B works by inhibiting either ovulation, fertilization, transportation, or implantation

2022 FDA statement

Plan B One-Step prevents pregnancy by acting on ovulation, which occurs well before implantation; evidence does not support that the drug affects implantation or maintenance of pregnancy after implantation, therefore, it does not terminate a pregnancy

Alabama puberty blocker law 2022

Governor Ivey signed Vulnerable Child Compassion and Protection Act; felony punishable by up to 10 years in prison for doctors to treat people under 19 with puberty blockers or hormones to affirm gender identity

Alabama puberty blocker January 2024

Alabama can enforce a ban outlawing the use of puberty blockers and hormones to treat transgender people under 19

Tennessee ban June 2025

U.S. Supreme Court upheld Tennessee's ban on providing gender-affirming care for minors

Pharmacist puberty blockers

Cannot dispense puberty blockers for gender due to it being an illegal prescription; can report but are not required to

Adults puberty blockers

NO known bans at this time

Right to refuse principle

You can object, but you cannot obstruct. You can get OUT of the way, but you cannot get IN the way

Carley's Law

April 2014: Governor Bentley signed allowing UAB to conduct research on CBD oil for treatment of seizures

UAB CBD research

December 2014-March 2015: Received green light from FDA and IRB; awaited DEA clearance

UAB study results

January-March 2016: Showed promising results; posters presented at international meetings

Leni's Law

May 2016: Governor Bentley signed allowing people to bring CBD oil into the state; legalizes possession of CBD oil of up to 3% THC

UAB study stop

August 2019: UAB stopped the study since Epidiolex was already approved

Compassion Act February 2021

Alabama Senate passes medical cannabis bill

Compassion Act May 2021

Alabama House passes; Senate approves; Governor Ivey signs into law

AMCC formation

September 2021: Ivey appoints 14-member Alabama Medical Cannabis Commission; Dr. Blakemore is the only pharmacist

AMCC license timeline

September 2022: Accepted applications; December 2022: Deadline; January-May 2023: Reviewed applications; June 2023: Awarded then rescinded due to scoring inconsistencies; August 2023: Awarded again with lawsuits; October 2023: New rules; December 2023: Awarded again; January 2024: Litigation; March 2025: Court allows AMCC to issue licenses again

Alabama medical cannabis conditions

Available to treat ~15 conditions including cancer, Parkinson's disease, and chronic pain

Alabama medical cannabis forms

Tablets, capsules, gummies, lozenges, topical oils, suppositories, transdermal patches, nebulizers, or vaporized oil

Alabama medical cannabis restrictions

Law forbids smoking or vaping medical cannabis, or baking it into food

Alabama medical cannabis approval

Patients need approval from a physician certified to dispense medical cannabis; must pay for registration card up to 65 a year

Alabama medical cannabis physician requirement