PHA 361 - Introduction to Ethics L5

Ethics

The study of moral principles and values that guide behavior and decision-making

Ethical dilemma

A conflict involving clashing values where there is no perfect solution

Right vs. right

A true ethical dilemma involving two morally acceptable choices

Right vs. wrong

A legal or moral issue where one option is clearly incorrect

The four paradigms of ethical dilemmas

Truth vs. Loyalty; Individual vs. Community; Short-term vs. Long-term; Justice vs. Mercy

Truth vs. Loyalty

Conflict between telling the truth and remaining loyal to a person, organization, or ideal

Truth

Conformity with facts or reality

Loyalty

Allegiance or fidelity owed to a person, government, or set of ideals

Individual vs. Community

Conflict between protecting individual rights and promoting the welfare of society

Example of Individual vs. Community

Immunizations and public health measures

Short-term vs. Long-term

Conflict between meeting present needs and planning for future consequences

Justice vs. Mercy

Conflict between fairness/rules and compassion/case-by-case consideration

Justice in ethical dilemmas

Following rules and fairness regardless of personal circumstances

Mercy in ethical dilemmas

Showing compassion and benevolence toward individuals

Ends-based thinking

Doing whatever produces the greatest good for the greatest number

Rules-based thinking

Following moral principles or duties regardless of consequences

Care-based thinking

Treating others the way you would want to be treated

Principles of Western Ethics

Autonomy, Veracity, Fidelity, Avoid Killing, Justice

Autonomy (Western ethics)

Respecting the independent choices of others

Veracity

Telling the truth

Fidelity

Keeping promises, commitments, contracts, and covenants

Avoid killing

The principle that taking human life is wrong

Justice (Western ethics)

Fair distribution of goods and harms

Clinical ethics

A structured approach to ethical questions in healthcare practice

Bioethics

The study of ethical issues in medicine and healthcare

The two major focuses of bioethics

Protection of life and transmission of life

Examples of protection of life issues

Abortion, organ transplants, stem cell research, addiction, mental health, death and dying

Examples of transmission of life issues

Fertility control, artificial insemination, IVF, sterilization, genetic counseling, genetic screening

Clinical ethics in practice

The ability to identify and analyze an ethical question and reach a reasonable conclusion and recommendation for action

Four principles of biomedical ethics

Beneficence, Nonmaleficence, Respect for patient autonomy, Justice

Beneficence

Actions required to provide benefit and promote patient welfare

Nonmaleficence

Actions required to prevent harm; “do no harm”

Respect for patient autonomy

Respecting a patient’s right to make their own healthcare decisions

Justice (Biomedical ethics)

Fair and equitable distribution of healthcare burdens and benefits

Beneficence examples

Removing harm, promoting welfare, balancing risks and benefits of therapy

Nonmaleficence and negligence

The professional must have a duty, breach the duty, harm occurs, and harm is caused by the breach

The four requirements for negligence

Duty; Breach of duty; Harm experienced; Harm caused by breach

Respect for patient autonomy includes

Informed consent, self-determination, avoiding paternalism

Paternalism

Acting like a parent by making decisions for the patient without their input

Justice and drug shortages

Fair distribution and allocation of limited healthcare resources

Western ethics vs biomedical ethics

Biomedical ethics replaces veracity/fidelity with beneficence and nonmaleficence

Hierarchy of decision making in pharmacy

Legal Duty → Principles of Western Ethics → Principles of Biomedical Ethics → Professional Duty (Covenant)

Legal duty

Laws and regulations governing pharmacy practice

Professional duty (covenant)

The pharmacist’s professional promise and obligation to the patient

Covenantal relationship

A professional promise between pharmacist and patient involving trust and responsibility

Patient role in the covenantal relationship

Providing health information and payment for services/products

Pharmacist role in the covenantal relationship

Providing pharmaceutical care to the patient

Oath of a Pharmacist

A pledge to devote oneself to lifelong service through pharmacy

Primary concerns in the Oath of a Pharmacist

Welfare of humanity and relief of suffering

What pharmacists must protect according to the oath

Personal and health information

What pharmacists must improve according to the oath

Professional knowledge, expertise, and self-awareness

What pharmacists should advocate for according to the oath

Justice and health equity

Code of Ethics for Pharmacists

Professional ethical standards adopted by APhA in 2007

A pharmacist respects the covenantal relationship

Principle I of the Code of Ethics

A pharmacist promotes the good of every patient

Principle II of the Code of Ethics

A pharmacist respects patient autonomy and dignity

Principle III of the Code of Ethics

A pharmacist acts with honesty and integrity

Principle IV of the Code of Ethics

A pharmacist maintains professional competence

Principle V of the Code of Ethics

A pharmacist respects colleagues and health professionals

Principle VI of the Code of Ethics

A pharmacist serves societal needs

Principle VII of the Code of Ethics

A pharmacist seeks justice in health resource distribution

Principle VIII of the Code of Ethics

Ethical dilemmas commonly faced by pharmacists

Conflicts between patient needs and societal needs, confidentiality issues, scarce resources, religious/cultural conflicts, and research conflicts

Example of pharmacist ethical conflict

A pharmacist refusing to fill a medication due to personal religious beliefs

Patient confidentiality ethical conflict

Balancing privacy with protecting others from harm

Research ethical conflict

Balancing patient needs with research protocol requirements

The Four Topics Chart

Medical Indications; Patient Preferences; Quality of Life; Contextual Features

Medical Indications

Facts about the patient’s condition that guide treatment decisions

Biomedical ethics principles linked to Medical Indications

Beneficence and Nonmaleficence

Patient Preferences

The tests and procedures the patient has consented to receive

Another term for Patient Preferences

Informed consent

Biomedical ethics principle linked to Patient Preferences

Autonomy

Quality of Life

The patient’s satisfaction with physical, mental, and social wellbeing

Biomedical ethics principles linked to Quality of Life

Autonomy, Beneficence, Nonmaleficence

Contextual Features

Outside factors influencing healthcare decisions

Examples of contextual features

Religious, legal, familial, institutional, and financial factors

Biomedical ethics principles linked to Contextual Features

Justice and Autonomy

Advance Directive for Health Care (ADHC)

A legal document allowing patients to appoint a healthcare agent and direct end-of-life care

What the ADHC replaces in Georgia

Durable Power of Attorney for Health Care and the Living Will

DNR order

Do Not Resuscitate; no CPR during cardiac or respiratory arrest

Organ donation documentation

A document expressing wishes regarding organ donation

Statement of personal values

A written expression of beliefs and healthcare wishes

Medical Indications principle connection

Beneficence and Nonmaleficence

Patient Preferences principle connection

Autonomy

Quality of Life principle connection

Autonomy, Beneficence, Nonmaleficence

Contextual Features principle connection

Justice and Autonomy

The pharmacist should act in a manner that helps others

Beneficence

The pharmacist should avoid actions that hurt others

Nonmaleficence

The pharmacist should tell the truth and act with integrity

Veracity and Fidelity

The pharmacist should respect rights and choices

Autonomy

The pharmacist should be faithful in relationships

Fidelity

The pharmacist should be fair

Justice

The pharmacist should be kind

Mercy and compassion

What principle is associated with “do no harm”?

Nonmaleficence

What principle is associated with promoting patient welfare?

Beneficence

What principle is associated with informed consent?

Respect for patient autonomy

What principle is associated with fairness in healthcare?

Justice

What ethical thinking asks “What is good for most people?”

Ends-based thinking

What ethical thinking asks “What is my duty?”

Rules-based thinking

What ethical thinking asks “How would I want to be treated?”

Care-based thinking

What does autonomy mean?

The moral right to choose and follow one’s own plan of life and action