Ethics Exam

Rest-Kohlberg’s Theory of Cognitive Moral Development Level 1 (Pre-conventional morality)

• around 9 years and younger

• no personal code of morality

• moral code shaped by standards of adults

• focus is on consequences of following or breaking rules

ex: dont want to help patients unless they get paid for it

Rest-Kohlberg’s Theory of Cognitive Moral Development Level 2 (conventional morality)

• most adults and adolescents

• begin to internalize the moral standards of valued adult role models

• reasoning based on norms of social groups

ex: consistent w/ state and federal laws

Rest-Kohlberg’s Theory of Cognitive Moral Development Level 3 (post-conventional morality)

• only 10-15% of people here

• individual judgment based on self-chosen, universal principals

• moral reasoning based on individual rights and justice

ex: if told that they cannot do patient centered care, will leave that job

why is moral reasoning skills important

higher level moral development is related to more professional decision-making, pre-disposition to patient centered care, and better clinical importance

• this is a teachable skill

list the characteristics of a profession and describe how pharmacy meets these characteristics

• specialized knowledge and training

• commitment to provide important services or information to patients, clients, students, or consumers

• maintain self-regulating organizations

• control entry into occupational roles through formal certification

• specify and enforce obligations of their members

in general, pharmacy is held to a higher moral standard than the general public and is reflected in the code of ethics

explain how general moral obligations, special relationship obligations, and moral ideals are different

• general moral obligations are the moral actions we owe to all other persons regardless of relationships

• special relationship moral obligations are the moral actions we owe to other bc of our professional role or other relationships we have with them

• moral ideas are actions that are aspirational, but not required

identify differences between the 1852 and 1994 pharmacist codes of ethics

similarities:

• professional relationships (teamwork)

• competency and quality of products

• important of integrity

differences:

• 1994: more patient centered relationships and no business practices mentioned

• 1852: product focused

recognize ethical situations, ethical dilemmas, and sources of moral distress

an ethical situation is one in which the rights or welfare of others is impacted (many ethical issues) (rights = automatic)

an ethical dilemma is when there is significant uncertainty about the correct action to take

most ethical situations are not dilemmas because you know the right action to take, but when you are prevented from this you experience distress

define virtues and recognize that they can vary among groups of people

virtues: morally good traits or habits

• most impt. virtues for a group of people can vary

• groups with similar culture or language are likely to have similar virtues

list the health care professional virtues (6)

• care

• compassion

• discernment

• trustworthiness

• integrity

• conscientiousness

define the health care professional virtue: care

emotional commitment to and willingness to act on behalf of persons with whom has a significant relationship

define the health care professional virtue: compassion

• Prelude to caring → the beginning of caring / what comes before you start caring

• Active regard for another’s welfare combined with empathy → actually caring about someone and understanding how they feel

• The capacity to feel sorrow for another’s suffering → being able to feel sad when someone else is hurting

define the health care professional virtue: discernment

• Ability to make appropriate judgments and reach decisions without being unduly influenced by extraneous considerations → making good decisions without letting unimportant stuff affect you

• Practical wisdom → using common sense and real-life experience to make good choices

define the health care professional virtue: trustworthiness

To merit confidence in one’s character and conduct → being someone people can trust because of how you act and who you are

define the health care professional virtue: integrity

• Soundness, reliability, wholeness, and integration of moral character → being a strong, consistent, and honest person overall

• Objectivity, impartiality, and fidelity to moral norms → being fair, unbiased, and sticking to what’s right

define the health care professional virtue: conscientiousness

do what is right because it is right, trying with due diligence to determine what is right, intending to do what is right, and exerting appropriate effort to do so

health care professional virtues are present in the pharmacist code of ethics: 1— a pharmacist resects the covenantal relationship between the patient and pharmacist

patient-pharmacist relationship —> care

committed to their welfare—> compassion

and to maintain their trust —> trustworthiness

health care professional virtues are present in the pharmacist code of ethics: 2—promotes the good of every patient in a caring, compassionate, and confidential manner

dedicated to protecting the dignity in a confidential manner —> based on trust

health care professional virtues are present in the pharmacist code of ethics: 3— a pharmacist respects the autonomy and dignity of each patient

communicates with patients in terms that are understandable —> conscientiousness

respects —> trust

health care professional virtues are present in the pharmacist code of ethics: 4— a pharmacist acts with honesty and integrity in professional relationships

duty to tell the truth and to act with conviction— consciousnessness

health care professional virtues are present in the pharmacist code of ethics: 5— a pharmacist maintains professional competence

a pharmacist has a duty to maintain knowledge and abilities —> integrity and consciounessness

health care professional virtues are present in the pharmacist code of ethics: 6—a pharmacist respects the values and abilities of colleagues and other health professionals

when appropriate, a pharmacist asks for the consultation ….. acknowledges that colleagues and other health professionals may differ —> discernment

health care professional virtues are present in the pharmacist code of ethics: 7—serves individual, community, and societal needs

recognizes the responsibilities that accompany these obligations and act accordingly —> discernment and integrity

health care professional virtues are present in the pharmacist code of ethics: 8— seeks justice in the distribution of health resources

balancing the needs of patients and society —> discernment

identify the 6 domains of the Moral Foundations Theroy

• care

• fairness

• liberty

• loyalty

• authority

• sanctity

define values, and differentiate them from virtues

values are what we hold dear — what is important to you?

virtues are who we are — how would you describe your character

define empathy and differentiate the two aspects of empathy

the ability to recognize, understand, and share the thoughts and feelings of another person

the affective aspect of empathy addresses the emotional response
the cognitive aspect addresses perspective-taking

explain four challenges with empathy

• similarity bias that inhibits universal empathy

• psychological distress clinicians can experience

• assumption of being the expert of the patients experience

• temptation to use “fake empathy”

describe the origins of apothecaries and their role in Western Civilization

• The concept of pharmacists began during the Golden Age of Islam (~850 AD in Baghdad), where early apothecaries (Sayadilah) developed new drugs, preparations, and systems of regulation

• This idea spread to Europe (Spain & Italy around 1200) and became the apothecary profession

• Apothecaries played many roles:

  • Prepared and compounded medicines

  • Ensured drug quality and identity

  • Acted as shopkeepers and healthcare providers

  • Participated in guilds and government-regulated systems

• They were important in society as trusted middle-class professionals responsible for medicines and public safety

discuss how American pharmacy evolved

• Early US pharmacy was based on apprenticeship training (before ~1920) where individuals learned under a master apothecary

• 1800s–early 1900s:

  • Establishment of pharmacy schools (ex: Philadelphia College of Pharmacy, 1821)

  • Formation of professional organizations (APhA, 1852)

• Late 1800s–1930s:

  • Licensing laws and state board exams introduced

  • Shift toward formal education (BSc became standard by ~1932)

• Post-1950:

  • Push for pharmacy as a scientific, educated profession (PharmD movement)

  • Expansion of hospital pharmacy and new drug therapies

• After 1975:

  • Shift from independent store owners → employed professionals in larger systems

define characteristics of socialization in pharmacy

• Socialization = process of learning the values, skills, attitudes, and culture of the profession

• Includes:

  • Confidentiality

  • Responsibility and accuracy

  • Integrity and professionalism

  • Patient care mindset

• Occurs through:

  • Apprenticeships (historically)

  • Education, rotations, and workplace culture (modern)

• Two types:

  • Primary socialization: early life experiences

  • Secondary socialization: learning workplace/professional culture

• Historically involved hands-on learning, long hours, and mentorship under a master

outline educational shifts address professional aspirations in US pharmacy

• Transition from:

  • Apprenticeship model → formal education system

• Key changes:

  • Introduction of pharmacy schools (1800s)

  • Licensing requirements and standardized exams

  • Expansion to 2–3 year programs → 4-year BSc → 6-year PharmD

• After 1950:

  • Focus shifted from training shopkeepers to scientifically trained healthcare professionals

• Modern era:

  • Emphasis on clinical training, rotations, and patient care skills

  • Socialization becomes part of formal education (especially after universal PharmD)

characterize the paradigm shift in pharmacy practice that occurred with the general adoption of clinical pharmacy in the 1960’s and 70’s

• Major shift from:

  • Product-focused (dispensing drugs) → Patient-centered care

• Key ideas:

  • “Right drug, right patient, right time”

  • Pharmacists responsible for optimizing patient outcomes

• Changes in role:

  • Counseling patients

  • Monitoring drug therapy (interactions, allergies, effectiveness)

  • Collaborating with healthcare providers

• Cultural shift:

  • From merchant/customer relationship → healthcare provider/patient relationship

• Ethics evolved to prioritize patient health and safety above all

define autonomy and paternalism

autonomy: self governance that is free from controlling interference and limitations that prevent meaningful choice

paternalism: overriding someones wishes or preferences for their own benefit

describe the steps of informed consent and how autonomy is reflected in this process

1. competence: ability to perform a task

2. disclosure: provision of information by HCP

3. understanding: acquired pertinent information and have relevant beliefs about the nature and consequences of their action

4. voluntariness: person wills the action without being under control of another person or condition

5. consent: person’s verbalized agreement to course of action

explain the difference between hard and soft paternalism and recognize examples

soft paternalism: interventions intended to prevent or mitigate harm or to benefit a person when the person has not made an autonomous (informed) decision

hard paternalism: interventions intended to prevent or mitigate harm or to benefit a person despite the fact that the person’s risky choices and actions are autonomous (informed)

explain how pharmacists and other HCPs incorporate autonomy in the shared decision-making model

HCP can use shared decision-making (which incorporates many aspects of informed consent) to ensure patients are adequately informed about the anticipated benefits and harms of their choice and engage those patients in their care

define beneficence and nonmaleficence

beneficence is the bioethical principal that includes all actions taken to benefit another, including action to prevent harm

nonmaleficence is the bioethical principle that requires us to avoid causing harm

describe how nonmalifience and beneficence apply to the pyramid of moral obligations

tip to base:

moral ideals —> non-obligatory

special relationship obligations —> professional obligations

general moral obligations —> obligatory beneficent actions

explain why a failure to do a good act is not always a violation of beneficence

exceptions:

requires severe sacrifice

requires extreme altruism (selflessness concern for well-being of others w/o care of ones own)

action is unnecessary

the action is unlikely to cause the good intended

apply the rules of obligatory beneficence

1. protect and defend the rights of others

2. prevent harm from occurring to others

3. remove conditions that will cause harm to others

4. help persons with disabilities

5. rescue persons in danger

describe ways that pharmacists support beneficence in their practice

in every action they take to benefit another, including preventing harm (almost every responsibility of being a pharmacist)

describe ways that pharmacists may violate nonmaleficence in their practice

if they cause harm that cannot be justified by another principal (beneficence, autonomy) and they do not actively try to minimize the harm they cause

distributive justice

concerned with fair distribution of the benefits and burdens in society

procedural justice

concerned with fair methods of making decisions and settling disputes

corrective justice

concerned with correcting wrongs and harms through compensation or retribution

identify participants at each level (realm) of ethics

individual, organizational, societal)

primary concern of individual level

balance of benefit and harm within and between individuals

ex: participation in experimental treatment

primary concern of organizational level

the net organizational benefit— enables the organization to maximize its purpose now and into the future

ex: decision to downsize

primary concern of societal level

the common good of society —well-being of the community

ex: national health policy

how do the three levels inter-relate?

• individual choices impact organizations and society

• organizational choices impact individuals and society

• societal choices impact organizations and individuals

inter layer to outer layers:

• complexity and significance increases

• methods, concepts, principals, conclusions may not apply or have the same relevance at another level

• the ethical character of the outer levels powerfully defines the limits on ethical behavior of the inner levels

• deficits on outer levels cannot be adequately compensated by intervention on inner levels

describe characteristics of procedural justice

focus: fair methods of making decisions

1. oversight by a legitimate institution

2. transparent decision-making

3. reasoning according to info and principals (values) that can all accept as relevant (really hard)

4. procedures for appealing and revising individual decisions

5. meaningful public engagement

describe who has the strongest claim on scarce medical resources

those most likely to be benefited from receiving it, harmed from not receiving it, and desire to receive it

in some cases, health care workers may also have a strong claim due to reciprocity or utilitarian reasons

describe strategies for allocating scarce resources and limitations of each: utilitarian

do the most “good”

limitation: may result in unjust distribution of resources across individuals, despite the overall societal benefit

QWOLLY: measure that combines quantity in years and QOL (0-100%)

• prioritizes younger lives and may disadvantage those with chronic illness if they have a lower QOL

describe strategies for allocating scarce resources and limitations of each: egalitarian

everyone has an equal chance

limitations: ignores factors that are intuitively important in health care such as patient need and likelihood of benefit

describe strategies for allocating scarce resources and limitations of each: libertarian

each person is “entitled” to what their skills attain for them in a free market

limitation: prioritizes individual rights over welfare of society, assumption of level playing field where skills/efforts is the only differentiating factor

describe strategies for allocating scarce resources and limitations of each: prioritarian

help those who are the worst off

limitations: greatest need can be defined in different ways which can discriminate against certain patient groups, may result in inefficient use of resources