Ethical Behavior When Communicating with Patients

Ethical Patient Care

  • What is ethical behavior?
    • Generally, it is doing the right thing and adhering to professional standards. In pharmacy in NB, ethical guidelines are set up by the NB College of Pharmacists. NBCP gives each member a set of guidelines to follow when the member is faced with an ethical situation and dilemma
    • Pharmacists and pharmacy technicians in NB must follow the code of ethics outlined by NBCP. The Code of Ethics that NBCP uses is a values-based decision-making model along with bioethical principles of:
    • Beneficence
    • Non-maleficence
    • Respect for persons
    • Justice

A pharmacy Code of Conduct for a Modern World

  • Patient-centered approach
  • Be prepared to recognize and resolve ethical issues by understanding ethical principles and applying them to delivery of patient-centered care.

Key Principles Guiding Ethical Conduct

  • The Principal of Nonmalfeasance
    • Derived from primum non nocere: do not harm
    • The principle of non malfeasance requires a health care provider to not act in any way that inflicts needless harm to a patient, through acts of either commission or omission
    • Decide which course of action will do the greatest good
    • How can the principle of non malfeasance be violated?
    • Intentionally acting in a way that could cause harm to the patient: knowingly filling a prescription that the patient was allergic to
    • The result of negligence: filling a prescription for Zyrtec instead of Zyprexa
    • Must provide a standard of care that any reasonable professional would have provided under similar circumstances and at a level higher than an “ordinary person”
    • Held to “standards due care”
    • To further protect the public, standards have been established to
    • License and regulate pharmacy technicians and pharmacists in each province,
    • Pharmacy regulations,
    • Educational requirements for profession,
    • Continuing education for the profession
  • The Principle of Beneficence
    • To do no harm
    • Evaluate the potential benefits of intervention in relation to its risk of harming a patient.
    • Beneficence is the ethical principle that health professionals should behave in the best interest of those they serve.
    • Well-being of the patient at the center of professional practice.
    • Sometimes a conflict between patient and provider expectations; what the patient wants vs what a professional thinks they need.
    • Providing a treatment that treats the disease but has risks
  • The Principle of Autonomy: the right to make decisions on personal health care
    • Patient’s right to self- determination; the right of patients to choose their own life plans and courses of action.
    • Patient autonomy- actions that encourage patient involvement in decision-making
  • The Principle of Informed Consent: The way in which patient preferences become expressed and are applied out of respect for that patient’s autonomy
    • Patients have the right to full disclosure of all relevant aspects of care and must give deliberate consent to treatment based on “usable” information and a clear understanding of that information.
    • A provider withholding information as a way of influencing a patient’s decision is violating the principle of informed consent.
    • Sometimes more focus on disclosure than on patient understanding of the information.
    • The burden on health care providers is to make sure patients understand all they need to know both to make a reasoned decision about therapy and to implement therapeutic plans appropriately.
    • NBCPs definition of informed Consent: Requires the health care professional to disclose the amount of information that a reasonable person in the patient’s position would want to know. Informed patient consent can be garnered only if the patient understands treatment benefits and risk. Consent can be implied or expressed.
    • Taken from NBCP document Code of Ethics, Nov 27, 2017, page 9.
  • The Principle of Confidentially: Serves to ensure that health care providers are obligated to divulging information obtained from patients during medical treatment and to take reasonable precautions to protect that information
    • Regulations surrounding confidentially
    • The Personal Information Protection and Electronics Act: (PIPEDA)
    • The Right to Information and Privacy Act in NB
  • The Principles of Fidelity: faithfulness
    • Health care providers are expected to be loyal and/or faithful to their patients.
    • Main concern should be the welfare of the patients we serve.
    • Patients have the right to be treated with compassion and receive humane, sensitive care from their providers in a manner that will help them make the best decision they can
    • In the NBCP Code of Ethics this is referred to as a Fiduciary Relationship.
    • The definition they use is “ The health professional and the patient are engaged in a therapeutic relationship. “
    • This relationship is characterized by a power imbalance.
    • The professional is in a power position as a result of possessing specialized knowledge that the patient requires and the patient is vulnerable by virtue of being in need of that knowledge.
    • A consequence of this power imbalance is that the professional owes the patient a fiduciary duty, in other words, the professional has a duty to act in the patient’s best interest. This will require, amongst other considerations, the establishment of professional boundaries.
    • NBCP Code of Ethics, Nov 27, 2017 page 9.
  • The Principle of Justice: One of the four bioethical principles of the NBCP Code of Ethics
    • Justice: The social aspect of the principle of justice is paramount. Justice includes the broader social obligations to protect the public interest and includes facilitating equitable access to services and conducting business ethically.
    • Particularly challenging aspects of practice that justice impacts upon include allocation of rationed medication, patient incentives strategies, gifts, documentation, assumption and abrogation of responsibility, conflict of interest, dual relationships, advertising and referrals.
    • Taken from NBCP Code of Ethics, Nov 27,2017 page 7

How can Ethical Dilemmas Be Resolved

  • Ethical dilemmas exist when a decision or choice involves conflicts between competing \n moral claims or ethical principles.

  • To best reach an ethical decision you must use a structured approach. There are many guides available to help health care professionals through a decision-making process to reach an ethical decision.

    1. Will what I am about to do result in promoting and protecting the health, well-being, safety and interests of the public and/or patient?
    2. Will what I am about to do hold forth the independence, integrity and honor of the profession?

  • NBCP suggests using a process called “Values-Based Decision Making” where you asks yourself the following two questions:

  • The Process of Value-Based Decision Making

  1. Establish facts
  2. Ensure that everyone agrees on the facts
  3. Identify the conflicting or competing values of the parties involved
  4. Prioritize the core value of promoting and protecting the public interest
  5. Make a decision

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