Pharmacy ethics and prescription medicines

1
Pharmacy ethics and prescription medicines
Dr David Badcott Centre for Applied
Ethics Cardiff University UK Email
badcottd_at_cf.ac.uk.
2
Summary Slide

• Pharmacy ethics and prescription medicines

• Concepts of vulnerability, obligation and trust.
• Recognition of principled autonomy.
• An ethical aide memoir the Georgetown
  mantra.
• Ethical compliance and prescription medicines
• (a) generics
• (b) counterfeit products
• (c) matters of conscience
  (beginning-of-life and end-of-
• life issues.

3
Pharmacy ethics and prescription medicines
To everyone who proposes to have a good
career moral philosophy is indispensable.
Cicero, De Officiis (duty), 44 BC
4
Pharmacy ethics and prescription medicines
I want to suggest that there is an ethical
dimension that applies to the majority of
pharmacists who work in general practice
(community) pharmacy, and hospitals and that the
basis of this is patient vulnerability and
professional obligation.
5
Pharmacy ethics and prescription medicines
(a) Primary or intrinsic vulnerability due to
disease or illness (b) Secondary
vulnerability exposure to treatment
6
Pharmacy ethics and prescription medicines
Tacit understanding
I (the patient), am vulnerable, need your help
and expertise you (the pharmacist or other
healthcare professional) undertake to provide it
in accepting, you incur a consequent obligation
toward me.
7
Pharmacy ethics and prescription medicines
Trust
Vulnerability Obligation
Context of ethical relationships
Principled patient autonomy
8
Pharmacy ethics and prescription medicines
Professional obligation in pharmacy has two main
components (1)   Relating to technical and
legal aspects of pharmacy (2)  
Ethical aspects
9
Pharmacy ethics and prescription medicines
Ø      The law informs you about what you must
do or must not do Ø      Ethics
helps you to decide what you ought to
do when the law is silent (Pharmacy
543 Course Outline, Washington School of Pharmacy
2005)
10
Pharmacy ethics and prescription medicines

• Georgetown mantra (GTM)
• Beneficence
• Nonmaleficence
• Autonomy
• Justice
• Plus veracity, privacy, confidentiality and
• fidelity

11
Pharmacy ethics and prescription medicines

• RPSGB Code of Ethics for Pharmacists and Pharmacy
  Technicians
• Make the care of your patients your first
  concern.
• Exercise your professional judgment in the
  interests of patients and the public.
• Show respect for others.
• Encourage patients to participate in decisions
  about their care.
• Develop your professional knowledge and
  competence.
• Be honest and trustworthy.
• Take responsibility for your working practices.

12
Pharmacy ethics and prescription medicines
It is clear, however, that ethics is nothing to
do with punishment and reward in the normal sense
of these words. There must indeed be some kind
of ethical reward and ethical punishment, but
they must reside in the action itself.
Tractatus Logico-Philosophicus. London
Routledge and Kegan Paul.
13
Pharmacy ethics and prescription medicines

• Prescription medicines
• Pharmacist has both technical and ethical
  responsibility for all pharmaceutical medicines
  that he or she supplies.
• Technical, legal and ethical responsibilities are
  sometimes difficult to separate or disentangle.
• Particular problems may be associated with
• (a) generics
• (b) counterfeit medicines.
• (c) beginning and end-of-life moral issues

14
Pharmacy ethics and prescription medicines
Considerations and concerns context of patient
vulnerability and trust
Considerations Source of supply? Potential
bioequivalence problems? Physical appearance
(shape/colour/texture) and organoleptic
properties?
Possible concerns Reliable/validated/counterfeit?
Acceptable rate of absorption (pharmacokinetics
pharmacodynamics) confirmed? Possible
confusion for elderly patients?
15
Pharmacy ethics and prescription medicines
FIP policy statement (Vancouver September 1997)
indicates that (1)   responsibility for
selection of the medicinal product will be that
of the pharmacist (made within specified
criteria) and (2)   regulatory authorities and
manufacturers should provide to pharmacists and
prescribers, bioavailability and other relevant
data relating to all medicinal products, where
these are important factors relative to efficacy
.
16
Pharmacy ethics and prescription medicines
The RPSGB Accreditation of UK Pharmacy Degree
Courses published 16 May 2002, p.5 indicates
under Outcomes that the graduate is
able to interpret and evaluate, for safety,
quality, efficacy and economy, prescriptions and
other orders for medicines, and to advise
patients and other healthcare professionals about
medicines and their usage.  
17
Pharmacy ethics and prescription medicines
American Academy of Neurology concerns about
generic substitution of anticonvulsant drugs
where it is claimed that (a(a)    the US Food
and Drug Administration allows for significant
differences between name-brand and generic drugs
(but) (b(b)   for some patients with epilepsy,
even minor differences in the composition of
anticonvulsant drugs can make a big difference
(Medscape Medical News, April 19, 2007).
18
Pharmacy ethics and prescription medicines

• Counterfeit variants
• Genuine drug diluted
• Misbranding
• Unapproved version
• No active content
• Contaminated or adulterated
• Post expiry date

Legal obligations? Ethical obligation? Patients
vulnerability and trust
19
Pharmacy ethics and prescription medicines
Considerations and concerns context of patient
vulnerability and trust Beginning-of-life and
end-of-life issues
Considerations Legal requirements. Moral
sensitivities of both patient and pharmacist.
Possible concerns Individual conscience in
context of obligation. Patient vulnerability,
autonomy Code of ethics.
20
Pharmacy ethics and prescription medicines
Considerations and concerns context of patient
vulnerability and trust
RPSGB Code of Ethics for Pharmacists and Pharmacy
Technicians (August 1st 2007) Section 3.1
Recognise diversity and respect the cultural
differences, values and beliefs of others. 3.2
Treat others politely and considerately. 3.3
Make sure that your views about a persons
lifestyle, beliefs, race, gender, age sexuality,
disability or other perceived status do not
prejudice their treatment or care.

21
Pharmacy ethics and prescription medicines
Considerations and concerns context of patient
vulnerability and trust
RPSGB Code of Ethics for Pharmacists and Pharmacy
Technicians (August 1st 2007) Section 3.4 Show
respect for others Ensure that if your
religious or moral beliefs prevent you from
providing a particular professional service, the
relevant persons or authorities are informed of
this and patients are referred to alternative
providers for the service they require.

22
Pharmacy ethics and prescription medicines
23
Pharmacy ethics and prescription medicines
24
Pharmacy ethics and prescription medicines