Ethical Behavior when

communicating with patients

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Ethical patient care
 Health care ethics is the application of the
core principles of bioethics ( autonomy,
beneficence, no maleficence, justice) to
medical and health care decision.
 It is the field of applied ethics that is

concerned with the vast array of moral

decision-making situations that arise in
the practice of medicine in addition to the
procedures and the policies that are
designed to guide such practice.

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Cont’d…
 A defining responsibility of a practicing physician
is to make decisions on patient care in different
setting, these decisions involve more than
selecting the appropriate treatment or
intervention.
 Ethics is an inherent and inseparable part of

clinical medicine as the physician has an ethical

obligation
-to benefit the patient
-to avoid or minimize harm
-to respect the values and preference of
the patient

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Goals of ethics education

 To appreciate the ethical dimensions of

patient care
 To understand ethical principles of medical
profession
 To have competence in core ethical behavioral
skills
 To know the commonly encountered ethical
issues in general and in one’s specialty
 To have competence in analyzing and resolving
ethical problems

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Ethics in Pharmacy Practice

 It is important that pharmacists always

uphold their professional integrity and
endeavor to provide the best service to
their patients.
 This includes staying up-to-date with new

knowledge that could affect their decision

and using the trust held by the pharmacy
profession for positive outcomes to promote
the health of the general public whenever
possible.
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A Pharmacy Code of Conduct for
a Modern World
 Over the last few decades rapid
advancements in health care adoption of
new technologies have changed the
environment in which medical care is given.
 Despite its rapid change, the health care

environment remains an exciting and

complex arena offering rich opportunities
for growth , professional satisfaction, and
interesting intellectual challenges that
affect all professionals.

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Cont’d…
 Pharmacists are an essential part of the health
care multidisciplinary team. They help to ensure
that medicines are used in the safest and most
effective manner.
 However, the profession, particularly
community pharmacy, sits at the intersection
between health and retail, as the profits are
gained from making sales of medications. This
introduces a number of ethical complications
and a strong need for guidelines to base
decisions on that are centered on moral
obligations and virtues.

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The Pharmacists Code of
Ethics
 The pharmacist-patient interaction has
dramatically increased due to the expanding
pharmaceutical services, and therefore greater
attention is now paid to the proper relationship
between them.
 Knowledge of legal and ethical obligations
when providing pharmaceutical services will
improve the quality of treatment, as well as the
pharmacist-patient interaction and increased
cooperation, resulting in fewer patient’s
complaints from pharmacists regarding
prescription.
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Cont’d…
 The ethical responsibilities of a pharmacist
that relate to the consumer include:
-To recognize the consumer’s health
and wellbeing as their first
priority, and utilize knowledge and
provide compassionate care in appropriate
and professional manner.
-To respect the consumer’s autonomy
and rights and assist them in making
informed decisions about their health.

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Cont’d…
 The ethical responsibilities of a pharmacist
that relate to other health professionals
include:
-To work in cooperation and
collaboration
with other health care
professionals to
achieve the optimal health
outcomes
for consumers

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Cont’d…
 The ethical responsibilities of a pharmacist that relate
to the profession include:
-To commit to the development and enhancement
of the profession by becoming involved in
activities such as training staff, teaching, being
a preceptor or mentor for students
-To keep up-to-date with knowledge of pharmacy
practice with life long learning and self-
development
to maintain professional competence and personal
health to continue practicing

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Cont’d…
 The ethical responsibilities of a pharmacist
that relate to business practices include:
-To conduct the business practices of
pharmacy in
an ethical and professional manner
with the
consumer’s best interest in mind and
due respect
to colleagues and the reputation of the
profession

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1.The principle of
nonmaleficence
 The “principle of nonmaleficence” is commonly stated as the
principle of “above all else do no harm.”
 The principle of nonmaleficence requires a health care
provider to not act in any way that intentionally inflicts
needless harm or injury to a patient, either through acts of
commission or omission.
 The principle of nonmaleficence can be violated in two
distinct ways:-
 First, pharmacists can violate this principle if they knowingly
and intentionally cause a patient harm. For example,
knowingly filling a prescription to which a patient has an
allergy or filling a prescription in defiance of the published
literature that states it may have a drug–food interaction
without telling the patient about the drug–food interaction
may be seen as malfeasance

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Cont’d…
 The principle of nonmaleficence may also be
violated when no malice or intent to do harm is
involved
 The pharmacist may be considered as having
failed to exercise due care in discharging his or
her responsibilities as a professional may be held
accountable by the court system for his or her
actions.

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2.THE PRINCIPLE OF
BENEFICENCE
 beneficence is the principle that health
professionals should behave in the best interest
of their patients.
 When considering a medical or pharmaceutical

intervention that best benefits the patient, that

intervention should answer some or all of the
following seven questions:
-Does it promote health and prevent
disease?
-Does it relieve symptoms, pain, and
suffering?
-Does it cure the disease?
-Will it prevent untimely death?
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Cont’d…
-Will its educational content and counseling
help better a patient’s condition and prognosis?
-Will the intervention help avoid harm to the
patient in the course of care?

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3.THE PRINCIPLE OF AUTONOMY
VERSUS PATERNALISM
 Paternalism refers to those health professionals or
pharmacists who see their relationships with patients
as “paternalistic.” That is, they see themselves in a
parental role knowing what is best for the “child”
(patient).
 In essence, paternalism is a poor practice as it fails to
take into consideration the preferences, beliefs, and
practices of the patient, especially those that could
be of most benefit to them.
 Conversely, the principle of autonomy establishes a
patient’s rights to self-determination; that is, the
patient’s moral right to choose one’s own life plan
and action.

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Cont’d…
 Medical ethicists often state that the danger of
paternalism is that it threatens individual rights
and personal liberties.
 The ethics are challenged when a patient’s
autonomy is ignored, he is not told the truth, his
secretes are disclosed, or measures are taken to
end his life.
 Many patients do not have the ability to make their
own decisions. children and those with mental
disorders may be able to decide to some extent
about their interests and values, but they are
inadequately independent to determine their fate.

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Cont’d…
 Regarding autonomy, ethical challenges include
autonomy of adult with no consciousness. When
patient lack sufficient will to disagree about the
prescription, the pharmacist shouldn’t decide on
behalf of him/her.
 The assumption with children is that only parents
or those decided by authorities such as courts
can make decisions on behalf of them.

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 4.THE PRINCIPLE OF HONESTY
AND TRUTH TELLING
• On principle, all
communications between
patients and their health
professionals should be
truthful under all
instances.
• But what should be done
when full disclosure of
every detail could prove to
be harmful?

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Cont’d…
 The principle of honesty states that patients have
the right to truthful communication regarding
their medical condition, the course of their
disease, the treatments recommended, and
alternative treatments available
 The APhA Code of Ethics for Pharmacists (1994)
states that a pharmacist “has a duty to tell the
truth and to act with conviction of conscience.”
 Some health care providers, when withholding
information, will claim “therapeutic privilege” as
their reason for doing this. This is because they
perceive that full disclosure all medical
information would be harmful or upsetting to the
patient. 21
5.THE PRINCIPLE OF INFORMED
CONSENT
 Informed consent is the way in which patient
preferences become expressed and are applied
out of respect for that patient’s autonomy.
 The informed consent principle states that
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.

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Cont’d…
 In general, consent is not required when a
procedure is simple and the risks are commonly
understood. However, any provider who
recommends treatment for a patient, especially if
it is invasive, must obtain informed consent.
 Informed consent forms the ethical basis for the
patient provider relationship as it “consists of an
encounter characterized by mutual participation,
good communication, mutual respect, and shared
decision making”.

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6.THE PRINCIPLE OF
CONFIDENTIALITY
 The Hippocratic Oath states, “what I may see or
hear in or outside the course of treatment . . .
which on no account must be spread abroad, I
will keep to myself, holding such things shameful
to speak about.”
 The principle of confidentiality serves to ensure
that health care providers are obligated to refrain
from divulging information that is obtained from
patients during the course of medical treatment
and to take reasonable precautions to protect
that information.

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Cont’d…
 As pharmacists become more involved with direct
patient care, they gain access to a wide range of
sensitive and private patient information, which is
necessary for appropriately managing therapy.
 The pharmacist-patient relation is contract, but
the important point is the professional principles
including confidentiality should be observed and
by no means should the patient’s secrets be
disclosed.

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7.THE PRINCIPLE OF FIDELITY AND THE
PATIENT–PROVIDER RELATIONSHIP
 Fidelity is loyalty. It speaks to the special
relationship developed between patients and
their health care professionals.
 The ethics of medicine have traditionally directed
providers to attend exclusively to the needs of
the patient and to act in ways that best benefit
the patient.
 The focus on the rights of patients and the
obligations of providers can make the
relationships between them seem mechanistic
and legalistic.

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Cont’d…
 the ability to effectively work through sensitive
issues depends on trusting, caring relationships
between patients and providers.
 Patients need humane, sensitive care from
providers, care that will assist them in making the
best decisions they are able to make.

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Ethical dilemmas in
pharmacy
 Ethical dilemmas occur when there are
disagreements on ethical behaviour or
application of ethical principles.
 Ethical dilemmas can occur between

pharmacists and clients, pharmacists and

physicians, and among pharmacists
because the values, sense of justice and
fairness of each party may differ.

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Ethical dilemmas…
 Each party might espouse a different
principle, such as a utilitarian view versus
the respect for the individual. In health care,
ethical dilemmas most often affect
physicians, but in an increasing cascade
other health care providers, such as
pharmacists, are facing situations in their
practices that are causing ethical dilemmas.

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How Pharmacists Can Resolve
Ethical Dilemmas
 Resolving ethical dilemmas is challenging
for many health care professionals.
 The most optimal approach for resolving

this ethical dilemma would be for the

pharmacist to adhere to the Code of Ethics
for Pharmacists, earn the trust and
cooperation of the patient, and
subsequently take the time to explain to the
patient about his chronic illness along with
the importance of taking his maintenance
medication
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Steps in Ethical Decision-
Making
1. Recognize the moral dimensions.
2. Identify all stakeholders and interested parties.
3. Think through the shared values or principles involved.
4. Weigh the benefits and burdens.
5. Look for analogous cases.
6. Discuss the case with relevant parties and gather
opinions.
7. Consider the legal and organizational rules involved.
8. Reflect on how comfortable you are with the decision.
To reach ethical decisions pharmacists must use a
structured approach for identifying, analysing, and
resolving ethical issues.

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Cont’d…
When faced with an ethical or moral dilemma
that requires a decision to be made, a
pharmacist should;
-Recognize that the decision is one that
has moral importance created by conflicts
between two or more values or ideals.
-Consider and identify the shared values
or principles, such as autonomy, honesty, and
loyalty that may be at stake in making the
decision

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Cont’d…
Carefully weigh the benefits and the burdens
of the case.
-Identify who the interested parties are, who
has a stake in the decision, and what the
relationship is between the parties.
-Consult with colleagues and other relevant
advisors.

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