1 challenges for healthcare ethics in social pharmacy dr david badcott centre for applied ethics...

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Challenges for healthcare ethics in socialpharmacy

Dr David Badcott

Centre for Applied Ethics

Cardiff University

UK

Email: [email protected].

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Sociology is broadly concerned with the scientific study of human relationships.It seeks an understanding of the roles we both perform and occupy in our lives (members of a collective group belonging in a defined capacity), the practices we undertake (units of reciprocal behaviour informed by mutual recognition of shared intentions and beliefs), and processes of change. [W. G. Runciman, The Social Animal (1998)],

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In this paper I will concentrate briefly on 2 main

aspects of ethics and social pharmacy:

1. Changes in direction for pharmacy practice:

should we anticipate a power struggle?

2. The challenge of successfully accommodating

multicultural healthcare.

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Past changes in pharmacy practice include:

Compounding of medicines in the pharmacy has been replaced by dispensing of industrially manufactured proprietaries.Dispensing is now mostly in standard patient pre-packs.Computer-printed labels have replaced hand-written labels.Automatic database checks on dosage and therapeutic incompatibilities are routine.Prescriptions are written in English language rather than medical Latin and patient labels include the product name.

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Challenges for healthcare ethics in social pharmacy

New and transforming role for pharmacy that

takes account of:

(a) Time “freed up” by changes in pharmacy practice.

(b) Greater focus on patient care.

(c) Opportunities through understanding the implications of

the patient sick role and the biopsychosocial model.

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Traditionally, the practice of medicine and the provision of pharmaceutical medicine has been characterised by two components:

(a) Biomedical model of disease - mechanistic in nature in which diseases have identifiable causal mechanisms resulting in malfunction, and are susceptible, at least in principle to corresponding treatments.

(b) Sickness as a social role (Talcott Parsons, The Social System, 1951)

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Biomedical model of disease

Considered to be overly simplistic.

Doesn't take account of the overall context in

which the patient suffers or experiences an illness.

More holistic approach: “biopsychosocial model” (George Engel, 1977)


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Medical dominance (paternalistic system – supported by law)

Patient assumes the “sick role” (form of deviant behaviour)

Doctor gatekeeper for the “sick role”. Validates access to medication, social entitlement and absence from work.

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“…there is a sense that sickness is something we do rather than something we simply have. Being sick involves interpretation, choice and action. Being sick has, for human beings as social actors, a meaning. …To regard illness as a text open to a variety of perspectives is a radical approach to sickness, because it points to some of the problems in the medical model which underlies the basis of institutionalized, scientific, technologically directed medicine.”

Turner (1987, Medical Power and Social Knowledge, p.213)

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“A medicine dispensed or purchased represents a `trophy` that

confirms sickness. The medicine is expected to cure or alleviate

symptoms and if it achieves this aim it reinforces the patient’s trust.

If the medicine does not work, or it causes side effects, then this

trust may be damaged and blame attached”.

(Bates, Pharm J, 2002, 269:246)

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Differential Power relationships/hierarchy

Medical doctor: dominant, provides diagnosis, clinical care and oversight, and has overall responsibility for the patient

Pharmacist and other HCPs: subordinate, clinical service role

Patient: passive, acquiescent, dependent deferential and reliant

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Increasing patient power?

“Active citizenship”

“Expert patient”:

Patient`s often tacit knowledge of their illness.

Opportunity to encourage patient to take

greater responsibility for treatment and

decision-making.

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Pharmacy ethics and prescription medicines

Vulnerability Obligation

Trust

Principled patient autonomy

Context ofethical relationships

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Many traditional professional duties have been superseded allowing pharmacists to devote much more time to adopting an active patient-centred role. New role largely reflects government policy.

The UK Department of Health document Choosing health through pharmacy (April 2005) envisages pharmacy as an untapped resource with a significant potential role in health promotion which could include provision of advice or signposting services on smoking reduction, heart disease, strokes and cancer, under-18 conception, obesity in children, long term conditions, substance misuse, and immunisation services and other matters of public health.

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Pharmacist independent prescribers and supplementary prescribers intended to improve patient access to medicines. This could be a win-win or “nonzero sum” situation, and that would be good news for the patients and the NHS. Potential erosion of the monopolistic situation of medical profession. Medical profession`s attitude is crucial.


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Potential difficulties in dealing with patients

where there is substantial ethnic and cultural

diversity:

Language

Religious beliefs

Socio-cultural background

Age of patient (dignity?)

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Two types of potential problem:

Problems in communicating safety and dosage

information.

Problems of an ethical nature.

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RPSGB code of ethics:“Recognise diversity and respect the culturaldifferences, values and beliefs of others.”

IPF Statement on professional standards/codes of ethics(September 2004) “recognise and respect the cultural differences, beliefs and values of patients, particularly as they may affect a patient’s attitude to treatment.”

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Cultural Competence:

“Ability of individuals and systems to respond respectfully and effectively to people of all cultures, classes, races, ethnic backgrounds, and religions in a manner that recognizes, affirms and values the cultural differences and similarities and the worth of individuals, families, and communities and protects and preserves the dignity of each”

(quoted in American College of Clinical Pharmacy White Paper: “Cultural Competence in Health Care and Its Implications for Pharmacy”.Pharmacotherapy 2007; 27(7): 1062-1079)

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1 challenges for healthcare ethics in social pharmacy dr david badcott centre for applied ethics...

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