Pharmacy Professional Ethics

Ref: Pharmacy Ethics and Decision MakingPages: 95 - 107

Lecture -2 Topic : The professional decision-making process

Dr. Mohammad Almermesh Lecurer

Clinical Pharmacy Department & Pharmacology DepartmentCollege of Pharmacy

Why have a process for decision-making?• There are several features of decisions made by healthcare

professionals, including pharmacists, that single them out for special consideration.

• The consequences that may arise from a decision by a pharmacist will frequently affect the care of someone else and, in some instances, very adversely.

Why have a process for decision-making?, Cont…• Decisions by pharmacists are only part of an approach to

solving problems.

• A decision-making process can help you to analyze the bits of a problem that can be solved with some certainty and provide a framework to identify those remaining aspects that call for your judgment as a professional.

Claims for the value of a decision-making process:

1. a mechanism to allow you to practise dealing with problems before they arise.

2. a method of structured thinking that improves your ability to respond rationally when urgent problems arise and you are under pressure.

3. a means of identifying the values involved in your decision-making

Claims for the value of a decision-making process: , Cont…

4. a means of identifying areas of certainty and uncertainty

5. a basis for risk management in prospect

6. a basis for your defence in retrospect

7. an aid to reflective practice and improvement of practice

8. a technique that allows inclusion of all aspects of a problem – clinical, legal and ethical.

A good decisionSystematic structure• The vast majority of us take decisions at great speed and with

little reflection.

• In any practice situation, a pharmacist should at least give some consideration to the key accountability question: What happens if some-thing goes wrong? In retrospect, a systematic structure for decision making may provide some defence and insight into why you made the decision that you did.

Systematic structure, Cont….

• In most instances, particularly with complex systems involving many individuals, such as dispensing prescriptions or taking blood pressure or a drug history, some aspects of the process can be known with reasonable certainty. For these, it may be appropriate to delegate tasks to trained staff working within standard operating procedures, leaving the more uncertain areas to the pharmacist.

• Once the routine aspects of the situation have been addressed, the pharmacist can apply judgement and experience within a systematic framework of questions and options to achieve a resolution .

Rational reasoning

• A good professional decision should be underpinned by reason and rationality.

• It is important to reflect upon the reasons behind the decisions you take .

• Not only that but to consider whether the reasons are rational

(i.e. reasonable in the circumstances).

• This leads on to recognition that uncertainty can also arise because we cannot always establish all the required facts

Example • let us say that in your work as a pharmacist you decline to deal

with patients whose surnames suggest they are of Scottish origin – McClean, McTavish, Mackenzie, for example.

• Your reason is that you don’t like the Scots! Clearly, this is not an acceptable reason for your decisions.

Value-based reasoning• One way of establishing that reasons are rational would be to base

them on evidence.

• Basing decisions solely on evidence can lead to ‘Spock reason’ a term coined by Seedhouse to denote decision-making based on suppression of emotional response and reliance on logic alone.

• Evidence must be considered alongside values, particular those of the patient .

Example• Patients may be provided with and understand that treatment A is

better than B or even no treatment, based on empirical evidence, but nevertheless may choose to take another option based on what they value in their life.

• The decision may not seem rational to you as the pharmacist but is very much so for the patient, who will bring his or her own values into play.

Recorded decisions

• Unfortunately, pharmacists have traditionally been poor at recording their activities and decisions but this is changing.

• The RPSGB (Royal Pharmaceutical Society of Great Britain) re-issued guidance on ‘recording interventions’ in April 2006. This guidance includes amongst the reasons for keeping a record: ‘to have an accurate record available for scrutiny where decisions could be challenged’ and amongst the occasions when this might be necessary mentions ‘Interventions that could potentially be queried or refuted’.

Recorded decisions, Cont….

• As information technology progresses, it is likely that many patient record systems used by pharmacists will have provision for making records of such decisions – perhaps under ‘critical incidents’, although this term is more usually used for patient safety incidents.

• It is necessary to create records for those who buy non-prescription medicines or who simply seek advice.

Identifying issues and resources• It is rarely possible to make a good decision without information.

• The information needed for a professional decision is likely to be clinical, legal or ethical – or all three.

Identifying issues and resources , Cont …

• Identification of legal issues may also seem to be a fairly easy task for most pharmacists; they are well schooled in the detail of statutory law such as the Medicines Act and the Misuse of Drugs Act.

Identifying issues and resources , Cont …• Studying Code of Ethics for pharmacists added awareness of the

particular areas where ethical behavior may be called into question .

• The Code does not assist pharmacists to prioritise conflicting ethical obligations; rather it gives general guidance without balancing the pharmacist’s duties and responsibilities.’

Identifying issues and resources , Cont …

The principles for ethical decision-making are :

• To respect the autonomy of the individual.

• Avoid harm.

• Where possible achieve benefit

• Consider fairly the interests of all those affected.

Identifying issues and resources , Cont …

Classification of ethical issues :

• issues of conflict or choice: ‘situations in which…persons ought both to do or not do something’

• issues that may compromise long-term relationships

• issues involving threats to the practitioner’s integrity or reputation.

Stages of decision makingStage 1 Gather relevant facts

• Making an honest effort to understand the situation, to distinguish facts from mere opinion, is essential.

• Knowing the facts and carefully reviewing the circumstances

can go a long way to resolving disagreements at an early stage.

Stages of decision making, Cont….. Stage 2 Prioritise and ascribe values

• When you have all the information that you can get, you will find that some facts are going to be more important than others.

• Decide what priority and value you attach to the interests of the following:

the patient or customer those near to the patient those in contact with the patient your own profession and other professionals with whom you work your employer and work colleagues yourself.

Stages of decision making, Cont…..• Good pharmacy practice requires that the pharmacist balance

the disparate interests of all the parties concerned and are prepared to record where necessary and justify the reasoning that led to your eventual decision.

Stages of decision making, Cont…..Stage 3 Generate options• In other words, ask yourself: ‘What could I do in this

situation?’

• By careful analysis, you will be able to establish the likely consequences of each course of action and then choose which will have the best chance of a good outcome or, in some cases, the least likelihood of causing harm.

Stages of decision making, Cont…..Stage 4 Choose an option

• Remember that, when making your choice, you may have to be able to justify why you made that one. This is not as daunting as it may seem as you will be able to draw on many sources of help to reach your decision, such as your reference books and manuals, your colleagues, your employer or your professional and trade body.