Ethical Decision-Making in Pharmacy

Article excerpt

During the summer of 2001, a news story broke nationally that would shake pharmacy to its foundations. Incredibly, a pharmacist was charged with providing intravenous chemotherapy medication that was watered down-for not just one patient, but for many. The Robert Courtney case shocked the public and gave a black eye to the profession. Pharmacists who dispense millions of prescriptions during their professional career reeled from the news. How could this have happened, and how could it have happened thousands of times?

This infamous case demonstrated that no one, not even a well-known independent pharmacist like Courtney, a dedicated church member, is incapable of doing the wrong thing.

As the story unfolded, it became apparent that this business owner and professional had at one time done all the right things for patients. What changed? When did he cross the line, from perhaps making an error to intentionally committing fraud and malpractice? Could those around him have prevented these catastrophes, or could they have been stopped sooner?

MEDICAL ETHICS IN THE UNITED STATES

Pharmacy schools usually teach ethics within pharmacy law courses, which are built around national and state statutes and administrative rules. These laws form the backbone of legal and ethical pharmacy practice; often written with arcane legal phrases like "moral turpitude," these legal guidelines do not always provide a user-friendly guide for professional conduct.

To discuss the professional ethics involved in practicing pharmacy in the United States, it is impor(tant to outline the source of our common cultural ethics.

Ethics are systems of moral philosophy, and may be discussed in terms of a particular person, religion, group, profession, or society. As a philosophical discipline, ethics are more difficult to measure and describe than objective disciplines like chemistry or pharmacy.

We could begin by defining morality as it is understood in our larger culture. Socrates defined morality as "how we ought to live." Who decides how we should live, and what is right? Should moral decisions be made by the person who will be most affected, or by the person who must act?

CURRENT APPROACHES IN ETHICS

Long before the Courtney case, other highprofile medical cases have captured the public's attention. Some of the most famous cases have concerned patients who have lapsed into coma for years, unable to make their own medical decisions. Several of these patients have become the center of long legal battles within medical ethics, where seemingly everyone had a different answer to the dilemma.

General texts in ethics explore our culture's attitudes towards such dire medical decisions. In the case of the patients in a coma, some people rely on the benefits argument: whatever is best for the patient is the best course of action. The final decision, whether to continue life support or terminate it, will be based on the opinions of expert physicians who examine the patient. Some of these experts may find that the patient's quality of life is low and life is no longer of benefit; others may disagree. Which opinion should prevail?

Others base their opinions on the sanctity of human life argument, that is, that every human life is considered valuable, regardless of handicap, mental status, or consciousness. Proponents may insist that everything should be done for the patient, regardless of others' wishes (including the patient, who can't be consulted). This position implies that every patient should be kept alive as long as possible.

Still others argue that failing to do the utmost for the patient is a form of discrimination against the disabled and therefore unlawful, since the patient (disabled by coma) is protected by law.

Within the realm of medical ethics, U.S. physicians still take the Hippocratic oath. In essence, the ancient Greek physician Hippocrates said, first, do no harm. …