New Ethical Issues Facing Pharmacists

Article excerpt

The explosive advance in our knowledge and capabilities in medicine does not differ from any other explosion; individuals exposed to it are liable to be harmed.

-Speckler and Spitzer, 1966

INTRODUCTION

This pessimistic observation originally was part of a discussion questioning whether the good derived from advances in medical science justified the potential for harm to some patients. In discussing the high rate of adverse outcomes among hospitalized patients during the 1960s, Speckler and Spitzer continued their explosion analogy suggesting "that the individuals closest to the center of the explosion are most vulnerable to be most frequently and seriously injured."

These statements address one of the major ongoing issues at the heart of medical intervention and ethical considerations-whether the risks of the intervention outweigh the benefits. Harm to patients can take many forms. Traditionally, adverse effects that result from medical intervention have been called iatrogenic harm, although this term literally means "harm originating with the physician."

The primary purpose of the field of biomedical ethics is to provide guidelines to assist us in determining the right thing to do when faced with several possible courses of action or medical intervention (or no intervention). We seek to find the course of action that will result in the most benefit (health, happiness, well-being, and so on) at the least cost (adverse effects, dollar cost, unhappiness, etc.).

We also have to consider, in addition to the possibility of direct physical harm, whether harm can result from our actions in making significant changes in the processes of how we provide medical care, how it is paid for, and who makes healthcare decisions. Medical technology and its administration are advancing faster than our ability to evaluate the true risks and benefits associated with all the potential ramifications that can result from using that technology.

But whose ethical perspective and values are the correct ones in making decisions related to the use of new technology?

As a society, we will be required to continually redefine what we mean by life and by death, and what aspects of life we have a right or an obligation to control. This lesson presents:

the historical background from which our present day thinking on these matters derives;

an overview of some of the major ethical theories that can be used in evaluating medical and health care issues; and

a discussion of a sample of present and emerging ethical issues pharmacists are likely to encounter in the coming years as medical technology continues to reveal the mysteries of the human body

HISTORICAL BEGINNINGS

Before medical science began its evolution by leaps and bounds, during the late 19th century and especially after World War II, the role of the physician was largely supportive and at best palliative. Many individuals experienced harm to varying degrees as we groped in the darkness of early medical practice.

As researchers increased in scientific sophistication, medical discoveries based on an improved understanding of the workings of the human body came rapidly. Certainly, patients continued to be harmed in this well-intentioned process, and concerns were raised within the medical profession and the public. However, some argued that these unfortunate instances of harm represented a legitimate cost of scientific exploration and discovery for the greater good of society, and that those who suffered in the process did not do so in vain.

On the contrary, their sacrifice could be viewed as justifiable and as a noble service to society. These courageous and trusting souls made it possible for those of us who followed to enjoy the benefits of the great advances in our medical knowledge. This notion is supported by the evidence that during the last 100 years, we have achieved more progress in our medical sciences than was achieved in all previous history. …

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