Ethics and Pain
Baker, Kenneth R., Drug Topics
ETHICAL DECISION-MAKING IN PHARMACY
This article inaugurates a new column by Ken Baker, "Ethical Dedsion-makinß in Pharmacy, " which will appear bimonthly. Please send comments and suggestions for future subjects to firstname.lastname@example.org and/or email@example.com.
One hundred sixty years ago, in 1852, the American Pharmaceutical Association adopted its first Code of Ethics for pharmacists1, a code centered in the moral obligations pharmacists owe their patients.2 The preamble to the current Code of Ethics3 declares that the pharmacisfs duty is to "assist individuals in making the best use of medications." The Code is designed to "guide pharmacists in relationships with patients, health professionals, and society."4
Article Seven of the Code states: "A pharmacist serves individual, community, and societal needs." The statement is simple and direct. There are times, however, that conflicts arise when a practitioner tries to serve two masters simultaneously. in such instances, pharmacists may find themselves on the horns of a dilemma.
The problems are particularly acute in the dispensing and control of drugs with the potential for abuse, particularly drugs for pain. How does the pharmacist decide when the prescription is for a legitimate medical purpose and when it is not?
Needs of the patient
Indiana law, while not unique, says it well.5 It mandates that each pharmacist shall "exercise his professional judgment in the best interest of the patient's health." It further states that the "pharmacist has a duty to honor all prescriptions" from a licensed prescriber.5 The Code of Ethics, state law, and even federal law make clear that the pharmacist's first obligation is to the patient.
Community and societal needs
There is then the obligation to society. A prescription written without a legitimate medical purpose, even if written by a licensed prescriber, is not a valid order and may not be filled.
Again, Indiana law says it well: "Before honoring a prescription the pharmacist shall take reasonable steps to determine whether the prescription has been issued in compliance with the laws of the state where it originated."5
Turning a blind eye to a questionable prescription is neither ethical nor legal, nor is it in the best interests of the patient. The pharmacist must take reasonable steps to answer real questions of legitimacy, while not turning away a patient who is in pain.
Drug enforcement officers have argued that the mere fact that the physician has written for high levels and/or combinations of drugs that are often abused is sufficient to show there is no legitimate medical purpose to the prescriptions. …