Ethical Issues and Values in Pharmacy Practice

Abstract

During their work, pharmacists are faced with a number of ethically difficult situations which include consideration of the values, rights and responsibilities. The overall aim of this study was to analyse the factors that influence the ethical values of pharmacists. We aimed to determine the relationship of these factors and the pharmacists' perceptions of difficulty and frequency of ethical issues in community pharmacy settings. The research design was cross-sectional and descriptive; the data were gathered from a sample of community pharmacists in Serbia by using validated self-administered survey instrument. In all, 590 pharmacists participated (94.06% females) with working experience from 1 to 39 years (mean 15.17 ± 10.04 years). The majority of respondents stated that the main factor influencing the ethical values of pharmacists is professional ethics, followed by family norms. The most common reasons for addressing ethical issues associated with values are related to the following: importance of cooperation with other healthcare professionals, respect for the rules and regulations, patients` wellbeing, working within one's competence to limit liability, controlling and monitoring the organizational and occupational framework of pharmacy profession. The respondents in our study identified an ethical imperative for pharmacists in limiting harm to patients and resistance to commercial pressures which might compromise their judgment. The results demonstrate a need for careful examination of the values that could be identified and explored in dilemmas created by commercial environment and dual personality of users (patients, costumers) of community pharmacy service. RezumatPe parcursul activității profesionale, farmaciștii se confruntă cu multe situații dificile din punct de vedere etic, ceea ce presupune o analiză a valorilor, drepturilor și responsabilităților. Scopul principal al acestui studiu a fost analiza factorilor care au un impact deosebit asupra valorilor etice ale farmaciștilor. În al doilea rând, cercetarea vizează raporturile dintre acești factori, precum perceperea dificultăților aparente și frecvența dezvoltării problemelor legate de aspectele etice în farmacia comunitară. Design-ul studiului a fost trasversal (cross-sectional) și descriptiv; datele au fost colectate din eșantionul farmaciilor comunitare din Serbia prin folosirea instrumentului validat privind automedicația. Studiul a inclus 590 farmaciști (94,06% femei), cu experiență în activitatea profesională de un an până la treizeci de ani (în medie 15,17 ± 10,04). Majoritatea respondenților au afirmat că factorii principali care influențează valorile etice ale farmaciștilor sunt etica profesională și valorile etice familiale. Cele mai importante motive pentru evidențierea problemelor etice, asociate unui set de valori, sunt legate de: importanța relaționării cu alte cadre medicale, respectarea normelor și prevederilor profesionale, bunăstarea pacientului, exercitarea activității în vederea limitării numărului de persoane cu răspundere și ...

Ethics and Business in Community Pharmacies – A Framework for an Ethical Dialogue

“…The ideas and proposals resulting from our research and reflection on the conflicts between ethics and business in community pharmacies are also supported by what our peers have published on this subject in the past years. Thus, regarding the setting of sales targets by community pharmacists' employers, other authors have shown that such a policy by the company challenges pharmacists' professional independence [12,26], and the pressure of such policies could compromise their professional judgment [11]. Some authors also emphasized that pharmacists perceived these practices as a threat to their professional dignity and, even more, in the pharmacies in which "the culture of the organization was one where the pressure to meet targets was perceived as excessive or as prioritizing profit over meeting patient needs, this was viewed as detrimental to service quality" [10].…”

“…On the other hand, pharmacists' employers should develop organizational cultures that support team development to ensure a good working environment and quality of pharmaceutical services [10]. Regarding dispensing complementary medicines, it has become a common practice in many countries to increase sales in community pharmacies, more or less accompanied by counselling [9,11,16,17]. Indeed, the explosion in the number of such products on the market makes it difficult to keep knowledge up to date, even by professionals such as pharmacists, used to search and select proper scientific information.…”

“…Ethical competencies acquired by pharmacists during their education are heavily challenged by the business environment in which they work, even in the community pharmacy, "particularly where there are corporate values and reward systems in operation" [26]. Moreover, sometimes insufficient training for ethical decision-making in practice [1] makes them even more vulnerable to financial pressure, some of them being pushed into "moral distress" [8,11] or suffering a "crisis of professional identity" [9]. Indeed, a very competitive environment, such as that of community pharmacies, may exacerbate the pressure and conflicts between professional pharmaceutical ethics and employers' business interests [9,10,16,18,24,26].…”

“…Indeed, a very competitive environment, such as that of community pharmacies, may exacerbate the pressure and conflicts between professional pharmaceutical ethics and employers' business interests [9,10,16,18,24,26]. The most frequent conflicts faced by pharmacists in the community pharmacies are related to the setting of sales targets by their employers [10,11,19,24], dispensing complementary medicines [9,11,16,17,19], making time for patient counselling [9,17,18] and collecting expired medicines from patients for proper disposal [3,21,24]. Dealing with such conflict situations frequently may have a major negative impact on the pharmacists' professional satisfaction and commitment to providing quality services to their patients [10,18,26].…”

“…Furthermore, the broadening of community pharmacy activities (e.g., medication review and management, screening, testing, and vaccination) and the development of online pharmacies (e.g., internet sales, online communication with patients, providing software for health monitoring) require pharmacists to develop their ability to manage conflicts between ethics and business, including clinical versus commercial communication, in order to preserve the status of health professionals and protect the patients' interests [7,10,19,27]. Although pharmacists perceive commercial practices as unethical [6,11,[16][17][18]24], patients do not share the same opinion when it comes to incentives or loyalty programs: "pharmacists are perceived to be ethical decision makers" [15]. The patients' trust in pharmacists comes from a long tradition of quality services and fair treatment that they experienced in community pharmacies.…”