Professional ethics in pharmacy: the Australian experience

Abstract

Objective The profession of pharmacy has the unique characteristic of having both professional and business orientations. There is today, in addition to this unique characteristic, a strong shift in pharmacy towards more involvement in patient‐centred health care, and increased emphasis on the patient's best interests and autonomy, within a framework of what is known as ‘bioethics’. With this shift of professional focus comes a heightened level of responsibility due to increased expectations of the patient and greater involvement in healthcare and decision making at a personal level with the patient. There is therefore inherent in this increased involvement an increased propensity for ethical problems to arise. The aim of this study is to investigate the application of ethical theory in the practice of pharmacy in New South Wales (NSW), Australia. Method Semi‐structured interviews were carried out with 25 practitioners. The content of transcribed interviews was qualitatively analysed for emerging themes. Themes were identified by the primary researcher and independently validated by the other investigators. Key findings The majority of pharmacists interviewed in NSW Australia practised within a theoretical framework of ‘best interests of the patient’. Pharmacists experienced dilemmas in practice involving a number of ethical principles. Pharmacists relied on common sense to circumvent such dilemmas and never referred to their professional code of ethics. There appeared to be a general lack of training, and a varying perception of difficulty with decision making, regarding ethical dilemmas encountered, depending on issues such as legal requirements, personal opinions or financial demands. Conclusion Findings of this study indicated primarily that pharmacists in Australia regard the ethical principle of ‘best interest’ of the patient as the fundamental framework within which they practice. Pharmacists experience ethical dilemmas in practice, predominantly in the community setting, relying on logical reasoning, practical skills and personal morals to manage the situation, rather than consulting with a code of ethics. Also of significance in this study was the finding that financial pressure had a strong negative impact on the decision making and application of ethical principles of younger pharmacists in practice.

Pharmacy Ethics and the Spirit of Capitalism: A Review of the Literature

“…The profession status has been won based on the social role of the pharmacist in procurement, preparation and assessment of drugs, a role which has gradually vanished with the rise of the modern pharmaceutical industry and the occurrence of the premixed and prepackaged medicines [4,16,17]. This change has been described as a loss of the compounding function that relegated the pharmacy to the status of "another link in the chain of distribution" for the new healthcare industry [18].…”

“…This rule, already expressed by Greenwood, refers to the fact that professions discourage advertising [2], because allowing it would undermine the professional authority, entrusting the client with critical abilities in selecting competing professionals, as if the client would be able to judge the quality of a professional service [15]. As a second argument, the subordination of the professional goals to personal ones (noncommitment to altruistic values and goals) was cited by Denzin and Mettlin as a fact [15], although the contrary vision is usually held by the profession (in line with the ethics codes adopted by it [17]). A third argument advanced for the marginality of pharmacy profession is the acceptance by pharmacists to sell (non-professional items and objects) [15], pursuing a profit rather than perceiving a fee.…”

“…Contemporary codes of pharmacy ethics promote not only the classical principles of autonomy, non-maleficence, beneficence and justice, but they also tend to acknowledge that allowing business considerations to shape and dominate their demeanour may jeopardize the dignity and wellbeing of the patients [17,33]. Although ideally ethics should outweigh business, the scarce data available till now indicate that the reverse often does happen, although the regulatory framework, culture, economic environment in which pharmacy is immersed and so on have an important role.…”

“…Many of the employed pharmacists told of incidents where their employer (pharmacist owner) pressured them to "sell" or "move" products, whereas young pharmacist owners stated that their leading concern was not the patient's welfare but their obligation to pay back the financial institutions [17]. Financial considerations had such an impact on these latter pharmacists that the wellbeing of the patient was ignored if they perceived a risk of losing business (e.g.…”

“…dispensing pseudoephedrine to a hypertensive patient) [17]. Moreover, one of the pharmacists described how the gradual increase in the business-side involvement parallels a gradual decrease in the clinical involvement, to a point where selling a product becomes more important than caring for the patient [17].…”