Case Studies in Pharmacy Ethics

by Veatch, Robert M.; Haddad, Any

• ISBN13: 9780195133912
• ISBN10: 0195133919
• Edition: 1st
• Format: Paperback
• Copyright: 1999-09-23
• Publisher: Oxford University Press

Summary

Every pharmacist constantly makes ethical choices. Sometimes these choices are dramatic, life-and-death decisions, but often they are more subtle, less conspicuous choices that are nonetheless important. Assisted suicide, conscientious refusal, pain management, equitable and efficaciousdistribution of drug resources within institutions and managed care plans, confidentiality, and alternative and non-traditional therapies are among the issues that are of unique concern to pharmacists. One way of seeing the implications of such issues and the moral choices they pose is to look atthe experiences and the choices that have had to be made in situations typically faced by pharmacists. This book is a collection of those situations based on the real experiences of practicing pharmacists. The use of case studies in health care ethics is not new, but in pharmacy it is. This text isan important teaching tool that will help pharmacy students and pharmacists address the increasing number of ethical problems arising in their profession. It is not merely a compilation of cases, but rather is organized for the systematic study of applied ethics. Part I shows how to distinguishethical problems from other kinds of evaluative judgments and examines the sources of values in pharmacy, posing basic questions about the meaning and justification of ethical claims. Part II explores the basic principles of ethics as they have an impact on pharmacy. Specific cases from clinicalsettings present in a systematic way the various questions raised by each of the major ethical principles: benefiting the patient; distributing resources justly; respecting autonomy; dealing honestly with patients; keeping promises of confidentiality; and avoiding killing. Part III examines some ofthe special problems of contemporary pharmacy such as the linkages between pharmaceutical care and professional practice, human experimentation, reproductive issues, genetic technology, death and dying, and mental health.

Table of Contents

Cases	xv
Introduction: Four Questions of Ethics	3	(274)
What Makes Right Acts Right?	4	(5)
What Kinds of Acts Are Right?	9	(3)
How Do Rules Apply to Specific Situation?	12	(1)
What Ought to be Done in Specific Cases?	13	(1)
Notes	14	(5)
Part I Ethics and Values in Pharmacy
Values in Health and Illness	19	(12)
Identifying Value Judgments in Pharmacy	20	(6)
Separating Ethical and Other Evaluations	26	(5)
What Is the Source of Moral Judgments?	31	(18)
Grounding Ethics in the Professional Code	32	(4)
Grounding Ethics in the Physician's Orders	36	(3)
Grounding Ethics in Hospital Policy	39	(2)
Grounding Ethics in the Patient's Values	41	(2)
Grounding Ethics in Religious or Philosophical Perspectives	43	(2)
Notes	45	(4)
Part II Ethical Principles in Pharmacy Ethics
Benefiting the Patient and Others:The Duty to Do Good and Avoid Harm	49	(18)
Benefiting the Patient	50	(8)
Benefiting Society and Those Who Are Not Patients	58	(8)
Notes	66	(1)
Justice: The Allocation of Health Resources	67	(14)
Justice Among Patients	68	(3)
Justice between Patients and Others	71	(3)
Justice in Public Policy	74	(4)
Justice and Other Ethical Principles	78	(2)
Notes	80	(1)
Autonomy	81	(16)
Determining Whether a Patient Is Autonomous	84	(4)
External Constraints on Autonomy	88	(2)
Overriding the Choices of Autonomous Persons	90	(6)
Notes	96	(1)
Veractity: Dealing Honestly with Patients	97	(19)
The Condition of Doubt	99	(2)
Lying in Order to Benefit	101	(6)
Special Cases of Truth-Telling	107	(5)
The Right of Access to Medical Records	112	(2)
Notes	114	(2)
Fidelity:Promise-Keeping and Confidentiality	116	(18)
The Ethics of Promises:Explicit and Implicit	117	(4)
The Limits on the Promise of Confidentiality	121	(4)
Breaking Confidence to Benefit Others	125	(2)
Incompetent Impaired and Dishonest Colleagues	127	(5)
Notes	132	(2)
Avoidance of Killing	134	(25)
Active Killing Versus Letting Die	137	(4)
Withholding Versus Withdrawing Treatment	141	(2)
Direct Versus Indirect Killing	143	(4)
Justifiable Omissions	147	(2)
Voluntary and Involuntary Killing	149	(3)
Killing As Punishment	152	(2)
Notes	154	(5)
Part III Special Problem Areas
Abortion, Sterilization, and Contraception	159	(23)
Abortion	159	(14)
Sterilization	173	(2)
Contraception	175	(5)
Notes	180	(2)
Genetics, Birth, and the Biological Revolution	182	(18)
Genetic Counseling	184	(4)
Genetic Screening	188	(2)
In Vitro Fertilization	190	(3)
Surrogate Motherhood	193	(2)
Genetic Engineering	195	(3)
Notes	198	(2)
Mental Health and Behavior Control	200	(17)
The Concept of Mental Health	201	(4)
Mental Illness and Autonomous Behavior	205	(3)
Mental Illness and Third-Party Interests	208	(3)
Other Behavior-Controlling Therapies	211	(5)
Notes	216	(1)
Experimentation on Human Subjects	217	(20)
Calculating Risks and Benefits	220	(4)
Privacy and Confidentiality	224	(3)
Equity in Research	227	(3)
Conflicts of Interest in Research	230	(2)
Informed Consent in Research	232	(3)
Notes	235	(2)
Consent and The Right to Refuse Treatment	237	(20)
The Elements of a Consent	238	(3)
The Standards for Consent	241	(4)
Comprehension and Voluntariness	245	(11)
Notes	256	(1)
Death and Dying	257	(20)
The Definition of Death	258	(4)
Competent and Formerly Competent Patients	262	(2)
Never Competent Patients	264	(5)
Limits Based on Interests of Others	269	(5)
Notes	274	(3)
Appendix	277	(4)
The Hippocratic Oath	277	(1)
American Pharmaceutical Association:Code of Ethics for Pharmacists	278	(3)
Index	281