Code of Ethics (Detailed)

Preamble

The pharmacist, by entering the profession, is committed to moral norms of conduct and assumes a professional commitment to the health and well-being of patients. As citizens, pharmacists continue to be bound by the moral and legal norms shared by all other participants in society. As individuals, pharmacists have a right to choose to live by their own values as long as those values do not compromise pharmacy care.

Adoption of the Code represents a conscious undertaking on the part of the members of the College of Pharmacists of British Columbia to be responsible for practicing in accordance with the expressed principles (values and obligations). The Code defines and seeks to clarify the obligations of pharmacists to use their knowledge and skills for the benefit of others, to minimize harm, to respect patient autonomy and to provide fair and just pharmacy care for their patients.

• For those entering the profession, the Code identifies the basic moral commitments of pharmacy care and serves as a source for education and reflection.
  
• For those within the profession, the Code serves as a basis for self-evaluation and peer review.
  
• For those outside the profession, the Code provides public identification of the professional ethical expectation of its members.

Therefore the Code of Ethics is educational, guides behaviour, and expresses to the larger community the values and ideals that we espouse by reason of trust and commitment.

Elements of the Code

The Code contains different elements designed to help the pharmacist in its interpretation. The values and obligations are presented by topic and not in order of importance.

• Values express broad ideals of pharmacy practice. They establish correct directions for pharmacy practice. In the absence of a conflict of ethics, the fact that a particular action promotes a value of pharmacy practice may be decisive in some specific instances. Pharmacist behaviour can always be appraised in terms of values; How closely did the behaviour approach the value? How widely did it deviate from the value? The values expressed in the Code must be adhered to by all pharmacists in their practice. Because they are so broad, however, values may not give specific guidance in difficult instances.
  
• Obligations provide more specific direction for conduct than do values; obligations spell out what a value requires under particular circumstances.

It is also important to emphasize that even when a value or obligation must be limited, it nonetheless carries moral weight. For example, a pharmacist who is compelled to testify in a court of law on confidential matters is still subject to the values and obligations of confidentiality. While the requirement to testify is a justified limitation upon confidentiality, in other respects confidentiality must be observed. The pharmacist must only reveal that confidential information that is pertinent to the case at hand, and such revelation must take place within the appropriate context.

Value 1 - A pharmacist respects the professional relationship with the patient and acts with honesty, integrity and compassion.

Obligations

1. The patient-pharmacist relationship is a covenant, meaning that a pharmacist has moral obligations in response to the trust received from society. In return for this, a pharmacist promises to help patients achieve optimum benefit from their medications, to be committed to their welfare, and to maintain their trust.

2. A pharmacist has a duty to tell the truth, to act with conviction of conscience, and to avoid discriminatory practices and behaviour.

Value 2 - A pharmacist honours the individual needs, values and dignity of the patient.

Obligations

1. A pharmacist assists patients to make informed choices about their own best interests.

2. A pharmacist aids patients in their expression of needs and values, and recognizes their right to live at risk.

3. A pharmacist's commitment to the patient's care must be sensitive to, but not prejudiced by, factors such as the patient's race, religion, ethnic origin, social or marital status, gender, sexual orientation, age, or health status.

4. A pharmacist recognizes the patient's membership in a family of choice, and, with the patient's consent, attempts to facilitate, where appropriate, the participation of significant others in the care of the patient.

5. A pharmacist's conduct at all times acknowledges the patient as a person. Discussion of care in the presence of the patient should, whenever possible, actively include the patient.

Value 3 - A pharmacist supports the right of the patient to make personal choices about pharmacy care.

Obligations

1. A pharmacist has the primary responsibility to inform the patient about available pharmacy care. Consent is an essential precondition to the provision of care.

2. A pharmacist owes a duty to disclose material risks associated with medication therapy. Adequate disclosure is normally achieved by highlighting the more frequent and serious side effects, as well the probability of their occurrence.

3. Valid consent, usually verbal, represents the free and informed choice of the competent patient to undergo pharmacy care.

4. A pharmacist should aid patients in becoming an active participant in their care to the maximum extent that circumstances permit.

5. A pharmacist provides information to the patient in an understandable and sensitive way.

6. A pharmacist does not withhold pertinent medication information or use deceptive tactics in obtaining consent. When the patient's questions require information beyond that available to a pharmacist, the patient will be referred to an appropriate health care professional.

Value 4 - A pharmacist provides competent care to the patient and actively supports the patient's right to receive competent and ethical health care.

Obligations

1. A pharmacist places concern for the well-being of the patient at the centre of professional practice, providing the best care that circumstances, experience and education permit.

2. A pharmacist who suspects incompetence or unethical conduct by a health care professional will first consider the welfare of the patient. Subject to that principle, the following will apply:

• A pharmacist should engage in direct discussion with the health care professional involved, if a situation can be resolved without peril to the patient.
  
• A pharmacist shall not participate in efforts to deceive or mislead patients about the cause of alleged harm or injury resulting from unethical or incompetent conduct.
  

3. A pharmacist commits to lifelong learning designed to maintain relevant knowledge and skills.

Value 5 - A pharmacist protects the patient's right of confidentiality.

Obligations

1. A pharmacist provides pharmacy care with consideration for the personal privacy of patients.

2. An affirmative duty exists to institute and maintain practices that protect patient confidentiality.

3. A pharmacist, where appropriate, reveals to the patient the boundaries of professional confidentiality. Pharmacy care may require that other health care personnel have access to or be provided with the relevant information. Whenever possible, the patient should be informed, and generally, it is up to the patient to determine who should be informed and what personal information should be released.

4. When a pharmacist is confronted with the necessity to disclose, confidentiality should be preserved as much as possible. Both the amount of information disclosed and those to whom disclosure is made should be restricted to that which is necessary.

5. A pharmacist may breach confidentiality when the failure to disclose information will place other persons or the patient in serious danger. A pharmacist will, whenever possible, consult with other health professionals involved with the patient before breaching confidentiality.

Value 6 - A pharmacist respects the values and abilities of colleagues and other health professionals.

Obligations

1. A pharmacist accepts responsibility to work with colleagues and other health care professionals and with public interest pharmacy organizations and patient advocacy groups, to promote safe and effective pharmacy care.

2. A pharmacist, when appropriate, asks for the consultation of colleagues or other health professionals or refers the patient.

Value 7 - A pharmacist endeavours to ensure that the practice environment contributes to safe and effective pharmacy care.

Obligations

1. A pharmacist manager has a responsibility to foster an optimal practice environment and to ensure the provision of required resources.

2. If there is a conflict between professional activities and management policies, professional responsibilities will take precedence.

3. A pharmacist will challenge employment conditions that are inconsistent with professional practice as described in this code.

Value 8 - A pharmacist ensures continuity of care in the event of job action, pharmacy closure or conflict with moral beliefs.

Obligations

1. A pharmacist has a duty through coordination and communication to ensure the provision of essential pharmacy care throughout the duration of any job action or pharmacy closure. Patients who require ongoing or emergency pharmacy care are entitled to have those needs satisfied.

2. A pharmacist is not ethically obliged to provide requested pharmacy care when compliance would involve a violation of his or her moral beliefs. When that request falls within recognized forms of pharmacy care, however, there is a professional obligation to refer the patient to a pharmacist who is willing to provide the service. The pharmacist shall provide the requested pharmacy care if there is no other pharmacist within a reasonable distance or available within a reasonable time willing to provide the service.

Commentary

Ethical Problems

Situations often arise that present ethical problems for pharmacists in their practice. These situations tend to fall into three categories:

(a) Ethical violations involve the neglect of moral obligation; for example, a pharmacist who neglects to provide competent pharmacy care to a patient because of personal inconvenience has ethically failed the patient.

(b) Ethical dilemmas arise where ethical reasons both for and against a particular course of action are present and one option must be selected. A patient who is likely to refuse some appropriate form of pharmacy care presents the pharmacist with an ethical dilemma. For example, a patient might refuse to take medication to treat their cancer if there is a likelihood of hair loss. In this case, substantial moral reasons may be offered on behalf of several opposing options.

(c) Ethical distress occurs when pharmacists experience the imposition of practices that provoke feelings of guilt, concern or distaste. Such feelings may occur when pharmacists are ethically obliged to provide particular types of pharmacy care despite their personal disagreement or discomfort with the course of treatment prescribed. For example, the sale of injection devices for nonmedical use has been shown to reduce the HIV infection rate, but a pharmacist may hold a personal belief against facilitating the use of illicit drugs.

The Code provide clear direction for avoiding ethical violations. When a course of action is mandated by the Code, and there exists no opposing ethical principle, ethical conduct requires that course of action.

The Code cannot serve the same function for all ethical dilemmas or for ethical distress. There is room within the profession of pharmacy for conscientious disagreement among pharmacists. The resolution of any dilemma often depends upon the specific circumstances of the case in question, and no particular resolution may be definitive of good pharmacy practice. Resolution may also depend upon the relative weight of the opposing principles, a matter about which reasonable people may disagree.

The Code cannot relieve ethical distress but it may serve as a guide for pharmacists to weigh and consider their responsibilities in the particular situation, Inevitably, pharmacists must reconcile their actions with their consciences in providing pharmacy care to patients.

The Code tries to provide guidance for those pharmacists who face ethical problems. Proper consideration of the Code should lead to better decision-making when ethical problems are encountered.

It should be noted that many problems or situations seen as ethical in nature are problems of miscommunication, failure of trust or management dilemmas in disguise. There is, therefore, a distinct need to clarify whether the problem is an ethical one or one of another sort.