Pharmacy Ethics: A Case-Based Analysis of Ethical Dilemmas in Pharmacy Practice, Slides of Ethics

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Pharmacy Ethics:

A Case-Based

Introduction

January 14, 2014

Bruce D. White

Objectives

• Define e thics and law and clarify differences and

similarities between the two.

• Explain normative ethics and show how ethical and

legal violations and consequences relate to one other.

• Use a normal distribution curve to highlight standards

and ethical and legal boundaries.

• Illustrate normative ethics conceptually with examples

of ethical-unethical and legal-illegal conduct.

Standards and Normative Ethics

• How are ethics and law related?
  • Standards?
  • Establish conduct minimums?
  • Created and enforced by some authority?
• Professional ethics? Codes of ethics?
• What does normative ethics mean?
• How does normative ethics relate to ethical and

legal professional standards?

Normal Distribution Curve

Pharmacy Disciplinary Actions

• 173,000 pharmacists in 2011
• Recall difficulties with reporting, analyzing
• NABP reported disciplinary rate for 2011 ~1.6%

(16.24 actions per 1000 licenses)

• 1986-88 disciplinary rate range: 1.49 actions/

to 45.61 actions/1000. See

http://oig.hhs.gov/oei/reports/oai-01-89-89020.pdf

(accessed 07-16-12).

Reason for Disciplinary Actions

Percent Alleged violation 19.5% Uncategorized (<1% each): Default on health education loan or scholarship obligations; failure to obtain informed consent; failure to provide medically reasonable or necessary items or services; filing false records or falsifying records; immediate threat to health or safety; improper or inadequate supervision or delegation; malpractice; misleading, false, or deceptive advertising or marketing; negligence; nolo contendere plea; other – not classified; practicing beyond the scope of practice; submitting false claims; substandard or inadequate care; unable to practice safely; unauthorized administration of medication 19.5% Violation of federal or state statute or regulation 10.4% Diversion of controlled substance

Board Sanctions Imposed

Percent Sanction 19.7% Probation of license 14.8% Administrative or publicly available fine or monetary penalty 12.5% Revocation of license 11.0% Suspension of license 10.7% Voluntary surrender of license 10.0% Unclassified sanction (<3%): denial of initial license; denial of license renewal; extension of previous action; licensure restoration or reinstatement denied; limitation or restriction of license; other licensure action

• not classified; reduction of previous action 9.2% License restored or reinstated (complete and conditional) 9.0% Reprimand or censure 3.0% Summary or emergency suspension of license

Normal Distribution Curve

Normative Behaviors “Curve” or

Ethics Continuum

What are we really talking about?

What are we really talking about?

What is an ethical dilemma?

• It may turn on the individual question: “Should I do

this?” This is a question that implicates “normative

ethics.”

• Normative ethics involves recognized (“cherished”)

personal and societal values and principles

expressed as accepted behavioral “norms.”

Typically, values inform choices (decision making)

and principles inform rules (standards setting).

What is an ethical dilemma?

[continued]

• Principles are implicated in normative ethics and

ethical theories: (1) virtue ethics (Aristotle [Greek,

383-322 BC]) and St. Thomas Aquinas [Italian,

1225-1274]); (2) deontological [duty-based] ethics

(Kant [German, 1724-1804]); and teleological

[consequentialist, utilitarian] ethics (Bentham

[English, 1748-1832]; Mill [English, 1806-1873]).

What is an ethical dilemma?

[continued]

• The various ethical theories implicate: motive(s) and

intent (emphasized in virtue theory); intent and

act(s) (emphasized in value theory); and outcome(s)

and consequence(s) (emphasized in action theory).

• Recall that once a decision is made and actions

taken, outcomes are not always predictable.