Ethical Issues in Pharmacy Practice Michael Manolakis, PharmD, PhD 2015 CPFI ANNUAL MEETING FLAT ROCK, NC

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1 Ethical Issues in Pharmacy Practice Michael Manolakis, PharmD, PhD 2015 CPFI ANNUAL MEETING FLAT ROCK, NC

2 I have no conflicts of interest to disclose.

3 Objectives Describe a strategy for making an ethicallybased decision. Differentiate ways that individuals can suffer Asses the difference between the biomedical good of a patient and the subjective good of that same patient

4 4 Imagine, if you will

5 5 Imagine, if you will

6 6 Imagine, if you will

7 What do 7 you do?

8 What should you do? 8

9 What should you do? 9 You can get it done.

10 What should you do? 10 You can get it done. It is your job!

11 What should you do? 11 You can get it done. It is your job! The action is legal.

12 What should you do? 12 You can get it done. It is your job! We are doing a good thing by helping. The action is legal.

13 What should you do? 13 You can get it done. It is your job! Duty to Care We are doing a good thing by helping. The action is legal.

14 General Principles of Biomedical Ethics 14 Respect for Autonomy Justice Beneficence Nonmaleficence

15 An Ethical Decision Making Model Bruce Weinstein, PhD & Alvin Moss, MD 15 Clarify the Facts Clarify the Values Determine the Options Choose an Option Ethically Defensible Choice

16 But, what if something gets in the way? 16

17 Moral Distress 17 First defined by Andrew Jameton in 1984 Moral distress: the inability of a moral agent to act according to his or her core values and perceived obligations due to internal and external constraints.* Causes, Factors and Effects ** Grady, C. Moral Distress: a growing problem in health professions. The Hastings Center Report. January-February 2010: p 20. Gallagher A. Moral Distress and Moral Courage in Everyday Nursing Practice. The Online Journal of Issues in Nursing. Vol. 16 No. 2 (March 21, 2010)

18 Looking at Everyday Nursing* 18 Causes: poor quality and futile care, unsuccessful advocacy, raising unrealistic hope Factors: staff education level, peer support, educational level / experience Effects: mixed with respect to positive or negative impact on care, reduced job satisfaction *Gallagher, A. Moral Distress and Moral Courage in Everyday Nursing Practice. The Online Journal of Issues in Nursing. Vol. 16, No. 2.

19 Experienced at least once within the past 6 months Percentage of Respondents Ethically troubling interaction with professional from another discipline Any sitution that didn't seem quite right from ethical perspective Conflict with policy that prevented doing the right thing Directive from supervisor that raised ethical concern

20 Can you name this philosopher? 20

21 Aristotle 21

22 22 Foolhardiness Courage Cowardice The man who shuns and fears everything and never stands his ground becomes a coward, whereas a man who knows no fear at all and goes to meet every danger becomes reckless. - Aristotle, Nicomachean Ethics, II a20-23

23 One Definition of Moral Courage* 23 Presence and recognition of a moral situation Moral choice Behavior Individuality Fear Miller, R. Moral Courage: Definition and Development. Ethics Resource Center March Development.pdf. Accessed 5/28/15.

24 Attributes of the morally courageous leader Greater confidence in principles than in personality Formidable persistence and determination Higher tolerance for ambiguity, exposure and personal loss Independence of thought Acceptance of deferred gratification & simple rewards

25 The case of Judy

26 Our Ethical Decision Making Model: What are the facts and values at play? 26 Clarify the Facts Clarify the Values Determine the Options Choose an Option Ethically Defensible Choice

27 Suffering Pathophysiologybased Acute care Chronic care Long term care

28 Suffering Pathophysiologybased Acute care Chronic care Long term care Spiritual-based Our broken, fractured self Our broken state in a spiritual sense

29 Suffering Pathophysiologybased Acute care Chronic care Long term care Spiritual-based Our broken, fractured self Our broken state in a spiritual sense we suffer with him in order that we may also be glorified with him. Romans 8:17 (ESV)

30 How should a pharmacist act? Ethical Mandates Faith Mandates Legal Mandates Policy Mandates

31 The balance required by the Christian Pharmacist. Internal External

32 So, let s revise our question how should a Christian pharmacist act? Ethical Mandates Faith Mandates Legal Mandates Policy Mandates

33 2 Timothy 1:7 (ESV) for God gave us a spirit not of fear but of power and love and self-control.

34 Isaiah 58:10 (ESV) if you pour yourself out for the hungry and satisfy the desire of the afflicted, then shall your light rise in the darkness and your gloom be as the noonday.

35 So, we return again to the question how should a Christian pharmacist act? Ethical Mandates Faith Mandates Legal Mandates Policy Mandates

36 Thank you!

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