Prepared and presented by

Dr.Magdi Thabet
Lecturer of Management & Marketing
Faculty of pharmacy
1
❖ Professionalism
❖ Components of Professionalism
❖ Development levels
❖ Identifies Competencies
❖ Competencies maps
❖ Ethical decision making
❖ Purposes of ethical decision making
❖ Factors Affecting Ethical Decision Making
❖ Framework For ethical decision making
❖ Professionals Ethics concepts & importance
❖ Pharmacist in modern society
❖ Three Basic Elements in Professionals Ethics
❖ Methods to Promote Professionals Ethics
❖ Code of Ethics
❖ Theories of Professionals Ethics
❖ Basic biomedical ethical responsibilities
❖ Pharmaceutical ethics and prescription medicines
❖ The ethical conflicts in pharmaceutical practice
❖ Ethical Relationships between pharmacist and his colleagues
❖ Ethical Relationships between pharmacist and his doctors
❖ Ethical Relationships between pharmacist and his patients
❖ Ethical Relationships between pharmacist and his Med. Reps
• Moral values- refers to people’s fundamental
beliefs regarding what is right or wrong, good
or bad

• Ethics- [ethos] Єθοσ

• Greek word for practice or habit,
the characteristic conduct of an individual
human life.
• Ethics- [ethos] Єθοσ
• For the first time the word "ethics" was
used in earliest Greek by philosopher
Aristotle to refer to the science that
studies the well-being of human nature.
• Ethics - is a requirement for human life. It
is our means of deciding a course of action

• Ethics- refers to standards of conduct

which are based on moral values, that
guide people’s decisions and behaviors
 “The system or code of morals of a
particular person, group or profession.”

“Pharmaceutical Ethics is what you do,

not what you say.”
• Professional Ethics is the field of study that is
Ethical judgments are concerned with
differentiating “good” or “bad” behavior in a
given situation
• Professional Ethics include the standards,
values, morals, principles, etc., that we use as
the basis for our decisions or actions
• In ethical decision making, there is often no
clear “right” or clear "wrong” answer
• Professional Ethics refers to well based
standards of right and wrong that prescribe
what we ought to do
• Professional Ethics is usually expressed in
terms of rights, obligations, benefits to
society, fairness, or specific features
• Professional Ethics refers to those standards
that impose reasonable obligations to
refrain from, stealing, killing and fraud
• Ethics means a continuous effort of studying
our own moral beliefs and our moral
conduct
• Through the application of ethics, we try to
ensure that we, and the organizations we
help to shape, live up to standards that are
reasonable and solidly-based
• Ethics in business, or professional ethics as
it is often called, is the application of the
discipline, principles, and theories of ethics
to the organizational framework.
• Professional ethics have been defined as
“principles and standards that guide
behavior in the world of business.”
• Ethics also refers to the study and
development of one's ethical standards
• Feelings, laws, and social standards can
deviate from what is ethical way
• It is necessary to continuously examine
one's standards to ensure that they are
reasonable, rational and committed to ethics
• "Ethics is a guide for our morality
when we face complicated
situations that darken the level of
our prior moral experience.“
• "Ethics is mostly about how
people should be treated and how
one should act, “
• “if one wishes to act rightly."
• A standard
-is an acceptable or approved statement
of something against which measurement
and/or judgment takes place.
-It must be relevant, achievable, Validity,
and measurable.
Values are things that an individual
believes to be essentially worthy or
desirable, that are respected for
themselves (e.g. truth, honesty,
justice, respect for people and the
environment).
• Deontology - the science of professional
ethics of the pharmaceutical workers, for
medical personnel management, principles
designed to maximize the usefulness of
treatment and medical care.
 Pharmacist in modern society

 The main objective of the professional pharmaceutical activity

is treatment and prevention of diseases, preservation and
strengthening of human health.
 Pharmacists in his practice on the matters of drugs and
medical products promoting must submit with the legislation
of Egypt about advertising of drugs, medical equipment,
methods of prevention, diagnostics, treatment and
rehabilitation.
 To promote development of health sphere, Through
pharmaceutical sector.
 improving of the profession image, pharmacists should
actively participate in the activities of national and
international civic and professional organizations .
 Pharmacist and scientific progress

Pharmacist must raise his ethical, professional level

and skills.
Pharmacist should contribute to conducting of various
studies aimed at increasing efficiency and availability
of pharmaceutical care.
When creating preclinical, clinical trials of drugs,
registration, manufacture and their sales, pharmacist
must follow the requirements of international
standards.
Clinical trials of new drugs should be carried out
according to bioethical principles.
• Personal level--situations faced in personal life
• Professional level—workplace situations faced
as managers and employees .
• Societal and international levels—local-to-
global situations
 people Good Bad

environment

Good people behave Bad people behave

Good ethically in an ethical unethically in any
environment setting

with resistance Bad people influence

Bad Good people forced organization to
to behave become an unethical
unethically by environment
external forces
Importance of Professionals Ethics

• A pharmacist’s responsibility is to benefit

patients and prevent harm by dispensing the
right drug in the right amount and with
complete use information.
• Failure to fulfill these responsibilities can lead
to loss of disease control, disability, and/or
death.
• Adherence to both professional standards and
a code of ethics is vital if these problems are to
be avoided.
 Importance of Professionals Ethics

• ↓ Financial risks
• ↑ Reputation and competitive advantage
• ↑ Efficiency and effectiveness
• ↑ Customer trust, loyalty & commitment

22
 Importance of Professionals Ethics

• Ethical conduct of information professionals is

– Validation of the critical value of services
– Validation of responsibility to themselves and
society
– Validation of respect for others
– Validation of the need to improve society
 Professionals Ethics in Science

• Information ethics:
Use and misuse of information
– Ownership of information
– Intellectual property rights
– Free or restricted access to information
– Use of government information
– Assurance of privacy and confidentiality
– Data integrity
– International flow of information
 Pharmaceutical Information
• Providing of pharmaceutical information in
professional and public publications, any media,
speeches of pharmacists at scientific conferences in
the conditions of professional and practical activity
should be subject to ethical rules and regulations,
avoiding demonstration of advertising, self-
promotion and unfair competition.
• Pharmacist must give the patient complete and
available information on application,
contraindications, side effects of drugs and medical
products, even against his own or commercial
interests.
 Categories of Ethical Concern

• Free access to information/effects of

information
• Privacy
• Copyright
• Information organization
• Information policy
• Information quality
Methods to Promote Professionals Ethics

• Establishing rules and regulations

• Developing training and education programs
• Punishing individual for ethical violations
• Hiring and promoting individuals with ethical
behavior and understanding
• Developing a system of rewards for both ethical
actions and unethical ones
• Establishing an ethics code for the organization
 Code of Ethics

-These are guidelines derived from values

and principals intended for the suitable
behavior while practicing various
professional activities
- They indicate the way a doctor is expected to
behave
Code of Ethics

1)Contribute to society and human well-being.

2) Avoid harm to others.
3)Be honest and trustworthy.
4)Respect the privacy of others.
5)Honor confidentiality.
6)Acquire and maintain professional competence.
7)Differentiate between our personal opinions
and professional duties …

29
 RPSGB Code of Ethics for Pharmacists
and Pharmacy Technicians
• Make the care of your patients your first concern.
• Exercise your professional judgment in the
interests of patients and the public.
• Show respect for others.
• Encourage patients to participate in decisions
about their care.
• Develop your professional knowledge and
competence.
• Be honest and trustworthy.
• Take responsibility for your working practices.
30
Royal Pharmaceutical Society of Great Britain
31
Theories of professional Ethics
• Four major theories of professional
ethics:
– Utilitarianism: net benefits
– Rights: entitlement
– Egoism: self-interest
– Justice: fairness
Theories of professional Ethics
• Utilitarianism
– examine an action’s effects to decide
whether it is morally correct
– Action is morally right if the total net
benefit of the action exceeds the total net
benefit of any other action
– Assumes a person can assess all costs
and benefits of an action
– Assessment of net benefits includes any
important indirect effects
 Theories of professional Ethics
• Utilitarianism (cont.)
– Rule utilitarianism asks a person to assess
& set of rules designed to yield the greatest
net benefit to all affected
– Act utilitarianism asks a person to assess
the effects of all actions according to a set
of rules designed
– Compares act to rules
– Does not accept an action as right if it
maximizes net benefits only once
 Theories of professional Ethics

• Rights
– Right: a person’s just claim or entitlement
– Focuses on the person’s actions or the
actions of others toward the person

– Purpose: let a person freely follow certain

actions without interference from others
 Theories of professional Ethics

• Rights
• Legal rights: defined by a system of laws
• Moral rights: based on ethical standards
– Examples
• Legal right: right to a fair trial
• Moral right: right to due process within an
organization
 Theories of professional Ethics

• Rights
– Features
• Respect the rights of others
• Let's people act as equals
• Moral justification of a person’s action
 Theories of professional Ethics

• Egoism
– defines right and wrong in terms of the
values to one’s self.
– Egoism is defined by self-interest.
– An egoist would evaluate an ethical issue
in terms of how different ways of action
would affect his physical, mental, or
emotional well being.
 Theories of professional Ethics

• Justice
– Justice-based theories of ethics concern
the perceived fairness of actions.
–
– A just ethical action is one that treats all
fairly and constantly in accord with
ethical or legal standards.
 Theories of professional Ethics

• Justice
– Looks at the balance of benefits and loads
distributed among members of a group
– Can result from the application of rules,
policies, or laws that apply to a society or
a group
– Just results of actions override utilitarian
results
 Theories of professional Ethics
• Justice
- Distributive fairness is based on the outcomes
received by individuals and their perceptions of
these outcomes.
– Procedural fairness is based on the processes
(policies, procedures, rules) employed to reach
decisions.
– Individuals evaluate the fairness of these processes
in addition to the outcomes received.
 Reasons of Injustice
• Emotions
• Low sense of responsibility
• Poor use of authority
• Poor competencies
• Incomplete information
• Lack of efforts
 Requirements of Justice

• Competencies
• Sense of responsibility
• equal opportunities
• Proper selection
• Courage
• Massive effort
• Clean reputation
 BIOETHICS VS ETHICS
Bioethics is a way of understanding and
examining the moral aspects of
biomedical practice and research

But

Ethics are ways of understanding and

examining the morals in life, or right and
wrong human conduct.
 Medical Ethics

The application of moral

principles and analysis to
medical situations
 Medical Ethics
Is based on philosophical ethics
• It isn’t any ethics but special ethics
of special cases.
• Medical ethics is not only concerned with
doctors but also patients and society.
• The central question of medical ethics is
“the doctor-patient relationship”.
Basic biomedical ethical responsibilities

• benefiting the patient,

• supporting a patient’s right to self-
determination/autonomy,
• refraining from harming the patient,
• assisting and advocating on behalf of the
patient to ensure effective and safe healthcare,
• protecting the patient’s medical privacy,
• maintaining professional competency and
knowledge
Pharmaceutical ethics and prescription
medicines
FIP policy statement (Vancouver September 1997)
indicates that:

(1) “…responsibility for selection of the

medicinal product will be that of the pharmacist
(made within specified criteria) and
(2) regulatory authorities and manufacturers
should provide to pharmacists and prescribers,
bioavailability and other relevant data relating to
all medicinal products, where these are important
factors relative to efficacy …”.
51
Pharmaceutical ethics and prescription
medicines

The RPSGB “Accreditation of UK Pharmacy Degree

Courses published 16 May 2002, p.5 indicates under
“Outcomes” that:
– the graduate pharmacist…
is able to interpret and evaluate, for safety, quality,
efficacy and economy, prescriptions and other orders for
medicines, and to advise patients and other healthcare
professionals about medicines and their usage.

52
 4 ethical rules
• Veracity – truth telling, informed consent,
respect for autonomy

• Privacy – a persons right to remain private,

to not disclose information

• Confidentiality – only sharing private

information on a ‘need to know basis’

• Fidelity – loyalty, maintaining the duty to

care for all no matter who they are or what
they may have done
 Ethical Dilemma
A conflict between moral necessities,
i.e., “what is the right thing to do?”
• What is “medically” right vs. patient
preference
• What is preferred by patient vs. proxy
decision maker
• What is best for patient vs. what is best for
society
The ethical conflicts in pharmaceutical
practice
• allocation of time between dispensing and
clinical services;
• patient advocacy responsibilities;
• social, moral, or religious objections to
certain drug uses;
• conflicts of interest with pharmaceutical
companies;
• drug deviation and abuse;
• healthcare resource stewardship.
 Quality Concepts
“Quality is conformance to
requirements” (or standards)
“ Doing the right thing, right, the first
time.”
“Doing it better the next time”
 Quality Definitions

"The quality of technical care in the

application of medical science and
technology works in a manner that
maximizes its benefits to health without
correspondingly increasing its risks.
The degree of quality is therefore the extent to
which the care provided is expected to
achieve the most favorable balance of risks
and benefits."
 Quality Definitions

The proper performance (according

to standards) of interventions that
are known to be safe, affordable to
the society, and have the ability to
produce an impact on morbidity,
mortality, disability and
malnutrition .
 Quality is achieved when:

• The organization’s process and

activities are designed and
implemented to continuously meet
the organization’s customers’
needs and expectations.
 Maxwell’s QA Theory

Maxwell (1984) mentioned a six-dimensional

model to explain health care quality:
* Accessibility to service; distance, time and
money.
* Relevance to needs of the population as a
whole.
* Effectiveness; achieving the best available
results (objectives).
 Maxwell’s QA Theory

* Equity; fair treatment of all patients relative

to each other.
* Acceptability; delivering the service
humanely and considerably to meet
patient’s expectations and needs.
* Efficiency; making the maximum use of
resources.
Ethical Relationships between pharmacist
and his colleagues

• Pharmacist must build relationships with

colleagues based on mutual respect, trust,
take by professional ethics.
• Pharmacist should create and maintain
favorable moral and psychological climate in
the team.
• Pharmacist must criticize incompetence and
unprofessional actions of colleagues that
may harm health of the population.
Ethical Relationships between pharmacist
and his colleagues

• The pharmacist should not offend his

colleagues, either by detracting from their
practical, moral, or Economically status, or
by any other means.
• Refraining from illegal means to attract
customers to his pharmacy
• The pharmacist should refrain from
speculation and stick to the specified prices
(discount is illegal)
Ethical Relationships between pharmacist
and doctor

Pharmacist as a specialist of this scope shall:

• Inform the doctor about drugs, their availability,
distinctions of pharmacotherapy and use of analogues.
• Provide the doctor with complete information about
the new preventive and diagnostic drugs.
• Require from the physician to exactly follow the
established regulations of writing drugs prescriptions;
• Detect the medical errors in drugs prescription and
discuss them with the doctor.
• The pharmacist should strongly support the authority
of the doctor for saving patient's confidence in the
effectiveness of medicines.
Ethical Relationships between pharmacist
and doctor

Pharmacist as a specialist of this scope shall:

• Build a effective relationship of knowledge, respect
and appreciation between the pharmacist and the
doctor, in order to benefit the patient and his recovery
• These relations must be based on mutual
understanding and support to each other authority in
the eyes of the patient.
• It is not accepted for the pharmacist to achieve an
agreement with a physician to dispense medicines to
his patients on special conditions.
 Ethical Relations between pharmacist
and patient
Pharmacist must:
• Treat each patient with respect from meaning individual
approach showing no favorite or dislike;
• Have effective communication skills to be able to
achieve confidence and mutual understanding between
pharmacist and the patient;
• To act openly, honestly and objectively, without using
in personal or their institution’s benefit
• Do not take advantage of the patient’s lack of
information and ignorance about drugs and medical
products,
 Ethical Relations between pharmacist
and patient
Pharmacist must:
• Don't place pressure on the patient (in whatever form)
for their purchase.
• The pharmacist may not disclose the secrets entrusted
to him through his profession, except to the extent
required by law.
• The pharmacist must ensure the dignity of his
institution in front of the public in general and his
customers in particular.
Ethical Relations between pharmacist
and patient
Pharmacist must:
• be able to listen to the patient. The patient should allow
The conversation is best to lead in the form of a short
dialogue, influencing the feelings of the patient, and the
message should contain only the words that will
convince the patient to the treatment efficiency.
• Explain in detail how to keep at home, how and when to
take. We must warn about possible side effects of
drugs and explain, stop taking it, consult a doctor, to
reduce the dose.
 Ethical Relations between pharmacist
and Medical Representatives
• Medical representatives is one of the main sources of
information about company-specific drugs.
• Performance relationships between pharmacists and
Med. Reps. is determined not only mutual economic
interest, but complicated relationship of ethical
character.
• The importance of communicating parties confirmed
professional and ethical issues, rules, how to make a
proper impression and create an atmosphere of mutual
comfort.
 Ethical Relations between pharmacist
and Medical Representatives
• Important in the relationship of pharmacists and
med. Rep. is to establish a trusting relationship
that will not accept false promises, providing
false information.
• Med. Rep. Trying to form a positive attitude
towards the company and its products,
• Med. Rep. should not use reducing the
advantages of drugs of competing firms,
promoting ineffective drugs, giving gifts,
souvenirs.
Respect for the profession of pharmacist

The principle of respect for his profession must

be maintained in all areas of pharmacist’s
activity: professional, social, scientific,
educational and any other and fully supported
by every pharmacist.
Unacceptable from a professional and ethical
point of view is disrespect and negative
statements about pharmaceutical profession.
Any activity of pharmacist should contribute to
the prestige of the profession, preservation and
increase of its best traditions.
Respect for the profession of pharmacist

Pharmacist is responsible for the violation of

standards and principles of professional ethics
in front of the pharmaceutical community as
well as of the current legislation of Egypt, if the
violation also related to its standards.