Ethical Aspects Of Drug Information Practice

By: Hizkel E. (B Pharm, MSc)

 What is Ethics?
2

 Ethics is "the philosophical inquiry of the

moral dimensions of human conduct“(American
association of college of pharmacy.(AACP,))

 describe an action or decision as "good" or

"right." ((Aristotle)
 Generally ethics is the systematic study of
what is right and good with respect to
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conduct and character.
 What is Ethics?
3

 Ethics can be defined broadly as a set of moral principles or

values governing a behavior or conduct.
 Each of us has such a set of values.
 We may or may not have considered them explicitly.
 Ethics is not values clarification, it is not the study of moral
development, it is not the law.
 Veatch stated that “an ethical or moral issue involves
judgments between right and wrong human conduct or
praiseworthy and blameworthy human character”.

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 Cont’d…
4

 Ethical deliberation may be differentiated from other

types of decision-making by three characteristics:
1. It is ultimate or fundamental, there is no
higher standard against which to measure the
rightness of the decision or action
2. The issue is universal, the parties in
disagreement do not consider it simply a
difference of opinion or taste- each party
believes there is a right or wrong answer- even if
they are not sure what the answer is; &
3. The deliberation takes into account the welfare
of all involved or affected by the judgment at hand
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 professional ethics
5

 professional ethics has been defined as "rules of conduct or

standards by which a particular group in society regulates its
actions and sets standards for its members.“
 Professional ethics focuses on explicit or implicit rules and
standards set by a professional subgroup of society, and addresses
the responsibilities of only those who are members of that
subgroup.
 Law involves written rules set by the whole society (or its
representatives) that address responsibilities of that society's
members.

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 Why People Act Unethically?...
6
 Why People Act Unethically?
 The person’s ethical standards are different
from those of society as a whole
 The person chooses to act selfishly
 In many instances, both reasons exist

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Ethical Dilemmas in Pharmacy
Practice:
7

 An ethical dilemma is a situation a person faces in which a

decision must be made about appropriate behavior

 All pharmacists who provide DI must address the ethical

dilemmas that arise in the course of providing this service

 Aspects of moral life that can prepare, guide, & support

pharmacists faced with Ethical Dilemmas during the

course of providing drug information:

 Principles & rules; Rights; Character & virtues, &

 Moral emotions 01/21/2025

 Resolving Ethical Dilemmas:
8

1. Obtain the relevant facts

2. Identify the ethical issues from the facts
3. Determine who is affected
4. Identify the alternatives available to the person who
must resolve the dilemma
5. Identify the likely consequence of each alternative
6. Decide the appropriate action

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 Ethics Analysis:

 Beauchamp & Childress defined ethics as “a

generic term for several ways of
examining the moral life”.
 These authors described a process of
deliberation & justification that is
necessary when confronting a moral
dilemma
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 Ethics Analysis…….
10
 When we deliberate we are considering which judgment
is morally justified
 They indicated that, “Particular judgments are justified by
moral rules, which in turn are justified by principles, w/h
ultimately are defended by an ethical theory”
Ethical theory
Action-guides
Principles

Rules

Particular judgments
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 Cont’d…
11

 The authors referred to these hierarchical levels of analysis

(particularly rules and principles) as action-guides,
which are utilized to justify a particular judgment
 They describe a rule of ethics as specific to context and
relatively restricted in scope;
for instance, the moral rule about confidentiality that specifically
addresses a patient’s right to consent prior to release of
privileged information
 Principles are more broad and fundamental in scope;
for example, the principle of respect for autonomy, which is the
patient’s right to decide on personal issues
 They describe ethical theories as “integrated bodies of
principles and rules that may include mediating rules that
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govern cases of conflicts”
 Ethical theories:
12

 The prominent rules and principles guiding

ethical decision-making by health care
professionals can generally be placed within one of
two broad ethical theories:
1. Consequentialist theory or
2. Deontological (derived from the Greek word
deon, meaning duty) theory

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 Consequentialist theories
13

 Describe actions or decisions as morally right

or wrong based on their consequences,
 rather than on any intrinsic features they may
have
 Two cardinal principles of ------ are:
 Beneficence (do that which promotes a
good outcome)
 Nonmaleficence (do that which minimizes
bad outcomes)
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 Cont’d…
14

 e.g, an informed consent ethical rule can be of value

within consequentialist theory
 b/c consent generally results in improved compliance &
outcome—good consequences.

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 Duty driven (deontological)
theories
15

 Look more to intrinsic qualities of an act or

decision to assert its moral rightness or
wrongness.
 Consider other inherent features of an act,
besides consequences, as also relevant & often
of greater importance.
 e.g, in various forms of deontological theory,
the act is considered inherently wrong if it is
dishonest or breaks confidentiality, or if it
doesn’t respect individual autonomy.
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 Analyzing Ethical Dilemmas:
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 Veatch indicated that often we reach particular ethical

decision without a great deal of conscious deliberation,
through our moral intuition, and without subsequent challenge
from any external party
 However, on occasion, when pondering a certain ethical
judgment, we are called on (internally or externally) to analyze
and justify the basis for our conviction
 He suggested that when this occurs, it is first important to
understand the facts of the specific case
 He then described progression through three additional
process stages of reflection (on ethical 01/21/2025
rules, principles, &
 Process of Ethical Analysis: Solving
Ethical Dilemmas in provision of DI
17

I. Identification of relevant background information

A. Factual details of the issue at hand
B. Consideration of who is affected by the ethical issue
C. Learn and respectfully address the cultural perspectives
(including applicable legal requirements) for those affected
by the dilemma
II. Identification & justification of the relevant moral rules &
principles (action-guides) pertinent to the case
III. Deliberation, through the use of moral intuition & application
of ethical theory, on how to rank/balance the rules & principles
pertinent to the case in order to resolve the ethical dilemma
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 Step I: Identification of Relevant
Background
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Information
 This 1st step deserves careful consideration & research
 Once the facts of a case are known, the moral concerns
may be resolved
 This step has been divided into three parts:
Data gathering
Consideration of the welfare of all affected

parties
Respect for the cultural perspectives of these

parties
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 Step II: Use of Rules & Principles (Action-
Guides)
to Assist in Analysis of an Ethical
19 Dilemma
 If the dilemma persists after step 1, the process of ethical
deliberation should proceed.
 This 2nd process step of analysis will look at moral rules that
may apply to the specific case, as well as at more general
pertinent ethical principles
 Defining the relevant action-guides as rules or principles help
in assessing which are more fundamental to the issue at hand.
 It should be noted that specific action-guides may be considered a
rule within one ethical theory and a principle within another.

e.g, veracity (truth telling), may be considered by some ethicists
to be a specific moral rule & by others to be a general principle,
depending on which ethical theory is followed.01/21/2025
 Cont’d…
20

 E.g.
1. In a particular dilemma, a professional may choose the

primary principle of respecting autonomy, providing a

complete information (informed consent rule) so that
the patient make an informed decision.
2. A professional may choose the ‘do not harm’ principle

and choose an action accordingly.

 A conflict in moral principles may sometimes arises.

 e.g. A pharmacist may withhold disclosing a full

information (breaching the informed consent rule

and possibly the ‘do no harm’ rule) in order to
facilitate good compliance.
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 Step III: Ethical Theory as a Means to
Clarify or
Resolve Ethical Dilemmas
 This third step of ethical analysis reveals how relevant moral
rules & principles interact within the preferred ethical theory
to address the given dilemma
 When confronted with conflicting ethical rules or
principles, the pharmacist may resolve the dilemma via
his or her moral intuition of “the right thing to do”
 Consciously deliberating on how the ethical theories
suggest particular rules/principles should be prioritized
or balanced, this process step can lead to more rational and
honest decision-making or action-taking
 He suggests that these ultimate deliberations at the level of
ethical theory will be affected by our most basic religious
&/or philosophical commitments
 It is important that the pharmacist recognizes and
acknowledges the impact on decision-making of his or her
own personal ethical perspective 01/21/2025
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 Ethical Rules & Principles (Action-
guides)
22

Nonmaleficence:
 A basic principle of consequentialist theory; encompasses

the duty to do no harm

 The obligation to avoid inflicting either physical or

psychological harm on others

 This tenet has a long history as part of the Hippocratic

tradition, where it has often been described in terms of the

health care provider’s duty to the individual patient
 It is also cited as justification for actions benefiting all.

 Principle of avoiding harm to the patient

 Justification for ‘ acts and omissions’ distinction in law
(withholding/withdrawing treatment that is not benefiting
patient) 01/21/2025
 Beneficence
23

A basic principle of consequentialist

theory
that expresses the duty to promote good
 Principle of doing what is best for the
patient
 Promotion of patients best interests

 Prevent or remove harm

 Again, conflict can arise b/n what constitutes

“good” for one individual versus the larger
societal group
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Respecting the patient-professional
relationship:
24
 A moral rule, often referring to respect for the physician-
patient relationship, but also applicable to other
professional- patient relationships, as well
 As expressed in Hippocratic traditions, this rule indicates
that the physician’s primary duty is to the patient and tends to
give the physician, rather than the patient, control in the
relationship

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 Cont’d….
25
 This rule is particularly noted in duty-driven
(deontological) ethical theories that consider the
professional’s duty to the patient, but also supports
consequentialist theory to the extent that good
outcomes are enhanced

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 Respect for autonomy
26

A principle described particularly within

deontological theory
 This principle is founded on a belief in the

right of the individual to self-rule

 It speaks to the individual’s right to
decide on issues that primarily affect
self
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 Cont..
27

 The principle of self rule

 Right to participate in and decide on a
coarse of action; freedom to act
independently
 Competent adults to informed decision to
refuse (even life saving) treatment
supersedes offer of treatment 01/21/2025
 Consent
28

A moral rule related to the principle of

autonomy which states that the client has a
right to be informed & to freely choose a
course of action;
e.g, informed consent to receive a therapy or
procedure

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 Confidentiality
29

A moral rule, also related to the principle of autonomy,

which specifically addresses the individual client’s
right to give or refuse consent relative to release of
privileged information

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 Privacy
30

 Another rule within the principle of

autonomy, more generally relating to the
right of the individual to control his or her
own affairs without interference from or
knowledge of outside parties

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 Respect for persons
31

A principle expressing duty to the welfare of

the individual, particularly described within
religion-based deontological theories
= This principle may also be expressed
within dignity of life or sanctity of human
life principles

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 Cont…
32
 It has common elements with the respect for
autonomy principle,
 but addresses more directly a belief in the inherent value
of human life,
 independent of characteristics or abilities of the specific
human being

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 Veracity
33

 addresses the obligation to truth telling or honesty.

 Veracity is considered an ethical principle within
deontological theory.
 However, it is considered a useful rule within
consequentialist theory, to the extent that it
promotes good

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 Fidelity (loyalty)
34

 Another principle of moral duty in

deontological theory that addresses the
responsibility to be trustworthy & keep
promises

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 Justice
35

 relate to fairness & tendering what is

due; providing that to which the
individual is entitled

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 Cont…
36

 Principles based on fairness, equity and

equality
 Treat similar cases in similar ways
 Distribute health care resources (goods and
services) fairly
 Proper distribution of benefits and burdens
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