Case Studies in Pharmacy Ethics

Introduction: Four Questions of Ethics What Are the Source, Meaning, and Justification of Ethical Claims? 1. Distinguish Between Evaluative Statements and Statements Presenting Nonevaluative Facts 2. Distinguish Between Moral and Nonmoral Evaluations 3. Determine Who Ought to Decide What Kinds of Acts Are Right? Consequentialism Deontological or "Duty-Based" Ethics Other Issues of Normative Ethics How Do Rules Apply to Specific Situations? What Ought to Be Done in Specific Cases? Notes

PART I: Ethics and Values in Pharmacy

Chapter 1: A Model for Ethical Problem Solving The Five-Step Model Application of the Model 1. Respond to the Sense That Something Is Wrong 2. Gather Information 3. Identify the Ethical Problem/Moral Diagnosis 4. Seek a Resolution 5. Work with Others to Choose a Course of Action Notes

Chapter 2: Values in Health and Illness Identifying Value Judgments in Pharmacy Separating Ethical and Other Evaluations

Chapter 3: What Is the Source of Moral Judgments? Grounding Ethics in the Professional Code Grounding Ethics in the Prescriber's Orders Grounding Ethics in Hospital Policy Grounding Ethics in the Patient's Values Grounding Ethics in Religious or Philosophical Perspectives Notes

PART II: Ethical Principles in Pharmacy Ethics

Chapter 4: Benefiting the Patient and Others: The Duty to Do Good and Avoid Harm Benefiting the Patient Health in Conflict with Other Goods Relating Benefits and Harms Benefits of Rules and Benefits in Specific Cases Benefiting Society and Individuals Who Are Not Patients Benefits to Society Benefits to Specific Nonpatients Benefit to the Profession Benefit to the Pharmacist and the Pharmacist's Family Notes

Chapter 5: Justice: The Allocation of Health Resources Justice Among Patients Justice Between Patients and Others Justice in Public Policy Justice and Other Ethical Principles Notes

Chapter 6: Autonomy Determining Whether a Patient Is Autonomous External Constraints on Autonomy Overriding the Choices of Autonomous Persons Notes

Chapter 7: Veracity: Dealing Honestly with Patients The Condition of Doubt Lying in Order to Benefit Protecting the Patient by Lying Protecting the Welfare of Others Special Cases of Truth Telling Patients Who Don't Want to Be Told Family Members Who Insist the Patient Not Be Told The Right of Access to Medical Records Notes

Chapter 8: Fidelity: Promise-Keeping and Confidentiality The Ethics of Promises: Explicit and Implicit The Limits on the Promise of Confidentiality Breaking Confidence to Benefit the Patient Breaking Confidence to Benefit Others Incompetent, Impaired, and Dishonest Colleagues Notes

Chapter 9: Avoidance of Killing Active Killing Versus Letting One Die Withholding Versus Withdrawing Treatment Direct Versus Indirect Killing Justifiable Omissions Voluntary and Involuntary Killing Killing as Punishment Notes

Part III: Special Problem Areas

Chapter 10: Abortion, Sterilization, and Contraception Abortion Abortion for Medical Problems of the Fetus Abortion Following Sexual Assault Abortion to Save the Life of the Pregnant Woman Abortion and the Mentally Incapacitated Woman Abortion for Socioeconomic Reasons Sterilization Contraception Notes

Chapter 11: Genetics, Birth, and the Biological Revolution Genetic Counseling Genetic and Genomic Screening In Vitro Fertilization Surrogate Motherhood Gene Therapy Notes

Chapter 12: Mental Health and Behavior Control The Concept of Mental Health Mental Illness and Autonomous Behavior Mental Illness and Third-Party Interests Other Behavior-Controlling Therapies Notes

Chapter 13: Formularies and Drug Distribution Systems Formularies Eliminating Unproven Therapies Eliminating Proven but Marginally Beneficial Therapies Eliminating Proven but Cost-Ineffective Therapies Appeals to Override Formularies Physician Behavior with Drug Company Influence Drug Distribution Systems Mail-Order Pharmacies Drugs from Outside the US Notes

Chapter 14: Health Insurance, Health System Planning, and Rationing Patient Autonomy and Mandated Insurance Morally Controversial Treatment Coverage Insurance Coverage for Expensive Drugs Marginally Beneficial, Expensive Medications Off-label Therapies Notes

Chapter 15: Experimentation on Human Subjects Calculating Risks and Benefits Privacy and Confidentiality Equity in Research Conflicts of Interest in Research Informed Consent in Research Notes

Chapter 16: Consent and the Right to Refuse Treatment The Elements of a Consent The Standards for Consent Comprehension and Voluntariness Notes

Chapter 17: Death and Dying The Definition of Death Competent and Formerly Competent Patients Never-Competent Patients Limits Based on Interests of Others Notes

Appendix: Codes of Ethics