Terra Sigillata

For those who have been asking over the last couple of days, here are the oath of a pharmacist as recited at US colleges of pharmacy and a code of ethics adopted in 1994 by the then-American Pharmaceutical Association (now the American Pharmacists Association; still APhA). There seems to be a strong focus on the patient in the code of ethics but there’s also a bit of wiggle room that can be interpreted as one sees fit.

Oath of a Pharmacist

At this time, I vow to devote my professional life to the service of all humankind through the profession of pharmacy.

I will consider the welfare of humanity and relief of human suffering my primary concerns.

I will apply my knowledge, experience, and skills to the best of my ability to assure optimal drug therapy outcomes for the patients I serve.

I will keep abreast of developments and maintain professional competency in my profession of pharmacy. I will maintain the highest principles of moral, ethical and legal conduct.

I will embrace and advocate change in the profession of pharmacy that improves patient care.

I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.

APhA Code of Pharmacist Ethics

Pharmacists are health professionals who assist individuals in making the best use of medications. This Code, prepared and supported by pharmacists, is intended to state publicly the principles that form the fundamental basis of the roles and responsibilities of pharmacists. These principles, based on moral obligations and virtues, are established to guide pharmacists in relationships with patients, health professionals, and society.

I. A pharmacist respects the covenantal relationship between the patient and pharmacist.

Considering the patient-pharmacist relationship as a covenant means that a pharmacist has moral obligations in response to the gift of trust received from society. In return for this gift, a pharmacist promises to help individuals achieve optimum benefit from their medications, to be committed to their welfare, and to maintain their trust.

II. A pharmacist promotes the good of every patient in a caring, compassionate, and confidential manner.

A pharmacist places concern for the well-being of the patient at the center of professional practice. In doing so, a pharmacist considers needs stated by the patient as well as those defined by health science. A pharmacist is dedicated to protecting the dignity of the patient. With a caring attitude and a compassionate spirit, a pharmacist focuses on serving the patient in a private and confidential manner.

III. A pharmacist respects the autonomy and dignity of each patient.

A pharmacist promotes the right of self-determination and recognizes individual self-worth by encouraging patients to participate in decisions about their health. A pharmacist communicates with patients in terms that are understandable. In all cases, a pharmacist respects personal and cultural differences among patients.

IV. A pharmacist acts with honesty and integrity in professional relationships.

A pharmacist has a duty to tell the truth and to act with conviction of conscience. A pharmacist avoids discriminatory practices, behavior or work conditions that impair professional judgment, and actions that compromise dedication to the best interests of patients.

V. A pharmacist maintains professional competence.

A pharmacist has a duty to maintain knowledge and abilities as new medications, devices, and technologies become available and as health information advances.

VI. A pharmacist respects the values and abilities of colleagues and other health professionals.

When appropriate, a pharmacist asks for the consultation of colleagues or other health professionals or refers the patient. A pharmacist acknowledges that colleagues and other health professionals may differ in the beliefs and values they apply tothe care of the patient.

VII. A pharmacist serves individual, community, and societal needs.

The primary obligation of a pharmacist is to individual patients. However, the obligations of a pharmacist may at times extend beyond the individual to the community and society. In these situations, the pharmacist recognizes the responsibilities that accompany these obligations and acts accordingly.

VIII. A pharmacist seeks justice in the distribution of health resources.

When health resources are allocated, a pharmacist is fair andequitable, balancing the needs of patients and society.

Finally, despite an earthquake, the ever-dedicated Prof Janet Stemwedel put up a typically well-reasoned post entitled, “Dissent in professional communities.” (Actually, the earthquake followed her post by 10 minutes.).

A dissenting member has the option of leaving the profession over the disagreement. Or, the dissenting member can stay in the professional community and try to work it out, either figuring out how to embrace the value in question or working to persuade the professional community to change that value.

[...]

If the conflict is about a value integral to what the profession is about, however, there may not be room for negotiation. The member dissenting from that value will have to make the case to the community that the disputed value really can be excised or changed without totally changing the nature of that profession. And, if the community is not persuaded, the dissenter has to expect that she won’t be regarded as a real member of the community any more, no matter how much she feels the other values shared by that professional community to be her own.

Janet’s entire post is very well-worth reading, and closes with her caveat that one must know the code for one’s profession before we can even have this discussion.

Comments

  1. #1 Joe
    March 3, 2007

    I find this (all three posts on the subject) quite interesting. The last sentence of this post “… one must know the code for one’s profession before we can even have this discussion.” is key. This problem is in the news, today, and I hope it comes out early in pharmacy school now. I wonder how many pharmacy students (in the past) with strong “moral” convictions contemplated dispensing something of which they disapprove, until they face it in practice.

  2. #2 John J. Coupal
    March 3, 2007

    APhA now stands for American Pharmacists Association, not vice versa.

  3. #3 Abel Pharmboy
    March 4, 2007

    I stand corrected on the juxtaposition and have fixed above. Thanks.

  4. #4 laughingman
    March 4, 2007

    It seems to me that article III (A pharmacist respects the autonomy and dignity of each patient) and its attendant explanation would strongly imply that a pharmacist’s moral and ethical concerns are secondary to the patient’s. I’m curious as to what “wiggle room” there is on this: “In all cases, a pharmacist respects personal and cultural differences among patients.” Perhaps something in article VI? Those bits about consulting with colleagues and recognizing their different “beliefs and values” in treating patients seems to be relevant.

    I am no medical ethicist, just someone with a lot of experience in reading and interpreting contract language. If this oath doesn’t have the force of a contract, my reading might be wrong. I’d appreciate any corrections or clarifications you could add.

  5. #5 bob koepp
    March 5, 2007

    Respecting patient autonomy doesn’t mean that one must assist the patient in realizing his/her interests, but it does mean not actively obstructing the patient’s efforts. It’s important to not intepret patient autonomy in a way that negates the autonomy of providers. That’s why the most careful and insightful analysis of the provider-pateint relationship have proposed viewing it as a sort of partnership formed to pursue _shared_ goals.

  6. #6 John J. Coupal
    March 5, 2007

    Just because a patient wishes a medical procedure/drug from a specific physician, nurse, pharmacist, P.A., etc., does not mean that the specific practitioner must provide it, if the procedure or item in question is immoral to said practitioner.

    Check out the “Illinois Health Care Right of Conscience Act” which is in effect in that state , as an example.

The site is currently under maintenance and will be back shortly. New comments have been disabled during this time, please check back soon.