magine you are a pharmacist working on an interdisciplinary team that is treating a patient for severe opioid dependence. The idea arises to treat the addiction by slowly replacing the active drug with an inert substance, such as lactose, without the consent of the patient. As the pharmacist, it is your responsibility to compound these capsules where the amount of active drug is slowly tapered until the capsules are entirely lactose. Is it ethically permissible for the pharmacist to knowingly deceive the patient to treat the underlying addiction? What duties to the patient come into conflict during this situation?
Ethical dilemmas often arise when a person is seemingly required to perform two or more incompatible actions. These situations are not uncommon in health care and often professional students receive minimal training on how to navigate these complex issues. Taking a closer look at this particular case, it seems clear that on the one hand, most practitioners agree that deceiving patients and hindering their ability to make informed decisions violates the trust that is fundamental to any patient–practitioner relationship. But on the other hand, treating the patient’s addiction would potentially save their life, even if the treatment relies on
deception.
Can pharmacists forgo patient autonomy in an attempt to act in their best interest? These types of questions make ethics courses vital for student pharmacists because they build the foundational knowledge necessary to navigate the ethical dilemmas that inevitably arise in caring for patients with diverse backgrounds.
Student pharmacists are fortunate to be entering the profession in a time where the responsibilities of the
pharmacist are rapidly growing. Each moment brings pharmacists closer to the day when provider status will finally become a reality, which would enable pharmacists to practice at the top of their education and grant them the ability to bill for their valuable services. However, this impending expansion of clinical responsibility ushers in an epoch in which pharmacists will increasingly encounter challenging ethical dilemmas, and it is imperative that future pharmacists possess the foundational ethical reasoning skills required to navigate these morally gray areas.
Benefits of pursuing a degree in bioethics
My master’s coursework in bioethics assists in expanding my understanding of cultural, religious, and moral nuances that emerge during patient–practitioner encounters. Taking courses in clinical bioethics, law, and research allows me to draw from a broad base of knowledge whenever I speak to a patient. Having studied challenges in a variety of areas of health care, I am more keenly aware of the fact that people from different cultures approach medical decisions in starkly different manners. Being cognizant of these variances allows me to navigate what medical care is or is not ethically permissible.
The most valuable benefit of earning a degree in both bioethics and pharmacy is that it provides me the fundamental knowledge that is necessary when discussing ethical situations. Just as student pharmacists learn a new language to interpret medication information, or students in law school learn the language of legislation, earning a bioethics degree develops the language necessary to actively engage in ethical discussions.
Beyond opening up professional opportunities to serve as part of an institutional review board or on a hospital’s ethics committee, this unique combination of bioethical and medication expertise has prepared me to play a key leadership role in interdisciplinary teams where ethical dilemmas
surrounding health care or research may arise.
The next step
Many complex situations arise in patient care where the morally right course of action is not clear. Encouraging colleges and schools of pharmacy to require ethics courses would cultivate students’ ability to discuss
ethical dilemmas coherently. Professional codes of ethics are necessary to provide general guidance on how members of the profession should act, though they often prove inadequate for solving many challenging ethical
situations.
In the case of the proposed use of placebos to taper a patient off opioids, the Code of Ethics for Pharmacists seemingly demands the pharmacist to concurrently take two incompatible courses of action: ensure the patient’s well-being by utilizing the deceptive taper to potentially save their life and to protect patient autonomy and the coveted patient–practitioner relationship by not misleading the patient. Having the ability to identify these conflicting moral requirements is a crucial skill for pharmacists.
Furthermore, in my opinion, it is imperative that colleges of pharmacy incorporate ethics courses into their curriculum to provide student pharmacists with the foundational knowledge necessary to navigate ethical dilemmas.
Maximillian H. Stevenson is a third-year PharmD/MA–Bioethics candidate at The Ohio State University College of Pharmacy.