Case Studies in Pharmacy Ethics

Pharmacists constantly face ethical choices -- sometimes dramatic matters of life-and-death decisions, but more often subtle, less conspicuous choices that are nonetheless important. Case Studies in Pharmacy Ethics identifies and discusses the broad range of ethics issues pharmacists confront in practice. Ranging from situations faced in direct patient care to broader issues, this book uses cases to explore topics and the ethical framework within which practitioners make decisions about such issues as assisted suicide, conscientious refusal, pain management, and confidentiality as well as the equitable distribution of drug resources within institutions or managed care organizations and clinical studies on vulnerable populations.As the scope of the pharmacist's role expands, pharmacists find themselves facing new ethical challenges. This third edition accounts for some of the many changes in pharmacy practice and in the delivery of health care since the second edition. It includes an entirely new chapter on health insurance and health system planning, and a discussion of the impact of the Affordable Care Act and cases that are updated to reflect current pharmacy practice models. It serves as a valuable resource regarding topics that are both specific to pharmacy practice and those that involve the health care system more generally.

Table of Contents:
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

About the Author :
Robert Veatch graduated from the Purdue University School of Pharmacy and has been at the Kennedy Institute of Ethics at Georgetown since 1979 serving as Director before returning to the faculty. He is the author or editor of over 60 books including a series of case study books covering the various health professions. Amy Haddad is Professor in the Department of Pharmacy Sciences in the School of Pharmacy and Health Professions at Creighton University. E. J. Last received her B.S. studying the neurosciences from the University of Chicago, her D.Pharm from Midwestern University Chicago College of Pharmacy, and her J.D. from Indiana University.