A patient comes to your pharmacy on a Friday night

He is not a regular patient of your pharmacy but has his prescription vial and a list
of his medications, which he filled at another pharmacy. The prescription vial
indicates that he does not have any additional refills from his physician. Both the
pharmacy that filled the original prescription and the physician’s office are now
closed until Monday. You know this physician has a policy of not renewing
prescriptions without an appointment. You work with this physician a lot and
don’t want to undermine her policy or put a strain on your collaborative
relationship. However, the patient could potentially experience side effects if they
don’t have their medication (which is not a controlled substance).

What do you do?

Scenario: You are working in the pharmacy, and one of your coworkers is looking
up a patient’s health history profile. You assume they are being ethical and using
the profile for a reasonable purpose, so at first you assume nothing of it.
However, you then see your coworker taking pictures of the patient’s profile and
sending it to friends of the patient, which is clearly a violation of HIPAA laws.
Since you just started working here and want to be friends with everyone, you are
considering just pretending like you didn’t see anything. Yet, you know how
important professionalism is in the work setting, and are considering reporting
this incident to the manager. What would you do in this situation?

Case 1

Note - this case and case discussion have been adapted from Case Studies in
Pharmacy Ethics (1).

You are a relief pharmacist at an independent pharmacy. A patient walks into the
pharmacy and asks for Robitussin Cough and Cold. You cannot find the Robitussin
Cough and Cold in the OTC section of the pharmacy. While scanning the OTC
shelves, you realize there are no products containing dextromethorphan
available. You call the pharmacy manager to ask where the dextromethorphan-
containing products are. The manager states that dextromethorphan is
a potentially harmful medication and should not be available to patients without
counseling from the pharmacist. The manager stresses to only give the Robitussin
to the patient if he really needs it, to counsel him on the risks, and to sell him just
one bottle.

Your task:

 Consider if this is an ethical dilemma

 If this is an ethical dilemma, what are the key ethical principles involved?

Case 2

Note - this case is based on the author's experiences in hospital pharmacy. The
case has been slightly altered to prevent the identification of any persons
involved.

You are the pharmacist covering the Medical Floor in an acute care community
hospital. Patient JR on the Medical Floor has requested to speak to you regarding
two newly-started medications. The medications are Zytiga (abiraterone), which is
used in the treatment of prostate cancer, and prednisone, which is given as
adjunctive therapy to Zytiga. After prescribing these medications for JR, the
physician gave JR an extensive pamphlet outlining all the adverse effects and
instructions for use.

Upon discussion with the patient, you realize that he is uncomfortable starting
these two new medications. He is worried about all the adverse effects, and the
stringent instructions for use which could reduce his quality of life. He seems
upset about starting these medications, but states, "I know I need to do what I'm
told."

Case 3
Note - this case has been adapted from the Defining Issues Test.

You are the pharmacist in a palliative care centre. Patient BM is in the last stages
of breast cancer. She is in terrible pain and has asked the doctor to increase her
dose of pain-killer medicine. BM is already taking the maximum safe dose
recommended for this medication, and the doctor is hesitant to increase the dose
any further since it would likely hasten her death. BM has expressed to both you
and the doctor that she understands this risk, but she would like to be
comfortable for the short remainder of her life. BM is clear and rational while
expressing this. The doctor has asked you for your advice.