Ethics / Ethics in pharmacy practice Ethics, morality, value – the basic theory Week 3 + 4, Part I Ethics Solve: • what is good for individuals and society? • principles affecting how people make decisions and lead their life/being Ethics • The term ethics derives from Ancient Greek ἠθικός (ethikos), meaning „habit, custom“ Ethics branch of philosophy systematizing, defending, recommending concepts of right and wrong conduct Concepts of ethics: • derived from religions, philosophies and cultures Values • Principles or standards of behaviour; • one's judgement • denotes the degree of importance of some thing or some action Morality • from the Latin moralis „manner, character, proper behavior“ Definition? One of thousands… „ refers to the most important code of conduct put forward and accepted by any group, or even by an individual. Different moralities can vary in content quite substantially.“ Stanford Encyclopedia of philosophy Morality • a particular system of values and principles of conduct „ "goodness" or "rightness". Morality • what the members of a particular society or group actually : obey, what their society requires and what, on the contrary, they reject. Ethics / Morality and practice • People in-general are more comfortable with dichotomies (two opposites). • However, in ethical decisions the answer is almost never a "yes or no", "right or wrong" statement. • (the issues are most often multifaceted and address many different areas concurrently.) Areas of study within ethics • Descriptive ethics • Meta-ethics: • Normative ethics • Applied ethics Ethics and moral map • think of euthanasia • Some moral issues are such emotional issues • ethics provides us with a moral map -- like a framework -- that we can use to find our way through difficult issues. Thought experiments in ethics • The trolley problém – and variation Other experiments • The violinist • transplant surgeon and five patients • ticking time bomb scenario Where does ethics come from? Philosophers have several answers to this question: • Religion • Human conscience and intuition • Rational moral cost-benefit analysis of actions and their effects • the example of good human beings • a desire for the best for people in each unique situation • political power Four ethical 'isms' 1. Moral realism 2. Subjectivism 3. Emotivism 4. Prescriptivism Theory: God-based ethics - supernaturalism „something is good because God says it is, and the way to lead a good life is to do what God wants.“ • makes ethics inseparable from religion • It teaches that the only source of moral rules is God. Theory: Intuitionism • Intuitionists think that goodness or badness can be detected by adults • human beings have an intuitive moral sense that enables them to detect real moral truths Theory: Consequentialism • that people should do whatever produces the greatest amount of good consequences. 'the greatest good for the greatest number of people' Other Deontological ethics Virtue ethics Situation ethics, . . . . . Ethics and ideology – the power…. Are there universal moral rules? Moral absolutism • some moral rules that are always true • there are such universal rules that apply to everyone Moral relativism different cultures or different periods in history: you'll find that they have different moral rules • Enculturation • Acculturation Difference Between Illegal and Unethical Illegal behavior is easy to detect • Morals are deep seated whereas values keep on changing with time and needs. Cyberethics • pertaining to computer/user behavior • Freedom of information • Private data collection • Intellectual property right Machine ethics • Artificial intelligence • Moral Machines: Teaching Robots Right from Wrong • learning algorithms • How should machines with artificial intelligence and morals be trained • Business ethics • Political ethics • Publication ethics Animal ethics • to describe human-animal relationships • how animals ought to be treated • includes: • animal rights, animal welfare, animal law, • animal cognition, • wildlife conservation, • the moral status of nonhuman animals, the concept of nonhuman personhood, the history of animal use…. Bioethics • study of controversial ethics brought about by advances in biology and medicine • Affect basic biology and future humans. Bioethics Include: • cloning, • gene therapy, • human genetic engineering, • manipulation of basic biology through altered DNA, RNA and proteins, • astroethics and life in space, … • Research ethics • Nursing ethics • Medicinal ethics • Ethics in pharmaceutical sales • Ethics in pharmacy practice Ethics in health care; Ethics and pharmacy practice Seminar part The obligations of pharmacists formalised in ethical codes should at least include: • honesty and • not engage in any behaviour or activity likely to bring the profession into disrepute or to undermine public confidence in the profession The obligations of pharmacists formalised in ethical codes should at least include: • priorities are the safety, well-being and the best interests • autonomous health professionals, The obligations of pharmacists formalised in ethical codes should at least include • to always act professionally, in accordance with scientific principles and professional standards, including those developed by the FIP. The obligations of pharmacists formalised in ethical codes should at least include • to co-operate • always considering the limitations of available resources and the principles of equity and justice; The obligations of pharmacists formalised in ethical codes should at least include • to respect and protect the confidentiality of patient information • informed consent The obligations of pharmacists formalised in ethical codes should at least include • to respect patients’ rights The obligations of pharmacists formalised in ethical codes should at least include • to ensure continuity of care The obligations of pharmacists formalised in ethical codes should at least include • to comply with legislation and accepted codes and standards of practice in the provision of all professional services and pharmaceutical products The obligations of pharmacists formalised in ethical codes should at least include • In every country, pharmacists associations produce or support the development by competent authorities of an up-to-date: Code of Ethics for pharmacists The obligations of pharmacists formalised in ethical codes should at least include • continuing professional development Ethical Code of Czech Chamber of Pharmacists • Serves to the public • With the same care to all patients • Patient‘s profit is on the first place • Respects patient‘s right on freedom in treatment choice • Provides patient with understandable and true information Ethical Code of Czech Chamber of Pharmacists • Keeps the confidentality: about patient‘s matters about which he found out during his pharmacy practice • responsible for all the pharmacy stuff Ethical Code of Czech Chamber of Pharmacists • Is responsible for the continuity of the pharmaceutical services Ethical Code of Czech Chamber of Pharmacists • Cooperation • Can not limit the freedom of patient. • good manners, respects the Chamber bodies and its decissions. • If patient urgently needs a medical care, pharmacists must reffer him to it. Ethical Code of Czech Chamber of Pharmacists • Pharmacist will not take place in unfair competition, especially not: • Deals which would exclude other pharmacy • Benefits or presents for other health care professionals • Doesn‘t pretend special position of his pharmacy Ethical Code of Czech Chamber of Pharmacists On the other side • Pharmacist has a right to promote his pharmacy Ethical Code of Czech Chamber of Pharmacists • Doesnt perform any commercial actvities which are non-compatible with the professional honour. • Acts honestly in the commercial activities Ethical Code of Czech Chamber of Pharmacists • Must know and follow the inner regulations and legal backround • Life-long learning Ethical Code of Czech Chamber of Pharmacists • Helps with pharmacy students‘ education. • Cooperates on raising patients‘ health-awareness. • Pharmacist‘s duty is to keep professional independence and freedom in profesisonal decission-making process Ethical Code of Czech Chamber of Pharmacists • inform the patient about his name and his position in the pharmacy. Ethical Codes in healthcare • Czech Chamber of doctors, pharmacists, dentists… Ethics in pharmacy practice Week 3+4 Part II Ethical Problems Relating to Dispensing Medicines • Ethical Problems Relating to Dispensing Medicines • Controlled Drugs • Emergency Supplies • Financial Implications of Dispensing Medicines • Pressure to sell…/Commercial Decisions Ethical responsibility Economic Responsibility Legal responsibility Empirical findings from research • useful for acknowledging that ethics has a significant presence in pharmacy practice today • pharmacists tend to take a commonsense approach to ethics in their work Empirical findings from research Results: • understand ethics as being a mixture of personal opinion, peer consensus, cultural influence and institutional rules • ‘patchwork’ Ethics in pharmacy practice • In fact, the majority of pharmacists across the sectors reported the patient’s health interests as the most important factor to consider when making ethical decisions. Empirical findings from research • One of the strongest themes : institutional rules x interests of the patient. Ethics in pharmacy practice • corresponding with the change in the professional role of pharmacists being more patient-centred Ethics in pharmacy practice The important questions to follow: • how well pharmacists are dealing with the ethical problems of their work • and what impact this may have on the services the pharmacists deliver ?? Ethics in pharmacy practice • Motivation? Conclusions Ethical problem solving How to solve ethical dilemma 1. DETERMINE 2. IDENTIFY 3. RANK 4. Determine 5. Consider options 6. DEVELOP 7. IMPLEMENT 8. REFLECT Solving problems People solving moral issue.. • find that what they disagree about is just one particular part of the issue, • that they broadly agree on everything else • Ethical code: „hint at a way for them to resolve their problem“ Ethics and solving problems • often there isn't one right answer - there may be several right answers, or just some least worst answers Thinking ethically • Ethics is about the 'other' • ethics is a care about something or someone other than ourselves and our own self-interest • other people's interests, the interest of society Ethics as source of group‘s strength Do some problems with ethics exist? • used as „a weapon.“ Non semper salus, sed voluntas aegroti suprema lex Medical ethics The Four Pillars: • Non-Maleficence: • Beneficience: • Autonomy: • Justice: Convention for the Protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine • was opened for signature on 4 April 1997 in Oviedo • The Convention entered into force on 1 December 1999. CHARTER OF FUNDAMENTAL RIGHTS AND FREEDOMS • 1993 • Part of the Constitution • Everyone has the right to live. • No one shall be deprived of life.