Case Studies in Pharmacy Ethics (3rd edition)

ISBN : 9780190277000

Robert M. Veatch; Amy Haddad; E. J. Last
376 Pages
156 x 235 mm
Pub date
Jul 2017
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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.


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?
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?
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
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
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
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
Chapter 6: Autonomy
Determining Whether a Patient Is Autonomous
External Constraints on Autonomy
Overriding the Choices of Autonomous Persons
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
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
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
Part III: Special Problem Areas
Chapter 10: Abortion, Sterilization, and Contraception
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
Chapter 11: Genetics, Birth, and the Biological Revolution
Genetic Counseling
Genetic and Genomic Screening
In Vitro Fertilization
Surrogate Motherhood
Gene Therapy
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
Chapter 13: Formularies and Drug Distribution Systems
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
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
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
Chapter 16: Consent and the Right to Refuse Treatment
The Elements of a Consent
The Standards for Consent
Comprehension and Voluntariness
Chapter 17: Death and Dying
The Definition of Death
Competent and Formerly Competent Patients
Never-Competent Patients
Limits Based on Interests of Others
Appendix: Codes of Ethics

About the author: 

Robert Veatch 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 the Director for the Center for Health Policy & Ethics and the Dr. C.C. and Mabel L. Criss Endowed Chair in the Health Sciences.; 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.

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