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PubMed2001

The relationship between pharmacists' tenure in community setting and moral reasoning.

OBJECTIVE: To explore the relationship between pharmacists' tenure in the community setting and their moral reasoning abilities. DESIGN: Systematic random sample design. SETTING: A large southeastern city in the United States. PARTICIPANTS: 450 independent and chain community pharmacists identified from the state board of pharmacy list of licensed community pharmacists. INTERVENTIONS: A mailed questionnaire that included a well-known moral reasoning instrument and collected demographic information. MAIN OUTCOME MEASURES: Moral Reasoning abilities and tenure of community pharmacists. RESULTS: As a group, community pharmacists with greater years of tenure in community practice scored significantly lower on moral reasoning than those pharmacists with fewer years of tenure (p=0.016). CONCLUSION: Four plausible explanations for the results are given including: a) a selection of lower ethical reasoners and/or an exodus of higher ethical reasoners from the community setting; b) a retrogression in the moral reasoning skills as community pharmacists obtain tenure in this setting; c) differences between the low and high moral reasoning groups may be due to a cohort effect; and d) the obtained practitioner sample may not have been representative of the population of community pharmacists.

Community Pharmacy Services↗
PubMed1961

Dangerous and Hypnotic Drug Act.

It is unprofessional conduct within the meaning of the Medical Practice Act to prescribe a dangerous drug without either a medical examination by a physician or other medical indications. Dangerous and hypnotic drugs are specifically defined by both state and federal law and distribution is strictly regulated.A physician may administer to his own patients such amounts of dangerous drugs as are necessary for the immediate needs of the patient. The physician may obtain such needed amounts of these drugs by an order placed with a pharmacist marked "for administration to immediate needs of patients." A licensed physician may also prescribe dangerous and hypnotic drugs for patients and such prescriptions may be refilled on the specific authorization of the physician.A physician who dispenses dangerous and hypnotic drugs to patients must obtain a hypnotic drug license; he must use specific purchase orders when purchasing; the drugs must be labeled in the manner provided by law; and all records of sale shall be open to inspection by authorized officers of the law and kept for three years. By the Principles of Medical Ethics physicians are bound to limit the source of their professional income to medical services actually rendered. Recent decisions of the Judicial Council answer questions concerning a physician's interest in a corporation which purchases, packages and sells medicines under a corporate name. Also answered are questions as to the measures that exist to prevent physicians from abusing the privilege of owning a pharmacy, and whether a physician can ethically rent space in a building owned by him to a pharmacist with a percentage of the income of the pharmacy as rental. The public welfare of California and the nation as determined by legislation strictly regulates the distribution of dangerous drugs. It is in the best interest of the medical profession and its patients that these laws be understood and carefully observed.

California↗
PubMed1996

Conscientious objection to assisted death: can pharmacy address this in a systematic fashion?

OBJECTIVE: To describe a legal structure for the accommodation of pharmacists' rights of conscience in the dispensing of drugs for pharmaceutically assisted death. BACKGROUND: Pharmacists have indicated that there is disagreement in the profession regarding the appropriateness of a practice known as "pharmaceutically assisted death," in which lethal medications are prescribed for terminally ill patients who want to end their lives. Pharmacists who object to pharmaceutically assisted death may be asserting a conscientious objection that threatens to create a conflict with their employers. In addition, pharmacists who support pharmaceutically assisted death, but whose employers forbid the dispensing of medications for this purpose, may face a similar conflict. Current laws and principles of professional ethics fail to adequately address the resolution of either of these conflicts. DISCUSSION: We propose a system within which the pharmacy profession could accommodate the right to conscientious objection without sacrificing the quality of patient care. At the heart of our proposal is the understanding that employers must respect an employee's right to beliefs that differ from those of the employer and, correspondingly, the understanding that employees must respect the employer's duty to provide products and services to those who seek them from the employer. CONCLUSIONS: Pharmacy associations can adopt policies for conscientious objection and have those policies become law through action of the state legislature or the state board of pharmacy. This approach could lead to the development of a clear policy and procedure for resolving the issue of conscientious objection within the pharmacy community, making it far less likely that institutions outside pharmacy would be required to develop a solution for pharmacy.

Ethics, Pharmacy↗
PubMed2004

Nailing Jell-O to a wall: regulating Internet pharmacies.

The growth of the Internet pharmacy industry is challenging the ethical and regulatory systems that govern the sale and distribution of prescription drugs. New forms of regulation are necessary to prevent abuse and minimize mistakes by consumers, doctors, and pharmaceutical companies. Unfortunately, the mercurial nature of the Internet makes trying to regulate it "like trying to nail Jell-O to a wall." Effective regulation will require greater coordination among state, national, and international regulatory bodies. In addition, consumereducation programs are necessary to inform the public of the problems that are caused by the impersonal and commercial nature of marketing drugs over the Internet. At a minimum, the author suggests that states should uniformly adopt laws that prohibit a physician from prescribing drugs without any face-to-face communication between the physician and the patient, and the United States should work to make this a uniform international standard.

Ethics↗
PubMed1989

Harvey A.K. Whitney lecture. Taking charge of the profession.

The relationship between pharmacists' attitudes toward the profession and their career opportunities is described. Pharmacists must be committed to the idea that pharmacy is an essential component of health care. Pharmacy education needs to instill an attitude of service and excellence and an expectation of success. Social, political, economic, and professional change has challenged fundamental assumptions and values that made life predictable in the past. Pharmacists have permitted others to establish the scope and limits of professional pharmacy practice; it is time for pharmacists themselves to determine the future of their profession by focusing on providing services to fulfill unmet health-care needs. The profession as a whole will suffer if pharmacists view certain practice roles or settings as inferior. When all pharmacists accept "drug-use control" as the primary ethic that drives pharmaceutical decisions, the public, the government, and other health-care providers will respect that role for pharmacists. Studying the pharmacy literature can enhance pharmacists' positive feelings about their contributions. Pharmacists alone are responsible for the status of the profession and for changing what needs to be changed. By changing their thinking about the profession, pharmacists can broaden their career opportunities.

Attitude of Health Personnel↗
PubMed1999

Pharmacists' concerns and perceived benefits from the deregulation of hormonal emergency contraception (HEC).

OBJECTIVE: To ascertain pharmacists' views, assess willingness for involvement and delineate individual perceived competence in the supply of deregulated hormonal emergency contraception (HEC). DESIGN: Cross-sectional postal questionnaire utilising closed, open and Likert-scale questions. SUBJECTS: Three thousand nine hundred and ninety-nine registered pharmacists abstracted from the mailing list of the Royal Pharmaceutical Society of Great Britain. RESULTS: In total 1543 (38.6%) questionnaires were returned and analysed. Overall 1165 (75.5%) of pharmacists stated their willingness to be involved in the deregulated supply of HEC. However, pharmacists identified the need for specific training before effective deregulation should take place. Overall, 616 (39.9%) of respondents felt individually competent to supply deregulated HEC with a positive association between perceived competence and willingness to supply deregulated HEC (p < 0.05). Pharmacists perceive the major benefits of deregulation to be a reduced unwanted pregnancy rate and a subsequent reduced abortion rate. They perceive that deregulation would allow quicker and less restricted access to HEC by clients, facilitating an increased overall supply of HEC. Pharmacists express a number of concerns, tempering their collective desire to see HEC deregulation. The majority of these concerns related to safeguarding clients and the possible adverse public health effects associated with the possible reduced use of barrier methods of contraception. CONCLUSIONS: Most pharmacists would be willing to supply HEC if it were deregulated to 'pharmacy only' from 'prescription only' medicine status. Although concerns were raised, these were mainly related to safety issues, with few pharmacists identifying moral and ethical barriers to deregulation. For effective deregulation to occur issues of professional competence need to be addressed.

Abortion, Induced↗
PubMed2003

[The directions of the activity of the Society of Lithuanian Pharmacists in 1922-1940].

The aim of this work is to examine the directions of the activity of the Society of Lithuanian Pharmacists in 1922-1940. When preparing this work archive documents, the publications of the magazine "Pharmaceutical News" and other periodical press was investigated. In the independent Republic of Lithuania (1918-1940) four professional pharmaceutical organizations were active. The most influential one was the Society of Lithuanian Pharmacists, established on September 18, 1922, where only owners of pharmacies could become its real members. This organization united about 80% of owners of pharmacies in all the country. The main directions of the activity of the Society were the following: active participation in the creation of a legitimate basis of pharmacy, concern for the interests and ethics of its members, publication, participation in an international activity. The Society of Lithuanian Pharmacists belonged to the International Pharmaceutical Federation (IPF), and established the Society of Baltic Pharmacists together with societies of Latvian and Estonian pharmacists in 1938. The Society of Lithuanian Pharmacists paid great attention to the problems of professional ethics and it used to fight with the so called "soiled competition". The Court of Honour was established for this purpose which tried the violations of ethics by the members of the society. The magazine "Pharmaceutical News" was being published in common with the Union of Lithuanian Pharmacists in 1923-1940. It was the main professional pharmaceutical magazine in Lithuania which reflected pharmaceutical problems of that time, was concerned with the ways to solve them and the activity of organizations. The Society of Lithuanian Pharmacists became stronger and stronger gradually, gained bigger and bigger authority and extended the directions of its activity. Moreover, it started to take care of the heritage of pharmaceutical history and charity as well. In particular, the Society of Lithuanian Pharmacists established the museum of an ancient Lithuanian pharmacy, financially supported the Society of Lithuanian Pharmacy Students and other organizations. When Lithuanian was occupied by the Soviet Union, the activity of all societies was ceased, societies of Lithuanian pharmacists stopped functioning on September 13, 1940 as well.

History of Pharmacy↗
PubMed1992

Pharmacy computer prescription databases: methodologic issues of access and confidentiality.

OBJECTIVE: To examine methodologic issues of access and confidentiality regarding the use of pharmacy computer prescription databases (PCPDs) for participant selection to receive mailed, self-administered, hypertensive quality-of-life survey outside a primary-care setting. DESIGN: Two separate PCPD searches by pharmacist owners for patients prescribed at least one of 130 potential antihypertensive medications. The first PCPD used a nonrandom sample of all patients (n = 635); the second PCPD used a random sample (n = 100) of three specific antihypertensive drug groups. Research protocol was approved by the investigators' institutional review board. SETTING: Two independent, privately owned PCPDs. PATIENTS OR OTHER PARTICIPANTS: Individuals prescribed at least 1 of 130 PCPD medications potentially used in antihypertensive treatment. INTERVENTIONS: Individually addressed cover letter on pharmacy letterhead signed by a pharmacist requesting voluntary completion of the enclosed, self-administered, opinion survey on quality of life. MAIN OUTCOME MEASURE: Anonymous survey return to off-site post office box in envelope provided. RESULTS: Favorable or no opposition to PCPD methodology from pharmacist or participants. Ethical opposition was encountered when incorporating PCPD sampling technique into grant proposal. CONCLUSIONS: The American Pharmaceutical Association Code of Ethics is used as a basis to provide recommendations to examine and justify PCPD investigative use. Increasing availability of PCPD technology encourages more efficient and easier methods of research strategy. PCPD use, however, demands identical stringent guidelines used in traditional research and raises potential issues regarding pharmacist-patient confidentiality as well as the right of PCPD use by others.

Clinical Pharmacy Information Systems↗
PubMed1987

Harvey A.K. Whitney lecture. Intimations on a profession: retrospect and prospect.

The evolution and development of institutional pharmacy and its pathfinders are discussed, and future directions for the profession are suggested. From the Bulletin of the American Society of Hospital Pharmacists to the American Journal of Hospital Pharmacy, hospital pharmacy literature has helped the profession evolve by providing specialized information while continuing to meet practitioners' changing needs over time. Editorials help to establish unity of purpose among members by encouraging consensus development. Other publications and programs of ASHP extend its mission into institutions nationwide. To achieve unity of purpose, the profession relies on the formal organization (ASHP and its chapters) for providing order and the informal organization (meetings) for exchanging information and providing motivation. Pharmacy "trains its own" via residency programs, whose prototypes, nonacademic internships, were designed by pathfinder preceptors like Harvey A. K. Whitney. These programs have ensured continuity in improving practice standards and a source of skilled professionals. Women have been leaders in the history and development of hospital pharmacy. The sound economic management of the Society has led to accelerated developments for institutional pharmacy. In the future, ASHP should seek to become more involved in public policy issues concerning health care in general; develop a written set of ethical standards to guide institutional practitioners; and prepare an updated history of ASHP and the hospital pharmacy movement, including an interpretation of events, or a cultural perspective. ASHP has established a strong foundation for hospital pharmacy as envisioned by the early pathfinders; young pharmacists are the pathfinders for future progress.

Ethics, Professional↗