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Ethical Principle

Beneficence Doing good


Non malficence Preventing harm
Autonomy Right of determination
Paternalism Violating autonomy
Justice Equality with everyone
Honesty Tell the truth
Veracity Honesty without deception
Fidelity Best interest of patient

BENEFICENCE:
Beneficence indicates that you act in a manner to do good for another
The quality of being kind, helpful or generous.
The health professional should act in best interest of patient.
One clear example exists in health care where the principle of beneficence is given
priority over the principle of respect for patient autonomy. This example comes from
Emergency Medicine. When the patient is disable by an accident or illness, we
presume that the reasonable person would want to be treated aggressively, and we
rush to provide beneficent intervention by stemming the bleeding, mending the
broken or suturing the wounded.
In this culture, when the physician acts from a kind spirit in providing beneficent
treatment that in the physician's opinion is in the best interests of the patient, without
consulting the patient, or by overriding the patient's wishes(autonomy), it is
considered to be "Paternalism."
The most clear cut case of justified paternalism is seen in the treatment of suicidal
patients who are a clear and present danger to themselves. Here, the duty of
beneficence requires that the physician intervene on behalf of saving the patient's life
or placing the patient in a protective environment, in the belief that the patient is
compromised and cannot act in his own best interest at the moment.
NON MALEFICENCE:
This includes the prevention of harm and the removal of harmful conditions.
Nonmaleficence overlap beneficence but here it prevents harm.
The principle of nonmaleficence requires of us that we not intentionally create a
needless harm or injury to the patient. Providing a proper standard of care that
avoids or minimizes the risk of harm is supported not only by our commonly held
moral convictions, but by the laws of society as well.
Examples:
Dispense the tablet in child lock bottle
Breaking pills for patient having arthritis
Referring patient to an emergency service

AUTONOMY:
Right of determination. The right of individuals to make decisions about what will
happen to their bodies, what choices will be made among competing options and
what they choose to take or not into their bodies.
Letting the patient have the final decision, even if it is not in their interest.
Example:
Refusal of surgery or treatment by the patient
PATERNALISM: Strong Paternalism, Weak Paternalism
When one fails to respect anothers autonomy and act with disregard to the
individual rights. Substitute their own benefits, opinions and judgment to that of
another.
Weak paternalism: It is a form of medical paternalism which allows the autonomy of
an individual to be violated if that individual is not or does not appear to be
autonomous.
Harm principle: Under the harm principle, one is justified in over riding the autonomy
of another if in the exercise of that autonomy, harm may come to others
Pharmacist refer one product out of 5 by following paternalism and violating
autonomy.
JUSTICE:
Distributive justice, equal distribution of the benefits and burdens of society among
all members of this society. Justice demands that the focus be on patients and their
medical needs, not on the financial impact on the health - care professional.
Equitable distribution of benefits and burdens.
The distribution of service based on first-come first-serve basis.
HONESTY:
Tell the truth
VERACITY:
Pharmacists should be honest in their dealing with patients.
There may be times when violation of veracity may be ethical justifiable (like the use
of placebo), but the violation of this principle for non patient centered reasons would
appear to ne unethical.
FIDELITY:
Pharmacists should demonstrate loyalty towards their patients. In community
pharmacy for example, practitioners have the same obligation to show fidelity to an
occasional patient as they would for regular customer.
Confidentiality:
Pharmacists should keep information private from others, unless the patient
gives permission to release it. Medical confidentiality need not be requested
explicitly by patients; all medical information, by nature is generally considered
to be confidential unless the patient grants approval for its release or required by law.
Confidentiality has two exceptions: weak paternalism and harm principle.

Informed Consent:
Patients must be fully informed about the benefits and risks of their participation in
a clinical trial, taking a medication, electing to have surgery. This disclosure must be
followed by their autonomous consent. Informed consent is composed of 5 elements:
1. Disclosure:
Directs that all pertinent information that is necessary for an informed decision
must be made available to the patient.
2. Understanding:
Requires that patients fully understand what they are consenting to,
including any benefits or hazards.
3. Voluntariness:
Instructs that patients who choose to enroll in a research endeavor or be compliant
in taking medications must be free from coercion.
4. Competence:
Requires that the patients be autonomous individuals, who have the functioning
ability to make decisions for themselves
5. Consent:
Provides the patients with a point of decision and is the final legal and moral
criterion to be met in ensuring that informed consent has been obtained.
Sample questions
:
The following statements describes different situations. Answer what are ethics:
1. Technician leaves computer screen accessible : Not ethical
2. Husband requests copies of wife's record : not allowed, unless we have wife
consent
3. Physicians calls in to request patient's drug history (emergency situation) : Ethical,
professional judgment.
4. Patient divulges information about child abuse : Must report
5. Police ask questions about a patient's medication : Not ethical, can not give
information
6. Police present a warrant for narcotic records for a patient : Ethical, can give
information with a warrant.
7. College requests patient records : Ethical, if college representative shows college
I.D. (i.e, OCP college inspector came about a patient complaint)
8. In order to convince a reluctant patient to use his prescribed medication a
pharmacist tells the patient that the medication is a multivitamin. Which ethic has he
violated?
(a) veracity
(b) beneficence
(c) non-malficence
(d) autonomy
(e) justice
Answer is (A). This is the best answer. However in this case, the principle of
autonomy is also violated since the patient is unable to make an "informed" choice
based on truthful information. If the question is K-Type select "veracity" and
"autonomy".

9. A pharmacist who refuses to counsel an HIV patient violates the principle of


(a) veracity
(b) beneficence
(c) non-malficence
(d) autonomy
(e) justice
ANS: E
10. A physician phones a pharmacist and tells him not to tell the patient about the
side-effects of his medication, as this would encourage the patient not to take the
medication. Which of the following ethic was violated by both the physician and the
pharmacist
(a) veracity
(b) beneficence
(c) non-malficence
(d) autonomy
(e) justice
ANS: D Note: If K-type, the principles of veracity and non-maleficence have also
been violated.
11. A pharmacist who does not counsel a patient on warfarin side-effects violates the
ethic of
(a) veracity
(b) beneficence
(c) non-malficence
(d) autonomy
(e) justice
ANS: C

Scenario: One person is going outside the country for a week. He is at the air port
and realized that he forgot his lipid pills. He go to the pharmacy at the air port and
request to the pharmacist that his medication is finished and is he going away for a
week, please issue the pills for a week.
If Pharmacist refuse to give medication, which ethics he is following?
If Pharmacist giving him medication, which ethics he is following? Beneficence
If Pharmacist giving him medication, which ethics he is violating?
Scenario: A drug addict come to you pharmacy who is in hurry and ask for a syringe
as he wanted to use it for his drug (Heroin). Pharmacist decided to give him a
syringe.

What ethics is he following by giving him syringe? Why? Nonmaleficence


What ethics is he following if he refuse to give him syringe?
Scenario: A doctor diagnosed one pregnant woman with cancer of the uterus. The
usual treatment, removal of the uterus is considered a life saving treatment.
However, this procedure would result in the death of the fetus.
What ethics doctor follows if he decided to remove the uterus? Nonmaleficence
Scenario: Mr. Smith have a belief that it is wrong to accept a blood transfusion. He
has an accident and physician diagnosed that he needs a blood very badly.
In analyzing the above case, the physician had a duty to respect the autonomous
choice of the patient, as well as a duty to avoid harm and to provide a medical
benefit.
Physician decided to put him on blood infusion as blood infusion will save his life.
Which ethics Physician is following? Nonmaleficence
Which ethics Physician is violating? Autonomy
By contrast, if the patient in above scenario happened to be a ten year old child, and
the parents were refusing a life saving blood transfusion and physician decided to
give blood.
Which ethics Physician following? paternalism
Which ethics Physician violating? fidelity

Scenario: Mr. Same is a father of a 18 yrs old daughter. He cam to know that his
daughter is taking contraceptive pills. Mr. Same believes that Contraception is not
good for the body and he force her daughter to stop taking pills.
Which ethics is violated? Autonomy
Which ethics is followed? Paternalism
Scenario: Parents strictly believes that its not safe to use contraception for the
body. When they came to know that their daughter got the contraceptive pills from X
pharmacy, they called the pharmacist and warned him for not to dispense
contraceptive to her daughter otherwise they will take him to court.
Which ethics Parents are following?
If Pharmacist ignore the call and dispense the medication, which ethics is he
following?
Scenario:
Patient having psychosis and he is not ready to take drugs. If he has been forced to
take medicine, he will attempt suicide. Doctor phoned pharmacist and told him that
he should tell patient that this medication is multivitamin.

Which ethics Doctor and Pharmacist followed?


Which ethics Doctor and Pharmacist violated?
Scenario:
A patient having Diabetes for which he has to take life long treatment. But doctor tell
patient that this treatment is just for a short duration of time.
Which ethics doctor is following?

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