ACPE UAN: 0475-0000-22-019-L04-P. An application-based activity.
ACPE logo The European Association of Hospital Pharmacists (EAHP) is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
More information: https://www.eahp.eu/congresses/acpe
Self-assessment questions:

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* 1. The general steps for the process of ethical decision-making as recommended by experts in the field have much in common with Pharmacists’ Patient Care Process

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* 2. Revisiting and/or revising ethical decisions in light of further evidence or arguments should always be allowed

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* 3. Patients’ perception of their best interests does not conflict with other legitimate considerations such as medications available on an institutional formulary

Student Programme - Contemporary ethical challenges in hospital pharmacy practice

Linked to EAHP Statements
Section 4 - Clinical Pharmacy Services: Statements 4.1, 4.6, 4.7
Section 5 - Patient Safety and Quality Assurance: Statements 5.1, 5.5, 5.6, 5.9

ACPE UAN: 0475-0000-22-019-L04-P. An application-based activity.

Abstract
Ethical issues arise in everyday practice of a hospital pharmacist. Fundamental ethical principles, such as respect of the patient’s autonomy, integrity, privacy and confidentiality reflect the right of a patient to accept or refuse treatment and responsibility of a hospital pharmacist as a healthcare professional to act in the patient’s best interests and do no harm while enacting ethical principles.

Optimal and rational use of medicines as part of patient-centred care relies on ethically driven decisions taken by a hospital pharmacist. Hospital pharmacists also play a vital role in providing to their patients with an insight into risks and benefits of participating in a clinical trial involving medicines, where a clear patient’s or career’s understanding is of essence when providing consent. Moreover, formulary management and conservative prescribing make decision-making even more complex in times of limited healthcare-associated resources and frequent medicine shortages. At the same time, a hospital pharmacist needs to protect the patient’s integrity and preferences as ethical considerations at an individual level and allow for population-level ethical aspects to be considered, which yields conflicts among healthcare providers, funding bodies and patients. Therefore, fear from rationing and limited access to medicines place an additional burden on hospital pharmacists, who needs to provide best care in times of shortages and overcome ethical challenges.

Mitigating medicine shortages within multidisciplinary teams, in accordance with ethical principles, provides foundation on how to properly substitute a medicine and to whom to provide the alternative first. Therefore, it is necessary to have a process in place defining an alternative's approval and ethical considerations for a substitute's allocation that has already been established prior to a shortage occurring.

Learning objectives

After the student programme, participants should be able to:
  • Differentiate individual and population-level ethical aspects in delivering pharmaceutical care
  • Describe ethical considerations in pharmaceutical decision-making process
  • Describe ethical considerations in managing medicine shortages
Educational need addressed
Hospital pharmacists provide their services in complex environment where ethical principles are challenged by scarcity of resources and patient’s and healthcare professional preferences. In order to overcome these challenges hospital pharmacists need to understand how to balance between individual and population-level ethical aspects and at the same time provide best pharmaceutical care to their patients.

Keywords: ethical principles, pharmacy practice, decision making, medicine shortages

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