Case Studies in Pharmacy Ethics

Robert Veatch graduated from the Purdue University School of Pharmacy and 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 Professor in the Department of Pharmacy Sciences in the School of Pharmacy and Health Professions at Creighton University. 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.

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?
Consequentialism
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?
Notes

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
Notes

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
Notes

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
Notes

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
Notes

Chapter 6: Autonomy
Determining Whether a Patient Is Autonomous
External Constraints on Autonomy
Overriding the Choices of Autonomous Persons
Notes

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
Notes

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
Notes

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
Notes

Part III: Special Problem Areas

Chapter 10: Abortion, Sterilization, and Contraception
Abortion
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
Sterilization
Contraception
Notes

Chapter 11: Genetics, Birth, and the Biological Revolution
Genetic Counseling
Genetic and Genomic Screening
In Vitro Fertilization
Surrogate Motherhood
Gene Therapy
Notes

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
Notes

Chapter 13: Formularies and Drug Distribution Systems
Formularies
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
Notes

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
Notes

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
Notes

Chapter 16: Consent and the Right to Refuse Treatment
The Elements of a Consent
The Standards for Consent
Comprehension and Voluntariness
Notes

Chapter 17: Death and Dying
The Definition of Death
Competent and Formerly Competent Patients
Never-Competent Patients
Limits Based on Interests of Others
Notes

Appendix: Codes of Ethics