Feedback for Proposed Revision of the Code of Ethics

Pharmacist  ·  Nov. 5, 2015

1."The Code of Ethics is applicable in all pharmacy practice, education and research environments including non-traditional practice settings which may not involve a healthcare professional/patient relationship." (Ref: p1).
The term "non-traditional practice settings" is vague and raises a concern as to what constitutes "traditional practice setting." As one reads through the document, there are abundant sections that would not even touch on an educational or research type of setting. As such, an unlevel playing field is created because in essence the Code will NOT be applicable to all members of the College.

The proposed revision is categorized into four main sections, all of which consider a "patient" environment. It will be difficult to try and apply these to the "non-traditional" practice settings where such patient involvement (beneficence, non-maleficence, respect for persons/justice, and accountability/fidelity) are not part of the practice. It may be advisable to define the term "traditional practice setting." If that is to mean "community pharmacy practice" and/or "hospital pharmacy practice" then ensure that this is so-defined.

2.Sections 1.7, 2.8 and 4.20
These sections will leave no room for the College to allow the sale of products from within pharmacies that are repeatedly at the forefront of debate in the professional blogs, columns, etc. as to efficacy. If there is no "evidence-based information" to show the efficacy (in keeping with requirements of approved marketed health products) of products such as homeopathic remedies, then the College must proactively prevent the sale of such products from pharmacies. That includes where a portion of premises (i.e., in a grocery store) is a pharmacy but the pharmacy attempts to sell them from the grocery area so as to avoid being deemed to be "sale from a pharmacy." If the entire premises is accredited as a pharmacy in order to allow the sale of scheduled drugs via all checkouts (including front checkouts such as is the case at Costco, far removed from any pharmacy oversight), then no such sale should be allowed.

Expecting members to abide by the Code also carries a responsibility by the College to ensure that this is done. Since no scientific evidence to efficacy is available for homeopathic products, by extension they cannot be condoned to be sold per the revised Code. The College, knowing such products are presently being sold, would be mandated to effect their removal.

Section 4.20 should be re-worded because "no potential benefit" can be argued to say that one can always allude to a "potential benefit" to a patient -- even if the placebo effect is considered (or, because no harm is reasonably an outcome, this equates to allowing the sale). The term "potential" would appear to be the word at issue, because in theory one can always argue there's a potential -- even if not based in science, or clinically-oriented. A "snowball's chance in hell" should not be seen as a "potential benefit."

3.Section 2.5
It would be advisable to include wording that supports the idea that in doing so in good faith, members are not to be "blackballed." In many jurisdictions, the terminology includes such wording as "Members should, without fear of reprisal, challenge..."

4.Sections 2.11, 2.12 (sexual behaviour/harassment)
The term "patient" should be defined. At present, the existing HPPC (RHPA) addresses these same areas and even there, the "patient" is not defined. The OCP has taken a benchmark to mean there is a clinical record of treatment (whether prescription, or OTC and then documented "for continuity of care" purposes), as required under Standards of Practice. Rather than get into debates over what constitutes a "patient" it would be much easier to define it for purposes of this document.

Section 2.12, as presently worded, would appear to be applicable in situations that are not "patient" oriented. (The word is not included). As such, that would include staff members as well, outside a "patient" relationship existing. If that was the intention, I applaud its broader application. The term "harassment" also has a pre-condition that when such actions are conducted, a person must first be made aware of the unappreciation of such conduct moving forward, before (upon a subsequent occurrence) it becomes harassment.

5.Section 2.14
The word "Member" should likely be "Members", or "A member..."

This section, as presently worded, would require all four subsections to be effected before a professional relationship may be ended (due to the use of "and" at the end of clause iii instead of "or" after each clause). However, it does not make an allowance for cases where a treatment contract has been entered into (e.g., methadone, substance abuse treatment) that contains its own clause where certain actions committed by a patient are to result in immediate cessation of the relationship. As such, wording should be included to take these types of contractual agreements into consideration so that the spirit and intent of such contracts are not compromised by first requiring four other conditions to be met. Perhaps adding revising the opening statement to: "Absent a contracted agreement between a member and a patient where breach of that agreement may provide for or constitute an ending of the professional/patient relationship, a member may only consider ending the professional/patient relationship when the member has met the following conditions:..."

6.Section 2.17
There is a typo ("polices") which should likely be "policies".

7.Section 2.20
It is unclear how this section, as worded, will allow for "Part B" pharmacists (still "members") to not have to remain "current" when they are not subject to "practice review" as they are not practising in a direct patient care environment. By very nature of the regulatory restrictions on a Part B member, the same level of clinical knowledge, etc. incumbent upon a Part A member is not required. While Part B pharmacists would ethically keep current in terms of whatever they are doing OUTSIDE a direct patient care setting, perhaps inclusion of "relevant to their practice environment" after "professional knowledge and skills" would be advisable.

8.Section 3.6
The term "individual" should be replaced by "patient" to remain in context with the subject matter preceding being specific to "patient."

9.Section 3.10
The word "expressed" should likely be "express". Privacy legislation generally uses the phrase "express or implied", rather than "implied or express (sic)". (Note: also applicable in section 4.35, where "expressed purpose" should be "express purpose").

10.Section 3.11
The term "minor" should be defined; it can involve various ranges of ages depending upon the specific legislation/document in which it is being used. Inserting clarification in brackets after the term (e.g., "under the age of ...") would clarify. Otherwise, members could impart their own definition as they see fit, and too much variance would occur.

11.Section 4 ("custodian of the public trust")
The public trust does include public funding (e.g., ODB and use of public monies). So when a member commits fraud involving such public funds, it is not in the "best interests of their patients and society" since this inevitably leads to increases in drug plan costs and/or decreased coverage by limitations on inclusions of further drugs on such plans. Such actions should be included in the "A, B, C" of this section to reflect this reality, in addition to the important items listed under those sections.

12.Section 4.3
The meaning of this section does not appear to be conveyed by the wording. If the issue is a member using the specific absence of a type of behaviour from mention in the Code being "permissive" of such behaviour, then re-wording would clarify this: "...that because such behaviour is not expressly prohibited in a Standard of this Code, it is therefore deemed permissible."

13.Sections 4.11, 4.12
As per comments in #3 above, wording such as "without fear of reprisal" should be included in both these sections at the appropriate spot (typically, after the word "Members" such as "Members, without fear of reprisal, ...").

It would also be worthwhile to consider adding another bulleted item at this location, renumbering those that then follow, as 4.13:

"Members do not exhibit prejudice in any way towards other members complying with and components of this Code, including in particular sections 4.11 and 4.12."

14.Section 4.18
While this section states that members "recognize" this point, it does not go any further to say what should occur if a member identifies such actions where they are "employed by." So as such, a member could say they know it's going on but there's no duty to do anything further (as they would be fearful of reporting such regarding an employer). Nothing in this section requires them to do anything other than "recognize" it, if occurring.

15.Section 4.35
Mentioned earlier in #9: "expressed" should be "express". As well, consider replacing "benefiting financially" with "personal financial benefit".

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