Feedback for Proposed Revision of the Code of Ethics

Pharmacist  ·  Nov. 6, 2015

Hello- thank you for the opportunity to review and give feedback on the new code of ethics for our College.

Overall, the document should maybe define that where "patient" is stated in the Code, it includes both patients and substitute-decision-makers.

Re: P 2 paragraph 1- The most important feature or characteristic that distinguishes a healthcare professional from another type of professional is that: healthcare professionals are committed, first and foremost, to the direct benefit of their patients and only secondarily to making a profit. Pharmacists and pharmacy technicians are healthcare professionals Instead of "profit" suggest "personal gain". I do not think that profit ($) is the most applicable word to apply to our profession, and that personal gain, which encompasses status, recognition, in addition to money is a better description.

P2- When we become a regulated healthcare professional we implicitly enter into what is commonly referred to as a ?social contract with society?. I find this reference awkward. Perhaps the intent is the "social contract"? If there is going to be something in quotes, it should be referenced.

Re: the "ethical principles of healthcare"- There are many ethical principles that apply to healthcare. I suggest this introduction be reworked- to state that the OCP's Code focuses the the principles of: beneficence, non-maleficence, respect for persons/justice and accountability (fildelity) among the many that apply to the provision of health care.

Re: the definitions of the principles I do not agree with the all the stated definitions of the principles chosen.

Beneficence (to benefi) Beneficence is not to benefit. It is act with the best interest of the other in mind. The first sentence of the definition (P2-3) implies that our role is to benefit ourselves. Perhaps the intent was to state: The first foundational principle that forms enshrines our commitment to serve and protect the best interests of our patients.

Respect for persons/Justice In the biomedical ethics literature, these are separate principles with different meanings.
Respect for persons upholds our commitment to respect the intrinsic humanity of our patients, making them and their decisions worthy of respect, compassion and consideration. Importantly, this helps us build on the foundational relationship between the individual pharmacist and patient as decisions are undertaken, and emphasizes that all people are entitled to participate in decision-making to the extent that they are able. I believe that justice should be a separate and recognized principle in the Code. It upholds the premise of our contributions to the best interests of society. The principle of justice states that we will treat people in similar circumstances in similar ways.

Accountability (fidelity) This relates to our obligation to keep promises and maintain trust in our relationships with patients. I think this is the section that relates more to us applying our specialized knowledge to improve patients' lives. That is what the public trusts us to do. The word "fiduciary" though it doesn't exclusively relate to money, does carry that implication, and so I would suggest not using it in our College's Code of Ethics. Instead, consider: Accountability recognizes our professional promise to maintain the trust of our patients and society, as we apply our knowledge and expertise, acting in their best interests. This principle holds us accountable, not just for our own actions and behaviours, but for those of our colleagues as well.

P3- Code of Ethics and Standards of Application The Ontario College of Pharmacists Code of Ethics is founded on the core ethical principles of healthcare: beneficence, non-maleficence, respect for persons/justice and accountability (fidelity). These principles are not "the core ethical principles of healthcare"- instead, consider saying "... Code of Ethics is founded on the principles of.....'

About the following Standards of Application? I liked the format of our last Code of Ethics; the current version I find unnecessarily lengthy. It becomes difficult to find the sections one might want to locate. For example, 1.2 would seem to encompass all of 1.3, 1.4, 1.5, and 1.7

2.1 Consider splitting into 2 sentences: Members refrain from behaviours/attitudes which could potentially result in Harm. In addition, members make every reasonable and conscientious effort to prevent harm to patients and society.

(suggest word change): 2.5 Members challenge the judgment of their colleagues or other healthcare professionals if they have good reason to believe that their those decisions or actions could adversely affect patient care.

2.17: I don?t know what this means. Are we saying pharmacy technicians are required ethically staff the departments or stores where they work?

3.11: Consider changing to encompass the extent of decision making allowed all people in Ontario regardless of age: Suggest: 3.11: Members respect the right of all patients to make decisions about their health care to the extent that they are able.

3.12: regarding substitute decision-makers (SDM?s), SDM?s are the people who must make decisions when a patient is unable to make it for his/herself. The ?incompetent patient? is just the person unable to make that decision for him/herself at that time. Suggest striking ?incompetent patient? from this statement and from 3.13. Instead, consider: 3.12: ?members recognize and respect the right of authorized substitute decision-makers to make decisions on the patients? behalf. 3.13: Members apply the known wishes/intentions of a patient where those wishes, through a personal directive were expressed before the person was incapable of making the decision.

In the Declaration page to be signed, instead of: I will protect my patients? vulnerability and respect their rights as autonomous persons. Consider, ?I will respect my patients? rights are autonomous decision-makers?. I don?t think I should be protecting my patients? vulnerability. What was the intention of this phrase?

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