The Ontario College of Pharmacists presents the Introduction to the Code of Ethics e-Learning Module
Welcome to the first in a series of e-learning modules on the Code ofEthics. These modules have been developed by the College to assist current and future pharmacists and pharmacy technicians – like you – understand and apply the Code of Ethics in your everyday practice.
The Code of Ethics(to be referred in this module as the Code) is available on the College website. You are encouraged to read the Code and refer back as needed while viewing the modules.
Along with the Code is a supporting document called the Declaration of Commitment that outlines the promise that pharmacists and pharmacy technicians make to serve and protect their patients and society. This declaration is a constant reminder to keep this commitment at the forefront of your daily practice.
After completing this module you will understand:
- the role and purpose of the Code of Ethics;
- your professional role and commitment as a healthcare professional; and
- the ‘social contract’ and the core ethical principles that guide your practice as a healthcare professional
Let’s start with a few true or false type questions to see what you may already know about the Code of Ethics.
The Code of Ethics is not aspirational. Rather, the Code outlines the minimum expectations of behaviour and conduct expected of you in practice. This is similar to the Standards of Practice which is also not aspirational but rather outlines the minimum expectations of how to practice. It is these two foundational documents – Standards of Practice and Code of Ethics; supported by legislation, policies and guidelines – that provide the framework for minimum expectations of practice and behaviour that you are held accountable to as a healthcare professional.
Your personal values or beliefs must not influence your professional decision-making. The established principles of healthcare ethics in the Code must guide your decisions. Abiding by these principles is not optional and is not unique to pharmacists and pharmacy technicians. These principles apply to all healthcare professionals.
Although your diligence to minimize harm cannot be understated, your overriding responsibility as a healthcare professional is to benefit your patients. You must never lose sight of the fact that patients are vulnerable and rely on their healthcare professionals – including pharmacists and pharmacy technicians – to apply the unique knowledge, skills and abilities that they possess, to help make them better.
The basic purpose of a code of ethics is to outline the ethical principles and standards that healthcare professionals are guided by and held accountable to.
It is the document that outlines your professional role and commitment as a pharmacist and pharmacy technician.
Understanding this is critical because as a healthcare professional, you are held accountable – not just to the College but more importantly to patients, colleagues and society - to a unique set of obligations and expectations of behaviour and conduct which are outlined in the Code.
When you become a pharmacist or pharmacy technician, like all healthcare professionals you entered into what is commonly referred to as a “social contract with society”.
This contract requires that you act in the best interest of your patients and place their well-being first and foremost.
In exchange, society (or government) agrees to provide the profession with the autonomy to govern itself as a self-regulating profession.
Commitment to this promise is essential because it creates a bond of trust between yourself, as the healthcare professional, and your patients. Assuring them and society at large, that you are committed to using your knowledge, skills and abilities to promote and protect their best interests, not your own.
At the core of this, is the commitment to put patients first.
You must always remember that patients are vulnerable. Some more than others - the very young or old, those in excruciating pain or mentally incapacitated - but all patients are vulnerable by the simple fact that you have something that they don’t, specialized knowledge and skills.
Patients come to you with the expectation that you will apply your professional knowledge and skills to their particular condition and circumstances to try to make them better.
Quite simply; your commitment to uphold this promise is your primary ethical obligation as a healthcare professional. It is not optional. It is not sometimes or most of the time. It is each and every time, with each and every patient.
In keeping this promise, you must recognize and remember that you have not simply chosen a profession but also a vocation. A vocation which requires you to commit yourself to help and benefit those entrusted to your care in a spirit of altruism, goodwill, sincerity and integrity.
To support practitioners in upholding this overarching commitment – to put patients first – healthcare professionals share common ethical principles. The foundation for these principles, and ultimately codes of ethics for healthcare professions, can be traced back to ancient Greece and the Hippocratic Oath.
Codes are all founded on the same core ethical principles of healthcare.
These principles shape your behaviour and conduct and serve as a compass to guide and inform every decision you make and action you take as a healthcare professional.
It is crucial to remember that your own personal values or beliefs do not guide your professional decision-making.
Instead, the established ethical principles of healthcare must be your guide. Similar to your commitment to the social contract, abiding by these established and recognized principles of healthcare – is not optional. Nor are these principles unique to pharmacists and pharmacy technicians, they apply to all healthcare professionals.
The principles that form the foundation for the Code of Ethics include:
• Beneficence (to benefit),
• Non maleficence (to do no harm, and whenever possible, prevent harm from occurring),
• Respect for Persons and Justice,
and;
• Accountability (or fidelity).
The Code consists of ‘ethical standards’ or expectations of conduct and behavior.
Each of these specific standards have been purposefully aligned under its most relevant and appropriate principle.
In subsequent modules we will explore, in greater detail, each of these principles and examine a number of the key standards or expectations that have been described in the Code.
For the purposes of this introductory module, we will focus on defining the principles and help you understand how these work together to provide the framework that ensures you remain committed to upholding your professional promise – to serve and protect the best interest of your patients and society.
The first foundational principle is Beneficence . . . to benefit.
Beneficence refers to your obligation to actively and positively benefit patients and society.
You must never lose sight of the fact that patients come to you – as they do any other healthcare professional – with one simple objective; they want to get better.
As pointed out in one of the introductory true or false questions, although your diligence to minimize harm cannot be understated, your overriding responsibility as a healthcare professional is to actively and positively benefit your patients. They are relying on you, and in fact trust you, to apply your knowledge, skills and abilities to help make them better.
Non maleficence describes your responsibility – as you strive to benefit your patients – to be diligent in your efforts to do no harm and, whenever possible, prevent harm from occurring.
When we look at the two principles, beneficence and non maleficence together, your responsibilities seem simple enough. You need to help your patients and do your best not to harm them, and prevent harm from occurring.
But, when applying these principles in practice, it is important that you have not lost sight of the fact that the Code also provides guidance with respect to where – as a pharmacist and pharmacy technician – you place your focus.
Let’s reflect for a moment on your own practice.
Where do you currently place your focus? Do you spend as much time and attention on ensuring that the prescribed therapy will, or is, optimizing your patient’s health outcome as you do ensuring that you have accurately dispensed the prescription?
Given the history of the profession and the significance placed on pharmacy professionals as dispensers of medications, it’s not surprising if a disproportionate amount of a pharmacist’s focus is currently placed on ensuring the accuracy of dispensing. Being diligent to ensure there are no contraindications, drug interactions or allergic reactions.
As the medication expert on the healthcare team, a pharmacist needs to be just as diligent in assessing the appropriateness of the medication therapy to optimize the patient’s health outcome.
To illustrate this further, let’s consider the following. If, based on your assessment of a patient and understanding of their current condition, you believe that the medication therapy being prescribed will not optimize their health outcome, you must intervene in some way.
Allowing a patient to leave your care with an inappropriate medication or a medication with a sub-optimal dose – one that you know on the one hand may not harm them, but on the other hand is unlikely to provide the desired therapeutic benefit – is an example of not upholding your commitment to beneficence. This obligation to actively benefit patients is at the core of your role and responsibility as a healthcare professional. Simply put; it is not enough . . . to do no harm.
You must always remember that patients don’t know, what they don’t know and trust that their healthcare professionals – including you – are looking out for their best interests and will intervene when necessary.
By choosing to do nothing – whether that is filling a prescription you know isn’t going to be effective or gnoring an identified drug interaction – you must recognize that you have in fact made a decision. In accordance with the Code you are held equally accountable to your decision to do nothing as you are to any other decision you might make.
“Respect for Persons” and “Justice”
These principles refer to your dual obligation as a healthcare professional to respect and honour the intrinsic worth and dignity of every patient as a human being, and to treat all patients fairly and equitably.
The Code outlines standards that describe the specific actions and behaviours expected of you in order to demonstrate your commitment to these principles. For example; you must recognize the vulnerability of patients, value their autonomy and dignity, and treat them with sensitivity, care, consideration and respect.
Why might you find this challenging?
Perhaps part of what makes this challenging is that as a healthcare professional, you must uphold this principle of respect and justice for all patients, in all circumstances – not just for those patients whose values and decisions happen to align with your own.
Respecting your patient means that you do not allow your views about a patient’s personal life, religious beliefs, or other morally irrelevant factors such as race, gender, identity, sexual orientation, age, disability, marital status, and any other factors, influence how you treat the patient or affect the quality of care you provide.
You also demonstrate your commitment to “respect for persons” when you obtain patient’s consent, uphold their confidentiality, and respect their autonomy to make their own informed decisions about their healthcare.
This includes their right to accept or refuse services and their right to choose the pharmacy and/or pharmacy professional they wish to receive services from. It’s not about you, it’s about the patient.
The last core principle of healthcare ethics that the Code is founded on is Accountability, sometimes referred to as Fidelity.
This principle requires you to be a fiduciary of the public trust; accountable for not just your own actions and behaviours but for those of your colleagues as well.
This principle directly ties pharmacists and pharmacy technicians to the professional promise outlined in the social contract - to always and invariably act in the best interest of your patients . For example, ensure that you are only providing pharmacy services to patients based on their needs as opposed to financial gain.
Given the broad scope of this principle, the Code includes general requirements related to professional accountability as well as specific standards pertaining to ethical business practices and conflict of interest.
In a later module, we will go into greater detail, but for the purpose of this introductory module, let’s take a closer look at one of the fundamental responsibilities.
Commonly referred to as - Duty to Report - standard 4:10 in the Code states that you; “report professional incompetence or unethical behaviour by colleagues or other healthcare professionals to the appropriate regulatory authority”.
Let’s use an example of how this standard applies in practice to help illustrate the reason for, and the importance, of this obligation.
Assume you work for a corporation as a pharmacy manager. You have strong evidence to support the fact that one of your staff pharmacists or pharmacy technicians has engaged in unethical behaviour. What do you do? Report them to head office? Terminate their employment?
It is likely that you would do both these things and in many jobs, reporting the employee or terminating their employment may be enough. But, as a healthcare professional your obligation extends beyond that.
By releasing this individual from your employment you may be protecting the patients in your pharmacy but what about other patients, in other pharmacies? Isn’t it likely this individual will simply get a job in another pharmacy?
You must always remember that your commitment to protect the best interests of patients extends to all patients and in fact, to society at large.
Therefore, in a situation such as the one described here - regardless of whatever other actions you have taken - you are required to report this individual to the College. It’s important to note that this obligation also extends beyond your own profession. For example, if you were to become aware of professional incompetence or unethical behaviour by another healthcare professional - e.g. a physician or nurse - you are required to report that situation to their regulatory college.
Upholding your obligation to report is particularly important in circumstances where there is a serious and egregious breach of patient trust, such as an incident where you have reasonable grounds to suspect that inappropriate sexual conduct has occurred. In cases like these, your duty to report is not only ethical, but legal. The provisions in the RHPA with respect to sexual abuse of patients by health care professionals is to encourage the reporting of such abuse and to provide funding for therapy for patients who have been sexually abused by health care professionals.
Click on the icon to review information on inappropriate sexual conduct. [http://www.ocpinfo.com/protecting-the-public/complaints-reports/mandatory-reporting/ ]
We have now introduced the core elements - the social contract and the principles of healthcare ethics - that provide the foundation and framework for the Code of Ethics. It is important to illustrate how these elements work together and in fact guide your conduct and behaviour in practice.
Ethical principles shape the interactions that you have with patients on an ongoing basis and have always provided the framework that ensures the safe, effective and ethical delivery of pharmacy services.
To illustrate this point let’s consider the following case study.
A male patient about 70 years old well known to your pharmacy, suffering with a sinus and chest cold, walks in looking for advice for an over-the-counter remedy.
He approaches the pharmacy technician and asks for advice on a product to provide him with some relief since he does not have time to see a doctor.
The patient explains that for over a week, he has been suffering with congestion, sinus headaches and a nagging cough that persists throughout the night, making it impossible to sleep.
Hethinks he may have had a fever on and off but has not consulted aphysician. The patient is not currently taking any medications. In fact, given that the patient has trouble tolerating ibuprofen, he has been reluctant to take anything to deal with his current symptoms. The pharmacy technician suggests he speak with the pharmacist to make an appropriate recommendation.
The patient further explains to the pharmacist that he is a widower on a fixed income, lives alone and is not a fan of medication or doctors. But, thought he would see if an over the counter medication could help as he does not want to end up in hospital, like he did last year, with pneumonia.
The pharmacist, suspects that the patient – based on his symptoms and history – may have an infection better treated by antibiotics. The pharmacist strongly recommends that he consult with his physician as soon as possible, and if symptoms persist or worsen, go to his local hospital emergency department.
Although the patient is very attentive to the pharmacist’s recommendation, he insists that he does not want to do that at this time and just wants some advice on an over the counter medication.
Having considered all of this information, the pharmacist recommends the generic brand of a cough and cold medication (without ibuprofen) and emphasizes that this will only help alleviate some of his symptoms.
He explains to the patient how best to take the medication and reminds him once again to see his doctor and if his symptoms worsen, he really must go to the hospital emergency room.
As the patient leaves, the pharmacist makes a note to follow up with him in the next day to ensure that his symptoms are improving and if not, to further reinforce the need and urgency to see his physician for treatment.
Let’s reflect for a moment. Can you identify where the core ethical principles have been applied in the decisions made?
This scenario helps to demonstrate that when the ethical principles are used to guide your actions and decisions in practice, the outcome is the fulfillment of your professional role and commitment: that is, to work together with your patients to serve and protect their best interests.
In this module, you learned the following key points:
• Your expected conduct and behavior as a healthcare professional is outlined in the Code of Ethics.
• Your role and commitment is to put the best interests of your patients first: never loosing sight of the fact that it’s not about you, it’s about the patient.
• Your actions and decisions in practice are guided by the principles of healthcare ethics, not your own values and beliefs
• A decision to do nothing is a decision and you are held equally accountable to it, as you are any other decision you might make.
• Finally, you learned that your primary responsibility – in fact what patients trust and are relying on - is that you will apply your knowledge and skills to help make them better
Other modules in this series will explore each of the ethical principles in more detail, using practice scenarios to illustrate the application of some of the more significant ‘standards’ or expectations outlined in the Code.