Lesson 4

Placebo

- contains no biologically active substance yet it is used to achieve a therapeutic outcome

Conscientious Objection

A deeply held conviction, motivated by conscience, based upon personal religious or cultural values and beliefs, that a certain action or inaction is wrong Examples: Abortion Contraception Inoculation of children Blood transfusions Withholding enteral feeding Objection must be specific to the medication and not the patient (abortion pill) and not to specifics about the patient or his/her lifestyle (HIV, drug abuse, SARS) Conscientious objection allows the health care professional to transfer the care to another provider The patient must NEVER be left without any options

What is a Code of Ethics in Health Care?

A document which articulates the ethical duties or obligations of professionals in specific healthcare professions

Incompetence

A person is deemed incompetent: - if he/she does not meet the criterion of capacity - Suffers from some general form of incompetence - e.g. later stages of Alzheimer's disease or extreme cases of an intellectual disability A patient may experience temporary incompetence: - if s/he is under the influence of drugs or alcohol - If s/he does not meet the chronological minimum age of consent to treatment as determined by statute in the province in which s/he resides

Responsibility to Society

An obligation to: Demonstrate and uphold public trust and confidence by acting with honesty and integrity Report incompetent or unethical behaviour Participate in advocacy, research and public education An obligation to: Faithfully comply with Legislation, Standards of Practice, Code of Ethics and Best Practice Guidelines Take responsibility for our actions: Not acceptable to try to justify or rationalize inappropriate behaviour because it is not explicitly captured in a standard or guideline found in the Code of Ethics

What does the Code of Ethics Do?

Articulates the commitment of the profession to serve the health and well being of patients Provides a means to educate and guide decision making for individuals practicing within the profession Informs the public about the ethical responsibilities of individuals practicing within the profession

Responsibility to the Profession

Commitment to personal and professional integrity Participation in ethical business practices Commitment to ongoing competence Commitment to personal and professional integrity is expressed through: Duty to self to act conscientiously and avoid unethical behaviour Duty to self to protect and maintain physical and mental health and well-being Cooperation with investigations about their own or other colleagues' fitness to practice Abiding by any undertaking or limitations and conditions placed on their practice

Commitment to ongoing competence involves:

Continuously self-evaluating knowledge and skills Participating in quality assurance requirements

How can we ensure patents understand information provided to them?

Deliver information in plain and simple language and if possible without the use of technical jargon Remember the experience of receiving information and providing information is a ongoing dialogue between patient and health care provider Pay attention to body language A good test for understanding is to have the patient repeat in his/her own words, what you have said

Surrogate Decision Makers

If a patient is deemed incompetent, s/he can retain the right to informed consent through a surrogate decision-maker Surrogate decision-makers could be: Persons authorized either through Personal Directives, or Proxy designations

Documenting Consent

Informed consent is first and foremost a verbal dialogue and often 'implied' rather than 'expressed' 'Implied' consent - presenting a prescription to be filled 'Expressed' consent - initiating a prescription change or new medication or service Recording and documenting informed consent is important especially in the event of litigation

Relevant Information

The kind of information that would be considered relevant includes: The facts about the proposed medication or service The relevant risks and benefits associated with the medication or service The costs associated with the medication or service Any other information the patient may require

Informed Consent - Competence

Only a competent person can make a legal and ethically appropriate decision A person is considered legally and ethically competent to provide consent if: He or she has the mental ability to understand the information provided to him/her Is able to appreciate the consequences of his/her choice to accept or refuse services

Participation in ethical business practices is accomplished by:

Only entering into relationships, contracts and agreements in which we can maintain our professional integrity and safeguard the interests of our patients Maintaining non-deceptive information in marketing and public education Maintaining professional boundaries and avoiding conflict of interest

Ethical Accountability

Pharmacy Technicians need ethical guidelines that outline their ethical responsibilities as accountable fiduciaries.

Truth Telling

Pharmacy Technicians, as health care professionals, have an ethical duty to be honest with their patients and to tell them the truth regarding any information they may need to exercise their right to act as autonomous moral agents and make their own decisions about their health care.

Responsibility to Patients

Placing the patients' health, well-being and best interests first and foremost Treating patients with respect and maintaining professional boundaries Promoting the patients' health & well-being through patient advocacy and best practices that support enhanced patient care Practicing within Scope of Practice and Standards of Practice - Referring as necessary and appropriate Fitness to practice Supporting patients in making informed choices

Characteristics of a Good Fiduciary

Protects and benefits the patient Advocates on behalf of the patient Provides open communication Maintains patient privacy and confidentiality Is sensitive and caring Is effective in conflict resolution Inspires trust, respect and confidence

Conscientious Objection. What does this mean?

Technician may object to providing a product or service for conscientious reasons, but: Must make his/her objection known to the pharmacist/manager Must not discuss his/her conscientious objection with the patient Must ensure that someone else can provide the product or service - if this is not possible within a reasonable period of time, the technician must provide the product or service her/himself

Positive Standards of Behaviour:

The Code of Ethics for Pharmacy Technicians outlines behaviours that Pharmacy Technicians are committed to engage in, to actually benefit patients, as apposed to merely avoiding harming them

Negative Standards of Behaviour:

The Code of Ethics for Pharmacy Technicians outlines behaviours that Pharmacy Technicians are required to refrain from participating in, to avoid doing harm to their patients and whenever possible to prevent harm from occurring to their patients

Foundation for Ethical Accountability

The Social Contract, and Core Ethical Principles of: Non-maleficence Beneficence Respect for Persons Justice Veracity Fidelity Health professions develop their own specific and individual accountability mechanisms typically in documents called Codes of Ethics

May only refuse to provide requested services for the following reasons:

The patient requests the discontinuation of service, The health care professional does not possess the knowledge, skills and abilities to provide the service, The patient is abusive physically and/or verbally to the health care professional, Providing this service would present a conflict of interest for the healthcare professional The health care professional has a conscientious objection to providing the service

Informed Consent

Three conditions of Informed Consent: The individual must be Competent Consent must be Voluntary Information provided must be Adequate, Relevant and Understood by the patient

Informed Consent - Voluntary

To meet the established criteria, consent must have been obtained voluntarily - that is: the person did not feel that s/he was: Coerced Manipulated Mislead or deceived, in any way

Respect and Boundaries

Treating patients with respect and maintaining professional boundaries Example: Privacy and Confidentiality Patients trust that their personal health information will be held in confidence and not disclosed or shared with others without their implicit or explicit consent

Standards of Ethical Behaviour

Typical standards of ethical behaviour expressed in Codes of Ethics reference responsibilities to three key stakeholder groups: Responsibility to Patients Responsibility to Society Responsibility to the Profession

Appropriate Disclosure

When is it appropriate to disclose confidential information without the consent of the patient? When required by law; or When needed to protect the welfare of the patient; or When needed to protect the public interest.

What is a Fiduciary Relationship?

Where one person trusts or relies on another Acting in good faith in protecting the interests of others Working for the good or benefit of the patient Being accountable and responsible to the patient/society for his or her actions