ETHICAL DECISION-MAKING IN PHARMACY
“I told them if they didn’t get me more help, we would kill someone.” This sentence was part of a three-page handwritten letter sent to a board of pharmacy investigating a prescription error that led to the death of an elderly woman patient of a chain pharmacy. The pharmacist who wrote the letter had filled the woman’s prescription for a diuretic with digoxin instead. While there was a medical question of whether that mistake had caused the death, it probably was a factor.
A reading of the pharmacist’s entire letter left little doubt as to its meaning: “It wasn’t my fault, it was the boss’s fault.” The patient’s family later introduced this letter into the civil trial against the pharmacy chain.
The letter had little impact on the decision of the board of pharmacy. Clearly the pharmacist was the professional, and the pharmacist had put the wrong drug into the prescription bottle. However, the letter did influence the amount of money the chain ultimately paid to the family.
A set of virtues
Aristotle spoke of ethical decision-making as the application of a set of virtues. To Aristotle, the virtues were a set of principles that guided not just how men and women made decisions, but how they should live their lives. He listed many virtues, including truth, loyalty, trustworthiness, and courage. One could not pick and choose virtues, but must strive to embody all.
Sometimes when we are applying Aristotle’s thoughts to the practice of pharmacy, it can seem as if one virtue might conflict with the fulfillment of another.
Let us view the pharmacist’s letter to the board through the dual prisms of the virtues of loyalty and trustworthiness. Consider the duty of loyalty owed to our employer, layered upon our duty of trustworthiness owed to the patient.
The pharmacist had a valid point: The pharmacy where he worked had become increasingly busy almost overnight. The chain had bought out an independent pharmacy and had combined the two sets of prescription files. The chain was slow to add sufficient extra staff during the first days of the transition. It was during this time that the mistake was made.
During the board of pharmacy investigation, the pharmacist was given an opportunity to address the board. His response was the letter with the “I told them . . .” comment. Was the letter merely an honest statement of fact, or was its purpose, as most who read the letter at the time surmised, to shift blame from himself to the employer?
No simple answers
Aristotle said that each person must decide what the duty is and how far it goes. Under Aristotle’s teachings, there are no black-and-white answers. They vary from person to person and from situation to situation.
Loyalty to the boss does not include shirking the responsibility of trust each pharmacist owes to the patient. If the boss does not provide enough help, or if there is a flu epidemic that includes co-workers who will then be absent from work, or if one or more staffers quit the same day, the obligation to the patient remains unchanged. Pharmacists and technicians cannot “speed up” to fit the demands of the boss if it means putting the safety of patients at risk.
Only the professional
The pharmacist, the technician, and the needs of each individual patient must dictate how much time is spent on a prescription. Trustworthiness means taking the time to fill one prescription at a time, whether the patient is the only person waiting or the twenty-third in line.
It is the pharmacist, not the boss, who is the professional. Only the professional can determine whether it is safe to speed up the workflow.
The circumstance in which “the boss did not give me enough help” is an economic problem, not a safety issue. If it takes too long for the prescription to be filled, the customers will go somewhere else.
No one said ethics was easy.