Between cowardice and recklessness: The virtue of courage

April 15, 2011

We do not usually think of courage as a part of a pharmacist's ethical duties, but it is, and it is one that is sometimes the most difficult to practice.

Key Points

Panicking, she ran to the surgery, only to discover that the patient had died. Janice pulled the surgeon aside and told him about the error. The death, she was assured, was unrelated to the pharmacy error.

Janice did not need to confess to the error. It took courage to do so. She could have remained silent, but if she had done so, the pharmacy and the hospital would have learned nothing about how to prevent the next error.

Ethical duty

Two thousand, five hundred years ago, Aristotle wrote that courage is one of the virtues that lead to practical wisdom and a happy, fulfilled life. We do not usually think of courage as a part of a pharmacist's ethical duties, but it is, and it is one that is sometimes the most difficult to practice.

The I-95 corridor runs from Florida to Maine. One pharmacist who practices in a pharmacy along I-95 in Florida referred to it as the Oxycodone Express, because of the prevalence of questionable prescriptions filled in Florida, presumably to be sold in northern states.

This pharmacist describes her feelings of concern and sometimes fear when a prescription for one of the "street-popular" controlled substances is presented to her.

She has options. She can say, "We do not carry this" or "We are out of stock." She can also say, "I question this prescription and I am not going to fill it. I am calling the police." In actuality, she has, at different times, made all 3 responses.

With so many "bad" prescriptions, she has to remind herself that some are "good." These drugs are powerful pain relievers that are necessary and appropriate for many patients. Sometimes pain relief requires very high doses of these drugs, and pharmacists become concerned about their own liability in dispensing them. Pharmacists must make courageous decisions every day.

Between 2 vices

Aristotle said that the virtue of courage cannot be applied by formula. It is not the same for all persons or under all circumstances. In other words, it is hard. Courage, Aristotle said, lies somewhere along the line between the vice of cowardice and the vice of recklessness. Courage is not exactly in the middle - it is closer to the reckless end of the spectrum than to that of cowardice. Each person must make his or her own decision in each situation.

The APhA Code of Ethics talks about our duty to our patients, but also about pharmacists' duty to society. Pharmacists are the gatekeepers of dangerous and Rx Only drugs. As such, sometimes they must admit they made a mistake, so that future errors can be avoided. Sometimes pharmacists must say "No," and sometimes it is equally hard to say "Yes."

Pharmacists make courageous decisions every day and many can be hard. In the end, the only test of an ethical decision is "Did I do my best?"

This article is not intended as legal advice and should not be used as such. When legal questions arise, pharmacists should consult with attorneys familiar with pharmacy law in their states.

Ken Baker is a pharmacist and an attorney. He consults in the areas of pharmacy error reduction, communication, and risk management. Mr. Baker is an attorney of counsel with the Arizona law firm of Renaud Cook Drury Mesaros, Pa. Contact him by e-mail at ken@kenbakerconsulting.com
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