The condition of doubt in pharmaceutical practice: bioethical aspects

Abstract

Introduction: Veracity is one of the principles of biomedical ethics that set truth telling as a rule in medical professionals' relations with patients. However, in daily pharmacy practice, the principle of veracity is violated in different ways: by the act of lying, omission or by deliberative cloaking of information in jargon or language that fails to convey information in a way that can be understood by the recipient or that intentionally misleads the patient. Sometimes, the pharmacist faces a problem of what the patient should be told, because he (the pharmacist) is not yet sure what the facts are, situation which in health care is referred to as the “condition of doubt”. This problem also relates to the ethics of relations between health care professionals. Often, in daily practice, pharmacists when filling in doctor’s prescriptions might disagree about the assigned medication and based on their legitimate right to “correct” doctor’s “potential” mistakes, might suggest a safer alternative for the patient. This leads to conflicts between pharmacists and doctors in patient’s treatment. Purpose and objectives: Analysis of moral dilemmas related to the “condition of doubt” in pharmacy practice on behalf of bioethical principle of veracity and ethics of the relation between medical professionals. Materials and methods: The research was based on the analysis of relevant scientific literature (articles, conference and symposium papers), case studies and ethical (bioethical) codes of medical professionals through the application of analytical, bioethical, comparative, medical-historical methods. Results: The traditional Hippocratic medical code of ethics does not require that medical professionals deal honestly with patients and accept lies when they produce more good than harm for the patient, while the modern ethical codes, following the principle of veracity, consider truthfulness as part of the essential characteristics of the pharmacist. Veracity focuses on the inherent moral element, such as the patient’s right to be told the truth. Before disclosing information, the pharmacist should have the sense of exactly what he should tell the patient. The confusion referred to as the condition of doubt may be in regards to a diagnosis about which the pharmacist has only a preliminary suspicion (in case of innovative therapies where the effects of therapy are not very clear) or the pharmacist has only a limited understanding of the patient’s condition (compared with the doctor’s knowledge). The professional codes foresee that if the medical professional does not posses enough knowledge or experience in order to guarantee adequate care, he or she shall consult other professionals or guide the patient towards further advice from another medical staff. However, in practice this rule is not always respected neither by pharmacist nor doctors. Facing the condition of doubt alone, the pharmacist either lives with the uncertainty, or risks being dishonest leading to the quality of the pharmaceutical care being affected. Conclusion: moral dilemmas of condition of doubt can be resolved considering the reasonable person standard (the pharmacist should say what the reasonable patient would want to know before consenting) and the principle of autonomy (the patient must be told what he or she needs to know to make an informed choice, even if the information is doubtful) and developing a more advanced pharmacist-doctor working relationship system.