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Letters to the Editor
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Diamorphine shortage
A question of ethics and professionalism
From Professor J. Wingfield, FRPharmS
It is always difficult for a member of the Royal Pharmaceutical Society’s
staff to give instant and short replies to queries on ethics (I know,
I have been there) but I find the “official” response to
the letter about reissue of diamorphine ampoules both dismissive and
disheartening (PJ, 22 January, p85).
Ethics, particularly when applied to health care, is rarely a matter
of absolutes. Can we conceive of no situation when the reissue of a medicine
which appears to have retained its integrity can be justified? Well,
actually we already have — in NHS hospitals. Patients’ own
drug are reissued, albeit it is hoped to the patient who brought them
into hospital, after screening by a technician working within a set of
exclusion criteria designed to reduce to a minimum the likelihood that
the medicine is not of known quality.
Of course, it is true that “poor storage may have been such that
it [diamorphine] is no longer efficacious or stable”. It is equally
likely that storage has been perfectly adequate. Can one not inquire
into these matters?
Laws and codes of ethics can never cover every situation that may confront
a health professional, although they may well apply to the vast majority.
Surely the mark of a professional is the capacity to make individual
judgements when the extreme or unexpected arises, albeit in the expectation
that one had better have a well-reasoned basis for that judgement and
to be held accountable for it. Would patients in severe pain agree that
diamorphine should be withheld from them, even when we have no good reason
to believe that it has deteriorated?
In my view, for the Royal Pharmaceutical Society to say it cannot endorse
the supply of patient-returned medicines (what, never?) sells us short
and undermines our claims to professionalism.
Joy Wingfield
Professor of Pharmacy Law and Ethics
University of Nottingham
Common sense should prevail
From Mrs J. M. Maynard, MRPharmS
Further to the Royal Pharmaceutical Society’s refusal to endorse
the supply of patient-returned diamorphine, which is in short supply,
would Priya Sejpal (PJ, 22 January, p85) feel the same if she,
or a relative, needed diamorphine to cope with the severe pain of terminal
illness?
Has pharmacy completely forgotten patients and their needs? Common sense
should prevail.
Janet Maynard
Exmouth, Devon
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