The Pharmaceutical Journal
Vol 280 No 7487 p122
2 February 2008

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More law and ethics learning needed

Being a professional has, perhaps, never been so complicated or so risky, so it is imperative that pharmacy professionals are alert to both the ethics and the law surrounding their professional practice, Sheila McLean and Ken McPhail say

The recent review of the Code of Ethics for Pharmacists and Pharmacy Technicians, combined with legislative reform, like the 2006 Health Act, have resulted in yet further professionalisation of the practice of pharmacy.

Although greater recognition of the vital role played by pharmacists and technicians in the effective delivery of healthcare is to be welcomed, with this increased recognition come additional ethical and legal responsibilities. All professions are coming under increased pressure to adhere to stringent ethical standards and are increasingly subject to new legislative requirements.

Professional ethics, while of great importance, are just one aspect of the wider concept of ethics, and law is much more than mere statutes. Each will affect the way in which professionals behave if they are to safeguard themselves and their patients and contribute towards society more generally.

The new code of ethics is based on principles. In practice, pharmacists are expected to apply these principles when determining how they should act, as opposed to simply following a set of rules. This kind of approach to professional codes is appropriate for two reasons.

First, many of the ethical dilemmas that professionals face tend not to lend themselves to the simple application of a rule and, secondly, we would normally assume that the ability to apply one’s professional judgement, even to the extent of knowing when a principle should not apply, is part of what it means to be a professional.

However, although it may be relatively easy to agree on a list of general principles, implementing them in everyday practice is a different matter.

Applying principles to complex professional dilemmas requires the development of a set of ethical competencies. It cannot be assumed that once the principles have been established all pharmacy professionals will intuitively know why they are important or how to translate them into action. Although the scope and nature of these competencies is a matter for considerable debate, a principle-based code would normally require at least the following to help it function:

• A well-developed sense of when ethical dilemmas arise in the first instance (often, professional practice becomes so taken for granted that it is not easy to recognise when conflicts arise)

• An understanding of the reasons that make the principles worth pursuing (eg, why should pharmacists encourage patients to participate in decisions about their health?)

• An understanding of the different ways in which it might be possible to translate a principle into an action (eg, when exercising professional judgement, how does a pharmacy professional determine what the interests of the public are in contrast to the interests of patients?)

• The ability to resolve a situation where principles are in conflict (the breadth and complexity of the organisational structures within which pharmacists work, for example, as employees of a large multinational organisation or as part of a team of healthcare professionals, would suggest that conflicts between principles will routinely arise)

A principle-based approach to professional ethics, therefore, requires the development of an associated set of ethical skills and competences and requires a supporting framework of ongoing education to help it function. Superimposed on these ethical complexities are the requirements of the law.

Law and ethics go hand in hand

As professions develop ever more sophisticated codes of ethics, it might be supposed that the question of their legal liability will become less important. In other words, if best practice standards emerge from the experience of professions in the shape of ethical codes and accompanying standards and guidelines, this will, presumably, mean that adherence to these guidelines will always (or most often) ensure that practice has been legally as well as ethically and professionally sound.

However, this may not be the case for two main reasons. First, the law imposes additional responsibilities, which are difficult to encapsulate in a code of ethics. The statutes governing sale of goods and liability for defective products, for example, are unlikely candidates for inclusion in an ethics code. Nonetheless, they play a role in holding pharmacy professionals to account for their behaviour.

Lessons may be learnt from the code of ethics, but awareness of the additional legal requirements of professional practice is essential.

Secondly, like it or not, the law affecting pharmacy also needs to rest on and accommodate wider areas of social concern, such as the need to provide redress for certain outcomes and to acknowledge the intricacies of the laws of negligence and contract.

Although attention to the code of ethics, therefore, may be prima facie evidence of good professional behaviour it need not be definitive of the question of legal liability. Ethics and law, therefore, perform complementary but different roles in the lives of all professionals.

The expanding responsibilities of pharmacy professionals are welcomed but bring with them additional potential sources of liability. Recognition of this possibility is apparent in the updating of the code of ethics and the professional standards and guidelines that accompany it.

Equally, however, these additional responsibilities bring with them the need to ensure that pharmacy professionals are aware both of the role of ethics and of the role of the law in their practice. This brings with it the need for appropriate education.

The Royal Pharmaceutical Society’s practice framework is an acknowledgement of the profession’s need to provide a coherent framework across policies relating to education and practice. The framework not only describes what a “day one pharmacist” should be able to do but also stresses the importance of continuing professional development, which includes acquiring and developing a high level of ethical literacy.

The ultimate aspiration is that pharmacy practitioners, with the assistance of CPD programmes, will become critically reflective practitioners. Mere knowledge of a code of is not sufficient; putting that code into practice, and appreciating the subtleties of ethics is critical. Equally, mere knowledge of legal rules, without understanding the purposes they serve and the rationale for their existence, is not enough.

New e-learning programme

In recognition of the need for targeted and appropriate education for pharmacy professionals, the Centre for Applied Ethics and Legal Philosophy at Glasgow University has been working closely with a number of professional bodies to develop a new e-learning CPD programme. The programme will be available from March 2008 and aims to equip pharmacy and other professionals for the new legal and ethical environment facing them.

It currently consists of six modules covering various aspects of professional ethics, business ethics, negligence and liability for failures in drug therapy. It represents the outcome of a collaboration between leading academic experts in these fields, an international e-learning company and major professional institutions, including the Society.

This is probably one of the first collaborations of its type and has resulted in a relevant but challenging applied programme that employs some of the most leading edge thinking on e-learning.

Readers can visit www.gla.ac.uk to find out more and to register interest.