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Challenges for healthcare ethics in social pharmacy. Dr David Badcott Centre for Applied Ethics Cardiff University UK Email: badcottd@cf.ac.uk. Challenges for healthcare ethics in social pharmacy. Sociology is broadly concerned with the scientific study of human relationships.
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Challenges for healthcare ethics in socialpharmacy Dr David Badcott Centre for Applied Ethics Cardiff University UK Email: badcottd@cf.ac.uk.
Challenges for healthcare ethics in socialpharmacy Sociology is broadly concerned with the scientific study of human relationships. It seeks an understanding of the roles we both perform and occupy in our lives (members of a collective group belonging in a defined capacity), the practices we undertake (units of reciprocal behaviour informed by mutual recognition of shared intentions and beliefs), and processes of change. [W. G. Runciman, The Social Animal (1998)],
Challenges for healthcare ethics in socialpharmacy • In this paper I will concentrate briefly on 2 main • aspects of ethics and social pharmacy: • Changes in direction for pharmacy practice: should we anticipate a power struggle? • The challenge of successfully accommodating multicultural healthcare.
Challenges for healthcare ethics in socialpharmacy • Past changes in pharmacy practice include: • Compounding of medicines in the pharmacy has been replaced by dispensing of industrially manufactured proprietaries. • Dispensing is now mostly in standard patient pre-packs. • Computer-printed labels have replaced hand-written labels. • Automatic database checks on dosage and therapeutic incompatibilities are routine. • Prescriptions are written in English language rather than medical Latin and patient labels include the product name.
Challenges for healthcare ethics in social pharmacy • New and transforming role for pharmacy that • takes account of: • Time “freed up” by changes in pharmacy practice. • Greater focus on patient care. • Opportunities through understanding the implications of the patient sick role and the biopsychosocial model.
Challenges for healthcare ethics in socialpharmacy • Traditionally, the practice of medicine and the provision • of pharmaceutical medicine has been characterised by • two components: • Biomedical model of disease - mechanistic in nature in which diseases have identifiable causal mechanisms resulting in malfunction, and are susceptible, at least in principle to corresponding treatments. • Sickness as a social role (Talcott Parsons, The Social • System, 1951)
Challenges for healthcare ethics in social pharmacy Biomedical model of disease Considered to be overly simplistic. Doesn't take account of the overall context in which the patient suffers or experiences an illness. More holistic approach: “biopsychosocial model” (George Engel, 1977)
Challenges for healthcare ethics in socialpharmacy Medical dominance (paternalistic system – supported by law) Patient assumes the “sick role” (form of deviant behaviour) Doctor gatekeeper for the “sick role”. Validates access to medication, social entitlement and absence from work.
Challenges for healthcare ethics in socialpharmacy “…there is a sense that sickness is something we do rather than something we simply have. Being sick involves interpretation, choice and action. Being sick has, for human beings as social actors, a meaning. …To regard illness as a text open to a variety of perspectives is a radical approach to sickness, because it points to some of the problems in the medical model which underlies the basis of institutionalized, scientific, technologically directed medicine.” Turner (1987, Medical Power and Social Knowledge, p.213)
Challenges for healthcare ethics in socialpharmacy “A medicine dispensed or purchased represents a `trophy` that confirms sickness. The medicine is expected to cure or alleviate symptoms and if it achieves this aim it reinforces the patient’s trust. If the medicine does not work, or it causes side effects, then this trust may be damaged and blame attached”. (Bates, Pharm J, 2002, 269:246)
Challenges for healthcare ethics in socialpharmacy • Differential Power relationships/hierarchy • Medical doctor: dominant, provides diagnosis, clinical care and oversight, and has overall responsibility for the patient • Pharmacist and other HCPs: subordinate, clinical service role • Patient: passive, acquiescent, dependent deferential and reliant
Challenges for healthcare ethics in socialpharmacy • Increasing patient power? • “Active citizenship” • “Expert patient”: • Patient`s often tacit knowledge of their illness. • Opportunity to encourage patient to take greater responsibility for treatment and decision-making.
Pharmacy ethics and prescriptionmedicines Trust Vulnerability Obligation Context of ethical relationships Principled patient autonomy
Challenges for healthcare ethics in socialpharmacy Many traditional professional duties have been superseded allowing pharmacists to devote much more time to adopting an active patient-centred role. New role largely reflects government policy. The UK Department of Health document Choosing health through pharmacy (April 2005) envisages pharmacy as an untapped resource with a significant potential role in health promotion which could include provision of advice or signposting services on smoking reduction, heart disease, strokes and cancer, under-18 conception, obesity in children, long term conditions, substance misuse, and immunisation services and other matters of public health.
Challenges for healthcare ethics in social pharmacy Pharmacist independent prescribers and supplementary prescribers intended to improve patient access to medicines. This could be a win-win or “nonzero sum” situation, and that would be good news for the patients and the NHS. Potential erosion of the monopolistic situation of medical profession. Medical profession`s attitude is crucial.
Challenges for healthcare ethics in socialpharmacy • Potential difficulties in dealing with patients where there is substantial ethnic and cultural diversity: • Language • Religious beliefs • Socio-cultural background • Age of patient (dignity?)
Challenges for healthcare ethics in socialpharmacy • Two types of potential problem: • Problems in communicating safety and dosage information. • Problems of an ethical nature.
Challenges for healthcare ethics in socialpharmacy RPSGB code of ethics: “Recognise diversity and respect the cultural differences, values and beliefs of others.” IPF Statement on professional standards/codes of ethics (September 2004) “recognise and respect the cultural differences, beliefs and values of patients, particularly as they may affect a patient’s attitude to treatment.”
Challenges for healthcare ethics in socialpharmacy Cultural Competence: “Ability of individuals and systems to respond respectfully and effectively to people of all cultures, classes, races, ethnic backgrounds, and religions in a manner that recognizes, affirms and values the cultural differences and similarities and the worth of individuals, families, and communities and protects and preserves the dignity of each” (quoted in American College of Clinical Pharmacy White Paper: “Cultural Competence in Health Care and Its Implications for Pharmacy”. Pharmacotherapy 2007; 27(7): 1062-1079)
