Ethical Behavior when

Communicating with
Patients
COMMUNICATION SKILLS IN PHARMACY PRACTICE
Ethical Principles
Ethical Rules
 Veracity – truth telling, informed consent, respect for autonomy.

 Privacy – a persons right to remain private, to not disclose

information.

 Confidentiality – only sharing private information on a ‘need to

know basis’.

 Fidelity – loyalty, maintaining the duty to care for all no matter

who they are or what they may have done.
Code of Ethics for Pharmacists
The eight principles described in the APhA Code of Ethics for Pharmacists
are as follows:

 Principle I: A pharmacist respects the covenantal relationship between the patient and pharmacist.

 Principle II: A pharmacist promotes the good of every patient in a caring, compassionate, and confidential
manner.

 Principle III: A pharmacist respects the autonomy and dignity of each patient.

 Principle IV: A pharmacist acts with honesty and integrity in professional

 relationships.

 Principle V: A pharmacist maintains professional competence.

 Principle VI: A pharmacist respects the values and abilities of colleagues and other health professionals.

 Principle VII: A pharmacist serves individual community and societal needs.

 Principle VIII: A pharmacist seeks justice in the distribution of health

resources.
Underlying Ethical Principles
 Non maleficence
 Beneficence
 Autonomy versus paternalism
 Honesty and truth telling
 Informed consent
 Confidentiality
 Fidelity
1. Autonomy
 Freedom to influence course of life/treatment
 Requires the person to be competent in decision making
capacity
 The right to participate in and decide on a course of action
without undue influence. To act independently.
 Healthcare providers need to respect patient’s rights to
make choices about healthcare, even if the healthcare
providers do not agree with the patient’s decision.
 Ex: informed consent, treatment planning, etc.
Autonomy Cont’d

 Concerned with individuality and a person's unique wishes and

values.
– Respecting a person's right to be involved in their own health
care is embedded in the principle of autonomy.

 Includes:
– Respect a person’s right to make their own decisions
– Teach people to be able to make their own choices
– Support people in their individual choices
– Do not force or coerce people to do things
– ‘Informed Consent’ is an important outcome of this principle
2. Informed Consent

 Patient is presented all alternatives so they can make a

decision.
 Requirements
o Decision making capacity - patient must be competent
o Voluntary

 Respect refusal
 Requires honesty and autonomy to exist
 Patients have the right to full information of all relevant facts
and must give explicit consent before treatment
Informed Consent (cont.)

Informed consent exists when:

 All relevant information has been provided
 The patient understands the information
 Consent is freely given and there is no
coercion
 The patient is capable of understanding the
information.
3. Beneficence

 Obligation to preserve life, restore health, relieve suffering

and maintain function
 Non-abandonment – obligation to provide ongoing care
 Requires the health professional to go beyond doing no harm
 Actively contributing to the health and well being of the
patients served. = To do “good”
 Ex. In an emergency, when a patient is incapacitated, the
health care worker assumes the person would want to be
treated. This is also implied consent.
4. Non maleficence

 “Do no harm” – Hippocratic oath

 Requires the health practitioner to first do no harm and to
actively prevent harm when possible.
 To protect individuals who are unable to protect themselves
 This principle is nearly impossible to achieve in any given
form of medical therapy,
– since all therapeutic and pharmacological options are
associated with side effects.
– There are risks associated with almost every form of therapy
5. Fidelity
 The right of patients to have practitioners provide services
that are in the patients best interest

 Infidelity from an Rx could be:

o Recommending vitamins patients don’t need

o Failing to confront a doctor with an inappropriate
prescription out of fear that the doctor will direct his/her
patients elsewhere
6. Veracity/Honesty
 Veracity is an important component of building trusting
relationships.
 The patient has the right to the truth
 Medical condition, course of the disease
 Treatments
 Code of ethics states:
A pharmacist: “has the duty to tell the truth and to act with
conviction of conscience”
 Rapport is built on trust, which is based on honesty
7. Confidentiality

 From the patients perspective this is “self-disclosure” and they

should be the ones making this decision.
 Patients are expected to divulge information to practitioners, the
only choice is which one
 Trust in confidentiality becomes very important
 Rule of confidentiality, like informed consent, is an application of
the principle of patient autonomy.
 When pharmacists keep information private from others, unless
the patient gives permission to release it, they respect the
autonomous decision of the individual.
 Medical confidentiality need not be requested explicitly by
patients; all medical information, by nature, is generally considered
to be confidential.
Case 1
 Ms. Edwards is starting on a new medication for
schizophrenia. The drug has a number of side effects, some
of which are serious. She asks you several questions about
the purpose of the medication and possible side effects.
When you ask her what the physician told her about the
medication, she reports that he said “I’ve got a lot of patients
on this medication and they are doing fine.” It is obvious to
you that she is unclear about the purpose of this drug or any
possible problems. Your concern is that Ms. Edwards may be
noncompliant if told about possible side effects. What will you
do?
Points for Case1
 Edwards does not understand the purpose / side effects.
 No informed consent can exist under these circumstances.
 If she knew, she might not take the medication. (beneficence)
 May see it as the doctors duty to inform her about the disease
and treatment
 Fear about doctor getting mad at you if you tell the patient
things s/he didn’t.
 Autonomy would require you to tell her because she has a
right to choose what happens to her body.
 May need to call doctor to discuss – how to approach this –
assertiveness?