Exploring pharmacy ethics in developing countries: a scoping review
Authors : Leen B. Fino, Iman A. Basheti, Bandana Saini, Rebekah Moles & Betty B. Chaar
Abstract : Background Healthcare ethics have been profoundly influenced by principles of bioethics that emerged post-World War II in the Declaration of Geneva 1948. ‘Beneficence’ (to do good), ‘Non-Maleficence’ (to do no harm), ‘Justice’ (fairness and justice in access) and ‘Respect for Autonomy’ (respect for patient individuality, including decision making, privacy, and right to refuse), have become foundational principles of contemporary medical codes of ethics. These principles are well reflected in most professional pharmacy code of ethics globally. This domain remains relatively unexplored in most developing countries and the majority of what has been published in this area relates to western cultures. There have been no attempts to pool findings from a similar scope of research emanating in developing countries. Aim of the review This study aims to explore the scope of pharmacy ethics in the literature pertaining to developing countries. Methods An extensive search of three relevant (Scopus, CINAHL, IPA) databases was conducted from Jan 2000 to Feb 2020, in order to identify relevant studies conducted in or focussed on ethics in pharmacy in developing countries. A separate Google Scholar search was carried out in an effort to locate supplementary articles, hand-searched articles were also included to achieve an exhaustive investigation of all current relevant studies. Results The full text of 20 relevant articles that met inclusion criteria were critically analysed and qualitatively categorised into three emerging themes; Ethical challenges in pharmacy practice, Approaches used in teaching pharmacy ethics, and Code of ethics analysis and implementation. Conclusions: Findings of this literature review illuminated a gap in pharmacy ethics literacy in developing countries and variances in pharmacists’ ethical attitudes in handling ethical dilemmas, as well as a lack of familiarity with ethical principles and codes of ethics. Pharmacists’ lack of respect for patients’ autonomy and pharmacists being prone to financial pressure were found to have a significant impact on pharmacy practice in most of developing countries. However, attempts are being made to rectify this gap by efforts to incorporate ethical and professional education in undergraduate curricula, and by studies in which new codes of ethics are being implemented.
Keywords : Developing countries, Literature review, Pharmacy ethics Pharmacy ethics teaching
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Exploring Ethical Pharmacy Practice in Jordan
Authors : Leen B. Fino, Iman A. Basheti & Betty B. Chaar
Abstract : Patient-centered pharmacy practice involves increased pharmacist engagement inpatient care. This increased involvement can sometimes require diverse decision-making when handling various situations, ranging from simple matters to major ethical dilemmas. There is literature about pharmacy ethics in developed Western countries. However, little is known about pharmacists’ practices in many developing countries. For example, there is a paucity of research conducted in the area of pharmacy ethics in Jordan. This study aimed to explore the manner in which ethical dilemmas were handled by Jordanian pharmacists, the resources used and their attitudes towards them. Semi-structured, face to face interviews were carried out with30 Jordanian registered pharmacists. The transcribed interviews were thematically analyzed for emerging themes. Four major themes were identified: legal practice; familiarity with the code of ethics; personal judgement, cultural and religious values; and Experience. Findings showed that ethical decision-making in pharmacy practice in Jordan was decisively influenced by pharmacists’ personal moral values, legal requirements and managed by exercising common sense and experience. This pointed to gaps in Jordanian pharmacists’ understanding and application of basic principles of pharmacy ethics and highlighted the need for professional ethics training, incorporating pharmacy ethics courses in pharmacy undergraduate curricula, as well as professional development courses. This study highlighted that paternal-ism, personal values and legal obligations were major drivers influencing decision-making processes of Jordanian pharmacists. Findings also highlighted an inclination towards lack of respect for patient autonomy. This illuminated the need for increasing pharmacists’ literacy in professional ethics.
Keywords : Ethical dilemmas · Pharmacy practice · Pharmacy ethics · Jordan
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Exploring and evaluating Vertically Integrated Teaching in Ethical Decision-Making (VIT-EDM) in pharmacy
Authors : Leen Fino, Iman A. Basheti, Bandana Saini, Rebekah Moles, Betty B. Chaar
Abstract : Background: With increased patient-centred care, pharmacists are often faced with ethical dilemmas and expected to provide solutions for practice dilemmas, relying on ethical judgment, principles of professional ethics, standards of practice, and moral reasoning capabilities. Pharmacists need to be competent in ethical decision-making which will enable them to act in a morally preferable and justifiable manner with patients. Literature has shown that moral reasoning skills are teachable and measurable competencies in healthcare. Objective: To evaluate the impact of implementing a vertically integrated teaching approach in ethical decision-making (VIT-EDM), on moral reasoning capabilities of pharmacy students as they progressed from year-one (pre-exposure to teaching intervention) to final year (post-intervention) of pharmacy studies, using the Professional Ethics in Pharmacy test (PEP) as a surrogate measure of moral reasoning capabilities. Methods: Cross-sectional, parallel cohort, comparison study, using PEP. A de-identified electronic survey link was emailed to enrolled students in each targeted cohort. Descriptive and inferential statistics were conducted using SPSS. Results: Fourth-year students’ confidence measures were significantly higher in decision-making. Furthermore, students’ decision-making and moral reasoning measures were higher in fourth-year students. They generally demonstrated moral reasoning capabilities belonging to stage four of moral reasoning levels, which is related to benefitting patients while respecting authorities and legal requirements. However, the difference in the P-scores (fourth-year and first-year) was not found statistically significant. Conclusion: Findings of this study underlined the positive impact of the (VIT-EDM) approach, a relatively novel mixed-method pedagogy in teaching pharmacy ethics. It highlighted the enhanced confidence of students in ethical decision-making when facing an ethical dilemma.
Keywords : Education. Ethical dilemma. Ethics Moral-reasoning. PEP. Pharmacy Ethics Teaching
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Implementing and evaluating a course in professional ethics for an undergraduate pharmacy curriculum: A feasibility study
Authors : Leen B. Fino, Ahmad R. Alsayed, Iman A. Basheti, Bandana Saini, Rebekah Moles, Betty B. Chaar
Abstract : Background Pharmacy practice today mandates “patient-centred care”, thereby assigning higher levels of professional responsibility for pharmacists leading to ethical challenges. These challenges often involve ethical principles, institutional, personal, or other constraints that can pull practitioners in incompatible opposite directions, creating “ethical dilemmas” in many circumstances. Pharmacists are expected to handle challenges competently and in the best interest of patients. Literature underlines the positive impact of educational interventions focusing on ethical awareness and competence, and that “gaps” existed in pharmacy training/curricula for Jordanian pharmacists. The objective of this study was to develop, implement, and evaluate the utility of a tailored ethics education component in the pharmacy curriculum for students enrolled at a well-ranked Jordanian university. Educational activity and setting Fifth-year pharmacy students attending summer school at a university in Jordan from July to September 2020 were invited to participate in an educational intervention (suite of didactic online lectures and skills-based workshops). This study was delivered in four parts, with a pre-test administered immediately before and a post-test survey immediately after the educational intervention, the educational intervention (three phases), and focus-group discussions to elicit students' feedback. Findings: Findings indicated enhanced levels of confidence in students' decision-making. The development of students' moral reasoning and decision-making skills were also observed to be improved. Summary This study highlighted the importance of the implementation of an ethics course in pharmacy undergraduate curricula. It emphasized the positive impact this course made on the students' learning experiences and provided a strong environment for discussion and group learning.
Keywords : Ethics Ethical decision-making Moral dilemmas Online Teaching Pharmacy ethics
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