Ethical dilemmas

Last updated: Sunday, September 25, 2022

Pharmacists are the commonest source of clinical advice about medicines in hospitals. But this advisory role can lead to ethical dilemmas if there is a conflict between giving information and a duty to someone else. They are situations that can make you feel uncertain or uncomfortable.

Ethical dilemmas are a grey area between requests that you would normally answer (e.g. ‘What is the dose of this drug?’) and questions that you would definitely not answer (e.g. ‘What dose of this drug can I use to kill someone?’).

Junior staff need to be able to recognise ethical dilemmas, but should always refer them to a more experienced pharmacist.

In practice, many ethical dilemmas involve questions from patients or members of the public. Remember that what may be an ethical dilemma from your point of view, is often simply a request for help or information from someone else's perspective so be helpful, polite, and sensitive. However, there are some recurring scenarios:

1. Third party enquiries. 

These are enquiries from a member of the public about someone else. Examples could include:

  • I'd like you to identify these tablets I found in my 18-year-old son’s jacket.
  • My neighbour is taking tamoxifen. What’s that for?

You must never breach patient confidentiality, but you also have a duty to protect the patient's privacy (even if the information is in the public domain). So generally, the rule should be not to answer an enquiry about a third party. However, there may be exceptions where you feel it is vital that the enquirer is given the information. An example would be where a mother asks you to identify tablets found in her six-year-old daughter’s room. Here the duty of the parent to safeguard the wellbeing of her child (a minor) is a very important consideration. If the daughter were 26 it might be inappropriate to answer.

Think about whether it is fair that the enquirer should know the information. Do not be afraid to refuse to answer if the question if you think the enquirer does not have a legitimate need to know. 

2. Patient pursuing a complaint. 

If a patient contacts you and makes it clear that they are pursuing a complaint against your employer, or may do so in the future, you should check your Trust’s complaints policy. You may have a dedicated team that will manage patient concerns and complaints.

3. Enquiries involving illicit drugs.

It is desirable to answer enquiries about street drugs if the enquirer is clearly seeking help to avoid self-harm (e.g. interactions between street drugs and medication). But you should not answer enquiries which might help clients extend their range of abuse behaviour or assist them to break the law or deceive a healthcare professional. Pharmacists should know how to refer to local and national substance misuse services when appropriate.

4. Criticism of other healthcare professionals. 

You should protect a patient’s relationship with other healthcare professionals. However, the duty of honesty is more important. You should never assist anyone to deceive or lie to a patient – do not assist in ‘covering up’ a medication error for example. A patient may ask you to check on information provided by another professional which you know to be incorrect. You should answer this sensitively but truthfully.

Apart from enquiries from the public, other ethical dilemmas can involve enquiries from the police. Here you should only supply information that it is legitimate for the police to ask for in the course of solving a crime and it is reasonable to ask for this to be confirmed in writing. Enquiries from legal representatives or the media can also sometimes be problematic: follow your employer’s policy in dealing with these.