Submission to the National Association of Pharmacy Regulatory
Authorities (NAPRA) (Canada)
Re: A Model Code of Ethics for Canadian Pharmacists
September, 2000
Full Text
PREAMBLE
[Draft model code]
Laws and ethics of health care overlap
considerably, since both share the concern that
the conduct of health care professionals should
reflect respect for the well being, dignity and
self-determination of the public. . .
Proposals
[Change]
...since both share the concern that the conduct of
health care professionals should reflect respect for
the well-being, dignity and self-determination of all people...
[Add]
A legitimate ethical goal is the maximum
accommodation of differing conscientious beliefs of
citizens in all walks of life. Nothing in this Code
shall be construed in a manner inconsistent with
this goal.
Reasons
Re: Change
Respect for the well being, dignity and
self-determination is due to all people, including
members of the profession.
"The public" is an abstraction; pharmacists care
for individual people. More important, the concepts
of well-being, dignity and self-determination are
primarily applicable to individuals, not to "the
public". It is desirable to avoid language that
could cause unintended dichotomies, such as
"well-being of the public" vs. "well-being of the
individual".
Re: Addition
It is important to ensure that a Code of Ethics does
not become an instrument for the suppression of
freedom of conscience within the profession.
STATEMENT II:
Guidelines for Interpretation
[Draft model code]
2. Pharmacists determine the patient's needs,
values and desired outcomes.
Proposals
[Change]
2. Pharmacists acquaint themselves with the
patient=s needs, values and desired outcomes.
Reasons
Re: Change
The change is recommended to avoid any conflict with
the notion of self-determination. The present text
can be misinterpreted to mean that the pharmacist
decides what the patient needs.
STATEMENT III
[Draft model code]
Pharmacists honour the
autonomy, values and dignity of each patient.
Proposals
[Add]
Guideline for Interpretation
This statement shall not be construed in a manner
that places the autonomy, values and dignity of the
patient in opposition to the autonomy, values and
dignity of the pharmacist.
Reasons
Re: Addition
In any professional relationship, all parties in the
relationship have legitimate spheres of personal
and/or professional autonomy, and are entitled to
respect for their values and dignity. In its
current, unqualified form, the text tends to invite
conflict rather than accommodation when
disagreements arise. The amendment seeks to avoid
such confrontation.
STATEMENT V
Guidelines for Interpretation
[Draft model code]
1. Pharmacists who object,
as a matter of conscience, to providing a
particular pharmacy product or service must be
prepared to explain the basis of their
objections to pharmacy management, not the
patient.
2. Pharmacist who object, as a matter of
conscience, to providing a particular pharmacy
product or service have a responsibility to
participate in a system designed to respect a
patient's right to receive pharmacy products and
services. The system must be pre-arranged to
enable the patient to obtain the product or
service in a timely and convenient manner,
minimizing suffering to the patient.
Proposals
[Change]
1. Pharmacists who object, as a matter of
conscience, to providing a particular pharmacy
product or service
a) should not be compelled to participate in
the provision of the product or service;
b) must give reasonable notice of their
objection to pharmacy management so that
arrangements can be made to accommodate them while
providing for the needs of the patient;
c ) should inform the patient of their
objection so that the patient may consult another
pharmacist;
d) must not prevent the provision of pharmacy
products and services by other pharmacists.
Reasons
Re: Change
Proposed changes (a) and (c) exactly parallel the
policy of the Canadian Medical Association with
respect to the rights and obligations of physicians
in the case of abortion.
Proposed change (b) is consistent with the law on
accommodation and with the objectives of the present
text (Guideline 2).
Proposed change (d) is consistent with the
objectives of the present text (Guideline 2), while
avoiding the likelihood that >participation= will be
interpreted in a manner prejudicial to freedom of
conscience.
STATEMENT VI
Guidelines for Interpretation
[Draft model code]
3. Pharmacists accept the ethical principles of
the profession.
Proposals
[Change]
3. Pharmacists abide by the Codes of Ethics in
force in their jurisdiction.
[Add]
7. No discrimination should be directed against
pharmacists who manifest conscientious convictions
by declining to provide pharmacy services or
products. Respect for decision in this area must be
stressed, particularly for pharmacy students and new
practitioners.
Reasons
Re: Change
Guideline 3 in its present form is unacceptably
vague, especially since it is contemplated that a
pharmacist could be disciplined for a breach of the
code. "Ethical principles of the profession" fails
to express precisely what those principles are, how
they are determined or changed, and by whom.
It is sufficient that pharmacists agree to abide
by codes of ethics or conduct, which are,
presumably, formulated with ethical principles in
mind.
Re: Addition
The additional guideline exactly parallels the
policy of the Canadian Medical Association with
respect to protection of physicians who have
conscientious objections to abortion. (Ref:CMA
Statement on Induced abortion, Approved by the
CMA Board of Directors, December 15, 1988)