Book Review: Dennis M. Sullivan, Douglas C. Anderson, and Justin W. Cole, “Ethics in Pharmacy Practice: A Practical Guide”

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Ethics in Pharmacy Practice: A Practical Guide

Dennis M. Sullivan, Douglas C. Anderson, and Justin W. Cole, Springer, 2021.
ISBN 978-3-030-72168-8, 234 Pages, Hardcover, $109.99

Along with nurses and medical doctors, pharmacists have long been recognized, and honored, by the public as professionals exhibiting honesty and high ethical standards. Serving as the medication expert in the healthcare system, both other medical professionals and patients alike rely heavily on the pharmacist’s knowledge and skills related to an increasingly complex landscape of medications and the diseases (or situations) that such are intended to prevent or treat. And it is expected—assumed even—that the pharmacist will leverage such expertise in the best interest of the patient—as a fiduciary, if you will—exercising a competent, selfless, and wise approach to each patient’s care. Such is the reasonable expectation of all healthcare professionals. As a pharmacist of more than thirty-five years, and a several-years professor of professional ethics in pharmacy, I hold no less of an expectation of myself or anyone who is likewise licensed to practice in this noble profession.

To be sure, considering the rapidly increasing number and types of new medications released to the market each year, and the challenging ethical dilemmas that accompany the use of many of these medications, it is paramount that pharmacists are well-prepared (both pre-licensure and throughout their careers) to address these dilemmas. Yet, especially compared with the profession of medicine, pharmacy is a relatively young profession. Relatedly, the associated integration of significant scholarly and practical ethics-related instruction in pharmacy curricula is younger still, and this is further evidenced in part by the lack of published textbooks in pharmacy ethics. The most notable resources on this short list include a textbook by Veatch, Haddad, and Last, which, via analyses of case studies, attempts to aid the student-pharmacist in recognizing the existence of multiple ethical perspectives (and theories) that might influence an individual’s decision regarding a specific ethical dilemma.[1] Although the reader is exposed to a variety of ethical constructs, the text provides limited practical guidance for the decision-making process, leaving the notion of deciding rightly as an illusive outcome.

Another text, by Buerki and Vottero unwraps and expounds on the elements of the Code of Ethics of the American Pharmacists Association (a potentially useful pursuit) and outlines a step-wise process for ethics-related decision-making.[2] However, like the previous text, it only assists the reader in reaching “a” conclusion, not necessarily “the right” conclusion about specific ethical dilemmas. Enter the present work by Sullivan, Anderson, and Cole, a textbook that leans on the centuries-old Hippocratic tradition of medicine and recognizes that, indeed, ethical decision-making is a challenging endeavor, but posits that the outcomes of such endeavors need be neither vague nor purely theoretical. There are, in fact, decisions to complex ethical dilemmas that find their basis in the study and application of normative ethics, and such decisions, rightly deduced, by their nature are both practical and defensible and would be broadly affirmed by other professionals.

Within the pages of this welcome addition to the ethics-related resources for pharmacy practice the authors provide a clear and concise historical framework for medical, indeed healthcare, ethics based on the Hippocratic tradition and walk the reader through the maturation of this tradition into our present-day understanding of medical principlism. They spend an appropriate and necessary portion of the text describing how medical principlism fits into the schema of commonly referenced and employed ethical theories (especially in healthcare), yet stands alone in its ability to serve as the construct for practical decision-making in the course of daily pharmacy practice.

Subsequently, as a means of demonstrating the validity of their positions, the authors unpack some of the more challenging, medication-associated ethical dilemmas of our day (e.g., abortion, contraception, assisted suicide, palliative care) and help the reader apply (and appreciate the application of) the theory of medical principlism to decision-making within these highly charged topics. The authors use the concluding portion of the textbook to present a series of brief case studies of several ethical issues that pharmacists regularly face in the course of practice (e.g., dealing with difficult patients, forged prescriptions, medical marijuana, etc.) and guiding the reader via a series of thought-provoking questions through the process of identifying and managing the competing duties present in each scenario (i.e., making a decision by employing the theory of medical principlism).

In the end, and of great value to the profession of pharmacy (and, by extension, the healthcare team and the patients we serve), the authors stated goal, “to teach the reader how to think, based on ethical principles, not necessarily what to think” (p. 2) is appreciably realized. This textbook is not just guiding readers to reasonable (or normative) ethical decisions associated with the dilemmas of our day—indeed, such would greatly short-change the pharmacists of tomorrow. It is, instead, providing both a decision-making framework and an appropriate ethical foundation for approaching dilemmas of any age. The dilemmas of today could not have been fully imagined just a couple of decades ago, and I sense that the decisions facing pharmacists tomorrow will be no less unexpected, and almost certainly weightier, than we can presently imagine.

I would commend consideration of this textbook by all instructors of student-pharmacists as the foundational resource for preparing tomorrow’s professionals for the successful navigation of the ethical dilemmas that they will surely face. Additionally, this textbook has been written in such a manner that it would prove a valuable read and serve as a future reference for all practicing pharmacists, regardless of their tenure in the profession. As a means of personal professional development, this should make it to the top of the books-to-read stack of all my pharmacist-colleagues. Our patients and our communities will surely benefit from just such an investment of time and contemplation.

References

[1] Robert M. Veatch, Amy Haddad, and E. J. Last, Case Studies in Pharmacy Ethics, 3^rd ed. (New York: Oxford University Press, 2017).

[2] Robert A. Buerki and Louis D. Vottero, Pharmacy Ethics: A Foundation for Professional Practice (Washington, D.C.: American Pharmacists Association, 2013).

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