Exploring influences on pharmacists’ and students’ ethical reasoning in a changing practice landscape in Australia
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Background Practising pharmacists continuously develop their ethical reasoning skills, which evolve with practice experience and exposure to challenging scenarios. Considering the recent expansion of the roles of pharmacists and the paradigm shift in pharmacy practice, it is timely to explore community pharmacists’ attitudes regarding the importance of ethics and their ethical reasoning. Objective To explore underlying factors influencing community pharmacists’ and pharmacy students’ ethical reasoning and attitudes towards pharmacy ethics, ethical reasoning processes and perceived current dilemmas. Setting Practising registered community pharmacists, pharmacists with provisional registration (interns) and final year pharmacy students in Australia. Method Two focus group discussions and two interviews were conducted with 16 Western Australian community pharmacists, interns and students. Participants were purposively selected for gender, background, practice setting, and practice experience. Main outcome measure Emerging themes embracing important influences on community pharmacists’, interns’ and students’ ethical reasoning and perceived current ethical dilemmas and challenges. Results Two major themes embraced participants’ ethical reasoning processes and conduct: (1) fundamental underpinning, from personal values and practice exposure, and (2) paradigm influenced, such as the changing healthcare landscape, expansion of roles, management of dilemmas, and competence. Increased frequency and complexity of ethical dilemmas related to role expansion. Rural pharmacists experienced unique ethical dilemmas in relation to practice isolation, privacy and confidentiality. Conclusion Changes in the community pharmacy practice environment has increasingly exposed pharmacists to more complex ethical dilemmas. Pharmacists practising in rural communities experience unique challenges. Structured and sound ethical reasoning skills are essential as pharmacists are faced with contemporary challenges.
KeywordsAustralia Ethical dilemma Ethical reasoning Ethics Pharmacist Pharmacy practice
The authors would like to acknowledge and thank all the participants for taking the time to participate in this study and Mrs Pascale Ng for facilitating the focus groups.
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflicts of interest
The authors declare that they have no conflict of interest.
- 1.Rapport F, Doel MA, Hutchings HA, Jerzembek GS, John DN, Wainwright P, et al. Through the looking glass: public and professional perspectives on patient-centred professionalism in modern-day community pharmacy. Forum Qual Soc Res. 2010;11(1):1–24.Google Scholar
- 2.International Pharmaceutical Federation. Statement of professional standards—code of ethics for pharmacists: FIP. 2014. Available from: https://www.fip.org/statements. Accessed 10 Feb 2018.
- 3.Pharmaceutical Society of Australia. Code of ethics for pharmacists. 2017. Available from: http://www.psa.org.au/practice-support-and-tools/psa-information-framework#pba-code-of-conduct-and-psa-code-of-ethics. Accessed 10 Apr 2018.
- 4.King MA, Hattingh HL. Integrating ethics into pharmacy practice. In: 17th Annual AAPAE conference—ethics in the professional life: past, present and future; The University of Sydney 2010.Google Scholar
- 5.Moullin JC, Sabater-Hernández D, Fernandez-Llimos F, Benrimoj SI. Defining professional pharmacy services in community pharmacy. Res Soc Adm Pharm. 2013;9(6):989–95.Google Scholar
- 6.Toklu HZ, Hussain A. The changing face of pharmacy practice and the need for a new model of pharmacy education. J Young Pharma. 2013;5(2):38–40.Google Scholar
- 7.Luetsch K. Attitudes and attributes of pharmacists in relation to practice change—a scoping review and discussion. Res Soc Adm Pharm. 2017;13(3):440–455.e11.Google Scholar
- 8.Roberts AS, Benrimoj SI, Chen TF, Williams KA, Aslani P. Practice change in community pharmacy: quantification of facilitators. Ann Pharmacother. 2008;42(6):861–8.Google Scholar
- 9.Sim TF, Hattingh HL, Sherriff J, Tee LBG. Towards the implementation of breastfeeding-related health services in community pharmacies: pharmacists’ perspectives. Res Soci Adm Pharm. 2017;13(5):980–8.Google Scholar
- 10.Pharmaceutical Society of Australia. National competency standards framework for pharmacists in Australia. 2016. Available from: http://www.psa.org.au/wp-content/uploads/National-Competency-Standards-Framework-for-Pharmacists-in-Australia-2016-PDF-2mb.pdf. Accessed 10 Apr 2018.
- 11.Pharmaceutical Society of Australia. Professional practice standards version 5. 2017. Available from: http://www.psa.org.au/wp-content/uploads/Professional-Practice-Standards-V5-PDF-5.5mb.pdf. Accessed 10 Apr 2018.
- 12.Sharif PS, Javadi M, Asghari F. Pharmacy ethics: evaluation pharmacists’ ethical attitude. J Med Ethics Hist Med. 2011;4:5.Google Scholar
- 13.Cooper RJ, Bissell P, Wingfield J. Ethical decision-making, passivity and pharmacy. J Med Ethics. 2008;34(6):441–5.Google Scholar
- 14.Wilson S, Tordoff A, Beckett G. Pharmacy professionalism: a systematic analysis of contemporary literature (1998–2009). Pharm Educ. 2010;10(1):27–31.Google Scholar
- 15.Roth MT, Zlatic TD. Development of student professionalism. Pharmacother. 2009;29(6):749–56.Google Scholar
- 16.Henning MA, Malpas P, Ram S, Rajput V, Krstić V, Boyd M, et al. Students’ responses to scenarios depicting ethical dilemmas: a study of pharmacy and medical students in New Zealand. J Med Ethics. 2016;42(7):466–73.Google Scholar
- 17.Hope DL, King MA, Hattingh HL. Responses of pharmacy students to hypothetical refusal of emergency hormonal contraception. Int J Pharm Pract. 2014;22(2):155–8.Google Scholar
- 18.Schlesselman LS. A cross-sectional study of applied bioethical reasoning in pharmacy students and preceptors. Pharm Pract. 2014;12(2):401.Google Scholar
- 19.Chaar BB. Professional ethics in pharmacy practice: developing a psychometric measure of moral reasoning. Pharm World Sci. 2009;31(4):439–49.Google Scholar
- 20.Eukel H, Frenzel J, Skoy E, Faure M. Longitudinal evaluation of student professionalism throughout the professional didactic curriculum of a pharmacy program. Curr Pharm Teach Learn. 2018;10(3):325–32.Google Scholar
- 21.Hammer D. Improving student professionalism during experiential learning. Am J Pharm Educ. 2006;70(3):59.Google Scholar
- 22.Mylrea MF, Gupta TS, Glass BD. Professionalization in pharmacy education as a matter of identity. Am J Pharm Educ. 2015;79(9):142.Google Scholar
- 23.Gettig JP, Noronha S, Graneto J, Obucina L, Christensen KJ, Fjortoft NF. Examining health care students’ attitudes toward e-professionalism. Am J Pharm Educ. 2016;80(10):169.Google Scholar
- 24.Chisholm-Burns MA, Spivey CA, Jaeger MC, Williams J, George C. Development of an instrument to measure pharmacy student attitudes toward social media professionalism. Am J Pharm Educ. 2017;81(4):65.Google Scholar
- 25.Noble C, O’Brien M, Coombes I, Shaw PN, Nissen L, Clavarino A. Becoming a pharmacist: students’ perceptions of their curricular experience and professional identity formation. Curr Pharm Teach Learn. 2014;6(3):327–39.Google Scholar
- 26.Hattingh L, Forrester K, Smith N, Searle J. Pharmacy practice developments: the potential impact on pharmacists’ legal liability. J Law Med. 2007;14:397–402.Google Scholar
- 27.Pharmacy Registration Board of Western Australia. Premises Register. 2016. Available from: https://www.pharmacyboardwa.com.au/index.php?page=premises_register. Accessed 20 June 2016.
- 28.Nyumba TO, Wilson K, Derrick CJ, Mukherjee N. The use of focus group discussion methodology: insights from two decades of application in conservation. Methods Ecol Evol. 2018;9(1):20–32.Google Scholar
- 29.Guest G, Namey E, McKenna K. How many focus groups are enough? Building an evidence base for nonprobability sample sizes. Field Methods. 2017;29(1):3–22.Google Scholar
- 30.Parker M, Luke H, Zhang J, Wilkinson D, Peterson R, Ozolins I. The, “pyramid of professionalism”: seven years of experience with an integrated program of teaching, developing, and assessing professionalism among medical students. Acad Med. 2008;83(8):733–41.Google Scholar
- 31.Cooper RJ, Bissell P, Wingfield J. `Islands’ and `doctor’s tool’: the ethical significance of isolation and subordination in UK community pharmacy. Health. 2009;13(3):297–316.Google Scholar
- 32.Saw PS, Chuah LH, Lee SWH. A practical approach toward teaching ethics to community pharmacists. Int J Clin Pharm. 2018;40(5):1131–6.Google Scholar
- 33.Resnik DB, Ranelli PL, Resnik SP. The conflict between ethics and business in community pharmacy: what about patient counseling? J Bus Ethics. 2000;28(2):179–86.Google Scholar
- 34.Bush J, Langley CA, Wilson KA. The corporatization of community pharmacy: implications for service provision, the public health function, and pharmacy’s claims to professional status in the United Kingdom. Res Soc Adm Pharm. 2009;5(4):305–18.Google Scholar
- 35.Kruijtbosch M, Göttgens-Jansen W, Floor-Schreudering A, van Leeuwen E, Bouvy ML. Moral dilemmas of community pharmacists: a narrative study. Int J Clin Pharm. 2018;40(1):74–83.Google Scholar
- 36.Chaar B, Brien J-a, Krass I. Professional ethics in pharmacy: the Australian experience. Int J Pharm Pract. 2005;13(3):195–204.Google Scholar
- 37.Nordin N, Ahmad H, Mohamed A, Sarriff A. A global picture of extended pharmacy services, perceptions and barriers toward its performance: a systematic review. Asian J Pharm Clin Res. 2017;10:417–27.Google Scholar
- 38.Sim TF, Hattingh HL, Sherriff J, Tee LBG. The use of non-prescription medicines during lactation: a qualitative study of community pharmacists’ attitudes and perspectives. Res Soc Adm Pharm. 2018;14(5):464–70.Google Scholar
- 39.Salman Popattia A, Winch S, La Caze A. Ethical responsibilities of pharmacists when selling complementary medicines: a systematic review. Int J Pharm Pract. 2018;26(2):93–103.Google Scholar
- 40.Benson A, Cribb A, Barber N. Understanding pharmacists’ values: a qualitative study of ideals and dilemmas in UK pharmacy practice. Soc Sci Med. 2009;68(12):2223–30.Google Scholar
- 41.Hattingh HL, Emmerton L, Ng Cheong Tin P, Green C. Utilization of community pharmacy space to enhance privacy: a qualitative study. Health Expect. 2016;19(5):1098–110.Google Scholar
- 42.Hattingh HL, Knox K, Fejzic J, McConnell D, Fowler JL, Mey A, et al. Privacy and confidentiality: perspectives of mental health consumers and carers in pharmacy settings. Int J Pharm Pract. 2015;23(1):52–60.Google Scholar