Pharmacists' Autonomy in Decision Making

The global healthcare presentations highlighted the varying roles of pharmacists across the world. After hearing about their roles, it was apparent that the United States provides us with greater opportunity to practice and apply the knowledge and skills we are fortunate to gain from our education. We also have greater opportunity to decide which field of pharmacy we choose to practice in and I personally have a greater appreciation for my education because of the resources I am provided. With that being said, I also believe that we, as pharmacists, must remain the accessible healthcare professionals we have been regarded as by our patients. As one of the most trusted professions, our patients turn to us for their healthcare needs and questions and therefore rely on our expertise and overall clinical judgment that guides the care we provide. I firmly believe that we are obligated to provide care to our patients without infringing on their rights to this care. This brings me to our last couple class discussions about ethics and moral beliefs and their association with our roles as pharmacists.

As a pharmacist, I will willingly take on the responsibility of upholding the health of my patients. I believe this includes providing care that is based on evidence based medicine and clinical judgment. According to the American Pharmacists Association, pharmacists must “apply their knowledge, experience, and skills to the best of their ability to assure optimal outcomes for their patients”. APhA also possesses a refusal clause that seems contradictory to this statement. If a pharmacist’s moral or ethical belief supersedes their discretion in providing care, they are not assuring “optimal outcomes for their patients”. Yes, they may be able to refer them somewhere that provides the care they are refusing, however this creates a barrier that ultimately results in delayed care to patients. Class discussion brought up some excellent examples about circumstances that could prove problematic if a pharmacist utilizes their moral/religious beliefs to guide the care they provide such as contraceptive and emergency contraceptive dispensing and substance abuse maintenance therapy.

One additional example I wanted to bring up centers on the autonomous role that pharmacists possess. I believe that pharmacists should not exercise their religious/moral beliefs within their scope of practice and their clinical judgment should guide the care they provide. I do however believe clinical judgment needs to be addressed as well. As a pharmacy technician a few years ago, I encountered a pharmacist who chose to withhold dispensing medication to a patient. The medications this patient requested were for a controlled pain reliever and an antibiotic, however when the patient came to pick them up, he decided he only wanted the controlled substance. The rationale for this pharmacist’s refusal to dispense both medications was based on the fact that he believed the patient should get the antibiotic, not just the pain reliever, and therefore refused to dispense the pain reliever if the patient did not want the antibiotic. This instance made the patient extremely frustrated and he was ultimately forced to go to another pharmacy. I am torn about my feelings about this encounter because although the pharmacist did not use his religious belief to guide his decision, he used his clinical judgment that eventually resulted in the patient not getting any medication. I believe we can only do so much as pharmacists to ensure patients take their medications appropriately and that the patient also has a responsibility to safeguard their health. Looking back, I feel it was the pharmacist’s obligation to have counseled the patient about the importance of taking the prescribed antibiotic along with the pain medication. He did not provide this service and just refused both medications if the patient was unwilling to purchase the antibiotic. The pharmacist created a barrier for this patient even though I do feel he thought it was in the patient’s best interest. Ultimately, I do see both sides of this situation. I feel like pharmacists should be able to make this decision based on the clinical judgment they have acquired in their years of education. The topic of autonomy is a convoluted one that is situation dependent and I believe pharmacists should practice with a patient-centered focus.

Thanks to class discussion, I have a strong sense of purpose. I am proud of the profession I am entering which allows me to exercise my clinical judgment so I can ensure I am providing the best care I can to my patients. I do believe that those who feel their moral or ethical views may interfere with the care they provide should explore other professional options. They are obligated to provide care that safeguards their patients, however their scope of practice should also be based on clinical judgment with a patient-centered focus. Pharmacist autonomy is not a black and white subject so I believe that pharmacists need to be aware of this when they enter the work force.