US Pharm. 2008;33(5):2.

During my retail pharmacy career, nothing made my blood boil more than hearing a patient ask me, "How hard is it to fill a prescription? All you have to do is pour pills from one bottle to another." I must admit, I think pharmacy has come a long way since my early days "behind the counter," and there is a better understanding today as to what pharmacists really do. But there is still much about our profession that John Q. Public doesn't know. For example, at one time or another, every pharmacist is faced with tough decisions that involve professional ethics.

While all medical professionals are required to perform within the legal constraints of their practice, they often face difficult ethical questions that are not necessarily guided by the legal system. What makes ethical decisions complicated is that they are oftentimes controversial, frequently based on deep-rooted moral and religious convictions, and in most cases have no right or wrong answers.

I get a fair amount of books sent to me for review every year, the majority of which are of the reference variety that contain primarily clinical content. While I enjoy glancing through them, publishing a formal book review is usually not within U.S. Pharmacist's editorial scope. However, I recently received a book in the mail that immediately caught my attention. The title is Case Studies in Pharmacy Ethics (second edition), published by Oxford University Press ( Since I had never seen the first edition, I found this book very interesting and eye-opening, so I thought I would share it with you. In the interest of full disclosure, let me say up front that this book was sent to me unsolicited and I have no financial or other ties to its authors or publisher.

What is so compelling about this book is that it presents a plethora of ethical situations by relating pharmacists' real-life stories in the form of case studies. Coauthors Robert M. Veatch and Amy Haddad tackle some very difficult ethical issues. Just a sampling of the topics include assisted suicide, purchasing drugs from Canada, conscientious refusal to fill certain prescriptions, pain management, issues of confidentiality, and alternative and nontraditional therapies. I am sure you will find yourself immersed in at least one or more case studies with personal application to your practice. The authors bring their unique perspective to each case with their own commentary. While you may or may not agree with their analyses, the discussions are based on their research and experience in dealing with a variety of ethical issues.

The number of case studies in this 300-plus-page paperback are too numerous and varied to discuss in detail here, but there appears to be something for everyone. One of the topics that I remember having to face during my pharmacy practice days was how to deal honestly with patients. One section of the book questions readers as to whether or not there is ever a good time to lie to a patient. For example, suppose you knew the truth about a patient's condition but the physician has not yet disclosed the full diagnosis to the patient. One day the patient walks into your pharmacy and asks you point blank what the prescription is for. This has happened to me several times during my retail career. It is at that instant an ethical decision must be made. Do you lie in order to protect the patient from the emotional stress of the truth? This is but one very small example of the situations faced daily by the dozens of pharmacists who were interviewed for this book.

It's not easy for most pharmacists to make decisions that may cause an ethical dilemma. While this book may not offer you the answers you are looking for, after reading it, it will be comforting to know that you are not alone in making those tough decisions.

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