US Pharm. 2014;39(5):1.

During their careers, most pharmacists have to deal with a number of state and federal regulatory issues. The laws that pharmacists must follow as a condition of maintaining their license to practice pharmacy in good standing are pretty clear and are enforced by such regulatory agencies as State Boards of Pharmacy, the Drug Enforcement Administration, and the FDA, to name a few. However, as is the case for most medical professionals, pharmacists follow other, more personal rules and regulations that are not always so well defined. These fall under the general heading of ethics, and the difficult decisions they engender have plagued many pharmacists in performing their daily professional duties.

As declared in the Oath of a Pharmacist of the American Association of Colleges of Pharmacy, pharmacists should hold themselves and their colleagues “to the highest principles of our profession’s moral, ethical and legal conduct.” As noble as the oath is, the nature of those principles is sometimes elusive and is generally left up to one’s personal interpretation. In reading a few of the other doctrines of the oath, the specifics of those principles may become somewhat more concrete. By taking the oath, pharmacists pledge to “consider the welfare of humanity and relief of suffering as their primary concerns” while embracing and advocating “changes that improve patient care.”

The latest challenge to pharmacists’ ethics is whether they should be involved in preparing medications that will be used to carry out the death penalty by lethal injection. While this issue could affect any practicing pharmacist, it is particularly troublesome for some compounding pharmacists who are being asked to participate in such preparation. Death by lethal injection is certainly not a new concept. As law scholar and pharmacist Jesse C. Vivian, RPh, JD, points out in an article published in U.S. Pharmacist, “Although the concept of lethal injection for the purpose of executing a prisoner was first introduced in 1888, it was not until 1982 that Texas became the first [state] to use it.” While the methodology for administering a lethal injection has varied over the years, most states today employ a three-drug cocktail consisting of a barbiturate, a paralytic, and a potassium chloride solution. Not surprisingly, it became common for prisons to stockpile these chemicals. The barbiturate generally used was sodium thiopental. Unfortunately, many stockpiles of that drug have been depleted, and currently no more of this chemical is being manufactured. The shortage has forced prison facilities to look elsewhere, and they have turned their attention to licensed compounding pharmacies.

As the humane treatment of prisoners who are put to death with this drug cocktail continues to be debated, so too do the ethical implications of its use for healthcare professionals asked to participate in the outcome. Should pharmacists be required to prepare the drug despite whatever moral or ethical objections they may have to capital punishment? Does refusing to participate in the preparation of these drugs violate portions of the Oath of a Pharmacist? Doesn’t a pharmacist have a professional obligation to fill any legal prescription, regardless of how it will be used? This is a complicated matter and one that is likely to be settled in a court of law. Until then, students should choose their career paths carefully before committing to a medical profession in which their moral and ethical beliefs could be seriously challenged. In the final analysis, as difficult as it may be, I believe that individuals who choose a medical profession must be dedicated to treating patients in a legal, professional, caring, and compassionate manner regardless of their personal beliefs.

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