ROUGHLY five minutes after qualifying as a pharmacist, I learned that breaking the law is not difficult at all. Pharmacy practice is by definition a rules-based game. Knowing where the boundaries are is, of course, critical to patient safety. It’s also important for pharmacists if they don’t want to get struck off. This is where ethics meets the law.
It may surprise a lay person or indeed an inexperienced pharmacist to know that there are a host of imaginative ways that the law can be broken whilst working as a pharmacist. This leads me on to a topic that is very close to my heart: professional judgement.
Can you justify an action in the course of your day-to-day practice even if this action results in you, the pharmacist, breaking the law?
An example I recently saw discussed online was whether or not to emergency supply MST 10mg tablets to a palliative care patient. For those reading this that are not pharmacists, the legal background to MST 10mg tablets is that it is a schedule 2 controlled drug. There are 5 schedules of controlled drugs. Schedule 1 drugs have the strictest controls and schedule 5 drugs have less stringent requirements. In the case of MST 10mg tablets, they must be kept under lock and key, are subject to a running balance being kept and must only be supplied if the pharmacist is in possession of a valid, correctly written prescription. Importantly, for this example, it is illegal for the pharmacist to make an emergency supply of any schedule 2 drug.
Ethical dilemma
As with many ethical situations in professional practice, or in life to be honest, there is no easy answer. Sometimes all we can do is pick away at the structure of the problem and make a decision that, crucially, for pharmacists is best for the patient.
The patient above is palliative. This means that it is expected that they will die in the very near future and they are being managed accordingly. I believe strongly that there is such a thing as a good death and that the healthcare team has a role to make the patient comfortable if at all possible. So, often the supply of a medicine is critical to achieving this ‘good death’.
With this in mind, the consequences of not supplying are possibly that the patient will begin to feel pain. It is horrible to think of our actions as pharmacists could actually cause pain, but of course, this is exactly what may happen.
Decision
I am not going to say how I would deal with this situation. That is for the individual pharmacist to assess on the day. I would say that it is important to follow the following advice;
- Take your time.
- Seek advice.
- Explore all the obvious options first.
- Remember your company procedures.
- Understand where each possible decision puts you in a legal sense.
There will most likely come a day when a patient will need you to break the law to help them. If and when that day comes I hope you have the courage to make a good decision at that moment.
As mentioned above pharmacy practice is a rules-based game. That is until we add the patient to the equation. How you act in these situations, for the good of the patient, is one of the purest tests of professionalism.