By David Reissner
At times of emergency or disaster, ethical and legal issues are thrown into sharp relief in pharmacy as in many other areas. We are faced with issues that make us question what is the right thing to do.
There is often no single right or wrong answer to questions of ethics. The Royal Pharmaceutical Society has published Guidance on ethical, professional decision making in the Covid-19 Pandemic.
This advises:
“Pharmacists should work in accordance with the latest evidence, putting patient safety at the forefront of their decision making”.
The kind of issues that arise include:
- Whether to sell face masks, hydrochloroquine or ibuprofen
- How far to go in pricing scarce products
- Whether to cease services if the professional or staff do not feel safe.
The RPS guidance also says: “Pharmacists’ key priorities are to protect patients and to make optimal use of medicines,” adding that decisions should be:
- based on the best evidence available at the time and
- made in accordance with the latest government, NHS, regulatory and professional guidance.
The RPS guidance is an important reminder that decision-making should be the result of a reasoning process because pharmacy professionals are accountable for their decisions and that a record of decisions should be made to demonstrate the reasoning process.
There is recognition that the time for is making decisions may be reduced, and that records need not be as detailed as in normal times.
Public Health England’s current advice is that face masks should only be worn by people in clinical settings. This suggests they should not be sold to the public. If they are, pharmacy professionals should probably advise the purchaser that there is no evidence that they prevent the spread of Covid-19.
The RPS guidance tackles head on the supply on private prescriptions for chloroquine and hydrochloroquine.
It says:
“During this pandemic…unlicensed treatments may be requested by patients. …Pharmacists and pharmacy technicians should not supply or offer to supply chloroquine or hydrochloroquine without establishing it is sought for a treatment for which it is licensed, as it is not licensed for the treatment of Covid-19”.
The issue of ibuprofen highlights the importance of ensuring that decisions should take into account the latest guidance, because advice can change quickly in a crisis.
In the middle of March, Public Health England said that although there was “no strong evidence that ibuprofen can make coronavirus worse,” and advised against self-medicating with it.
At that point, pharmacy professionals should not have been selling ibuprofen to treat Covid-19 symptoms. By the middle of April, the official advice had changed and patients were told they could self-medicate with either ibuprofen or paracetamol to treat fever or headache.
There are other ethical issues. At what point do pharmacy owners decline to provide services if staff feel at risk.
The RPS guidance says: “The safety of the workforce is paramount. Without an effective healthcare workforce, there is no care.”
That is a green light to close if there is a well-founded fear that lack of PPE poses a risk.
Finally, there have been occasional reports of profiteering, for example with the price of paracetamol. This damages the reputation of the profession.
The RPS guidance says pharmacy professionals “should not supply or offer to supply any product at an inflated price that may be seen to be profiteering or taking advantage of the pandemic.”
In the past, successive governments may have been slow to realise that pharmacy professionals put the welfare of patients before their own personal interests.
Hopefully, the important contribution the profession has been seen to make during the Covid-19 crisis will result in community pharmacy being seen in a new light by the government and officials, especially those who hold the purse strings.
David Reissner is Chair at Pharmacy Law & Ethics Association (PLEA).
