Pharmacist's Moral Dilemma in Japan ~What is pharmacist's asked education of ethics?~ Kazumi Kawamura *, Mikio Sakakibara, Hiroshi Okada, Keiji Arai (Sugi Medical Co.,LTD.Japan)
Introduction A pharmacist can't prescribe refill in Japan, and it isn't also admitted to do the medical practice like taking a blood sample. A doctor generally decides about medical practice. Before reporting the drug treatment which thinks pharmacists are most suitable from our special study-like angle in other words the pharmacy-like angle to a patient, co-medical pharmacist need doctor's understanding. Being different from doctor's preference in pharmacist's preference in that case and, we're opposed and often feel discord.
A pharmacist is the person in charge of medical and also is the person in charge of public health in our country. A pharmacist can find the individualismlike angle whether it's good for a patient individual how to do do and the global totalitarianism-like angle which considers the influence medicine exerts on the environment. It's necessary to keep conclusion with the validity such discord and worries a pharmacist or way of thinking multilaterally, derives a more probable conclusion and conquers those Dilemma.
Purpose Japanese pharmacists need systematic clinical education of ethics by the following reasons. 1Service business doesn't have much experience for a pharmacist. 2Medicine is a substance directly connected with the life. 3A pharmacist is the profession to which qualification could be given from a nation. 4A pharmacist is a medical specialist. 5A pharmacist is a supporter of public health. 6A hospital and a pharmacy were placed in "medical offer facilities".
Method It's effective in improvement of the sense of ethics to handle many cases in detail (Example: When you could press for dispensation of overlap prescription. When unused medicine was left by medical treatment at home. etc ) and pile up consideration. I introduce the Pharmacist s Moral Dilemma (case) which made the pharmacist serializing in "pharmacy" the subject up to now from January in 2008 this time. "Pharmacy" is a very popular magazine with the historical authority in Japan.
Taking refusal of medicine by patient's will I m the pharmacist working at an pharmacy (42 years old). About half year has passed since Mr. A (85 years old) delivered medicine to his home. Mr. A was reversed in the bathroom in his home last year, and was hospitalized because the femur was broken. A hospital as well as advanced age didn't put it lengthily, and I was hospitalized and almost all rehabilitation after leaving was performed, and it was.
It's in the bedridden state present. Just after the leaving, Mr. A I would like to die early" "Even if I live in such state, it's insignificant." "I'd like to free my wife from nursing.", "Didn't you give the medicine of which I can die right now to me?" was being complained repeatedly. An antibiotic started to have severe phlegm and be discharged from 2 weeks before, and was diagnosed as pneumonia, and was prescribed. But, these 2 weeks and the state which becomes good at all are not, and fever near 40 continues and is in the very dangerous state.
Anxiety of your wife who is 78 years old also seems to reach the limit, and a smiling face isn't seen any more after Mr. A contracts pneumonia. When visiting his home on some days, Paper bag of an antibiotic who should take medicine was found under his bed.
Pharmacist: I want talk about the antibiotic begun from 2 weeks before... Patient's wife: Yes. Pharmacist: Isn't your husband possibly drinking? Patient's wife: That's right. Pharmacist: Why is it? When not taking this pill, husband's pneumonia doesn't become good. Patient's wife: That's fine. Pharmacist: oh... I'm worried that they may concern the life of your husband by the this much high fever. I recommend to drink an antibiotic with doctor's directions. Patient's wife: My husband said that he didn't want to take medicine. I was saying that I'd like to be early easily repeatedly. I think I should grant the husband's last wish, too, so I don't want to do to make them drink by force. Pharmacist: What would a doctor say about this thing? Patient's wife: His doctor is unrelated. Because my husband wishes, this is fine. Pharmacist:...
If you're this pharmacist, how do you think? (1) It's impossible not to have been taking medicine as doctor's directions. I consult a family doctor, change it to an injection and have him throw an antibiotic directly. (2) I commission a doctor as well as my wife to cancel treatment. Because wife's expectation can also be understood and I think I myself should offer care along patient's request, too. (3) I didn't know. I think patient's selfish taking refusal is a problem, but because I'm calling at his home by chance, I understood and am irresponsible for me.
A case: When unused medicine was left by medical treatment at home.
Pharmacist's Moral Dilemma in Japan When dispensing error was found, Pharmacy, vol.59 No.1 2008 When a leaving saw the balance of a great deal of medicine, and was detected, vol.59 No.2 2008 When there was no prescribed medicine at a pharmacy, vol.59 No.3 2008 When a patient changes the internal use amount by own judgement, vol.59 No.7 2008 When I was commissioned to make academic meeting announcement material from a hospital commissioner of pharmaceutical affairs., vol.59 No.9 2008 When I encountered a medicine for a care giver, vol.59 No.12 2008 When a patient has decided interruption by pharmacist's dissemination of information, vol.60 No.2 2008
Result It's important to consider feeling and each values of oneself, the family and the person concerned as well as the viewpoint for the pharmacist who can't be service support. It's possible to be to consider an ethical problem with a possibility that one comes, analyze and pile up the experience in detail from which a conclusion is derived and improve judgement as a pharmacist. The training which considers cases with various medical experts makes its theory as a pharmacist one in which I hold a firm belief. When meeting miscellaneous problems in the clinical top, those will be one of problem-solving ability to which you lead and how do you handle and how to consider that.
Consideration Causing of the sense of ethics as the business worker is different from formation of general ideas on morals as man. The occupation isn't decided that it'll be the occupation from the time when everyone was born, and often decided postnatally. It's unreasonable to entrust professional ethics to personal ideas on morals. A consideration way using the case which includes Moral Dilemma when may which happen to itself is education of ethics along needs in a site at the viewpoint as the pharmacist. professional ethics personal ideas on morals
Conclusion Pharmacists are the business worker who can concern the people with the territory where "medicine" "health" "prevention" "hygiene" "the environment" "recuperation" is wide. When the people are sick when being healthy, a pharmacist is the only medical person who can access freely. We who could give state qualification as a pharmacist have to guarantee the quality beyond a constant level to the country. The quality of the pharmacist is guaranteed by knowledge, technology and the attitude+ professional ethics.