Abstract
Patient-centered pharmacy practice involves increased pharmacist engagement in patient care. This increased involvement can sometimes require diverse decision-making when handling various situations, ranging from simple matters to major ethical dilemmas. There is literature about pharmacy ethics in developed Western countries. However, little is known about pharmacists’ practices in many developing countries. For example, there is a paucity of research conducted in the area of pharmacy ethics in Jordan. This study aimed to explore the manner in which ethical dilemmas were handled by Jordanian pharmacists, the resources used and their attitudes towards them. Semi-structured, face to face interviews were carried out with 30 Jordanian registered pharmacists. The transcribed interviews were thematically analysed for emerging themes. Four major themes were identified: legal practice; familiarity with the code of ethics; personal judgement, cultural and religious values; and Experience. Findings showed that ethical decision-making in pharmacy practice in Jordan was decisively influenced by pharmacists’ personal moral values, legal requirements and managed by exercising common sense and experience. This pointed to gaps in Jordanian pharmacists’ understanding and application of basic principles of pharmacy ethics and highlighted the need for professional ethics training, incorporating pharmacy ethics courses in pharmacy undergraduate curricula, as well as professional development courses. This study highlighted that paternalism, personal values and legal obligations were major drivers influencing decision-making processes of Jordanian pharmacists. Findings also highlighted an inclination towards lack of respect for patient autonomy. This illuminated the need for increasing pharmacists’ literacy in professional ethics.
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Acknowledgements
Our thanks and appreciation go to all participants who were kind enough to share their views and experiences with us.
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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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All authors contributed to the study conception and design. Material preparation were performed by A.Prof. BBC, Miss. LBF and Prof. IAB. Data collection was performed by LBF and data analysis were performed by BBC, LBF and IAB. The first draft of the manuscript was written by LBF and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Appendices
Validated by accredited translator (National Australian Association for Translation and Interpretation (NAATI) Accreditation Number: 23–93).
Appendix A: The Jordanian Code of Ethics -Translated from Arabic to English
Validated by accredited translator (National Australian Association for Translation and Interpretation (NAATI) Accreditation Number: 23–93).
Statement: Ethics in Pharmacy Profession
Appendix B
Interview protocol for Jordanian pharmacists
Demographics
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How many years have you been practicing pharmacy?
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What type of workplace are you working in? (type of pharmacy)
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What is your job position?
Scenarios
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1.
A patient has a prescription for an opioid analgesic, but the prescription is Incorrect/ missing an important requirement. You know the doctor who prescribed the medication, but you cannot contact him. (patient’s needs Vs. Legal requirements)
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2.
A woman asks you for an emergency contraception pill. However, you are very religious and do not approve. (Patient’s needs Vs. Conscientious objections).
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3.
A close family member of an adult patient asks for confidential information about the patient. (Patient’s right to privacy Vs. Human values including social norms).
A teenage self-conscious about her appearance has a prescription for an antipsychotic that could cause weight gain as a side effect. You believe that withholding the truth or deliberately misleading her would mean she would be compliant with the treatment you believe is very important to her. (Patients’ right for information Vs. Patient’s best interest).
Prompts and Discussion Aids
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Do you think that pharmacists are adequately trained through their studies and/ or professional training to deal with ethical dilemmas/ problems? Why? (Have you had training in professional ethics in pharmacy practice?)
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Are you familiar with the Jordanian professional code of ethics?
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Do you think The Code is appropriate for addressing the changes that pharmacy profession is facing today? Why?
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Are your moral principles and worldviews sometimes in conflict with professional ethics? Can you give an example?
Appendix C
Appendix D-Participant Information Statement
Exploring Ethical Pharmacy Practice in Jordan
Participant Information Statement
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What is this study about?
Pharmacy practice has evolved in the last decade shifting from the product-centered domain which has focused upon pharmacists’ role in dispensing medications to patients. Today pharmacy practice is more patient-centered which means a closer involvement with the patient’s needs and wellbeing. Consequently, pharmacists’ responsibilities have increased significantly, as patient counseling about medication use, adverse effects and safety have become the pharmacist’s main role, ultimately aiming to achieve enhancement of patient quality of life. Consequently, ethical dilemmas concerning the pharmacist-patient relationship, and other professional relationships may arise in the practice of pharmacy.
There have been a number of international studies that have explored ethical dilemmas in daily practice and pharmacists’ perspectives. However, very few or no research has been conducted in the area of pharmacy ethics in Jordan.
The aim of this study is therefore to explore the experiences of ethical dilemmas in pharmacy practice in Jordan, and perspectives of Jordanian pharmacists in relation to management of these dilemmas.
You are invited to participate in this study because you are a practicing pharmacist registered for practice in Jordan.
This Participant Information Statement tells you about the research study. Knowing what is involved will help you decide if you want to take part in the research. Please read this sheet carefully and ask questions about anything that you do not understand or want to know more about.
Participation in this research study is voluntary. So it’s up to you whether you wish to take part or not. By giving your consent to take part in this study you are telling us that you:
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✓
Understand what you have read
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✓
Agree to take part in the research study as outlined below
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✓
Agree to the use of your personal information as described.
You will be given a copy of this Participant Information Statement to keep.
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✓
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Who is running the study?
The study is being conducted by the following researchers:
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What will the study involve for me?
You will be asked to participate in an interview at a location of convenience for you. If you are in a remote area, the interview may be undertaken over the phone with your consent. We ask that you sign a Consent form and send back to us in the stamped self-addressed envelope provided, before participating in a telephone interview.
We are seeking your perspective and experience about the ethical dilemmas associated with pharmacy practice in Jordan.
The interview will be tape recorded, but only with your permission. This is to enable us to transcribe accurately later. We will send you the transcript for confirming its accuracy and any emendations you wish to make, if you so wish. The transcript will then be de-identified and stored in a secure file.
Your privacy will be protected at all times, as required by the relevant Privacy legislation, particularly in regards to telephone recordings.
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How much of my time will the study take?
We anticipate the interview to take no longer than half an hour.
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Who can take part in the study?
Practicing pharmacists in Jordan.
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Do I have to be in the study? Can I withdraw from the study once I've started?
Being in this study is completely voluntary and you do not have to take part. Your decision whether to participate will not affect your current or future relationship with the researchers or anyone else at the University of Sydney.
If you decide to take part in the study and then change your mind later, you are free to withdraw at any time. You can do this by notifying us at any time, with no consequence whatsoever.
You are free to stop the interview at any time. Unless you say that you want us to keep them, any recordings will be erased and the information you have provided will not be included in the study results. You may also refuse to answer any questions that you do not wish to answer during the interview.
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Are there any risks or costs associated with being in the study?
We believe there are no risks or costs, other than your valuable time and effort, associated with taking part in this study.
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Are there any benefits associated with being in the study?
There will be no direct benefits to you but we hope that your contribution will help improve pharmacy practice in Jordan.
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What will happen to information about me that is collected during the study?
By providing your consent, you are agreeing to us collecting only a minimal amount of personal information about you for the purposes of this research study; specifically your name and address of the pharmacy you work in. Your information will only be used for the purposes outlined in this Participant Information Statement.
All data collected from the recordings of interviews will be de-identified – allocating only a number to the interview to allow us to analyse the data. No one other than the researchers will have access to the data.
Your information will be stored securely in the supervising researcher’s office and your identity/information will only be disclosed with your permission, except as required by law. Transcripts and recordings will be destroyed completely after 5 years. Study findings may be published, but you will not be identified in these publications.
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Can I tell other people about the study?
Yes, you are welcome to tell other people about the study.
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What if I would like further information about the study?
When you have read this information, Ms Leen Fino will be available to discuss it with you further and answer any questions you may have. If you would like to know more at any stage during the study, please feel free to contact …… Senior Lecturer in Pharmacy Practice.
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Will I be told the results of the study?
You have a right to receive feedback about the overall results of this study. You can tell us that you wish to receive feedback by ticking the relevant box on the consent form. This feedback will be in the form of a one page lay summary. You will receive this feedback after the study is finished.
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What if I have a complaint or any concerns about the study?
Research involving humans in Australia is reviewed by an independent group of people called a Human Research Ethics Committee (HREC). The ethical aspects of this study have been approved by the HREC of the University of Sydney (Project No: 2018/709) and by the HREC of Applied Science University (PH-3–2020). As part of this process, we have agreed to carry out the study according to the National Statement on Ethical Conduct in Human Research. This statement has been developed to protect people who agree to take part in research studies.
If you are concerned about the way this study is being conducted or you wish to make a complaint to someone independent from the study, please contact the university using the details outlined below. Please quote the study title and protocol number.
THIS INFORMATION STATEMENT IS FOR YOU TO KEEP
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Fino, L.B., Basheti, I.A. & Chaar, B.B. Exploring Ethical Pharmacy Practice in Jordan. Sci Eng Ethics 26, 2809–2834 (2020). https://doi.org/10.1007/s11948-020-00231-3
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DOI: https://doi.org/10.1007/s11948-020-00231-3