Hospital Pharmacy
Case 2
Note - this case is based on the author's experiences in hospital pharmacy. The case has been slightly altered to prevent the identification of any persons involved.
You are the pharmacist covering the Medical Floor in an acute care community hospital. Patient JR on the Medical Floor has requested to speak to you regarding two newly-started medications. The medications are Zytiga (abiraterone), which is used in the treatment of prostate cancer, and prednisone, which is given as adjunctive therapy to Zytiga. After prescribing these medications for JR, the physician gave JR an extensive pamphlet outlining all the adverse effects and instructions for use.
Upon discussion with the patient, you realize that he is uncomfortable starting these two new medications. He is worried about all the adverse effects, and the stringent instructions for use which could reduce his quality of life. He seems upset about starting these medications, but states, "I know I need to do what I'm told."
Your task:
Tip: Consider using the Documentation Tool to help you navigate through the case
Note - this case is based on the author's experiences in hospital pharmacy. The case has been slightly altered to prevent the identification of any persons involved.
You are the pharmacist covering the Medical Floor in an acute care community hospital. Patient JR on the Medical Floor has requested to speak to you regarding two newly-started medications. The medications are Zytiga (abiraterone), which is used in the treatment of prostate cancer, and prednisone, which is given as adjunctive therapy to Zytiga. After prescribing these medications for JR, the physician gave JR an extensive pamphlet outlining all the adverse effects and instructions for use.
Upon discussion with the patient, you realize that he is uncomfortable starting these two new medications. He is worried about all the adverse effects, and the stringent instructions for use which could reduce his quality of life. He seems upset about starting these medications, but states, "I know I need to do what I'm told."
Your task:
- Consider if this is an ethical dilemma
- If this is an ethical dilemma, what are the key ethical principles involved?
Tip: Consider using the Documentation Tool to help you navigate through the case
Case Discussion
Here we have an ethical dilemma regarding patient consent and the right to refuse treatment (1). This is related to the ethical principles of autonomy and justice. Another ethical principle involved is that of beneficence.
Autonomy and justice:
In order for a patient to provide adequate consent to treatment, the patient must be informed (1). However, patients must not only be informed of the benefits and risks, but also the probabilities of these risks and benefits occurring as well as treatment alternatives available to them. Patients also have the right to ask questions about the inconvenience that treatment may cause to their everyday lives and the cost of treatment. These considerations were not made for patient JR in the case above. His individual wishes and values were not considered by the prescriber, nor was he made aware of the benefits and risks associated with therapy in a justified manner. Therefore his rights of autonomy and justice were breached upon.
Beneficence:
The ethical principle of beneficence is apparent in this case. Zytiga and prednisone are adequate therapeutic options for this patient, and were prescribed to benefit the patient. However, it may be considered paternalistic in this case to prescribe a medication for the patient without consulting him appropriately.
Additional questions to consider:
Here we have an ethical dilemma regarding patient consent and the right to refuse treatment (1). This is related to the ethical principles of autonomy and justice. Another ethical principle involved is that of beneficence.
Autonomy and justice:
In order for a patient to provide adequate consent to treatment, the patient must be informed (1). However, patients must not only be informed of the benefits and risks, but also the probabilities of these risks and benefits occurring as well as treatment alternatives available to them. Patients also have the right to ask questions about the inconvenience that treatment may cause to their everyday lives and the cost of treatment. These considerations were not made for patient JR in the case above. His individual wishes and values were not considered by the prescriber, nor was he made aware of the benefits and risks associated with therapy in a justified manner. Therefore his rights of autonomy and justice were breached upon.
Beneficence:
The ethical principle of beneficence is apparent in this case. Zytiga and prednisone are adequate therapeutic options for this patient, and were prescribed to benefit the patient. However, it may be considered paternalistic in this case to prescribe a medication for the patient without consulting him appropriately.
Additional questions to consider:
- Would you discuss this ethical dilemma with the prescriber?
- How would you describe the ethical dilemma to the patient? Would you make it clear that a fellow practitioner may be at fault?
References
1. Haddad A, Veath RM. Case Studies in Pharmacy Ethics. 2nd ed. New York: Oxford University Press; 2008.
1. Haddad A, Veath RM. Case Studies in Pharmacy Ethics. 2nd ed. New York: Oxford University Press; 2008.