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LEARNING OBJECTIVES

  • Understand and appreciate the distinction between morality and ethics.

  • Understand and appreciate the distinctions between a moral dilemma and a conflict of commitment.

  • Explore health care providers' obligations to patients and the limits of those obligations when they conflict with providers' personal moral values.

  • Define the ethical principles of beneficence, nonmaleficence, respect for autonomy, and justice.

  • Apply an ethical decision-making model to complex clinical cases involving medications.

INTRODUCTION

This chapter introduces ethics in the context of women's health and pharmacotherapy. Common theories of medical ethics are discussed only briefly and only one of several types of case analysis is presented here. For those interested in a deeper engagement with ethical analysis, suggestions for further study are included at the conclusion of this chapter. Two cases will be used to apply ethics concepts to women's health care.

Patient Cases (Part 1) Patient Case 1—Patient Has No Money for Critical Medication

S.L. is a 24-year-old pregnant woman who presents to your corporate pharmacy on Saturday evening 5 minutes before the pharmacy closes.

Subjective Information

S.L. would like to pick up her buprenorphine that was called into the pharmacy from the inpatient addiction treatment program she was discharged from this morning. She tells you she is 28 weeks pregnant and is really excited because she has done well in rehabilitation and in learning coping skills. However, she claims that if she does not get this medicine, she will need to “go back out and use heroin.”

Patient Pharmacist Encounter

The pharmacist asks S.L. for her insurance. S.L. says she does not have any at this time because she was on a grant at the addiction treatment center. The pharmacist tells her it will be about 10 minutes to fill the prescription and determines the medication to be $40 for a 7-day supply. At the cash register, S.L. says there is no way she can pay that amount and she thought the grant would pay for it. She doesn't have a job (she has been in rehabilitation for over a month), has no family support, and does not want to go back to her dealer as he constantly hits her. The pharmacist offers her a couple days supply for whatever she can pay, but she starts crying and says she is headed to a halfway house and has no money at this time. Buprenorphine and methadone (which she will still not be able to afford) are the only options for medication assisted therapy for addiction in pregnancy. Buprenorphine is a controlled substance, so a pharmacist is not permitted to loan her any of the medication. The pharmacist also realizes if S.L. does not have this medication and relapses, it could cause her to go into withdrawal, which could harm both her and the fetus.

Patient Case 2—Patient with Intellectual Challenges Seeks Birth Control

P.R., a 23-year-old woman, comes into the pharmacy requesting a prescription for ...

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