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Ch 7. the health professional–patient relationship
- 1. Ch 7. The Health Professional–Patient Relationship Instructor’s Name: Berhanemeskel W/Gerima Email: aberhaneth@gmail.com Cell Phone: +251912024213 1 Introduction to Pharmacy Law & Ethics (Phar 4173)
- 2. 7. The Health Professional–Patient Relationship 7.1. Consumerism versus paternalism 7.2. Patients’ rights 7.3. Moral rights versus legal rights to health care 7.4. Legal Responsibility Versus Moral Obligation 7.5. Health care practitioners’ duty to their patients 7.6. Ethical Responsibility 2
- 3. 7.1. Consumerism Versus Paternalism In the Past • When patients were instructed by their health care professionals they did so without question. – physician or pharmacist to have an operation, go for a laboratory test, or take a medication • Medical paternalism: the belief that the health care professional knew best – Was accepted as standard practice by most health care professionals and their patients. • The medical rights of patients were not as widely recognized as other rights (such as suffrage or due process). 3
- 4. 7.1. Consumerism Versus Paternalism Nowadays • Patients have become true consumers of medical care. • Patients wish—and have a right—to be informed and to be asked for their consent. • To do otherwise would be – Patients both unprofessional and unethical – not to mention the potential legal ramifications. • expect a certain level of service, as with sellers of other goods and services • Health professionals who fail to meet the demands of health care consumers – may lose customers or – experience legal problems. 4
- 5. 7.2. Patients’ Rights • When patients seek the care of health care providers, – what rights do they have? – What can they reasonably expect from health care providers? • Patients can expect that clinicians will employ their knowledge and experience in caring for them. • As autonomous individuals, patients can expect that health care providers will respond to their wishes about their treatment. • At first glance, health care system seems fundamentally based upon ensuring the rights of patients. • Patients generally choose their own physician, pharmacy, and hospital. • Patients are allowed to choose from multiple options for treatment when they exist (such as surgery versus drug therapy). • Patients must give their approval, through the process of informed consent, prior to the initiation of care. 5
- 6. 7.2. Patients’ Rights • The United Nations (UN) Declaration of Human Rights – state “that all persons have a right to medical treatment” • A citizen cannot walk into a hospital, demand and receive treatment simply on the basis of the claim that the UN Declaration proclaims his or her right to such care. – For patients who are uninsured or lack the ability to pay, the right to choose the nature of their health care is meaningless. – treatment is available and that the patient has the economic wherewithal to pay for that treatment. • Patients also have a right to treatment that is both safe and effective within given parameters. • The fundamental question that must be posed prior to considering any medical or surgical treatment for a patient is, “Is the treatment safe and effective?” – Such a legal standard for drugs has been in effect since the early part of last century. – Not only must a drug be shown to be effective—that is, able to produce the effect for which it was administered—but it must do so with a certain degree of safety. 6
- 7. 7.3. Moral Rights Versus Legal Rights to Health Care Moral Rights • If accepted within a community, a justified claim that entitles us to demand that other persons act or desist from acting in certain ways. • Moral rights may be reinforced by laws, – but their basis lies not in the law, but in ethical principles. – Such rights might include • the right to live without fear of harm and • the right to food and adequate shelter. Legal Rights • A legal right is a right which is legally enforceable in a court of law. • Legal rights create legal obligations in another person or the State. • Some legal rights are also moral rights but not all moral rights are legal rights. 7
- 8. 7.3. Moral Rights Versus Legal Rights to Health Care • Moral rights may be reinforced by laws, – but their basis lies not in the law, but in ethical principles. – Such rights might include • the right to live without fear of harm and • the right to food and adequate shelter. • More recently, society have grappled with the question of health care as a moral right. – For example, Citizens with lowest economic status • As one might expect, moral rights and legal rights may be in conflict. – There is disagreement over whether issues like abortion involve moral rights or legal rights. • The question of the right to die has been played out in the media. – Dr. Jack Kevorkian and his so-called suicide machine have forced this society to deal with a moral question in legal terms. 8
- 9. 7.4. Legal Responsibility Versus Moral Obligation • Moral obligation of health care professionals to there patients referred from Hippocratic oath Medicine • Hippocratic oath states that – “medical professionals have an obligation to do whatever is necessary to relieve the pain and suffering of their patients”. • All pharmacists practice under the practical constraints of law that may limit their doing whatever is necessary. • Consequently, although they have a moral obligation to care for their patients, this obligation is constrained by law. • Thus, patient rights and practitioner responsibility may sometimes be in conflict, not on ethical grounds but on legal ones. • Directing a pharmacist to assume an individualistic approach and take an illegal, yet ethical, action for a patient despite legal consequences is asking the pharmacist to subjugate his or her own interests to that of the patient. 9
- 10. 7.4. Health care practitioners’ duty to their patients • What is the responsibility of medical practitioners? • Some might argue that health care providers have a Hippocratic responsibility to their patients, – and that this responsibility focuses solely on what is best for the patient, irrespective of the consequences to others. • This view is supported by the Code of Ethics of the Pharmaceutical Association, which states in part that “A pharmacist promotes the good of every patient in a caring, compassionate, and confidential manner” • The Code appears to suggest that – pharmacists have a moral obligation to do whatever they deem necessary in the interest of their patients. – But the Code goes on to state that "a pharmacist serves individual, community and societal needs.“ • Therefore, how far does a pharmacist’s or another health care professional’s duty to his or her patients go? • Is it the health care professional’s moral obligation to care for patients without exception? 10
- 11. 7.6. Ethical Responsibility • In traditional pharmacy practice, – both the legal and ethical obligations of pharmacists centered around • ensuring that the proper medication as ordered by the prescriber was delivered to the patient. – Physicians, not pharmacists, were the health care professionals who held ultimate responsibility • for monitoring the progress of a patient and ensuring that the desired outcome was achieved. • The concept of "pharmaceutical care," however, – directs that this responsibility is to be a shared obligation between the prescriber and the pharmacist. • The mission of pharmacy practice is to render pharmaceutical care. • Pharmaceutical care focuses – pharmacists' attitudes, behaviors, commitments, concerns, ethics, functions, knowledge, responsibilities, and skills on the provision of drug therapy with the goal of achieving definite outcomes toward the improvement of the quality of life of the patient. • Pharmaceutical care forces pharmacy practitioners to change their focus, broaden their professional responsibility. 11