Click on each ethical dilemma below

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• Ethical dilemma 1

  One of your patients being treated for a bipolar disorder has told you that she wants to discontinue mirtazapine. She has explicitly asked you not to notify her psychiatrist. You have explained to her that you can’t provide a full clinical assessment or advice because you don’t have all the relevant background information. Although you want to respect her autonomy, you also feel the psychiatrist should be involved in this decision. You are also concerned as you are aware she is the single mother of two young children, one of whom is still an infant.

  What do you do?

• Ethical dilemma 2

  A well-known elderly patient has recently been discharged from the hospital after a serious illness. A “Do Not Resuscitate” order has been signed by her daughter Claire, who has been caring for her since her condition began to deteriorate. The hospital consultant has begun a palliative care regime under which you regularly dispense methadone for Claire to collect on her mother’s behalf. The methadone is supplied weekly on a Thursday. One Tuesday, Mrs Dawson’s other daughter, Pauline arrives to the pharmacy. Pauline explains that Claire had an important meeting and that she is here in her place to collect her mother’s prescription. She maintains that the prescription had ran out early this week and she didn’t get time to see the GP to furnish a new one. You remember a note left in Pauline’s PMR from 3 years prior where she attempted to forge a prescription for benzodiazepines. You phone Claire and confirm that her mother has run out of medicine due to a spill. You have tried to contact the GP and they are not available.

  
  

  What do you do?

• Ethical dilemma 3

  A patient visited the pharmacy with a prescription for a medicine covered on the Hardship scheme. The medicine is very expensive, costing approximately 1000/month. You know if you order the medicine you will have to pay the wholesaler before the payment will come through from the HSE. You are a small pharmacy and this may cause considerable financial strain. You could refer the patient to another larger pharmacy in the next town, who will provide the medicine but this will cause considerable hassle for the patient who is already very unwell.

  What do you do?

• Ethical dilemma 4

  One of your regular customers is very concerned that his wife is addicted to co-codamol and implores you to stop selling it to her.

  
  

  What do you do?

• Ethical dilemma 5

  
  

  The pharmacy you are working in hasn’t turned a profit in 3 months and there is fear that it may have to close. This has caused the owner to resort to installing a “miracle cure” section in the pharmacy selling supplements with little proof of efficacy. Each member of staff is given a target of selling 5 of these items per week. A patient whom you have built a rapport with over the last few months comes in and tries to buy a very expensive “miracle cure” that a friend told him would help him give up smoking. The owner is in the dispensary and sends you to the counter to make the sale. Before buying it, he asks you if it really will cure his smoking addiction.

  
  

  How will you respond?

• Ethical dilemma 6

  
  

  You run a very successful community pharmacy. One day you receive a phone call from a prospective new patient asking for a medication that is used in HRT. The patient wanted to ring you in advance to tell you they are gender transitioning. You are very supportive and ask them to come in and have a chat in the consultation room. They come in and you have an extensive chat with them about their medications, what pronoun they would prefer etc. and assure the patient they are in a safe space. Over the course of the patient’s transition, the patient’s appearance begins to change. A pharmacy technician working with you becomes aware that the patient is transitioning and she expresses concern and tells you that the person must be “mentally unwell” and “needs to seek professional help”. The technician tells you that they do not want to serve the patient in question.

  
  

  How do you respond?

• Ethical dilemma 7

  
  

  A patient comes into your pharmacy just before closing on a Saturday evening, and requests for their prescription for temazepam to be filled. He has a flight tomorrow morning which is essential for work. He informs you that his doctor sent it in via email. You check Healthmail, but the patient’s prescription is not there. It was sent to a different pharmacy. That pharmacy will not open until Monday morning. You know that for a prescription to be valid, it must come from the prescriber.

  
  

  What do you do?

• Ethical dilemma 8

  
  

  You’re a locum pharmacist in a community pharmacy. A 40-year-old woman with diabetes (who states that she’s a regular customer in this pharmacy) comes in and requests an emergency supply of her insulin.

  
  

  She has enough at the minute but says that she’s going “away for a few days” and doesn’t have time to go to the GP.

  
  

  When you check the patient’s PMR, you notice that she’s been dispensed insulin without producing a prescription for the previous nine months.

  
  

  When you question her on this, she replies, ‘sure what's the point. It never changes anyway!’ She also asks for throat lozenges as she's been feeling thirsty the last couple of weeks.

  
  

  What do you do?

• Ethical dilemma 9

  
  

  While working in your community pharmacy, a well-known patient comes in with a new High-Tech prescription for Degarelix injection to treat his prostate cancer.

  
  

  His doctor has described all of the adverse effects of Degarelix and explained how it is used, as well as providing him with a leaflet containing all of this information

  
  

  As you counsel the patient, you see that he is unhappy with starting this treatment. He is uncomfortable with the potential side effects and the complicated instructions for use. Although he appears upset, he tells you “that he doesn’t want to cause any hassle” and that he should “just do what I’m told”.

  
  

  What do you do?