When I was at university studying pharmacy, my education was very traditional. The course consisted of pharmaceutical chemistry, pharmacology, pharmaceutical technology and pharmacognosy. What therapeutics and clinical pharmacy there were were buried in the pharmacology course. Although I subsequently undertook a postgraduate degree in clinical pharmacy, it has never ceased to amaze me how the expertise and knowledge one requires to do one’s job continually expands. I am not just talking about keeping up to date with the plethora of new drugs and treatments or the ever-increasing evidence being produced by clinical trials and meta-analysis.
I am thinking about how I have had to get to grips with subjects that initially do not seem to be related to hospital pharmacy. Over the years I have had to develop expertise in economics, both specific pharmacoeconomics and health economics generally, systems analysis, information technology, automated systems and ethics. When working as a research pharmacist I had to learn and utilise sociological skills, particularly when developing questionnaires and other survey tools.
Recently I have developed a particular interest in ethics, mainly because of my work on our research ethics committee, but also in a broader sense. As pharmacists we do not have to grapple with some of the more difficult issues that our medical colleagues have to, such as decisions to switch off ventilators or choosing which patient should get a transplant organ. However, there are times when we do have to make ethical decisions.
A professor in ethics who is also a pharmacist writes one of our articles in this issue. Her article makes for both interesting reading and food for thought (see pages 45–47).
One of the features of ethics is that there are no right or wrong answers. Making decisions has to be done on the basis of weighing up the issues, usually respect for autonomy, beneficence, non-maleficence and justice of all parties. This is where the problem lies – benefit for one party may mean harm for another. Take the example of where a pharmacist is asked to supply a potassium chloride injection to be injected into the amniotic fluid of a pregnant women who is having a late termination. Should the pharmacist supply? On a simplistic basis this is a balance between benefit for the woman against irreversible harm to the fetus, but it is actually much more complex. Read Professor Wingfield’s article, and after weighing up all the issues decide whether you would supply.
Chris Cairns, Consultant Editor