Case Study on "Pharmacist.In This Case, "
Case Study 5 pages (1583 words) Sources: 1+
[EXCERPT] . . . .
pharmacist."In this case, the pharmacist is faced with a moral and ethical dilemma of informing one Mr. Ramirez's (a congestive heart failure patient) doctor, the risks that he might be exposing himself to by his tendency/trend of increasing dosage of his medication while also consuming several packages of salted nuts. Such an increase of medication and ingestion of salt predisposes him patient to a cardiac arrest. The pharmacist could also attempt to explain to Mr. Ramirez the dangers he predisposes himself to.A review of the case indicates that Mr. Ramirez is an octogenarian who suffers from congestive heart failure. He is however taking a lethal combination of prescription pills (on an increasing scale) and salted peanuts under the watchful eye of a concerned pharmacist. This realization came to be after a rather moral and ethical concern from the pharmacists who noticed the worrying trend in his refill intervals coupled with the salted nuts intake. Of course the initial response from the pharmacist was rather natural.He asked Mr. Ramirez if he had been back to the doctor recently and had his medication dosage adjusted upwards. Mr. Ramirez replied that he had been increasing the dosage himself since he did not think it had been working as well as it used. He noted that he -he needed more to feel better. Because increasing the dosages actually worked, he saw no need to go to his doctor for the dosage adjustment.
Relevant facts, identification of the main issues as well as moral situation
Alteration of drug dosage is dangerous and constitutes irrational drug use
Rational drug use (RDU) is noted by Sankaravadivu et al. (2011) as
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Irrational drug use is noted by Sankaravadivu et al. (2011) to lead to an unsafe and ineffective drug treatment, adverse drug reaction as well as prolonging of the illness. The promotion of a safe and rational drug use usually entails a wide range of activities like the adaptation of the essential concepts of drugs, continuous training of doctors, nurses and pharmacists as well as the development of evidence-based clinical guidelines. Other moves that can promote a rational use of drugs include the provision of an unbiased and yet independent drug information, educating the consumer as well as the use of regulatory strategies (U.S.F.D.A,2006).
The drug related problems are numerous. Some of these include errors made during the prescription, dispensing as well as administration processes. Others include adverse drug reactions as well as drug interactions (Van Dan Bemt et al., 2000). The results of drug related problems are varied and numerous and may lead to a reduced quality of life as well as increased morbidity as well as mortality rates (Viktil & Blix,2008).
Adverse drug interaction can cause death in the elderly population
The work of Routledge, O'Mahony and Woodhouse (2004) affirmed that several studies indicates a correlation between the increasing age and the rate of drug reaction (commonly called drug reaction rate-ADR) in some medical conditions such as heart complications (Which Mr. Ramirez was suffering from). Routledge, O'Mahony and Woodhouse (2004) further noted that more than eighty percent of adverse drug reaction (ADR) rate that cause admission are dose related in nature are therefore predictable from the popular/known drug pharmacology of the given drug. This makes it potentially possible to avoid the drug over dose cases. Frail elderly persons/patients appear to be very vulnerable to the adverse drug reaction (ADR) rate associated risks. The toxicity of certain drug combinations may be synergetic and even be far much greater than the total sums of the risks of the toxicity the constituent agents when used alone. Routledge, O'Mahony and Woodhouse (2004) advised that good communication is crucial between the patients and prescribers. There is therefore a need for the development of an effective therapeutic partnership between the patients and the healthcare professionals.
Pharmacists have a role to play in the rational use of drugs
Drugs are noted by Passmore and Kailis (2004) to be a great technology in the fight against diseases at the individual as well as community levels. The management of drugs for the benefit of the general public health is therefore paramount. Pharmacists are therefore recognized by the World health organization (WHO) and other major players to play a key role in the promotion of rational drug use as well as in the strengthening of the effectiveness of drug management practices.
The practitioners are however noted to be answerable to their role in the effective communication of the relevant information to the patients as part of their clinical roles.The good things is that there is evidence of the ever expanding role of pharmacy in the global health sector. This is however coupled with a challenge of its role in the strengthening of the global public health care.
Their efforts in educating the public on the optimal drug use as well as compliance with the generally recognized drug dosages must be encouraged. In order for the overdose cases such as the one of the elderly Mr. Ramirez to end, there is a need the pharmacists to work together with the government and other stakeholders in the development of effective legislation and policies for the entire pharmaceutical sector.
Moral situation
It is a fact that pharmacists can only survive economically via the sale of their products. This however should never be their principal focus. The product selection or rate of consumption and sale should be appropriate to the exact need as well as circumstances of the patient. This must also be based on a sound and informed judgment. In addition to these, the patient should be referred by or to a licensed physician (WHO,2001).
Assessment of the rightness as well as wrongness of the various outcomes
Generally speaking, an evaluation of the case reveals that the pharmacists did the right thing. The rightness of the outcome is supported by the fact that the pharmacist took it upon himself to ask the patient (Mr.Ramirez) if his action of increasing his drug dosage was sanctioned by his doctor. This was the first step in ensuring the good communication was put into action. After this initial assessment, Mr. .Ramirez would be taught on the best way forward to self-manage his heart condition.
Decision as well as reaching of a solution
As noted earlier, Generally speaking, an evaluation of the case reveals that the pharmacists did the right thing. The rightness of the outcome is supported by the fact that the pharmacist took it upon himself to ask the patient (Mr.Ramirez) if his action of increasing his drug dosage was sanctioned by his doctor. This was the first step in ensuring the good communication was put into action. After this initial assessment, Mr. .Ramirez would be taught on the best way forward to self-manage his heart condition. The solution would therefore be the fostering of good communication between Mr. Ramirez and his doctor as well as educating him on the dangers of taking salty substance with his heart condition.
Justifying the decision
The decision is based on the key recommendation provided by the World Health Organization on the role of pharmacists on self-care and self-medication (WHO,2001).This includes opinions that he product selection or rate of consumption and sale should be appropriate to the exact need as well as circumstances of the patient. This must also be based on a sound and informed judgment. In… READ MORE
Quoted Instructions for "Pharmacist.In This Case, " Assignment:
Book: Morality and the Professional Life Values at Work by Cynthia A. Brincat & Victoria S. Wike
Chapter 6, Exercise 3 (pp. 163-65) [25 pts.]
Choose only one of the four cases in the exercises listed on the pages above, and apply the CRM as explained in the UCRM_Directions.rtf document in the Week 5 folder (this week*****'s folder). Please do not write just some kind of essay about the case you chose, without imposing this structure on it. The CRM structure is a must.
Such a detailed analysis should take at least 1500 words.
IMPORTANT: I give below directions as to how you should apply the Case
Resolution Model (CRM) to a case.
The directions I give sometimes expand on what your textbook says, and
sometimes tells you to do something differently than what the textbook says.
Please make sure that you follow my directions. If I tell you to do something
differently than the book does, please ignore the book and do what I say.
Among other things, this means that objecting to my grading with *****but the book
does it like this on page XYZ***** is not a valid objection.
You will see as you read below that I am using the textbook*****s CRM as a steppingstone
to something I consider to be better and clearer. So to make this even more
evident, let us call this new and hopefully improved model *****˜UCRM*****. From now on I
will be asking you to apply the UCRM, not the CRM, to cases.
Below, you will find directions about what to do at each of the 8 steps of the
UCRM. When you are doing this, please make sure that you name and/or number
the step you are doing. I do not want to guess what you are doing at any point! I
should be able to say, at any point in your assignment, something like *****the
sentence I am reading now is part of step X*****, whatever number that *****X***** might be.
I will not grade assignments that do not follow these instructions.
(1) Present the Problem
Here you will lay out the moral problem that needs to be solved as concisely as possible.
Do not spend a lot of time on the facts of the case since you will do this anyhow while
*****collecting the facts***** in the next section.
(2) Collect the facts
Each moral case has to be evaluated by looking at two things. First, one needs to
determine the facts of the case. And then one has to look at the values or evaluative
principles that can be brought to bear on these facts.
If you compare moral evaluation to a court case, this is the point at which the prosecutor
presents the jury with all the facts and evidence that pertains to the case (for example
*****Mr. X. was wounded, the bullet that did the wounding ballistically matches the gun
found in the bushes, and the gun belongs to Mr. Y*****).
In this imaginary court case, there is as yet no discussion of the legal principles (laws) that
will be applied to these facts.
In similar fashion, in this section, you need to list all and only the facts that seem to be
relevant to the moral evaluation of the case. Do not yet go into the values or the
evaluative principles; these you will investigate in the next section.
(3) List the relevant values
This is where, in a court case, the judge will inform the jury about the laws that apply to
such a case, and the various outcomes prescribed by the law: *****If the facts indicate that
the defendant did commit the crime, and that he did this with pre-meditation, then your
verdict will be that he is guilty of first-degree murder. And if you find the defendant
guilty of first degree murder, then you can give him a prison sentence between 22 to 35
years, etc.*****
Your book is not very clear about the nature of the values you are supposed to bring in at
this stage. Nevertheless, what they seem to have in mind are values such as beneficence
and respect, namely the main values they focus in the text (see p. 75, the section called
*****Articulating Holism through the Values Approach*****). Consequently, what I would like
you to do is to ultimately tie in any value you mention to one of these values. For
example, if you think that the privacy of individuals is a value at stake in a given case,
then I would expect you to tie this value to the value of respecting persons.
To make sure that*****s you do not ignore this, and to make it easier on me to follow your
evaluation, I will require you to boldface the primary value or values you invoke in this
paragraph. For example, if one of the primary values you invoke is respect, then I expect
you to boldface its just like I have done in this sentence.
(4) Explore the options
We are now at the heart of the UCRM. This is where you*****re supposed to apply the
theories you investigated in Chapter 5 to the case at hand, and decide which theory
prescribes which course of action.
I am hereby limiting the number of theories you need to apply to just three:
Consequentialism
Duty theory
Virtue theory
All three of these theories have to be applied; you cannot choose to apply some
other theory in place of one of these. Since some people in the past have said that they
have not understood what this means, I repeat: you have to apply Consequentialism,
Duty Theory, and Virtue Theory*****no exceptions. After you have finished your
assignment, go back to step four and take another look at it. If you have not applied one of
these theories, then you*****re guaranteed to lose points: take remedial action.
If you are interested, you*****re more than welcome to apply additional theories. But no
matter how many additional theories you apply, this will not replace the points you will
lose if you have failed to apply one of the theories mentioned above.
Here is how you should apply each theory:
Consequentialism: as you know from your textbook and the additional material I put
online, consequentialism is a comparative theory. It is a theory that compares more than
one course of action, and chooses the one which is optimal (optimal according to the
criteria of consequentialism, not your or my criteria. This is very important to keep in
mind). So the first thing you need to do is determine at least two alternative courses of
action one can follow, and tell me clearly what these are.
When you have more than one course of action outlined, you then need to consider the
positive and negative consequences of each course of action. When you*****re doing this, you
need to make sure that you consider the consequences to all those affected by the course
of action you are considering. For example, if you*****re a police officer and the course of
action you*****re contemplating is to shoot a criminal, you need to consider how your action
will affect the significant others of the criminal (among other things).
Once you*****re finished with listing the positive and negative consequences of the courses of
action you have focused on, you then need to compare these results and determine which
course of action maximizes utility (take another look at the *****Notes on Consequentialism*****
document I put online if you do not remember what *****maximizing utility***** means). I
emphasize, *****compare*****. If you just say that one course of action maximizes utility
without explaining why it has better utility in comparison with other courses of
action, you are not responding correctly to what I am asking.
So here is what I suggest: I will give the below the framework of how I expect you to
apply consequentialism and if you wish, you can copy and paste this in your assignment.
You can then fill in the details.
Course of Action 1: (here you write the description of the first course of action)
Affected parties: (here you list all those affected by this course of action)
Positive consequences: (here you describe the positive consequences of this course
of action)
Negative consequences: (here you describe the negative consequences of this
course of action)
Course of Action 2: (here you write the description of the second course of action)
Affected parties: (here you list all those affected by this course of action)
Positive consequences: (here you describe the positive consequences of this course
of action)
Negative consequences: (here you describe the negative consequences of this
course of action)
Outcome: The Xth course of action maximizes utility because (here you explain why you
think that the overall utility of the Xth course of action is more than all the others).
Duty Theory: Your textbook*****s discussion of Duty Theory is very sketchy. Its biggest
weakness is that it doesn*****t tell you how one determines what one*****s duties are. The
authors make it sound like one can pull duties off the air.
I cannot remedy this without changing the nature of this course drastically. So, I will let
you pull duties off the air, so to speak. But there are two things I would like you to do:
a. (a) Distinguish legal duties from moral duties, and distinguish both from
company policy. In other words, do not assume that a given company*****s policy
imposes any legal or moral duties on you (in fact it is sometimes possible for a
company policy to be both illegal and immoral). And do not assume that a legal
duty is a moral duty*****it is possible that some laws are immoral. Whether one
has the moral duty to obey immoral laws is a controversial issue.
So ignore the company policy (if there are any), and the legal duties (if there
are any), and focus on the moral duties. Don*****t even mention legal and
policy-based duties (unless you really think that they are relevant to the moral
duties). This is a course on ethics, not the law. Of course, we hope that
company policies are both legal and moral, and we hope that all of our laws are
morally acceptable. This is the ideal we all strive for. But we should keep in
mind that we cannot assume that we or anyone else has reached this ideal. In
any case, since this is a course about morality, we should keep that foremost
in our minds. Morality is primary, and it ought to inform both the legal system
and managerial policy.
a. (b) Even if you are pulling duties off the air, make sure that you are invoking
the widest general duty you can. What I mean is this: if I invoke a duty such as
not using too much salt in my cooking, this is presumably because I have a
wider duty to serve healthy meals. And the duty to serve healthy meals
presumably derives from a wider duty such as not causing unnecessary harm
to others and myself. When invoking a duty, make sure to invoke the widest,
the most inclusive duty--and then explain why that duty prescribes a specific
course of action.
So your explanation should be something like this: the duty not to harm others
unnecessarily means that I should not be cooking meals with too much salt,
because too much salt is unnecessary and harmful to people in the long run.
Finally, do not diminish the complexity of the cases we are dealing with by just
mentioning one duty. When we are dealing with moral problems, in 99% of the cases, we
are dealing with a clash of multiple duties (this, from the perspective of duty theory).
There is more than one duty in the picture and the real difficulty of the case is to
determine which one gains the upper hand. So, mention all the duties that are relevant to
the case and explain which one gets priority and why. Do not ignore the *****why*****!
Also, if and when you invoke a duty, make sure to consider all the responsibilities that
duty places on the person in question. So, say you invoke the duty of loyalty when
discussing what a soldier should do in a morally complex situation in war. Let us say her
commander has just told her to torch an enemy village. Here, loyalty places
responsibilities on her not only vis a vis her immediate commander, but also the larger
military institution of which she is a part. Maybe loyalty to the commander would
suggest that she follow the order, but loyalty to the larger military institution would
suggest that she disobey the order as going against the moral code of that institution.
Remember that life is rarely as simple as movies and TV tend to suggest.
Virtue Theory: I expanded on your book*****s treatment of Virtue Theory in the document
called *****Notes on Virtue Theory***** in the week 4 folder. What I need to remind you here is
this: just like duty theory, virtue theory suffers from the problem of determining where
virtues come from. Once again, I will let you invoke any virtue you wish, as long as you
follow the policy I outlined in (b) above under Duty Theory. That is, always invoke the
widest virtue possible, and show how it prescribes a specific course of action.
One common mistake in *****applying***** Virtue Theory is to forget to invoke any virtues.
People quite often say something like *****Virtue theory says we should do what a virtuous
person (or, a person who wishes to do the right thing) should do and so they should do
X*****. But notice that no virtue has been mentioned*****so we have no idea why X should be
done by a *****virtuous person*****!
Just as above, do not diminish the complexity of the cases we are dealing with by just
mentioning one virtue--mention all the virtues that are relevant to the case and explain
which one gets priority and why. Do not ignore the *****why*****!
Hence make sure you specifically mention the virtues you think are relevant to the case
(such as honesty, courage, etc.), explain which of them gets priority, and also explain what
course of action that virtue prescribes.
Read the last paragraph of the section on Duty Theory, except thinking now in terms of
virtues as opposed to duties. Remember that the same virtue can suggest conflicting
courses of action (just like duties) in the same situation.
(5) Assess the rightness or wrongness of various outcomes
I believe that this step of the CRM confuses people rather than helping them resolve a
moral problem. So I am canceling this step. SKIP STEP 5, but keep the original
numbering of the others steps.
(6) Decide
Keep this short. Just tell me what you have decided to do as concisely as you can.
Try to avoid being too wishy-washy here. For example, the authors***** prescription for
Abdul on page 156 of your textbook is too wishy-washy. They say Abdul should look
for some creative way to educate the clients. What creative way? Can you imagine a
general giving an order that goes *****Find a creative way to flank the enemy!*****? Or a
cookbook that says *****¦and then find a creative way to put all the ingredients together*****?
So please try to be much more precise in your prescriptions. For example, *****Abdul should
mistakenly forward to the client some links to newspaper articles about security problems
of firms that tried to cut too many corners. By doing this, he can further inform the
owners of the risk they are taking without appearing to do so.*****
(7) Defend
This is where you defend your decision. You try to come up with all the morally relevant
reasons for choosing the way you did. You can appeal to the prescriptions of the theories
you applied in step four, you can appeal to other moral reasons or values you hold. If you
happen to be taken by one of the theories discussed in the textbook, including the ones
you applied, feel free to say that you are adopting theory X, and for that reason you
would abide by its prescription. In other words, if while applying the three theories
in step 4, you fall in love with one of them, you can give priority to its support
(while bringing in other support as well). If you have decided on a course of action
prescribed by none of the theories, please make sure that you explain which moral value(s)
influence your decision.
(8) REFLECT
In this step, whatever else you do, do not forget to consider possible objections to your
chosen course of action (the decision you described in step 6). This means (a) stepping
into the shoes of a potential critic and trying to find the biggest problem with your
decision, and (b) stepping back into your own shoes and trying to find a response to that
criticism.
Performing the mental shift described in (b) will be the very difficult for most of you.
It requires you to step out of your own shoes and to step into the shoes of the opposing
viewpoint, so to speak. You are then supposed to attempt to undermine your own
position by finding the wea***** point in it. This is not something most of us are used to
do in the daily course of our lives; but it is a crucial component of critical thinking and
intellectual honesty. Sometimes, it enables us to strengthen our position (by finding a
response to the objection, as requested in (b) )*****sometimes, it shows us that we have
been holding an untenable position and hence enables us to avoid a mistake.
Please make sure you are not presenting objections that are transparently faulty (and
hence easy to answer). If you are capable of easily detecting a problem with what you give
as an objection, this means that you can most probably devise an improved objection that
avoids such transparent mistakes.
Here is a short example to illustrate: (In the example, I am not trying to make the
arguments flawless*****that is not the point. The point is to illustrate the argumentobjection-
response structure I describe above):
I decided in step 6 that Miss Jones should apologize to her subordinate.
{This is your decision. Now we change shoes and start (a)}
One might object to this as follows: if a person of higher rank apologizes to a subordinate, this is
tantamount to losing all credibility and workplace discipline. If Ms. Jones apologizes, she will
lose all her effectiveness.
{In the next paragraph, I step back into my shoes and respond to the objection*****this
is (b)}
This objection is based on a simplistic view of human psychology. If a higher-ranking official has
made a mistake, apologizing for the mistake does not make her lose credibility, it increases her
credibility! As long as such mistakes do not abound, she will be seen as a more credible and just
administrator for recognizing and facing up to her own mistakes. Instead, failing to apologize
multiplies her mistakes!
This example should give you a clear indication of what I am looking for in step 8.
Good luck! *****
How to Reference "Pharmacist.In This Case, " Case Study in a Bibliography
“Pharmacist.In This Case, .” A1-TermPaper.com, 2012, https://www.a1-termpaper.com/topics/essay/pharmacist-case/2981831. Accessed 3 Jul 2024.
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