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would be more bene cial. This is also in
concordance with the Code:
A pharmacist must:
7.2 Behave in a manner which makes it
clear that he or she is responsible and
accountable for all decisions made and
actions taken in professional practice.
7.3 Communicate with team members
regarding each person's sphere of
responsibility and line of reporting.
If the conversation becomes unpleasant,
it might be time for Daniel to look
elsewhere for employment; as advised in
additional guidance in the Code:
'It is advisable to refuse employment
where a pharmacist's professional
autonomy or judgement is denied or
integrity is compromised in any way.'
The owner's perspective
In this scenario the owner-pharmacist
intervened in the interests of relieving
tension between client and sta . The
intriguing question is, in a complex
situation, further complicated by an
imbalance of power -- as is the case here
-- was the decision to resolve the problem
by submitting to the client's demands,
an acceptable one? Bar the possibility
of criminal violence, and common sense
in such situations, the answer is: No, it
was not a good decision. Not only did
he override a colleague's professional
autonomy, he actually caused the client
harm, albeit unintentionally.
For all we know, Daniel's boss -- the owner,
could be a well meaning, e cient boss
who stepped in to resolve an aggressive
confrontation, which in his opinion might
have caused harm to Daniel, or to other
clients. He could well have intended to
protect Daniel and/or other clients in the
pharmacy. However, all things considered,
the action the owner decided to take was
not a wise one. His action caused harm.
At law, causation of harm is essential to
anyone's claim of negligence.
So, how do we strike a balance between
customer service (not only to the OST
client, but also with regards to others in
the pharmacy), keeping the peace, and
abiding by strict legal requirements? It
is certainly not an easy balance to strike,
but with careful planning and re ection
on how to improve practice in the
workplace, it is possible to achieve.
Had the owner taken a stand in solidarity
with Daniel, supporting his position --
rather than rushing to appease the client
regardless of regulations, the client might
well have thought twice about causing
any more havoc. Two professionals
making a rm stand is hardly dismissible,
unless of course the client was armed
with a weapon. Had the owner chosen
to call security, or calmly suggested he
might have to, an acceptable outcome
might have been achieved. Instead he
gave the client a dose of methadone,
which was highly inappropriate and
eventually caused more harm to the client
than good. The owner stands to take
blame for this action, and unfortunately,
should the client su er even further
complications such as death, could
be sued for negligence. No doubt the
owner did not mean for that to occur,
but there is no leniency in these matters
when it comes to civil courts and legal
procedures. It would be a terrible
experience for a well meaning pharmacist
to endure, and a needless one.
In deciding what action to take,
sometimes in a split second, it is
important to be rm about what matters
most. The guiding principle should be the
best interests of the client/patient, not
the business, not the discomfort of others
or the placating of an aggressive client/
patient. In this scenario, it was not in
the best interests of the client to receive
a dose of methadone. He ended up in
This incident should prompt Daniel
and the owner to set in place internal
policies designed to address such
situations e ciently, legally and safely.
This is important for all parties involved.
Patient safety is the core objective,
professional autonomy of colleagues
must be respected and open dialogue
about addressing such problems should
Questions and comment about issues
raised in Ethical Dilemmas is welcomed.
Send comments to: Australian.pharmacist@
In part 2 in the July issue the second issue --
providing OST in the pharmacy with all its
complexities is discussed.
1. Code of Ethics for Pharmacists. Pharmaceutical Society of
Australia, Canberra Australia, Sep 201.1
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