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Ethical decision-making, passivity and pharmacy

Cooper, R.J., Bissell, P. and Wingfield, J. (2008) Ethical decision-making, passivity and pharmacy. Journal of Medical Ethics, 34 (6). pp. 441-445. ISSN 0306-6800

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Abstract

Background: Increasing interest in empirical ethics has enhanced understanding of healthcare professionals' ethical problems and attendant decision-making. A four-stage decision-making model involving ethical attention, reasoning, intention and action offers further insights into how more than reasoning alone may contribute to decision-making.

Aims: To explore how the four-stage model can increase understanding of decision-making in healthcare and describe the decision-making of an under-researched professional group.

Methods: 23 purposively sampled UK community pharmacists were asked, in semi-structured interviews, to describe ethical problems in their work and how they were resolved. Framework analysis of transcribed interviews utilised the four decision-making stages, together with constant comparative methods and deviant-case analysis.

Results: Pharmacists were often inattentive and constructed problems in legal terms. Ethical reasoning was limited, but examples of appeals to consequences, the golden rule, religious faith and common-sense experience emerged. Ethical intention was compromised by frequent concern about legal prosecution. Ethical inaction was common, typified by pharmacists' failure to report healthcare professionals' bad practices, and ethical passivity emerged to describe these negative examples of the four decision-making stages. Pharmacists occasionally described more ethically active decision-making, but this often involved ethical uncertainty.

Discussion: The four decision-making stages are a useful tool in considering how healthcare professionals try to resolve ethical problems in practice. They reveal processes often ignored in normative theories, and their recognition and the emergence of ethical passivity indicates the complexity of decision-making in practice. Ethical passivity may be deleterious to patients' welfare, and concerns emerge about improving pharmacists' ethical training and promoting ethical awareness and responsibility.

Item Type: Article
Copyright, Publisher and Additional Information: © 2008 BMJ Publishing. Reproduced in accordance with the publisher's self-archiving policy.
Institution: The University of Sheffield
Academic Units: The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield)
Depositing User: Miss Anthea Tucker
Date Deposited: 02 Dec 2009 10:48
Last Modified: 04 Jun 2014 15:57
Published Version: http://dx.doi.org/10.1136/jme.2007.022624
Status: Published
Publisher: BMJ Publishing Group
Refereed: Yes
Identification Number: 10.1136/jme.2007.022624
URI: http://eprints.whiterose.ac.uk/id/eprint/10205

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