6.4 Professional Ethics & Code of Conduct

6.4 Professional Ethics & Code of Conduct

Quick Reference: The PSI Code of Conduct for Pharmacists (2019) is a statutory professional framework issued by the Pharmaceutical Society of Ireland under Section 7 of the Pharmacy Act 2007. It defines the ethical obligations, standards of practice, and professional values expected of every pharmacist registered in Ireland.

---

The 7 Core Principles of the PSI Code of Conduct

The Code of Conduct is structured around 7 Core Principles that guide professional practice and decision-making:

---

Ethical Decision-Making Framework

Pharmacists frequently encounter complex ethical dilemmas where legal rules, professional guidelines, and patient preferences conflict. The PSI recommends a systematic ethical decision-making framework:

1. Identify the Ethical Problem: Clarify the conflicting values, duties, or principles (e.g., patient autonomy vs. risk of harm).
2. Gather Relevant Facts: Review clinical details, legal statutes (Pharmacy Act, Medicinal Products Regulations), and PSI guidelines.
3. Evaluate Available Options: Analyze alternative courses of action against the 7 Core Principles of the Code of Conduct.
4. Consult Guidance & Colleagues: Seek input from senior colleagues, PSI guidance documents, or professional indemnity organizations.
5. Make & Implement Decision: Act decisively in the best interest of patient health and safety.
6. Document & Reflect: Record the rationale in professional notes and reflect on the outcome for future practice enhancement.

---

Conscientious Objection Protocols

Conscientious objection occurs when a pharmacist holds sincere moral or religious beliefs that prevent them from dispensing a particular product or participating in a specific healthcare service (e.g., emergency hormonal contraception, fertility treatments, or medical termination of pregnancy services).

Legal & Ethical Obligations Under Principle 1 & 3:

While the PSI Code of Conduct respects a pharmacist's personal right to conscientious objection, the health and care of the patient remain paramount:

• No Obstruction of Care: A pharmacist CANNOT refuse care in a manner that obstructs, delays, or denies patient access to lawful treatment.
• Mandatory Seamless Referral: The objecting pharmacist MUST immediately inform the patient of their inability to provide the service and facilitate an immediate, seamless referral to another accessible pharmacy or healthcare practitioner who will provide the service.
• Non-Judgmental Conduct: The pharmacist must communicate respectfully without expressing personal moral judgments, lecturing, or causing distress to the patient.
• Emergency Exceptions: In a life-threatening emergency where immediate supply is required and referral is impossible, the pharmacist's duty to preserve life overrides personal conscientious objection.

---

The Duty of Candour and Incident Management

The Duty of Candour is both an ethical principle under the PSI Code of Conduct and a statutory obligation (reinforced by the Civil Liability (Amendment) Act 2017 and Patient Safety (Notifiable Incidents) Act 2023).

Key Requirements Following a Dispensing Error or Safety Incident:

• Open & Immediate Disclosure: When a dispensing error or adverse incident occurs, the pharmacist must inform the affected patient (or family/carer) promptly, openly, and fully.
• Sincere Apology: Provide a clear, sincere apology and explanation of what occurred, without defensive posture.
• Remedial Action: Detail immediate clinical steps taken to mitigate harm and long-term systemic measures implemented to prevent recurrence.
• Root Cause Analysis (RCA): Document the incident in the pharmacy's Near Miss / Incident Log, conduct a root cause analysis, and report notifiable incidents to appropriate bodies (e.g., Health Protection Surveillance Centre or State Claims Agency where statutory thresholds are met).

---

Patient Confidentiality vs. Statutory Exceptions

Patient confidentiality (Principle 5) is a cornerstone of the pharmacist-patient therapeutic relationship. Pharmacists are bound by strict legal duties under the General Data Protection Regulation (GDPR) and the Data Protection Acts 1988–2018.

Lawful Exceptions to Confidentiality:

While information must generally be kept secret, disclosure without patient consent is legally justified under specific statutory circumstances:

1. Statutory Obligation: Laws requiring mandatory disclosure, such as:
   • Children First Act 2015: Mandatory reporting of suspected child abuse or neglect to Tusla (Child and Family Agency).
   • Infectious Diseases Regulations: Mandatory notification of specified infectious diseases to public health authorities.
2. Court Order or Legal Proceedings: Disclosure mandated by a judge or court subpoena.
3. Garda Investigations: Statutory request by An Garda Síochána investigating serious indictable offences under valid warrant or statutory disclosure provisions.
4. Prevention of Serious Harm: Disclosure necessary to prevent imminent, grave risk of death or severe bodily harm to the patient or a third party.

When disclosing information under statutory exceptions, the pharmacist must disclose ONLY the minimum necessary information required to satisfy the legal obligation.