Guest Editorial - Pharmacy School Interviews and the Ethics of the Profession

Recently, I had the privilege of helping interview a group of pharmacy school candidates for admission to a college of pharmacy where I serve as an adjunct assistant clinical professor on a part-time basis. Another professor and I met with 5 bright-eyed and smiling students. We were tasked with speaking to candidates to determine if they could communicate well and think on their feet— 2 useful skills for any practicing pharmacist. We did this by asking them questions on various topics, some of which were controversial. Listening to students express their opinions and, at times, debate with the other students gave us an idea of the communication skills of each student, as well as some indication of their personal beliefs and values. Because I was considering the topic for this editorial at the time that I was asked to conduct these interviews, I decided to incorporate the subject of ethics in pharmacy into my questions to the student panel. I asked them what they would write about, given the chance to compose an editorial on ethics in pharmacy. As might be expected, the answers reflected the opinions of an intelligent and concerned group of future pharmacists. Some of the comments made by these students seemed to us, their interviewers, naive; whereas other students demonstrated insight beyond their years. We did not score the students on the content of their responses; rather, they were scored on their ability to reason and communicate effectively. One student told us that the high price of drugs is a challenge to pharmacy ethics. She explained that she worked as a clerk in a pharmacy and that she encountered many patients who could not afford high-priced medications. When I asked her what should be done about this problem, she responded that drug companies should be pressured into giving their products to patients free of charge. I categorized this reply un der “naive,” though the student’s heart was in the right place. Her re sponse brought to mind a quote— often incorrectly attributed to Winston Churchill—“If a man is not a liberal when he is 20, he has no heart. If he is not a conservative by the time he is 40, he has no brain.” Another student said that there are 2 basic principles of ethics in pharmacy: autonomy and dignity. I thought that this well-studied answer could have come straight from the code of ethics statements by the American Pharmaceutical Association and the American Society of Health-System Pharmacists. The answer from another student disturbed me. He responded that pharmacists are obligated by law to fill every prescription. As an example, he said that should he be presented with a prescription for a morning-after pill, he would have to fill it, despite any moral, ethical, or religious objections to using that drug. Had time allowed, I would have asked this student to expand further on the subject of following the law in the face of a moral dilemma. Every pharmacist who has practiced for more than a few days has faced moral dilemmas, such as a patient who comes to the pharmacy on a Saturday, when a doctor cannot be reached, and who sincerely needs a medicine that has no refills. Some state laws explicitly permit “loaning” such patients a few pills until the physician can be contacted; others do not. The es sence of what makes a pharmacist a professional is ingrained in the decision to help a patient in need and the pharmacist’s the ability to exercise independent, in formed judgment in such cases. Time permitting, I would have spoken to this student more about the issue of the morning-after pill and of the potential conflict between a patient’s need and a pharmacist’s ethics. Certainly, this has been a controversial topic over the last few years. Personally, I do not oppose dispensing birth control pills or morning-after pills, but I have well-respected colleagues who do. In years past, there would have been no question that a pharmacist has the right to “conscientiously object” to dispensing such products, but the pendulum of