Ch.5: Read “The Potent Placebo” on pp.167-168. Should the new pharmacist refuse to fill the prescription? Why or why not?
5 Mar
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Professional Ethics Discussions 
Posted by Carol Kines on 2011/07/14 at 1:41 AM
I feel that the new pharmacist should fill the prescription in accordance with the orders from the doctor. The pharmacist has moral concerns with the deception involved in filling the order with the placebo, which is understandable. However, the pharmacist does not know or understand the details of the patient’s condition or history, and would be unable to determine the harm that might come if he were to divulge the fact that the prescription is a placebo or not fill the prescription. The doctor has embarked on a plan of deception, which he feels is in the best interests of the patient and will achieve the best outcome (teleological principle). The plan the doctor has in place has been effective and has achieved a good outcome for Mrs. Abraham for a period of time, and the pharmacy has been fair in the pricing provided for this placebo. The doctor is responsible for the patient, and is not giving the patient something dangerous or illicit. The pharmacy is following the orders of the doctor in providing an innocuous placebo, which has shown only positive outcomes. Thus, the new pharmacist should remain silent and fill the order in the same manner that the previous pharmacist filled the prescriptions. Although my recommendation appears to favor the military metaphor, there are cases where I would not recommend the pharmacist to merely follow the orders of the doctor. For example, if the drug the doctor had prescribed posed a danger to the woman, or had known medical issues, I feel the pharmacist would be duty-bound to protest filling the prescription.
CKines
Posted by Michael Green on 2011/07/16 at 6:37 PM
The pharmacists job is fill the order per the docs order. The doctor understand all reasoning behind his/her decisions. If the doctor believes that a placebo is the right course of action, then that is what should happen. However, I can see where the pharmacist feels he shouldnt be charging so much money for phony medication. The pharmacist should make a plan to decrease the costs.
Posted by Leah Richards on 2011/07/18 at 2:52 PM
The duty of a pharmacist is to fill perscriptions. So whatever the doctor orders for a patient, then the pharmacist must fill. If the medication is not killing Mrs. Abraham then the pharmacist should just do what they are supposed to do.
Posted by sebayus on 2011/07/27 at 5:58 AM
Although I admire the new pharmacist’s ethical unease about the “placebo” situation, I feel it is his duty to fill the description. He is new to his position and certainly does not know the patient and the details of her medical records like that of her ordering physician. The physician certainly has her best interests in mind, and the pharmacist should never question the “why” of a doctor’s orders. If he saw an error in dosage or contraindications, he would certainly be justified in questioning the doctor- but, refusing to fill it could be seen as insubordination- not only to the prescribing physician, but also to his manager and more experienced pharmacists where he is employed.
SBayus
Posted by Hilary Carr on 2011/07/27 at 3:36 PM
While reading the chapter and listening to the lectures I was appalled by the thought of physicians lying to patients…but now that this case is presented I feel a little differently.
I think the pharmacist should fill the prescription as usual and never hint at anything different.
The point of a placebo is to provide the therapy of taking a drug without putting the ACTUAL drug in the patient’s system – and it’s working! It would be wrong of the pharmacist to interfere in the patient’s care and the physician’s judgment in this particular case.
Not to say that a pharmacists job is to blindly follow orders, it is important for them to be aware of the different things being prescribed to a patient, but it just doesn’t seem right to step in on this case.
HCarr
Posted by Misty Bess on 2011/07/27 at 8:03 PM
I do not feel the new pharmacist should fill the patient’s prescription. After reading the chapters in the textbook, I felt myself completely agreeing with the position taken by Bok. It is not morally justifiable to deceive anyone. By taking the action of refilling the prescription, the pharmacist is partaking in the deceit initiated by the physician. Although, it seems there are many reasons that doing this could be beneficial to the patient, we do not know all of the consequences that could arise from this dishonesty. There are so many affected by this falseness: the patient, the pharmacists and possibly even family to name a few. The patient should be given the opportunity to make those decisions regarding her care after being fully informed of the situation. By misleading her we are taking away the patients right to give informed consent and fair autonomy. Now that the new pharmacist is aware of the circumstances continuing this cycle would be morally unjustified.
MBess
Posted by Tabitha Johnson on 2011/07/31 at 5:10 AM
I think the new pharmacist should refuse to fill the prescription. He would be decieving this woman. She believes she is taking a certain medication, and the pharmacy is giving her something completely different. This is no different then being prescribed a pain pill, and getting an antibodic. This woman has a right to know what she is putting in her system , as well as what she’s paying for. This is not exceptable. Tjohnson
Posted by christina johnson on 2011/07/31 at 4:19 PM
i think the pharmacist should do his job and fill the placebo prescription because no matter what in the end sometimes doctors always no best even though the doctor is making the patient pay alot of money for some milk and sugar he still the doctor and the pharmacist should just do his job and put the patient some paper where she can sign up for medical insurance thats what i think.christina
Posted by Walter Bell on 2011/07/31 at 6:57 PM
I do not believe deception should be used in any form of business or professional service. I agree with Bok, that there shouldn’t be deception. Just because one person feels it is the best decision for someone does not mean it is. It is still the person’s decision, not the professional’s decision. Although the doctor prescribed a placebo because of what he feels is best, Mrs. Abraham should be the one making the choice about what she takes. She is under the influence that she is buying the real drug, to sell placebos without her consent is selling a product she isn’t aware of. The doctor could be right, afterall he has the experience and education to make those decisions. However, Mrs. Abraham should be allowed to make the right choice for herself even if it isn’t what the doctor would do. As long as a person has the capacity to make educated decisions, then they should be able to do what they feel is right for themselves. I believe the pharmacist should follow his conviction of selling fake pills and not fill the prescription.
Posted by NChaney on 2011/08/02 at 10:45 PM
I do agree with Bok that deception is not morally justfiable, but everyone does it at some point. Sometimes doing the right thing can be morally wrong. Remember these are so called morals not laws that we ought to follow. In the case of the pharmacist, I feel he should fill the prescription. This would be a case where deception is the right thing to do. If the new pharmacist told Mrs. Abraham the truth, she may become very disheartend. Along with that her faith in her physician will deminish drastically. Even though the doctor and pharmacist may be decieving Mrs. Abraham its for the good of her health. If I were in her shoes I’d be more than happy to have people care fo my health in this way.
Posted by Ashley Whitford on 2011/08/03 at 6:48 AM
I feel that even though the pharmacist feels it is morally wrong to deceive Mrs. Abraham,he should still fill the prescription to the doctors orders. Even though he has some hesitations, he should not be concerned with the fact that the doctor is deceiving the patient. Just because the pill that Mrs. Abraham is getting is not what she thinks it is, does not mean that it is not doing an important job. Even though she is not getting a barbiturate anymore and her body does not need the medicine to help her sleep doesn’t mean that she does not need the pill for psychological reasons. The milk sugar pill Mrs. Abraham is taking is helping her psychologically more than anything. If she believes that she is getting better and her health is improving, then the pill is doing more good than harm. The doctor thinks that if he tells her that she is only taking a milk sugar pill that she may fall back into the bad state that she was at in the hospital. The doctor is taking the best precautions to keep Mrs. Abraham feeling better and out of the hospital. The doctor is also not charging her the full price of the prescription, which I believe is a good thing, because she is not paying for the real drug. For this particular situation, I would have to side with Collins and say that Mrs. Abraham should be deceived for the reason that just because the pill is not providing a chemical reaction in her body, it is producing a mental reaction and that is something that Mrs. Abraham needs.
AWhitford
Posted by Kimberly Bertmeyer on 2011/08/05 at 4:15 AM
I think that the pharmacist has a duty to the physician and to Mrs. Abraham to continue to fill the prescription. If the pharmacist were to expose the truth about the placebo to her several things could happen. She will know that the drug is a placebo and become convinced once again that she has insomnia. Then she would demand to be given the real drug once again. Then she runs the risk of becoming addicted to the drugs again. She may also lose trust in her physician. She has been seeing her current doctor for quite some time and knows him very well. She would probably not take it well. At her age this much stress could be dangerous to her health and she may have trouble trusting him or another physician ever again. I think it was a noble thing for the doctor to recognize that she was addicted to the drug and do what he could to ensure she didn’t stay addicted. If all was needed was a placebo to put the woman’s mind at ease and allow her to sleep, I would say in this case deception is acceptable. The deception is not hurting her in anyway. Some may say that she is losing money by paying for a fake drug, but more than likely if she had been told about it or allowed to keep taking the drug, she would have continued to take the real drug and pay for it anyway.
Posted by Mike Senchak on 2011/08/05 at 1:55 PM
The new pharmacist should refuse to refill the prescription. Many of the points made by Sissela Bok can be carried into this pharmacy example. Although most medical professions will place benifecence before honesty, that does not make it right. It is understood that this doctor and pharmacist have the best interest of the patient in mind but the patient has the right to know. In a case like this, the patient trusts the doctor and the pharmacist in providing services in order to deal with an illness. The doctor and the pharmacist are actively deceiving the patient. The patient has the right to be informed and to make the decisions.
Posted by Dominic DeRose on 2011/08/05 at 9:16 PM
The new pharmacist should fill the prescription. Dr. Little in this case had decided to ween Mrs. Abraham off of her addiction to the barbiturate. It is my understanding that non-maleficence and beneficence rank higher on the priority list than the principal of veracity. According to Collins, Dr. Little has de-ontological and teleological grounds for continuing the deception. Not for starting it in the first place since the patient Mrs. Abraham was not to be informed of anything critical to her health, having already defeated cancer. However, now that she is already so deep in the deception, it is important to maintain it so that the confidence in her physician is not damaged and she does not relapse back into full addiction. So again, while I disagree for starting the deception I find it important to continue it, since this late in the game, revealing the deception could cause more harm to the patient than good.
Posted by Michelle Green on 2011/08/09 at 2:01 AM
No the pharmacist should not refuse to sell the placebo. His job is to fill the prescription. If a doctor says that the placebo is whats good for the patient, then thats the way it is. He dont know any better than the doctor
Posted by Marc Kosec on 2011/08/09 at 11:49 PM
The new pharmacist should fill whatever prescription is received by the DOCTOR. I also believe that instead of simply lying to the customer, maybe provide an option for rehab to address the addiction issue. The pharmacist is not the one that should be having a moral dilemma. It is the doctor that should. They are the one making the decision to deceive the person. All in all, do what the doctor says and move on with your day.
Posted by Nicole Zarzycki on 2011/08/10 at 3:07 AM
The pharmacist should refuse o fill the prescription. By continuing to lie to the patient she is being stripped of her right to participate in her medical decisions. She deserves to know the truth. That way she can work with the doctor on a new course of action. But according to Ellin it would ok for the pharmacist to fill the prescription under the doctor’s orders since “deception is thus not a violation of professional morality, since professionsla are not mandated to protect the client’s interest in having true beliefs, in not being manipulated or in being treated with respect” (pg.136).
Posted by Michael Sammartino on 2011/08/10 at 8:20 PM
Yes in my opinion the pharmacist should fill the prescription. This goes back to the four models of the doctor and patient and in none of those is there a pharmacist included. The doctor is responsible for the patient and knows that patient best and the pharmacist’s job is simply to fill the medication order of the doctor. Since in some models doctors can ‘deceive’ patients (while doing what is best for them) I find this a simple choice of fill the prescription.
-msammartino
Posted by Natalie Haynam on 2011/08/10 at 8:54 PM
I do not believe the new pharmacist should refuse to fill the placebo drug prescription. In this chapter, Joseph Collins defends that in medical practice, it is okay to deceive your patients if it is for their own good. The placebo drug made from inert milk sugar allowed Mrs. Abraham to sleep at night because she became so depend on the barbiturate that without them she is unable to sleep. Her doctor knew that consuming the barbiturate could harm her health over a period of time, so she decided to prescribe a placebo that Mrs. Abraham thought was still the barbiturate. The new pharmacist believed it was wrong to deceive Mrs. Abraham about the drug and charge her for it. It was her doctor who chose to switch her patient to the placebo without her knowledge because she believed it was in the best interest of Mrs. Abraham. Her doctor acted in a way that allowed good to Mrs. Abraham which is the moral value beneficence. The long term barbiturate addiction could seriously harm Mrs. Abraham’s health. The new placebo pills are made from a byproduct of milk and are not harmful towards her health. Also, the placebo helps her sleep at night. If she was told the truth about the pills, she would most likely feel deceived, wronged, and trust would be lost not only in her doctor, but also any other doctor she may have in the future. The good of the placebo and the new pharmacist filling the prescription proves to produce the greatest good for the greatest number of people involved. From chapter one, we learned this view was called the Utilitarian view. The placebo not only produces good for Mrs. Abraham, but also for her family and her doctor.
Posted by Molly Jones on 2011/08/11 at 2:57 AM
Aside from the money Mrs. Abraham could take this two different ways if the new pharmacist told her the truth. Mrs. Abraham could think silly of herself for believe that milk and sugar really was placebo to help her sleep but see her doctors side of it that he was only trying to help her and this process helped her, or she could feel betrayed by her doctor and the pharmacist that they have been lying to her. I believe that the new pharmacist should explain to her the truth but also explain why this was done, and how much it helped her without her realizing it. I don’t believe any doctors should ever lie to their patients unless it is an act like this, something is done in silence to make one believe that they are getting the help the need. However I stand by my thought of truthfulness that when this act is finally taken care of, when Mrs. Abraham technically didn’t need the “placebo” anymore I think the truth should of came out. My mom, two sisters, and two cousins, all work at the same hospital and my mom does a lot for the doctors so whenever there is an issue with me I believe that what all the doctors and nurses tell me is the truth because I do have a relationship with a lot of my doctors and nurses so if I ever found out that they were decieveing me I would lose trust in them unless it was an act of silence to make me better, but I would still want them to explain themselves to me after the act was successful.
Posted by Matt Tobin on 2011/08/11 at 8:51 PM
I feel that the new pharmacist should fill the prescription. The pharmacist is simply following the orders of the doctor to fill this prescription and the doctor feels it is in the best interest of the patient to do this. The pharmacist should see no problem questioning the doctor’s judgment, and he doesn’t know about this patients past. I agree with the priestly model when it comes to the physician patient relationship. The physician thinks by doing this he is benefiting the patient and doing no harm. The doctor has the duty to deceive certain types of patients. This is a teleological principle, and I agree with Collin’s on this matter. The paternalism is justified on the implied agreement of the medical professional to pursue the relevant interests of the client. The doctor could morally justify his deception by saying he is showing concern for the private life of his patient after having gone through the emotional roller coaster of getting cancer.
MTobin
Posted by Philip Ciprian on 2011/08/11 at 11:35 PM
It is a pharmacist’s job to fill the prescription, nothing more. Therefore, he should do as directed if he wants to continue his current job. Otherwise, it would be better for him to simply find another pharmacist job more to his liking. This comes with any profession. Starting a job, you may find some disturbing aspects of it. However, as long as you are doing YOUR job correct, than you should not feel disturbed.
Posted by JScacchetti on 2011/08/11 at 11:48 PM
The new pharmacist should continue to refill her placebo. The result of her taking the placebo and its outcome out weights the price they are paying. It brings her happiness in the last years of her life without having any negative reactions to being addicted to a serious drug. Since the price is of the original medicine is so low and the pharmacist is keeping the price of the placebo the same low price, there is no harm being done. Peaceful blindness is better at that old age so that when she dies, she can be truly happy.
Posted by Alana Kane on 2011/08/12 at 8:46 PM
The pharmacist should continue to fill the prescription. The pharmacists duty, in this case, is to fill the prescription and follow the doctors instructions. The doctor’s motive is to benefit the patient in her last years of life. Because this treatment was to help rid the addiction to the sleeping pills, I believe it is a harmless deception to the patient. If the case was more serious, such as changing to a stronger or different pill, then I would agree that the doctor should tell the patient due to side effects and complications. The doctor is morally justified by looking out for the patients well-being and curing her addiction with a harmless pill, which could possibly keep the woman living longer and happier.