Oral+Presentation+Case+14

= Oral Presentation Case 14 =

//A doctor at the surgery next door to your pharmacy believes a patient has a chronic head ache due to psychological and attention‐seeking factors. He has exhausted all possible treatment avenues and requests that you dispense the patient a placebo sugar pill, and inform the patient that it is a medication for the treatment of headaches.

Discuss the potential concerns of following through with this request.//

Background
- pain is subjective

**Rights and Duties** - pharmacists don't have the right to diagnose patient as a hypochondriac, pharmacist have limited knowledge about this patient's background - patient has the right to be taken seriously, and seek effective treatment for his headache

**Consequentialism** - doctor, pharmacist breach patient's trust and confidence - may be hold legally liable if "persistant headache" turns out to be undiagnosed brain tumor or some other serious medical condition - cost issue - telling patient to pay for a drug that does nothing in reality - give patient false hope and delay diagnosis and treatment for underlying serious medical problem - only when assuming patient is indeed a hypochondriac, he may bother the doctor less, derive a beneficial placebo effect - in the short term, patient thinks the doctor is doing him some good, therefore stay with current doctor (longterm may still lose confidence in the doctor and go to another one)
 * bad consequences of dispensing placebo pill and not telling him**
 * good consequence of dispensing placebo pill and not telling him**

Hi! Today, the scenario that I will talk about is being requested to dispense sugar pills to a patient. The patient suffers from chronic headache and the doctor believes that his headache is due to psychological and attention-seeking factors. The doctor has request ed that I  dispense the sugar pills to this patient and to not tell him the truth about his medication. As a pharmacist, providing the most suitable treatments and accurate and truthful information are the primary duties. Ther is a conflict. So, t he ethical issue in this case is that whether I should  provide a potential treatment to the patient which is  giv ing  the patient a placebo sugar pill and violate my duty which is tell ing  the patient this medication <span style="font-size: 10pt; line-height: 115%; font-family: 'Arial','sans-serif'">is for the treatment of headache(s). <span style="font-size: 10pt; font-family: 'Arial','sans-serif'">I want to clarify that by telling <span style="font-size: 10pt; font-family: 'Arial','sans-serif'">him <span style="font-size: 10pt; font-family: 'Arial','sans-serif'"> the truth <span style="font-size: 10pt; font-family: 'Arial','sans-serif'">, <span style="font-size: 10pt; font-family: 'Arial','sans-serif'"> it means telling him that he is taking sugar pills. <span style="font-size: 10pt; font-family: 'Arial','sans-serif'">
 * Example **

The framework that I will use in this case is Consequentialism. Under Consequentialism, it judges the rightness or wrongness of an act by looking at its consequences.

I<span style="font-size: 10pt; line-height: 115%; font-family: 'Arial','sans-serif'"> am going to talk about the values for each party. For the doctor and myself, as the pharmacist, value <span style="font-size: 10pt; line-height: 115%; font-family: 'Arial','sans-serif'">respect, honesty and <span style="font-size: 10pt; line-height: 115%; font-family: 'Arial','sans-serif'">quality of life. <span style="font-size: 10pt; line-height: 115%; font-family: 'Arial','sans-serif'">Respect and honest can promote trustful relationships and good health outcomes thus minimising the harm to patients. <span style="font-size: 10pt; line-height: 115%; font-family: 'Arial','sans-serif'">The patient may have different values such as autonomy, trust, <span style="font-size: 10pt; line-height: 115%; font-family: 'Arial','sans-serif'">dignity <span style="font-size: 10pt; line-height: 115%; font-family: 'Arial','sans-serif'">, the right to be told the truth. <span style="font-size: 10pt; line-height: 115%; font-family: 'Arial','sans-serif'"> He may want to get a consensus with the doctor in the treatment decisions, and he wants to know the facts and being respected.

Regarding this scenario, I have three situations, each with a different action for which good and bad consequences are discussed as the following.

Firstly, let's assume that I dispense sugar pills for this patient and do not tell him the truth, the good consequences are that it may be an effective treatment for this patient as it can produce a placebo effect. As this mediation is a placebo, it is highly unlikely to produce serious and long term side effects. The patient's dependency on active medication will also be reduced. It can also avoid medication-overuse headache and being treated too aggressively as a consequence of this. However, the patient does not know the truth to what they are actually taking. If the patient knows that he is taking is placebo pills<span style="font-size: 10pt; font-family: 'Arial','sans-serif'">. It violates the right for him to be told the truth. .

The second situation is that I dispense placebo pills to this patient and tell him they are placebo. In this circumstance, the patient will be told the truth and his autonomy will be respected. It can also avoid serious side effects and avoid medication overuse headache.

For the adverse outcomes, he may refuse to take the placebo pills. As the therapeutic effects of placebo pills is that the patient believes he is taking an pharmacological active medication, it may not work in this patient. Also, it will destroy the relationship with the patient and his doctor. He will lose trust with the doctor. The next time when he has an illness, he may prefer to speak to a different doctor. He will become hesitant to present to the doctor, as he believes he will receive inappropriate treatment.

<span style="font-size: 10pt; line-height: 115%; font-family: 'Arial','sans-serif'">The third situation is that I do not dispense placebo pills and tell him the truth. The patient’s autonomy is respected and the relationship between the patient and me can be maintained. However, it may deprive a potential treatment for this patient. He may feel disappointed with the doctor because he believes this is not a suitable treatment for him.

Under Consequentialism, the act that produces more good consequences than bad is considered as ethically right. So in the first situation (where I dispense the sugar pills and do not tell him the truth), the good outcomes produced outweigh the bad outcomes, whereas the bad outcomes outweigh the good in the other situations.

<span style="font-size: 10pt; font-family: 'Arial','sans-serif'">So, my final decision is that I will dispense the placebo pills to this patient and not tell him the truth about his medication. So that this medication may work on him and relief his headache. <span style="font-size: 10pt; font-family: 'Arial','sans-serif'">

I will tell the patient the following things: This medication is for your headache. It may take a few days to work. This is a relatively safe medication and produces very few side effects such as nausea and vomiting. If the headache is still persists for more than 1 week, see your GP.

Thank you

Tiffany

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