1. Dilemma 7: Fidelity, Promise-Keeping, Loyalty to patients and impaired professionals Dishonest colleagues: intentionally shorting tablet counts Carey Landry Cathy Holmes Ian Handumon

2. The Scenario After Lorraine, a registered pharmacist, counseled her elderly patient, Mr. James, about his three cardiac maintenance medications at pick up, she was surprised by Mr. James’ final question, “Would you please open these prescriptions and count them for me so that I know I’m getting what I paid for? There was a letter in my favorite advice column last night that told about how you can get shorted on your prescriptions, so I just want to make sure all the pills are there. No offense meant, you understand. I just can’t afford to pay for pills and not get them.” Mr. James’ prescription had been filled by Lorraine’s boss, Glenn, who also owned the pharmacy. Lorraine decided to humor Mr. James and opened the first bottle. To her surprise the prescription was short by three tablets. She immediately made up the difference. The remaining two prescriptions were also short by the same amount. Lorraine added the correct number of tablets to Mr. James’ prescriptions and assured him they contained the correct number of tablets. Mr. James was not the only patient with concerns about shortages that day. Several clients had read the same article and asked for a tablet count. Lorraine took several calls from angry customers complaining of being shorted. She noted all the prescriptions and noticed they all were maintenance medications and all had been short. Glenn had also filled all the prescriptions.

3. Scenario cont’d… When Glenn arrived at the pharmacy, Lorraine told him about what she had discovered and the number of dissatisfied clients that called to complain about shortages. She expected Glenn to have a reasonable answer. He stated “It’s really a shame that advice column printed that letter. We’ll have to stop shorting maintenance prescriptions for a while until people get over the excitement and the need to count every pill.” Lorraine could not believe what she was hearing. ‘You mean that you have been intentionally shorting prescriptions?” Glenn shrugged his shoulders and said “Just the maintenance ones and only on the higher-end products. People don’t miss three or four pills a month and the pharmacy recouped a steady amount. Besides, they always come in for a refill before they run out, so the patients aren’t harmed. Most people forget to take a pill now and then anyway so they never miss the shortage. Four pills a month times three maintenance prescriptions for most patients, times over 1000 patients on these meds – that adds up to a lot tablets that I don’t have to purchase. I won’t stay in business long if I can’t make a profit somewhere. No one is harmed and the pharmacy can stay in business and provide good service to many people who need us.” Lorraine had always admired Glenn but his nonchalant admission of guilt instantly changed her mind about her employer. She had never knowingly shorted a prescription. How could she work for someone who did it as a matter of course? Furthermore, what should she do about this dishonesty in her colleague?

4. Parties Involved Lorraine- the pharmacist Glenn – owner/pharmacist Clients /would be clients

5. Ethical Principle in Question Veracity is the principle of truth telling, and it is grounded in respect for persons and the concept of autonomy. Truth telling is violated in at least two ways. The first is by the act of lying, or the deliberate exchange of erroneous information. However, the principle of veracity is also violated by omission, the deliberate withholding of all or portions of the truth. This questions Lorraine's loyalty towards the clients or her employer. Beneficence This principle is about doing more that just not harming another person. This principle suggests that ethical behavior must "do good". In fact this principle in its true meaning suggests an obligation to benefit others. In Lorraine's part , exercising the principle of beneficence would be to protect the client and would be client.

6. Ethical Principle in Question Non-malfeasanceto “do no harm.” Health provider must refrain from providing ineffective treatments or acting with malice toward patients. This principle, however, offers little useful guidance to provider since many beneficial therapies also have serious risks. The pertinent ethical issue is whether the benefits outweigh the burdens. Would Lorraine agree to Glenn’s reasoning that no one is put in harms way and the pharmacy can stay in business and provide good service to many people? JusticeThe principle of justice suggests that ethical behavior is conduct that treats people equitably. This questions Lorraine’s view of what is fair? and what is not?

7. Lorraine’s Options Be an advocate for her client and report her boss? Do nothing and not report her boss?

8. Possible consequences: Protect current and future client from potential danger of not having the right number of Rx. And getting value for their money Avoid a possible legal repercussion Have a clean conscience Keep pharmacy open; keep her job More profit for the pharmacy; more savings Avoid undermining her good working relationship with her boss Lorraine reports Glenn Lorraine does not report Glenn

9. Will you report Glenn? Or not?

10. Work Cited Ethics at a Glance. Regis University Rueckert-Hartman School for Health Professions, rhchp.regis.edu/HCE/EthicsAtAGlance/Veracity/Veracity.pdf retrieved: February 19, 2011 Landry, D., MSN Priniciples of Ethics handouts http://ftcc.mrooms3.net/mod/forum/discuss.php?d=76