Exploring professional judgement

Professional judgement is required in the day-to-day work of all pharmacists, whichever sector they work in. The concept itself is not difficult to understand but exercising professional judgement takes more consideration.

Professional judgement could be described as the use of accumulated knowledge and experience, in order to make an informed decision. It takes into account the law, ethical considerations and all other relevant factors related to the surrounding circumstances.

As a pharmacist, you will face situations where you have to choose between several courses of action, a crude example being to decide whether to supply a medicine or not.

In some cases there may be a conflict between your ethical duty to promote patient care and safety and legislation that restricts your action. You may have to choose the best option possible in the circumstances, and be prepared to defend your action.

Justification

It is possible for two pharmacists, faced with the same facts and circumstances to choose different courses of action. That is the nature of a finely balanced ethical dilemma. The actions could both be correct. They could each be justified and be legitimate choices for a significant body of pharmacists faced with the same dilemma.

The nature of a dilemma is that there will be strong arguments for at least two courses of action. Often, you will have to weigh up conflicting factors, which could involve patient interests, legal obligations, professional standards, public interest, contractual terms of service and company procedures.

You must be able to justify your decision if challenged. It is important to understand that professional judgement is not a blanket defence. Nor should it be an excuse to take the most convenient choice. Your judgement must be exercised properly, logically and for valid reasons. So, for example, if there are legal mechanisms to achieve a required goal it would be foolish to choose an illegal alternative. For example, the lending of a prescription-only medicine would be difficult to justify if an emergency supply could have been given.

Process

Many pharmacists exercise their professional judgement instinctively, but it can be helpful to break the process down into smaller steps as follows:

1. Identify the ethical dilemma or professional issue.
2. Gather all the information that is relevant (ie, facts, knowledge, laws, standards, good practice guidance). Advice could be obtained from support services (see Panel), your head office (if you have one), line managers or colleagues.
3. Identify the possible options.
4. Weigh up the benefits and risks, advantages and disadvantages of each of the options.
5. Choose an option, ensuring that you can justify your decision.
6. Where appropriate or significant, make a record of the decision making process and the reasons leading to your course of action. (It may be appropriate to make this record in the patient’s medication record, at the back of the prescription-only medicine register or in an interventions record book).

Further reading

• Wingfield J, Badcott D. Pharmacy ethics and decision making. London: Pharmaceutical Press; 2007.
• Appelbe G, Wingfield J. Dale and Appelbe’s pharmacy law and ethics. London: Pharmaceutical Press; 2009.

Next month, Wing Tang looks at dealing with requests for pseudoephedrine and ephedrine.