Stage i: Present the Problem
The main problem in the case study seems to be how the pharmacists can convince Mr. Ramirez to go for a checkup again before increasing his dosage and the unwillingness of Mr. Ramirez to consult his doctor. Therefore, in contrast to the pharmacists recommendation for Mr. Ramirez to get more information from his doctor before increasing his dosage, the client (Mr. Ramirez) replies that increasing his dosage helps him feel better and he sees no reason to go to the doctor.
Collect the Facts
The observant pharmacist is working in the drug store where Mr. Ramirez, a sixty-seven-year-old, is a regular customer because he usually comes during the shift of the observant pharmacist. The observant pharmacist realizes that the customer, Mr. Ramirez, has been increasing his dosage frequently that does not match the prescriptions for his medical condition. The pharmacist feels that the frequent refill by MR Ramirez is not out of the open refill indicated by the physician, but because of the, his increased salt intake from the nuts. Therefore, the pharmacist decides to ask Mr. Ramirez if he has gone to the doctor recently for a check-up. Mr. Ramirez replies that he has been increasing the doses by himself and that there is no need to consult the doctor because increased dosage helps him feel better; thus, no need to consult the doctor.
Stage ii: List the Relevant Values
As the stake is the well-being of the customer or patient (Mr. Ramirez) due to the fact that he frequently increases his dosage without a proper directive from his doctor. This raises the values of beneficence and non-maleficence. The value of beneficence examines the benefits and the person benefiting from a particular decision. In this case, the pharmacist is required to make a decision of what brings more benefit to the customer. The value of non-maleficence examines the extent of harm that can emerge out of a decision (Brincat & Wike, 2000). In the case study, what is the magnitude of the harm of increasing the patients dosage as frequent as he asks (maybe his health condition might get worse or he might develop other medical complications out of the increased dosage)?
There also is the question of pharmacist's-customers relationship. The relationship between the pharmacist and the customer, Mr. Ramirez, may be affected due to the conflict in drug dosage intake. The pharmacist should help the patient achieve the optimum benefit from the medications he/she provides to the customers (Brincat & Wike, 2000). Again, the pharmacist should be committed to the patients welfare and maintain their trust. In the case study, the question that arises is that will the increased dosage potentially compromise the health status of the patient? By allowing the patient to frequently increase his dosage is the pharmacist being professionally responsible? To what extent will he be held accountable in case the health of the patient deteriorates due to increased dosage? What about the pharmacists integrity as a professional? If his suggestion that Mr. Ramirez seeks the doctors directive before increasing his dosage is not respected, will he be able to do a competent and professional job as required?
Explore the Options by Seeing the Way in Which Theories Apply and Interpret the Values
The observant pharmacist could decide to use consequential theory to choose a decision that is more beneficial to their relationship with the customer, Mr. Ramirez. The pharmacists well-being is maintained and enhanced by the fulfillment of clients needs. However, this relationship would be affected if the pharmacist would decide not to sell the drugs to Mr. Ramirez as frequent as he needs them. Further, since there is an open refill that allows the patient to refill the dose as frequent as may be needed, Mr. Ramirez may be right that increasing his dosage enhances his health condition instead of wasting all the time going back for doctors consultation. On the other hand, the pharmacist may decide to use the consequentialist theory to choose an option that may not impact the patients well-being negatively. If increasing the dosage is the problem, the pharmacist may inquire further from other physicians before pressuring Mr. Ramirez to seek doctors consultation before increasing his medication dosage. Working to reduce the strain and conflict between the pharmacist and the client helps enhance the attractiveness between the two stakeholders; thus, maximizing the benefits. Therefore, the pharmacist needs to pay more attention to the beneficence and non-maleficence.
As a right theorist, the pharmacist would need to consider the clients rights in the situation. Of course, the client has a right to choose or make a decision regarding his life as long as he is mentally stable. Mr. Ramirez has a right to have his wishes fulfilled or met by the pharmacist because he is a client there; he only comes to buy medicine. However, the pharmacist also has a right to practice his professional obligation to ensure that his clients are not harmed in any form in the process of medication. Therefore, the pharmacist needs to find a common background that both include his rights and that of the clients thus, minimizing the strains between them. Further, as a duty theorist, the pharmacist may decide to threaten Mr. Ramirez not to sell the drugs to him if he does not seek the doctors approval of increasing medication dosage. In this case, the pharmacist would need to consider his obligations to beneficence and nonmaleficence, integrity, and client-pharmacists relationship. As a virtue theorist, the pharmacist may decide to advise the client on the dangers of increasing his medication dosage without the approval or consultation of the physician to help him (Mr. Ramirez) make the right decision that will both benefit their relationship. Acting virtuously helps enhance the relationship between the client and the pharmacist and also minimizes the risks associated with the unsupervised medication.
Assess the Rightness and Wrongness of Various Outcomes
The observant pharmacist may decide to consider the following conditions: It is his right as a pharmacist to provide his professional opinion to customers or clients when he feels that they are endangering their lives. The client, Mr. Ramirez, also has a right to choose what is right and best for his life. However, the client needs to have the final say on any decision. The pharmacist should only give him his professional opinion and not to pressure the customer to go for doctors approval before increasing his dosage. It is the client that should choose what he thinks is best for him.
The pharmacist should inquire and consult widely before providing his professional opinion to the client on the risks of increasing his medication dosage.
Stage iii: Defend
Given the options in the case study, this may be the best option because it allows the pharmacist to minimize the risks that may arise from medication; thus, enhancing and continuing their relationship. It is important to note that Mr. Ramirez is a regular client at the drug store because he usually comes every time the observant pharmacist is at work. Both the pharmacist and the client have had a good relationship; thus, it is in both their interest that this relationship continues without any problems. After inquiring and consulting widely with the physician, the pharmacist can educate Mr. Ramirez on the risks involved in increasing the medication dosage without the supervision of a physician.
Reflecting on the decisions made, it is important to note that the decisions and defense provided are well-supported. The pharmacist found a decision that is supported by the given moral theories; thus, he is able to realize all the relevant values. Of course, we cannot deny the possibilities that the theories could have been used differently to achieve a different decision (Brincat & Wike, 2000). For instance, as a consequentialist, the pharmacist may feel that more good can come from giving in to clients demands. However, the pharmacist may have enhanced the decision by inquiring more about Mr. Ramirezs condition and the need to increase his medication dosage before approaching him. He might have consulted a physician who has the idea of congestive heart failure and the factors that might pose a threat to the medication process. Therefore, in future, the pharmacist needs to have more information before approaching the client, especially when there is a space for a refill like in the case of Mr. Ramirez.
Brincat, C. A., & Wike, V. S. (2000). Morality and the professional life: Values at work. Pearson.
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