A man comes in to the pharmacy and asks to speak to you. Once in the consultation room, he hands over a box of an emergency hormonal contraceptive, which was dispensed at a nearby pharmacy under a PGD.
The man states he found the box in his 14-year-old daughter’s room and she refused to tell him why she had taken it. He asks you what the drug is for, as he is concerned for her wellbeing.
The fundamental ethical principle at issue here is confidentiality and disclosure of what might be sensitive information.
Disclosure is always heavily dependent on context. Suppose a pre-registration pharmacy student had asked you “what is this drug and what is it for?” – you would have no problem responding to this query. Such information is anyway easily available to a reasonably competent user of the internet, so you may
feel you have no business to be circumspect about disclosure in this case either.
However, you now have context – and once you have it, you cannot disregard it.
The surrounding information suggests that you now have a professional duty of care to several parties.
Because the actual supply of emergency hormonal contraception was made from another pharmacy, you may argue that the daughter is not ‘your patient’ and you have no clear duty of care towards her.
However, she is a client receiving pharmacy services and you carry
the reputation of the pharmacy profession.
Moreover, you have invited the father into your consulting room and he is asking for your advice; you now have a professional duty of care towards him. You also have a duty to the fellow pharmacist who made the supply. Would your action in this case compromise his or her position?
Having identified these ethical issues, whose interests would you consider most important?
Under the Fraser guidelines, a girl may be considered “Gillick competent” at 14 years of age. The daughter also clearly has an expectation of privacy, having already refused to tell her father why she has taken the drug. You might consider that by now the father probably has a good idea of what the drug is for – so your job is to assist him in deciding what to do with this information.
Conversely, you might judge it better to direct the father to the supplying pharmacy and indeed to his daughter for a proper exploration of the situation. Could you be liable for the consequences that arise from your decision?
Joy Wingfield is special professor of pharmacy law and ethics at the University of Nottingham
Where does the law stand?
Principally, the pharmacist’s duty of confidentiality here arises out of the common law duty of confidentiality, human rights legislation and out of the professional ethic codes of the General Pharmaceutical Council and the NHS Code. A patient has a right to respect for private and family life: this right is universal and exists despite a patient’s age, but may be overridden where it is in a patient’s best interests to do so.
The right to family life also provides for a parent’s right to information about their child enabling them to carry out their parental responsibility. As the law stands, however, failing to inform a parent may be justified where another’s rights are jeopardised.
Under the law, the best interests of the child should be the pharmacist’s primary consideration. In the case of Gillick, it was held that a doctor (or other professional) may prescribe contraceptive treatment to a child without informing the parents where they are satisfied that the child understands the advice; they could not persuade the child to tell their parents; the child is likely to have sexual intercourse with or without contraceptive treatment; the child’s physical or mental health may suffer without such treatment; and their best interests require such treatment be offered without the knowledge of their parents. These are known as the Fraser Guidelines. A 14-year-old child may fit this criteria.
The pharmacist should explain the Fraser Guidelines arising from the Gillick case (without reference to the contraceptive element) and suggest the father tries to understand the legal and professional duties owed by pharmacists to certain minor patients. Failure to respect the duty of confidentiality could lead to professional sanction, breach of the NHS contract and, in extreme cases, potential action under human rights legislation.
Hilary D’Cruz is a partner at Ansons LLP, specialists in pharmacy
What would YOU do?
• Do you have another solution to this dilemma?
• What would you do if confronted with this situation in your pharmacy?
• Or do you have an ethical dilemma you would like to share with other pharmacists?