PEBC Medical Ethics and Law 5 — Questions and Answers
Question 1: A pharmacist receives a prescription for a medication that is contraindicated with the patient's documented allergy. The prescriber insists on dispensing. The pharmacist should:
- Dispense because the prescriber takes final responsibility
- Refuse to dispense and document the clinical rationale for refusal (Correct answer)
- Dispense but warn the patient verbally about the allergy
- Contact the provincial college before taking any action
Correct answer: Refuse to dispense and document the clinical rationale for refusal
Pharmacists have an independent professional duty to refuse dispensing when patient safety is at risk, regardless of prescriber insistence.
Question 2: The doctrine of 'respondeat superior' in pharmacy law means:
- Patients are responsible for following medication instructions
- An employer may be liable for the negligent acts of an employee pharmacist (Correct answer)
- A pharmacist must defer to the supervising physician at all times
- The regulatory college is responsible for all licensee misconduct
Correct answer: An employer may be liable for the negligent acts of an employee pharmacist
Respondeat superior holds employers vicariously liable for negligent acts of employees performed within the scope of employment.
Question 3: A pharmacist is asked to dispense a drug not yet approved by Health Canada but available through the Special Access Programme (SAP). This is permissible when:
- The patient requests it directly without a prescription
- The prescriber submits an SAP request and Health Canada grants authorization (Correct answer)
- The pharmacist determines the drug is safe based on published literature
- The drug is approved in the United States or European Union
Correct answer: The prescriber submits an SAP request and Health Canada grants authorization
The SAP allows access to unauthorized drugs only after Health Canada reviews and approves the prescriber's application on behalf of a specific patient.
Question 4: A patient's substitute decision-maker (SDM) requests a medication change that the pharmacist believes is not in the patient's best interest. The pharmacist should:
- Follow the SDM's instruction without question
- Implement the change and alert the prescriber to potential concerns
- Communicate concerns to the prescriber and healthcare team while respecting the SDM's role (Correct answer)
- Override the SDM by applying the pharmacist's professional judgment
Correct answer: Communicate concerns to the prescriber and healthcare team while respecting the SDM's role
The pharmacist should voice clinical concerns to the care team while recognizing the SDM's legal authority to make decisions for incapable patients.
Question 5: Which of the following is the most accurate description of 'professional misconduct' in Canadian pharmacy regulation?
- Any error that results in patient harm
- Conduct that falls below the standard expected of a competent pharmacist (Correct answer)
- Disagreeing with a prescriber's therapeutic decision
- Failure to achieve continuing education requirements in a given year
Correct answer: Conduct that falls below the standard expected of a competent pharmacist
Professional misconduct is broadly defined as conduct unbecoming a pharmacist or conduct that fails to meet the professional standard of practice.
Question 6: A pharmacist is offered a gift by a pharmaceutical sales representative in exchange for promoting a specific drug. The pharmacist should:
- Accept only gifts of nominal value such as pens or notepads
- Decline the gift as it creates a conflict of interest (Correct answer)
- Accept if the drug is clinically appropriate for most patients
- Report the offer to the College before making a decision
Correct answer: Decline the gift as it creates a conflict of interest
Accepting gifts that could influence prescribing or dispensing decisions constitutes a conflict of interest and violates professional ethics codes.
Question 7: A pharmacist working in a long-term care facility notices that a resident is receiving a medication dose far above the recommended range for their age. The pharmacist's responsibility is to:
- Dispense as ordered because the prescriber is responsible
- Contact the prescriber to discuss the clinical appropriateness of the dose (Correct answer)
- Reduce the dose independently to the recommended range
- Document the concern and wait for the next medication review
Correct answer: Contact the prescriber to discuss the clinical appropriateness of the dose
Pharmacists have a professional duty to identify and communicate drug therapy problems, including inappropriate dosing, to the prescriber.
PEBC Medical Ethics and Law 5
A pharmacist receives a prescription for a medication that is contraindicated with the patient's documented allergy.
The prescriber insists on dispensing.
The pharmacist should: