Exploring Ethical Decision-Making in Oncology Pharmacy

Several factors give rise to ethical dilemmas in the oncology pharmacy space, including the evolving landscape of oncology medicine, issues of resource allocation, and the balance of efficacy and toxicity. Although there may not be clear-cut answers to many of these unique situations, ethical frameworks and guidance from colleagues can equip oncology pharmacists with the confidence to make the best decisions for their patients.

Answering a "wrong" or "right" ethical question / MarekPhotoDesign.com - stock.adobe.com

At the Hematology/Oncology Pharmacy Association Annual Conference 2024 in Tampa, Florida, Drug Topics interviewed Karen Fancher, PharmD, on her presentation titled “Ethical Dilemmas in Oncology Pharmacy: When Science and Morals Collide” to discuss how ethical principles can be applied to make informed decisions when faced with challenging situations in oncology pharmacy.

Drug Topics: How does the severity of a patient’s condition influence the ethical considerations and decision-making process for oncology pharmacists?

Karen Fancher, PharmD: I don't know if there's a one-size-fits-all answer to that question, because I feel that we have some patients that are very severely ill but are going to be cured. [For that patient, oncology pharmacists might take] a different approach than to a patient who is severely ill, and this is an end-of-life situation. I think that every individual situation would need to be addressed in that context—like the patient is severely ill right now, but what is the expected outcome? What is the patient's desire to proceed with further therapy? We also now are very interested in a concept called relational autonomy. So, what is the family's opinion on this situation? Can we make this decision as a group? I don't know if there's one guiding ethical principle that I could answer that question with. I just would stress that every individual situation should be given [the health care provider’s] full attention.

READ MORE: Personalized Care, Collaboration Key to Navigating Ethics in Oncology Pharmacy

Drug Topics: How can oncology pharmacists build a network of support and resources to consult with when facing complex ethical challenges in their practice?

Fancher: I think that medical ethics committees are very underutilized. So, most major health care systems will have a medical ethics committee, which most pharmacists are not even aware exists. I would stress to pharmacists to find out if your institution has one [and] how you [could] consult them if you had a medical dilemma that you wanted to get some assistance with. Most medical ethics committees that I've dealt with are actually very interested in having a pharmacist’s opinion. So, not only knowing about their existence, but certainly volunteering to go to one of their meetings, or one of their educational sessions—that's how I got on my own medical ethics committee. [I] just started asking some questions and the next thing you knew they asked me to join. I would certainly advocate for pharmacists to find out their own institution's availability of such a thing.

In addition to that, I think conferences like HOPA and others that are bringing ethics to the forefront is a wonderful way to learn, but also a wonderful way to meet other pharmacists. I think in my own ethical dilemmas, I've called some colleagues that I've met at places like HOPA [asking], ‘What do you think I should do?’ Building my own personal network at conferences like this has really been helpful when I need a second opinion or just some reassurance of how to proceed.

READ MORE: Oncology Resource Center