INTRODUCTION

Ethics focuses on one’s values, standards of conduct, and moral judgment.¹ These are typically well-founded standards of right and wrong that prescribe what humans ought to do, usually in terms of rights, obligations, benefits to society, fairness, or virtues.¹ Professional societies generally regulate specific codes of ethics, which stipulate a detailed, explicit, operational blueprint of the norms of professional conduct expected from the profession’s members. Such codes reflect collective values and aspirations to self-regulation rather than strict reliance on more stringent controls imposed by legislation. Society generally regards these ethical standards as essential elements for a profession, particularly professions associated with maintaining and extending the health and well-being of individuals within the society. Such codes of professional ethics have not only exerted a positive, cohesive force among individual members of a profession, but also serve as publicly proclaimed benchmarks to uphold society’s trust in the profession.

Practicing as a pharmacy technician carries obligations as well as privileges. It requires developing knowledge and skills to perform necessary job functions, maintaining professional relationships, and behaving in a way that promotes confidence and trust in the pharmacy profession. The Pharmacy Technician Code of Ethics provides guidance on the conduct, practice, and professional performance expected of pharmacy technicians. The principles of the code also inform the public of the standards of behavior they can expect from pharmacy technicians. This continuing education activity will explore the Code of Ethics developed by the Pharmacy Technician Certification Board (PTCB). It will identify the virtues and values deemed important by society to uphold basic patient rights and link them to specific principles in this code. Recognizing and applying theses virtues and values to one’s professional life will maintain patient safety and public confidence in the profession and promote the essential role of the pharmacy technician as integral to the profession of pharmacy.

CODE OF ETHICS FOR PHARMACY TECHNICIANS

Over the past decade the pharmacy technician role has changed and progressed to include more duties and responsibilities. As technicians were given increasing job responsibilities, the industry began to call for regulation of the job duties, training, and continuing education. Many advances have increased regulation in the pharmacy profession. Technician certification is now required in many states or organizations, but the exact educational requirements vary by program and state. PTCB issues certification, and it is also responsible for maintaining adherence to the Code of Ethics that American Association of Pharmacy Technicians (AAPT) approved in 1996.² This code is similar to the Pharmacists Code of Ethics and is based on the moral obligations guiding the profession in relationships with patients, healthcare professionals, and society. The code list 10 points that focus on patient safety, continuing education, and professionalism. The Code of Ethics for Pharmacy Technicians is as follows³:

• A pharmacy technician's first consideration is to ensure the patient’s health and safety and to use knowledge and skills to the best of his/her ability in serving patients
• A pharmacy technician supports and promotes honesty and integrity in the profession, which includes a duty to observe the law, maintain the highest moral and ethical conduct, and uphold the ethical principles of the profession
• A pharmacy technician assists and supports pharmacists in the safe, efficacious, and cost-effective distribution of health services and healthcare resources
• A pharmacy technician respects and values the abilities of pharmacists, colleagues and other healthcare professionals
• A pharmacy technician maintains competency in his/her practice and continually enhances his/her professional knowledge and expertise
• A pharmacy technician respects and supports the patient's individuality, dignity, and confidentiality
• A pharmacy technician respects the confidentiality of a patient's records and discloses pertinent information only with proper authorization
• A pharmacy technician never assists in dispensing, promoting, or distributing medication or medical devices that are not of good quality or do not meet the standards required by law
• A pharmacy technician does not engage in any activity that will discredit the profession or will expose illegal or unethical conduct of the profession
• A pharmacy technician associates with and engages in the support of organizations that promote the profession of pharmacy through the utilization and enhancement of pharmacy technicians

The Code of Ethics can best be described as the moral rules that relate to practicing as a pharmacy technician. These rules exist to advise technicians as to what is right and wrong as they perform job-related responsibilities. The Code of Ethics is intended as a guide rather than dictating a proper course of action. Codes of Conduct on the other hand, lay out specific guidelines that a profession’s members must follow and are always consistent with the Code of Ethics dictated by that profession.⁴ While a Code of Ethics is broader and establishes whether an action taken by someone is right or wrong, a Code of Conduct translates the rules in the Code of Ethics into specific guidelines that members of a profession must follow. PTCB established a Code of Conduct for Pharmacy Technicians to which all licensed pharmacy technicians must adhere (see Table 1).

As PTCB standardized regulation and registration of pharmacy technicians, discussions about professionalism brought the issue of ethics to the forefront. One standard listed in the Accreditation Council for Pharmacy Education’s standards for pharmacy technician education and training programs addresses the technicians’ abilities to demonstrate ethical conduct in all job-related activities.⁶ Consequently, it is imperative that pharmacy technicians learn about the Code of Ethics and Code of Conduct in a formal curriculum and apply these behaviors in practice to be in compliance with PTCB and accreditation requirements.

COMMON VALUES IN PHARMACY PRACTICE

Everyone draws upon a wide range of experiences and influences to form personal values system. The influences of those who play a regular role in our lives combine to form a basic value system that continues to grow with practical experience. The professional decisions one makes flow from this unique, highly complex set of values and can influence how a person approaches moral decisions. Society appears to have identified a number of values deemed essential in healthcare. Results in the latest Gallup Poll (December 2020) showed nurses earned a record 89% very high/high score for their honesty and ethics while pharmacists’ honesty and ethics rating was ranked at 71%.⁷ The American Association of College of Nursing provides an extensive list of values and attitudes it defines as crucial in the practice of nursing that can also be applied to pharmacy practice.⁸ Table 2 defines these attributes while demonstrating the professional behaviors that represent each value.

Case Example: Managing Conflicts Between Value Systems

In a work environment, value systems often clash. This can cause tension and disagreements between coworkers especially when a superior asks employees to compromise their personal value systems. In the following situation, consider what values are compromised.

A pharmacy technician settles into his new position at a well-established pharmacy in an exclusive neighborhood. His supervisor explains that certain cough syrups with small amounts of codeine (Schedule V preparations) are hidden from open view and should be sold only to “the right kind of customers,” adding, “We don’t want to attract any undesirable traffic in our store.” When the technician presses for clarification, his supervisor advises him to “tell anybody that doesn’t look right that we don’t carry those kinds of drugs.”

In this situation, the technician may be forced to compromise his own values of altruism and equality. Although there is no right or wrong answer here, the technician should consider working for an employer who share his value system, especially if the technician is being asked to compromise one or more sets of beliefs that he feels are important to uphold the practice of pharmacy to its highest standard.

INCORPORATING VALUES INTO THE CODE OF ETHICS

Although pharmacists incorporate a wide range of values in their practices, most of these can be discussed under 3 broad categories: fair dealing and equity, patient-centered services, and faithfulness.⁹ Each of these values has been incorporated into the code of ethics of the American Pharmacists Association and can also be found in the AAPT Code of Ethics for Pharmacy Technicians.

Fair Dealing and Equity

Fair business dealings seems to be a hallmark of most early codes of ethics for pharmacists.⁹ Practices that were deemed unethical were related to filling coded prescriptions (e.g., not identifying the drug on the label), imitating labels of competitors, seeking unjust compensation for services rendered, and unprofessional solicitation for consumer business.⁹ The Code of Ethics for Pharmacists currently states that pharmacists must act with honestly and integrity in all professional relationships which takes into account fair business practices.¹⁰ Similarly, the Code of Ethics for Pharmacy Technicians states that a pharmacy technician must support and promote honesty and integrity in the profession.³

Patient-Centered Services

As the focus of pharmacy practice began to shift from product-centered to patient-centered, the pharmacist was encouraged to render each patient his/her full measure of professional ability to promote optimal patient care. Society demanded that patient health and safety be the first consideration in practice. The current Code of Ethics for Pharmacists states that a pharmacist should promote the good of every patient in a caring, compassionate, and confidential manner.¹⁰ The Pharmacy Technician Code of Ethics similarly promotes the concept that a pharmacy technician's first consideration is to ensure patient health and safety, and to use knowledge and skills to the best of his/her ability in serving patients.³

Faithfulness

This value focuses on respecting each patient’s privacy and confidentiality. The pharmacist is encouraged never to divulge facts to unauthorized parties unless obliged to do so by law to be in compliance with the Health Insurance Portability and Accountability Act (HIPAA). The Code of Ethics for Pharmacists recognizes the pharmacist-patient relationship as a covenantal relationship and emphasizes the pharmacist serves the patient in a private and confidential manner.¹⁰ The pharmacy technician must also comply with HIPAA regulations and the Pharmacy Technician Code of Ethics maintains that a pharmacy technician respects the confidentiality of a patient's records and discloses pertinent information only with proper authorization.³

Now that we have discussed how values are incorporated into the Code of Ethics, let’s consider the following patient case. What ethical principles are compromised in the following situation?

A technician receives a prescription for a fertility drug from a Medicaid recipient with four young dependents. The patient overhears the technician telling a co-worker that the patient should be advised to have a tubal ligation.

In this case, the technician disrespects the value of freedom. In other words, regardless of the technician’s personal beliefs, he or she should respect each patient’s ability to make independent decisions. A pharmacy is a very challenging practice setting that requires a technician to respect patients’ self-determination, display attitudes that stress faithfulness and promise-keeping, and practice behaviors that display accountability and honesty. By adopting values consistent with appropriate moral decision making, a technician will exemplify the professional behavior consistent with expectations set forth by the Code of Ethics.

RIGHTS AND DUTIES IN PHARMACY PRACTICE

Nearly every institution and professional organization has embraced the notion of patient rights.⁹ Rights are defined as justified claims that individuals or groups can make on others or on society.⁹ Within the realm of natural rights falls the right to life, the right to freedom, and the right to die which are inherent in the human condition.⁹ Others such as a government agency or an institution must grant bestowed rights to a human entity and include such rights as the right to a living wage, the right to privacy, and the right to healthcare.⁹ Every right carries with it an obligation to perform some prescribed conduct which is referred to as a duty.⁹ Specific duties related to a pharmacy technician may include the duty to maintain a patient’s confidentiality, the duty to promote honesty and integrity in all interactions, the duty to maintain competency, and the duty to ensure the patient’s health and safety. In the patient case above, does the patient have the right to have her prescription filled? Does the pharmacy technician have the duty to respect the patient’s dignity? Of course, the answer to both questions is yes. The question then becomes, “What are the certain rights a patient is guaranteed?”

Practicing pharmacy is considered a privilege that is granted to one through a licensing agency of the state both for pharmacists and pharmacy technicians, not a right. In return, the people of the state expect a protection from certain risks in the healthcare system. The Pharmacy Patient Bill of Rights is written from the patient perspective and contains 5 rights that can be utilized to ensure that pharmacists and pharmacy technicians are making decisions while putting the needs of the patient in the forefront.¹¹ The following is a list of the Pharmacy Patient Bill of Rights.¹¹

1. I have the right to have only indicated medications ordered for and administered to me. To establish this right the pharmacist must know as much about the patient as possible which encourages pharmacy to be an essential member of a multi-disciplinary team. This information may include such things as the patient’s diagnosis, past medical history, nature of the condition/disease, and the medication’s relative cost-effectiveness.¹¹ The pharmacist must then use this information appropriately to be certain the patient receives the indicated medication ordered.
2. I have the right to a safe medication process that incorporates the “5 Rights.” The “5 Rights” include the right patient, the right drug, the right dose, the right route, and the right time.¹¹Active knowledge of the pharmacy department’s distribution process will ensure the criteria of the “5 Rights” are fulfilled. Safety protocols must be a critical value of any pharmacy organization to ensure this right is met.
3. I have the right to education about my medications. Education is important to promote patient safety and positive outcomes. Even if the education is provided by another discipline (e.g., nursing, physicians) the pharmacy must ensure the education is complete and accurate.
4. I have the right to meet my pharmacist and understand what he/she does. Meeting the pharmacy workforce and learning about its function will allow the patient to take full advantage of the services provided by the pharmacy.
5. I have the right to a knowledgeable and skilled pharmacy workforce. Pharmacist residency training and board certification and pharmacy technician training, education and certification are all components of a well-trained staff. 

Case Example: When Rights, Duties and Values Collide

Consider the following ethical issue which looks at the competing intersection of values versus rights and the pharmacy technician’s duties when administering vaccines. The move to make some vaccinations mandatory has ignited several contrasting stances that highlight not only ethical issues but policy issues. Health care professionals who hold the values of patient autonomy to be paramount tend to be skeptical about compulsory vaccination laws. Others might hold that minors have a right to be protected against vaccine-preventable diseases and that society has an interest, even a duty, to safeguard the welfare of children who may be harmed by their parents’ or guardians’ choices. Certainly, school-based laws have proven to be an effective, efficient way of boosting vaccination rates. A central ethical question surrounding this issue is whether a higher level of coverage justifies the infringement on patient autonomy that compulsory vaccination entails. One’s own value system will lead to different answers to this question. Pharmacy technicians who are involved in administering vaccines will need to assume a justifiable personal stance on this issue and decide what constitutes their professional duty and supports the Pharmacy Patient Bill of Rights, while still holding firm to their personal value system.

VIOLATIONS OF THE PHARMACY TECHNICIAN CODE OF ETHICS

PTCB handles Violations of the Code of Ethics and investigates all violations in technicians who are certified and those who are candidates for certification. Formal Conduct Case Procedures establish the process for handling conduct cases brought to the PTCB’s attention. As part of the licensing process, all certificants and candidates agree to follow and obey the Code of Conduct and comply with the Conduct Case Procedures. They also agree that they will not challenge the authority of PTCB to use the Code of Conduct, Conduct Case Procedures, or other policies.¹² In addition, PTCB certificants and candidates agree that the policy is a fair process for resolving all conduct review matters and agree to be bound by decisions made consistent with the policy.¹² The procedures are not formal legal hearings but a technician may choose to have an attorney present. The formal procedure involves various steps that are described in the following section.

Initiating a Complaint

Co-workers, patients, or anyone who witnesses an ethical violation can make reports and, in some situations, PTCB may initiate a complaint. To begin a conduct review matter, a complainant should complete a Conduct Charge Statement form that can be found online at www.PTCB.org. The statement must include a detailed written description of the information supporting the conduct charge against the respondent. The Executive Director or other designated PTCB representative receives all Conduct Charge Statements and determines if the matter can be resolved fairly without a formal conduct review. 

Mediation/Formal Complaint

The Executive Director may decide that the conduct complaint can be solved through mediation without a formal conduct review. In this case, if the complainant and respondent accept mediation, both parties agree to work with good faith effort to reach a fair and voluntary conclusion. If mediation does not resolve a conduct matter, the case will be referred to the Conduct Review Committee. The Resolution Officer will review the Conduct Charge Statement submitted by a complainant, and then determine if the allegations are sufficient to become the subject of a formal conduct complaint and investigation. If the Resolution Officer determines the charge and available proof support a legitimate complaint, a formal conduct complaint and investigation notice will be issued. If there is not enough evidence to support the conduct complaint, the charge will be rejected. If the complaint is rejected the complainant has 30 days to submit an appeal.

Conduct Complaint Response

Within 30 days of the mailing date of a conduct complaint, the respondent must submit a response to each violation and any other material the respondent believes will assist PTCB in the investigation process. Upon receipt of the formal conduct complaint and investigation notice, the respondent may request that the conduct complaint be reviewed and resolved by the Conduct Review Committee and may request a hearing before the review committee. If the respondent does not request review, the Resolution Officer will resolve the conduct complaint. The response to the violation is sent to the complainant who then has 10 days to submit a written reply to the respondent’s complaint response if any objections exist. This response is then sent back to the respondent who has 10 days to submit a written response if there are objections to the complainant’s reply.

Preliminary Actions

The respondent may be asked to accept, and agree to, a temporary suspension of PTCB certification and certain related conditions, which will remain in effect until the final resolution of the complaint. If a respondent does not agree to accept a voluntary suspension an order may be issued temporarily suspending the respondent’s certification and/or imposing appropriate conditions which will stay into effect until the final resolution of the complaint. Suspension orders are authorized if the respondent has been convicted or charged with a criminal act, has been sanctioned or disciplined by a government regulatory body, or if the respondent is subject of other legal action(s) relating to pharmacy technician activities.

Complaint Review and Resolution

If the respondent does not request review of the conduct complaint by the Conduct Review Committee, the Resolution Officer will consider and resolve the complaint and issue a final decision. If the Conduct Review Committee will review the complaint, the Executive Director formulates a committee consisting of at least 3 current certified pharmacy technicians in good standing and at least 2 pharmacists who will review the complaint. A hearing will be held no less than 60 days and no more than 120 days after PTCB issues a conduct complaint.

Approximately 30 days after a conduct case record is closed, the Resolution Officer or the Conduct Review Committee will send the formal decision to both parties. Disciplinary actions may includea recommendation that the candidate be ineligible for certification or that a certificant be ineligible for recertification; requirement that the respondent take corrective action(s); a private or public reprimand; certification probation for any period of up to 3 years; suspension of certification for a period of not less than 6 months and not more than 3 years; or revocation of certification. The respondent has 30 days to file an appeal and in return the complainant may respond to that appeal in hopes of having the appeal denied. Within 180 days after the submission of an appeal, the Conduct Appeals Committee will conduct a hearing to determine the appeal’s outcome and final resolution. This decision is final, and no other appeals will be made available. PTCB may notify appropriate government agencies or professional organizations of any final disciplinary action(s) taken by sending a copy of the final decision to appropriate parties.

Reinstatement Procedures

Five years after a final order is issued a respondent may submit a petition for permission to reapply for certification. Upon the request of the respondent, PTCB may shorten the minimum 5-year revocation period, if the respondent can show a compelling reason and substantial justification for earlier consideration of reapplication. The Certification Council has 90 days to review requests and will either grant, deny or choose to continue the proceedings pending more information. The respondent may be required to successfully complete the Pharmacy Technician Certification Exam as a requirement for reinstatement. The decision of this council is not permitted to be appealed but the respondent may submit a new petition 2 or more years after the issuance of this decision.

It is every pharmacy technician’s responsibility to apply the principles of the Code of Ethics and follow the Code of Conduct in daily work. All technicians are professionally accountable for their own practice which requires answering for actions or omissions, regardless of advice or direction from a supervisor or other colleagues. It is PTCB’s expectation upon certification that a pharmacy technician uses professional judgment while adhering the Code of Conduct and be able to justify one’s actions if asked to do so.

CONCLUSION

The care, well-being, and safety of patients are at the center of everyday pharmacy practice. This must be every pharmacy technician’s primary and continuing concern. Adhering to The Pharmacy Patient Bill of Rights will help ensure pharmacy technicians make thoughtful decisions while putting the needs of the patient in the forefront. Even if pharmacy technicians are not directly involved in patient care, their behaviors and attitudes can indirectly affect the outcome of appropriately delivered pharmaceutical care. Demonstrating respect for the rights, views and dignity of every person is fundamental in forming professional relationships and all efforts should be made to maintain professional boundaries with patients, caregivers, and colleagues. Patients, colleagues, and society place a significant amount of trust in the pharmacy technician and adhering to the standards of the Code of Ethics will exemplify and demonstrate that this trust is well placed. The following tips will ensure pharmacy technicians act in a morally and ethically responsible manner and in compliance with the Code of Ethics.

• Ensure safe and timely access to medications while ensuring the integrity and quality of these medications
• If one’s moral or religious beliefs prevent a service from being provided, make sure the patient has access to that service through another avenue
• Respond constructively to performance assessments and undertake training if necessary
• Practice only if you are fit and able to do so regarding any health deficits or current or potential legal proceedings
• Consider policies, procedures, and financial constraints, but they must not compromise the technician’s ability to make sound professional judgments

From time to time, a pharmacy technician may be faced with conflicting professional obligations or legal requirements. In these situations, one must evaluate the risks and benefits of each course of action and determine what is most appropriate and in the best interest of the patients and the public. Keeping this goal at the center of every ethical decision will allow a pharmacy technician to act in ways that promote confidence and trust in the pharmacy profession.

REFERENCES

1. Saunders M, Alexander G, Siegler M. Principles of Medical Ethics. In; McKean SC, Ross JJ, Dressler DD, Schuerer DB,eds. Principles and Practice of Hospital Medicine, 2e. McGraw-Hill; Accessed June 10, 2021. https://accessmedicine-mhmedical-com.neomed.idm.oclc.org/content.aspx?bookid=1872&sectionid=146991371
2. Pharmacy Technician Code of Ethics. American Association of Pharmacy Technicians. Accessed on June 10, 2021. https://www.pharmacytechnician.com/pharmacy-technician-code-of-ethics/
3. Code of Ethics for Pharmacy Technicians. Accessed on June 10, 2021. https://thepharmacyprofessionals.com/code-of-ethics
4. Snelling PC. The metaethics of nursing codes of ethics and conduct. Nurs Philos. 2016;17(4):229-249. doi: 10.1111/nup.12122. PMID: 27218833.
5. The Code of Conduct for Pharmacy Technicians. Accessed June 10, 2021.https://thepharmacyprofessionals.com/code-of-conduct
6. Accreditation Standards for Pharmacy Technician Education and Training Programs. 2016. Accreditation Council for Pharmacy Education. Accessed June 11, 2021.https://www.acpe-accredit.org/pdf/Standards2016FINAL.pdf
7. Honesty/Ethics in Professions. Gallup. Accessed July 1, 2021. https://news.gallup.com/poll/1654/Honesty-Ethics-Professions.aspx
8. Essentials of College and University Education for Professional Nursing. Final Report. American Association of Colleges of Nursing; 1986. (pp 6-7).
9. Buerki R, Vottero L. Ethical Responsibility in Pharmacy Practice. 2^nd 2002. Accessed June 11, 2021. https://books.google.com/books?hl=en&lr=&id=KCkdAIzqqlYC&oi=fnd&pg=PR9&ots=PFK7UcwLJp&sig=ynYMdQUoD9fR8CHz_Mc53itTkzc#v=onepage&q&f=true
10. American Pharmacists Association. Code of Ethics for Pharmacists. Accessed June 11, 2021. https://portal.pharmacist.com/code-ethics
11. Little J, Mark S. Pharmacy patient bill of rights: practice advancement from the patient perspective. Hospital Pharmacy. 2013;48(5):351-353. DOI: 10.1310/hpj4805-351
12. Pharmacy Technician Certification Board. Credentialing Guidelines and Requirements. Appendix A: Conduct Case Procedures. Accessed on June 12, 2021. https://www.ptcb.org/guidebook/conduct-case-procedures

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