Ethics and the Pharmacist

Controversial issues such as late-term abortion, euthanasia, physician-assisted suicide and contraceptives have dominated the news in recent month. Because of their controversial and difficult nature, these issues represent the need for the study of ethics.

Merriam-Webster defines ethics as “an area of study that deals with ideas about what is good and bad behavior; a branch of philosophy dealing with what is morally right and wrong.” Because ethics and healthcare are closely tied, students in Cedarville University’s School of Pharmacy are challenged with, exposed to and prepared for many ethical issues, both present and future.

Jeff Lewis, associate dean of the School of Pharmacy, began his career at Cedarville in 2009. Lewis said that as part of the University, the School of Pharmacy considers ethics a critical part of its curriculum.

“In every aspect of our curriculum, or even extracurricular work, we are attempting to help students understand how (ethics) fits in with the larger story of the gospel,” he said.

Lewis said Scripture is the basis for the School’s ethical principles. These principles, he said, aid students when they are faced with difficult ethical dilemmas.

“We are trying to uphold the truths of Scripture in the midst of the complexities of, in our case, the healthcare system,” he said.

Lewis said studying ethics allows students to understand who they are as part of God’s creation and how to relate to others. He said students must be prepared to care for patients who may not share the same values, religions or worldviews as they do. Conversations, course work and practical experiences throughout the professional program help pharmacy students develop their ethical stances, Lewis said.

Lewis said pharmacy students at Cedarville are exposed to ethical issues through case studies and clinical work. In each year of the professional program, students take part in clinical rotations through Introductory Pharmacy Practice Experiences (IPPE) and Advanced Pharmacy Practice Experience (APPE). After their clinical work, students are required to write reflection papers about specific ethical issues that arose during the experience.

However, Lewis said students also discuss ethical issues in almost every class.

“Every course that we have has essentially ethical components, and our faculty are always engaging in discussions about ethical issues as they arise,” he said. “We are grateful that we are in a place where we can actually do that.”

Center for Bioethics

Cedarville’s School of Pharmacy is divided into two departments, pharmacy practice and pharmaceutical science. Within the pharmacy practice department, one Cedarville professor, Dr. Dennis Sullivan, has dedicated his career to teaching students about ethical issues.

Sullivan, professor of pharmacy practice, is the director of Cedarville’s Center for Bioethics. Before coming to Cedarville, Sullivan served as a missionary and practicing surgeon in both Haiti and the Central African Republic. He was the medical director of an 80-bed hospital in the Central African Republic, but he and his family were moved to the U.S. when the country erupted in civil war. When Cedarville asked Sullivan to teach anatomy and physiology part time in 2004, he said he gladly agreed and changed his career to being a professor. Sullivan then pursued graduate training in bioethics, which he said is now his main academic area. He began the Center for Bioethics in 2006 and since then has primarily taught classes that focus on ethics.

The Center for Bioethics began as part of Sullivan’s vision for Cedarville. Sullivan said the Center’s goal is to encourage and promote academic work in clinical ethics. The Center’s many outlets include a peer-reviewed journal called “Bioethics in Faith and Practice,” a podcast and blog entitled “Bioethikos,” various speaking events and social media.

The main course Sullivan teaches is bioethics, which is currently offered only to P3, or sixth-year, pharmacy students. However, Lewis said the class will soon be offered to first-year graduate pharmacy students. He said this change will allow students to be exposed to ethical discussions at the beginning of the professional program.

Teaching ethics in the classroom

Sullivan said his approach to teaching ethics has two distinctive features. First, he strives to teach normative ethics rather than Christian ethics. He said normative ethics is the set of ethical standards that applies to all people, not just Christians.

To explain the concept, he used the example of abortion. Christians believe that abortion is wrong not just for other Christians, but for all people, he said. This is a case in which individuals use normative ethics, he said. In normative ethics, Sullivan said he teaches the general principles that have been accepted by the medical community for thousands of years. He said he teaches this way so his students are prepared to face ethical issues in secular environments.

When I train my students, I train them to enter the pluralistic marketplace of healthcare,” he said. “I’m training them to understand normative ethics so that they can work in a setting where their faith position may be the minority … yet they can still take a stand based on generally accepted secular principles.

Second, Sullivan promises a safe learning environment. While ethical discussions are often controversial, he said, students’ ethical convictions never affect their grade in the class.

“I have some very strong ethics opinions. But I have a safe classroom. Students agreeing with me on their particular conclusions has nothing to do with their grade,” Sullivan said. “I want them to arrive at their convictions because they’ve been convinced by the arguments and the evidence themselves.”

Sullivan said his bioethics class has four main components. First, he incorporates ethical theory, which is the study of the different approaches to ethics. Second, he includes human personhood, which is unique to Cedarville’s curriculum. Human personhood teaches students the foundation of the inherent value of humans, from theological, philosophical and scientific arguments. Third, Sullivan teaches historical ethics, or the history of the study of ethics, from Hippocrates to the modern era. Lastly, Sullivan touches on specific areas of ethics, such as end-of-life ethics, beginning-of-life ethics and genetic ethics.

Ethics today and tomorrow

Sullivan said the major ethical issues of today are abortion and assisted suicide, but more recently, the issue of professional right of conscience has gained attention. This refers to health professionals’ right to not be complicit with a moral evil, he said.

For example, while both physicians and nurses are allowed by Ohio law to choose not to refer a patient to an abortion clinic, pharmacists are not protected in this way. Yet Sullivan cautions that pharmacy students should exercise their rights with care and caution.

“If you’re going to exercise your right of conscience, you’re going to have to be thoughtful, careful and reason through it,” Sullivan said, “because otherwise you could really hurt the cause of Christ.”

Lewis said pharmacy students should be prepared to face future ethical issues, as well as those that are current.

“We’re trying to prepare (students) to address those dilemmas that don’t yet exist by giving them a solid foundation of principles and processes for evaluating a dilemma,” Lewis said.

Sullivan said he sees four coming ethical challenges in pharmacy and general healthcare. First, he said as abortion becomes easier, it will come with fewer consequences. Second, Sullivan said, healthcare will become more limited or rationed, based on utilitarian principles. For example, the elderly could become deprived of medical care based on their decreased “use” to society. Third, he said medicine will become more dehumanized and impersonal, especially as health professionals are pressured to see more patients in less time. And fourth, he said that as new technologies are developed, new challenges will arise, especially for beginning-of-life ethics and endof-life ethics.

While Sullivan said he incorporates Christian principles into his ethics classes, he said his goal is to teach his students multiple ethical theories and to equip them to use each theory well. These theories, he said, are sources outside of Christianity that students can rely on when making ethical decisions.

“We have to recognize that although Scripture is our primary source of ethical guidance, Scripture is not comprehensive. It doesn’t cover every possibly contingency,” he said. “We have other sources of wisdom.”

Students should use God’s gift of reason when making ethical decisions, he said.

Jeb Ballentine, associate professor of pharmacy practice, said the School of Pharmacy works to prepare students for future issues by equipping them with principles and processes.

(We are) giving you the tools to approach that problem the same way every time,” he said. “The variables will change a little bit, but the ultimate formula won’t.

Ballentine, who has been a professor at Cedarville for five years, said pharmacy is by nature a profession filled with ethical dilemmas.

“We’ve all entered this profession because we want to help people and heal people, but at the same time, because we are dealing with drugs, it’s a very regulated profession,” he said. “Almost daily your desire to heal is going to come into conflict with the laws you are bound to follow.”

Regarding right of conscience, Ballentine said a pharmacist’s current right in almost every state to choose which prescriptions to fill may change in coming years. However, he said that even though ethical issues will continue to fluctuate, students should make it a priority to learn about ethical issues and develop their own stance.

“The issues keep changing, but your values don’t and your approach to the issues shouldn’t,” he said.

Pharmaceutical sciences

Those more focused on pharmaceutical sciences also have their fair share of ethical dilemmas with which to grapple.

Elisha Injeti, vice chair and associate professor of pharmaceutical sciences, began working at Cedarville in 2009. Injeti said he became interested in the field of bioethics during his graduate studies when he began teaching a laboratory course on animal experimentation and research. He said he started asking questions such as, “What is the right way to treat animals, and who decides that?”

Injeti pursued further studies in bioethics, and when he arrived at Cedarville, he joined the Center for Bioethics.

Injeti said it is important for pharmacy students to know how to conduct research in an ethical manner.

“There are ethical principles that you follow when you are working with human research and when you are working with animal research,” he said.

Injeti said ethical issues, such as stem cell research, synthetic biology and research methods, face those in the field of pharmaceutical science.

Injeti said that, ultimately, students must make ethics a priority in order to serve and glorify God.

“We are called to do everything for his glory,” he said. “So, how can you do everything for God’s glory if you don’t even understand how God expects you to treat your research subjects?”

The Christian component

Cedarville students have a distinct opportunity to engage in meaningful discussions about ethics because of the structure of the university, Lewis said. He said that while other universities have similar approaches for teaching ethics, Cedarville uniquely combines Christian principles and Christian students.

“This is the only school of pharmacy where we not only have … Scripture as our guiding principles, but we also have a student body who professes a relationship with Christ,” he said. “It does offer a unique opportunity to train in a fashion that is not available anywhere else.”

Kjersti Fry is a sophomore pharmacy major and campus news editor for Cedars. She enjoys playing piano and ultimate frisbee and spending time with friends and family.

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