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The vulnerabilities of pharmacists would appear to be invisible in the euthanasia/assisted suicide debates.
As healthcare systems and societies are changing, the social positions of doctors, pharmacists, nurses and patients within them were changing too. In the past, clinical experts’ authority and patients’ autonomy have been in conflict. The current patient-centered / person-centered model of medical care, aims to establish egalitarian relationships between patients and healthcare clinicians and providers .
Vulnerability can be defined as a lack of autonomy and independence, bodily and psychological insecurity, marginalized or deviant status, lack of acknowledgement within the society (1).Vulnerable groups are exposed to discrimination, intolerant attitude, subordination. Vulnerability is usually seen as an inherent quality of certain social groups (but not others). However it has many dimensions and might be attributed to relatively “powerful” groups (2). Doctors, pharmacists and nurses i.e. so called powerful groups, are rarely characterized as vulnerable groups, but within certain circumstances, they can be recognized as “vulnerable”.
Doctors, pharmacists and nurses are in a situation where they are becoming more controlled by the patients. There is an emphasis on the myth that citizens (patients) should be autonomous and the inevitability and normality of dependency is not recognised (3). Dependency is an unavoidable feature of...
Doctors, pharmacists and nurses are in a situation where they are becoming more controlled by the patients. There is an emphasis on the myth that citizens (patients) should be autonomous and the inevitability and normality of dependency is not recognised (3). Dependency is an unavoidable feature of any society and it is not a feature that is taken into account from the liberal perspective. The recognition of universal vulnerability suggests that the autonomy model will have to re thought (4).
Ethics has not paid attention to vulnerability for three possible reasons (5):
• Vulnerability is the antithesis of the individualistic ethics predominating in Western societies.
• Vulnerability is not addressed in ethics because philosophy ignores the body.
• Ethics has been prominently rationalist and therefore feelings have been displaced or have not been taken into account.
It is methodologically important not to define certain groups as (not) vulnerable by default (2). There are many potential sources of vulnerability, and each of these constitutes a different, overlapping layer. This metaphor of layers presents a contextual and variable concept of vulnerability, moving away from the fixed and static view (6). The vulnerability of professionals e.g. pharmacists remains invisible as it does not correspond with their social position. The sufferings (existential and moral) of pharmacists in particular are invisible, denied and ignored in the euthanasia/assisted suicide debates.
All forms of euthanasia and physician assisted suicide require lethal medications. The role of pharmacists in the pharmaceutical care/medication use process at the end of life is often ignored, written out or overlooked. In the main doctors and nurses are included in “conscientious objection” legislative protections. Pharmacists are often excluded from protection of their human right to freedom of conscience and the derived right of “conscientious objection”. Pharmacists in all working environments (pharmaceutical industry , community pharmacy, hospital pharmacy, palliative care pharmacy, long term care, care of people with disabilities including intellectual disabilities, general practice pharmacists, etc. ) will be part of the process (7).
We can understand our humanity in a broader sense only by recognizing our universal vulnerability and interdependence (8). Pharmacists and their patients and colleagues are vulnerable and autonomous. The end of life medication use process (natural death or intentional death ) is dependent on the involvement and expertise of pharmacists. Failure to recognise this makes individual pharmacists and the pharmacy profession vulnerable.
1. Liamputtong, P. Researching the Vulnerable: A Guide to Sensitive Research Methods; SAGE: London, UK; Thousand Oaks, CA, USA, 2007; 246p.
2. Societies 2020, 10(1), 5; https://doi.org/10.3390/soc10010005
3. Fineman, Martha A., The Autonomy Myth: A Theory of Dependency, New York, The New Press, 2004.
4. Rodriguez, Janet Delgalo. The Relevance of the Ethics of Vulnerability in Bioethics. The Ethics Forum. Volume 12, Issue 2–3, Automne 2017, p. 154–179 https://doi.org/10.7202/1051280
5. Hoffmaster, Barry, “What Does Vulnerability Mean?”, Hastings Center Report, vol. 36, no. 2, 2006, pp. 38-45.
6. Luna, Florencia, “Vulnerabilidad: la metáfora de las capas”, Jurisprudencia Argentina, IV, 1, 2008, pp. 60-67.
7. Flood, Bernadette. Pharmacists and assisted dying. BMJ 2020 https://www.bmj.com/content/368/bmj.m1139.full