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This was published when the organisation was the Royal Pharmaceutical Society.

As a pharmacist, you’ll often have to choose between several courses of action when deciding whether to supply a medicine or not. In some cases, there may be a conflict between your ethical duty to promote patient care and safety and legislation which restricts your action.

You may therefore need to choose the best option possible in the circumstances and be prepared to defend your decision. You can use this guide to break the decision-making process down into smaller steps.

If you need help exercising your professional judgment in prescribing scenarios, our prescribing scenarios guide can help.

What is professional judgement?

Professional judgement can be described as the use of accumulated knowledge and experience, as well as critical reasoning, to make informed, professional decisions – often to help solve a problem in relation to a patient or policies and procedures affecting patients. 

It considers the law, ethical considerations, relevant standards, and all other relevant factors related to the surrounding circumstances.

Furthermore, it will resonate with the core values, attitudes and behavioural indicators of professionalism.

Why is it important?

Professional judgement is required in the day-to-day work of all pharmacists, whichever sector you work in.

The process of making a professional judgement is underpinned by knowledge.

Professional judgement is key to handling ethical dilemmas. Ethical issues often arise in situations where acting in the patient’s best interests may be outside the legal constraints of normal practice.

Exercising professional judgement

Many pharmacists exercise their professional judgement instinctively, but it may be helpful to break the process down into smaller steps:

1. Identify the ethical dilemma or professional issue.
   • E.g., deciding whether to supply a medicine or not.
2. Gather all the relevant information and research the problem to obtain:
   • Relevant facts
   • Relevant knowledge
   • Relevant laws
   • Relevant standards 
   • Relevant good practice guidance
   • Advice from support services, head office, line managers or colleagues
3. Identify all the possible solutions.
   • Consider and act in the best interests of the patient.
   • Consider and appropriately manage any personal interests or organisational goals, incentives or targets.
4. Consider the benefits and risks, and advantages and disadvantages of each of the options.
5. Choose an option, ensuring that you can justify the decision.
6. Record of the decision-making process.
   • Include your reasons leading to a particular course of action where appropriate.
   • This may be a record in the patient’s medication record (PMR), medical record, the back of the prescription register or an intervention record book. Evidence the thought processes leading to the decision.

Different choices

It is entirely possible for two different pharmacists, faced with the same facts and circumstances, to choose two different courses of action. Both options could be ‘correct’, justified and legitimate choices for a significant proportion of pharmacists if faced with the same dilemma.

Why is it important to be able to justify a decision?

You must be able to justify the decision made because, often, the ethical dilemma or professional issue means that you are considering conflicting obligations.

These could be:

• Genuine patient interest
• Legal obligations
• Professional standards
• Public interest
• Contractual terms of service and company procedures

Professional judgement – a blanket defence?

It is important to point out that professional judgement is not a blanket defence, or a blanket reason, to take the most convenient choice. It must be exercised properly, logically and for valid reasons.

If there are legal mechanisms to achieve the required goal, it would be inappropriate to choose an illegal alternative. For example, lending medication would be very difficult to justify if an emergency supply could have been used.

How we can support you 

The RCPharm one-to-one support service is available to members to help guide them to exercise their professional judgement and confidently choose the best option for their particular circumstances. 

We can help to:

• Gather more information
• Provide advice on relevant legal or ethical obligations
• Identify courses of action
• Discuss benefits and risks of different options

Further information

RCPharm

• Prescribing scenarios – ethical decision-making guidance for prescribers.

External

• American Board of Internal Medicine. Project Professionalism (7th printing). Philadelphia: the board; 2001.
• Dale and Appelbe’s Pharmacy and Medicines Law e-book
• Elvey R, et al. (2011). Patient-centred professionalism among newly registered pharmacists. Pharmacy Practice Research Trust. (Available from: www.pharmacyresearchuk.org)
• General Pharmaceutical Council. Standards for pharmacy professionals. 2017 
• Pharmacy Law and Ethics Association (PLEA)
• Royal College of Physicians working party. Doctors in society: Medical professionalism in a changing world. London: the college; 2005
• Schafheutle E, et al. (2010). Professionalism in pharmacy education. Pharmacy Practice Research Trust. (Available from: www.pharmacyresearchuk.org)
• Wingfield J, Badcott D. Pharmacy Ethics and Decision Making. Pharmaceutical Press. London; 2007