Pharmacy Ethics Research Articles

Exploring Structures and Processes Supporting Interprofessional Education During Experiential Learning Placements for Student Pharmacists

ObjectiveTo explore stakeholder views on the structures and processes supporting planned and unplanned interprofessional education (IPE) during experiential learning (EL) placements for student pharmacists in Scotland. MethodsOnline semistructured group interviews were conducted with academic staff, practice educators, and EL facilitators (preceptors). Recordings were transcribed verbatim and analyzed thematically. Systems theory underpinned the study. Ethical approval was granted by the School of Pharmacy and Life Sciences Ethics Review Committee at Robert Gordon University. ResultsThree main themes were identified: current IPE delivery and context, factors affecting IPE delivery and student pharmacist learning, and rethinking current IPE provision. Stakeholder views provided valuable insights into presage factors relating to contextual elements (cultural, logistical, regulatory) and their influence on IPE delivery and interprofessional learning. EL facilitator and student pharmacist characteristics were also highlighted as influencing factors; process factors included examples of planned and unplanned IPE experiences on offer in community, hospital, primary care, and specialist areas of pharmacy practice; product factors highlighted the importance of IPE to support the development of collaborative competencies. Future developments need to focus on a continuum of IPE learning and a coordinated approach between higher education institutions and placement providers and interprofessional practice teams. ConclusionCurricular development and implementation of new IPE is not without its challenges. This study has provided a strong foundation that will inform future developments to ensure new initiatives are conducive to supporting effective interprofessional learning during placements.

Exploring community pharmacists’ views around HRT and the menopause

Abstract Introduction The number of women in England prescribed HRT has increased dramatically in the last seven years.1 Meanwhile, from 2018, HRT product shortages have resulted in the release of Serious Shortage Protocols allowing community pharmacists to supply alternative HRT products where appropriate.2 Furthermore, in 2022, the first over-the-counter medication for vaginal atrophy in menopause was licensed.3 With so many recent changes, it seemed an opportune time to determine community pharmacists’ views on the topic. Aim The aim of this study was to explore community pharmacists’ views around HRT and the menopause. Methods A qualitative approach using semi-structured interviews was chosen to allow for exploration of views. A list of community pharmacies from Stoke-on-Trent and Staffordshire was obtained from the NHS website. They were grouped into independent and multiple pharmacies in both urban and rural areas. Twenty pharmacies were then randomly selected from across the lists, emailed and invited to participate in the study; a participant information sheet and consent form was attached. This was followed up with a telephone call one week later, and a day and time for interview was agreed. Telephone interviews were undertaken, with consent obtained verbally, and the interview digitally recorded. The interview guide was developed based on the literature review and aim of the study. The guide addressed experiences of patient queries regarding HRT and the menopause, views of the OTC vaginal tablet and their confidence in discussing menopause with patients. Interviews were transcribed verbatim and thematically analysed. Ethical approval was obtained from Keele School of Pharmacy and Bioengineering Ethics Committee. Results Nine interviews were undertaken in October 2022, lasting 10 to 15 minutes. Five interviewees were male, five from urban areas, all from different companies and experience ranged from 3 months to 45 years. Four themes emerged from the transcripts, namely: increase in queries; managing shortages; lack of knowledge on Gina®; and limited professional interest in the topic. Patients were found to rarely ask about menopausal symptoms, with most queries related to risks associated with HRT or advice on various formulations. All pharmacists found dealing with shortages to be time-consuming and potentially stressful. Many of the pharmacists had not heard of the new vaginal tablet and did not stock it. Those who did, felt it was expensive and unlikely to sell. All stated they would like further training on the menopause but only one would consider specialising as a future area of prescribing. Discussion/Conclusion This was a small study with relatively short interviews, due to the time constraints facing working pharmacists. Despite this, similarity in responses suggest that data saturation may have been reached. This study confirms previous reports of increasing queries relating to HRT, particularly around shortages, and the stress associated with dealing with them. The pharmacists stated they would like further training on the topic, although CPPE packages on menopause are available. Despite the increased attention and prescribing of HRT, there was little desire to specialise and prescribe in this area; this should be explored further.

Micronutrient supplements as antioxidants in improving sperm quality and reducing DNA fragmentation

BackgroundSpermatogenesis and sperm quality may be negatively impacted by an increase in reactive oxygen species. This study investigates the efficacy of combined antioxidant therapy for treating male infertility, as measured by semen analyses and the sperm DNA fragmentation index (DFI). Infertile men with a high sperm DNA fragmentation index were instructed to take two oral micronutrient capsules daily for three months. Each antioxidant formulation contained 60 mg vitamin E, 400 µg folic acid, 30 mg selenium, 125 mg L-arginine, 220 mg L-carnitine, 7.5 mg coenzyme Q10, 40 mg L-glutathione, and 20 mg zinc citrate. At entry and post-treatment, the general characteristics, semen analysis, and sperm chromatin dispersion assays were recorded and compared.ResultsAfter three months of treatment with antioxidant compounds, the quality of spermatozoa improved significantly, as indicated by a decrease in the mean DNA fragmentation index from 45.6 ± 17.2% to 34.8 ± 20.3%; an increase in sperm concentration from 29.7 × 106/mL to 35.7 × 106/mL (p < 0.001), an increase in a total number of spermatozoa from 72.1 × 106 to 95.5 × 106 (p = 0.012), and an increase in the vitality from 75.5 ± 17.1 to 81.1 ± 14.4% viable forms (p < 0.001).ConclusionsMicronutrient supplementation can improve sperm quality and DNA integrity in infertile men. Men with infertility and significant sperm DNA fragmentation who take antioxidants for three months experience a reduction in DNA fragmentation index and an increase in sperm quality as measured by the semen analysis.Trial registrationNCT04509583. Registered 12 August 2020, Hue University of Medicine and Pharmacy Ethics Committee—Retrospectively registered.

Enabling Access to Pharmacy Law Teaching during COVID-19: Student Perceptions of MyDispense and Assessment Outcomes

During the COVID-19 pandemic, it was not always possible to teach pharmacy practice and practical dispensing skills in person. Second-year pharmacy students (n = 147) were given access to a virtual simulation tool, MyDispense, to supplement their learning. This software enabled students to work remotely and access exercises in a 'safe' community pharmacy setting. This study evaluated second-year pharmacy students' perceptions of MyDispense, and the impact on assessment performance in the pharmacy law and ethics module. Students were able to access 22 MyDispense activities throughout the academic year (2020/2021). Exercise completion rates and assessment marks were analysed, along with findings from a cross-sectional survey about user experience. MyDispense data were available for all students (n = 147), and 76.1% (n = 115) completed the survey. The mean number of MyDispense exercises completed was nine. Higher levels of MyDispense exercise completion were associated with higher pass rates and mean scores (no exercises completed versus 1-10 activities completed: mean score 77.1 versus 83.1, respectively) and a statistically significant association between exercise usage and in-class assessed prescription scores. Overall, 46.1% (n = 53/115), 33.0% (n = 38/115) and 33.9% (n = 39/115) of students felt that MyDispense had helped them to prepare for their assessed prescriptions, mid-module test, and final exam, respectively. MyDispense has provided an accessible alternative to in-person teaching for students during the COVID-19 pandemic, and results showed a positive association with assessment performance in pharmacy law and ethics.

Assessment of Moral Development Among Undergraduate Pharmacy Students and Alumni

Objective. This study's principal aim was to assess the moral development of undergraduate pharmacy students and alumni at a university in Jordan.Methods. Using the Professional Ethics in Pharmacy (PEP) test, the moral reasoning of 512 pharmacy students and alumni was assessed in a cross-sectional design. The main assessment measure was the Principled Morality Score, which reflects an individual's level of moral judgment development and is given as a percentage, where higher values indicate greater moral development.Results. The response rate was 49%. The median Principled Morality Score was 16.7, with no significant differences observed across all five cohorts. No significant differences in median Principled Morality Scores were found between men and women (16.7 vs 20, respectively). Also, no significant differences in median Principled Morality scores were observed between students who had completed the ethics course versus those who had not completed the ethics course at the time of data collection (median Principled Morality Score 20 vs 16.7, respectively). No trends in median Principled Morality Scores were observed.Conclusion. In this study, the professional moral reasoning of prospective pharmacists was lower than expected. A further longitudinal study of the cohort, which attempts to correlate moral development with age, sex, education level, and moral education strategy, is warranted.

Interprofessional education during experiential learning placements for student pharmacists in Scotland. Exploring current support provision and stakeholder views

Abstract Introduction Increasing global awareness that interprofessional team working is essential within modern healthcare systems has led to regulatory bodies mandating the inclusion of interprofessional education (IPE) within undergraduate curricula. The General Pharmaceutical Council specifies in the 2021 initial education and training standards the requirement for an interprofessional learning plan in which “IPE must mirror practice”.1 Pharmacy educators are intensifying their efforts to ensure student pharmacists are presented with opportunities to develop collaborative competencies. Curricular development and implementation initiatives must explore structures and processes to ensure that experiential learning (EL) environments are conducive to supporting student pharmacists’ interprofessional learning. Aim To explore structures and processes needed to support effective planned and unplanned IPE during EL placements for student pharmacists. Methods A mixed methods approach underpinned by the Biggs 3P theoretical framework was adopted.2 This included (1) A document analysis reviewing resources including student pharmacist/EL facilitator university handbooks and NHS Education for Scotland Preparation for Facilitating Experiential Learning (PFEL) training - a mandatory requirement for all EL facilitators hosting student pharmacists on placement in Scotland. (2) A pre-piloted online survey distributed to EL facilitators. Survey development, guided by the Interprofessional Facilitation Scale, aimed to encourage EL facilitators to self-evaluate their own IPE facilitation skills.3 The final survey tool included ten items with responses rated on a 4-point Likert scale (Poor, Fair, Good and Excellent) and a demographic section (3) Online semi-structured focus groups/dyadic interviews conducted with six EL facilitators, four practice educators and two academic staff were recorded and transcribed. Descriptive statistics were employed for quantitative data generated from the survey tool; for qualitative data content analysis was applied to develop emerging themes. Ethical approval was granted (S292) from the School of Pharmacy and Life Sciences Ethics Review Committee at Robert Gordon University. Results (1) The document analysis concluded that although the resources reviewed could not be specifically classed as training to support IPE, data collected provided context to EL placements and the training and pre-activities that student pharmacists and EL facilitators complete. Three main themes emerged: “Lack of specific IPE training focus”, “Varied terminology”, “Lack of IPE pre-learning activities”. (2) The survey was completed by ninety EL facilitators working in various practice settings: hospital 41.1% (n=37); primary care 25.6% (n=23); community 21.1% (n=19); academia 2.2% (n=2); other 8.9% (n=8). Survey responses indicated that 51.1% (n=46) and 42.2% (n=38) of respondents rated their ability to role model positive interactions with other healthcare professionals as good and excellent. However, responses to items relating more specifically to IPE facilitation skills indicated a lower confidence level. (3) Initial themes emerging from focus groups/dyadic interviews include “Profession-related perceptions of IPE”, “Factors influencing IPE delivery and student learning”, “Factors influencing future developments”. Discussion/Conclusion This exploratory study has provided valuable insight into multifactorial aspects affecting IPE during EL placements; this will be used to guide future development of IPE initiatives. One limitation is that student pharmacists were not included in this study; the next phase of this research programme will explore student pharmacists’ perceptions of IPE in EL.

Case analysis in ethics instruction: bootlegging theory in a topical structure

Robert Veatch was a notable and prolific author in a variety of areas in philosophy, health care practice, and policy. However, it is evident by the sheer number of case study in ethics books, eighteen editions of case collections in all, that this approach to teaching ethics in the health sciences was especially important to him. A few of these case study collections he wrote alone, but the majority were written with co-authors from nursing, dentistry, pharmacy, allied health, and medicine, drawing on their respective areas of disciplinary expertise and experience as educators. The aim of this article is to focus on the pedagogy and framework Veatch developed to expose students to the rudiments of philosophical ethics so they could understand the conflicts between values, principles, and ethical theories. Authentic clinical cases, he believed, were a useful way to engage students. Putting the two ideas together, Veatch argued the best method of structuring cases is "bootlegging theory in a topical structure" (Veatch, Robert M., Case analysis in ethics instruction. In: Amy Haddad (ed) Teaching and learning strategies in pharmacy ethics, Creighton University, Omaha, 85-97, 1992). Veatch's rationale for this carefully planned systematic arrangement between case topics and philosophical ethics content are presented. The influence and input of co-authors from different disciplines are explored regarding case development and commentary content. Finally, the impact of these interdisciplinary case study textbooks on ethics instruction in the health sciences is evaluated.

Use of Situational Judgment Tests to Teach Empathy, Assertiveness, Communication, and Ethics

Objective. The objectives of this study were to develop situational judgment test (SJT) scenarios for use in teaching empathy, assertiveness, and interprofessional communication in second-year pharmacy (P2) students and ethics in third-year pharmacy (P3) students, determine whether the SJTs developed were effective at measuring students' communication skills and ethical judgment, compare the performance of individual third-year students to the performance of teams of third-year students on the ethics SJT, and evaluate student feedback about SJTs as a teaching tool.Methods. Pharmacy faculty developed five SJT scenarios related to communications and five SJT scenarios related to ethics and piloted the scenarios with P2 and P3 students, respectively. Second-year students completed SJTs individually, while P3 students completed SJTs individually and in teams. Scenarios and responses were discussed with faculty after completion of the SJTs, and students completed a questionnaire to provide feedback on the SJTs.Results. The communications SJT was completed by 59 P2 students with a mean score of 67.5%. The ethics SJT was completed by 57 P3 students with a mean score of 80.1%. The ethics SJT was also completed by 10 teams of P3 students resulting in a mean score of 93.2%. Students indicated the SJT content was realistic and the tests provided the opportunity to reflect on how to approach challenging situations.Conclusion. Situational judgment tests were useful for teaching empathy, assertiveness, interprofessional communication, and ethics in pharmacy students. Future research should focus on predictive validity of SJTs for these content areas.

The Concept of Pharmacy Ethics and the Examples of Ethical Dilemmas Encountered by Pharmacists in the Asir Region, Saudi Arabia: A Qualitative Study.

IntroductionPharmacists’ involvement in patient care is expanding. The inclusion of this function within a complex healthcare system populated by demanding patients may create ethical challenges. In Saudi Arabia, few studies have been conducted on pharmacy ethics, and the available data are quantitative in nature. Thus, there remains a need for a qualitative assessment of the ethical dilemmas facing pharmacists.MethodsThis exploratory study utilized a qualitative methodology that included open-ended, in-depth, semi-structured interviews, followed by content analysis. The study recruited credentialed pharmacists from community and hospital pharmacies. Themes and codes were created and classified.ResultsEighteen pharmacists were interviewed, and their responses were categorized into eight areas of ethical dilemma: beneficence and non-maleficence, autonomy, justice, confidentiality, veracity, communication skills, sincerity and religion, and law. Taken together, it appears that most of the ethical challenges to the practice of pharmacy center on the theme of beneficence and non-maleficence. Additionally, it was found that some social and religious practices and beliefs contribute to the formation of participants’ ethical backgrounds.ConclusionThese findings may aid in the development of national pharmacy ethics guidelines in Saudi Arabia. Additional quantitative research is necessary to confirm the study’s findings.

The ethical challenges in pharmacy practice in community Pharmacies: A qualitative study

BackgroundPharmacists as a group of health care professionals, face different types of ethical challenges in their everyday routine that may impede pharmaceutical care. ObjectivesIn this study, we aimed at evaluation and recognition of the ethical challenges of pharmacy practice in community pharmacies. MethodsThis exploratory study was conducted as a qualitative study consisting of open-ended in-depth interviews and focus group discussions followed by content analysis. The study participants were chosen from pharmacists with PharmD degree who had at least 4 years work experience and were the founders or technical managers of community pharmacies, either as governmental or private. Interviews continued until data saturation and transcribed verbatim. The content analysis was done by Graneheim and Lundman method. The codes were generated, and categorized. After assessment and final modifications, the results of the study were discussed and confirmed in a focus group discussion conducted by 7 experts who teach medical ethics and/or pharmacy ethics. ResultsOverall, 40 pharmacists were interviewed (mean age 46 ± 11.3 years). The extracted ethical challenges of pharmacy practice were categorized into 3 main themes, 11 subthemes and 102 codes. The themes were achieved as challenges related to professionalism and professional practice, challenges related to professional communications and challenges related to regulations and policies. ConclusionTaken together, it seems that most of the challenges of pharmacy practice are related to professionalism and professional commitment; however, the regulations and policies provide serious obstacles for pharmacy practice and pharmaceutical care. More efforts towards teaching professionalism and modification of regulations and policies are recommended.

Exploring and evaluating Vertically Integrated Teaching in Ethical Decision-Making (VIT-EDM) in pharmacy

Background: With increased patient-centred care, pharmacists are often faced with ethical dilemmas and expected to provide solutions for practice dilemmas, relying on ethical judgment, principles of professional ethics, standards of practice, and moral reasoning capabilities. Pharmacists need to be competent in ethical decision-making which will enable them to act in a morally preferable and justifiable manner with patients. Literature has shown that moral reasoning skills are teachable and measurable competencies in healthcare. Objective: To evaluate the impact of implementing a vertically integrated teaching approach in ethical decision-making (VIT-EDM), on moral reasoning capabilities of pharmacy students as they progressed from year-one (pre-exposure to teaching intervention) to final year (post-intervention) of pharmacy studies, using the Professional Ethics in Pharmacy test (PEP) as a surrogate measure of moral reasoning capabilities. Methods: Cross-sectional, parallel cohort, comparison study, using PEP. A de-identified electronic survey link was emailed to enrolled students in each targeted cohort. Descriptive and inferential statistics were conducted using SPSS. Results: Fourth-year students’ confidence measures were significantly higher in decision-making. Furthermore, students’ decision-making and moral reasoning measures were higher in fourth-year students. They generally demonstrated moral reasoning capabilities belonging to stage four of moral reasoning levels, which is related to benefitting patients while respecting authorities and legal requirements. However, the difference in the P-scores (fourth-year and first-year) was not found statistically significant. Conclusion: Findings of this study underlined the positive impact of the (VIT-EDM) approach, a relatively novel mixed-method pedagogy in teaching pharmacy ethics. It highlighted the enhanced confidence of students in ethical decision-making when facing an ethical dilemma.

Ethics education for contemporary clinical pharmacy practice in Africa.

The paradigm shift to a patient-centred pharmacy practice model has resulted in dramatic increases in the number and variety of ethical and other dilemmas that confront pharmacists in their routine practice. However, ethical problems may go undetected by many pharmacists in most developing countries. Hence, there is a huge need for sound educational preparation of future pharmacists before they are faced with an urgent decision. This paper highlights the urgent need for pharmacy ethics to be adequately taught in schools of pharmacy, especially at the undergraduate and professional levels, so that future pharmacists can begin their professional careers with adequate ethical knowledge, skills, competencies and experience to detect and resolve ethical dilemmas of the contemporary patient-centred pharmacy practice.

Pharmacy education during and beyond COVID-19 in six Asia-Pacific countries: Changes, challenges, and experiences

The COVID-19 pandemic shifted pharmacy education to remote teaching and learning (T&amp;L) strategies. To share changes, challenges, and experiences in pharmacy education among member countries, the Federation of Asian Pharmaceutical Associations hosted a 1.5-hour webinar on 15th May 2020. Questions collected during registration and the live webinar were coded using thematic analysis. A total of 794 participants from 18 countries/territories registered, while 346 attended the webinar. Of 445 questions, 392 were from the registration form and 53 from the webinar. All questions were coded to four major themes: new normal pharmacy education, ethics and safety, material accessibility, and teaching and evaluation methods. Questions during registration were mostly on new normal adaptation (n=79), T&amp;L formats (n=65), and access/resources/ sustainability (n=59). Webinar questions were mainly on assessment format (n=13), laboratory skills (n=9), and access/resources/sustainability (n=9). The webinar provided an opportunity to quickly identify issues regarding pharmacy education during the COVID-19 pandemic for prompt actions and further research.

Tribute: Joy Wingfield

I was shocked and saddened to learn of the sudden and untimely death of my friend and colleague, Joy Wingfield, whom I had known for many years. Others will write about her roles as an academic, as an author, and as founder of the Pharmacy Law and Ethics Association, but I would like to pay […]

Joy Wingfield (1947–2021)

Joy Wingfield, professor of pharmacy law and ethics and a Fellow of the Royal Pharmaceutical Society (RPS), has died aged 73 years. Wingfield qualified as a pharmacist in 1971 and within six years had risen to become an inspector for the Royal Pharmaceutical Society of Great Britain (RPSGB). In 1986, she took up the role […]

RPS pays tribute to pharmacy law and ethics pioneer Joy Wingfield

RPS pays tribute to pharmacy law and ethics pioneer Joy Wingfield

Lanthanide-semiconductor probes for precise imaging-guided phototherapy and immunotherapy

Abstract Objective: Immunotherapy is an effective tumor treatment strategy. However, its long treatment cycle limits its wide application across all cancer types. In this study, we optimized upconversion nanoparticles and manganese composite particles with a porous structure as a nanoplatform for synergistic photodynamic therapy (PDT) and photothermal therapy (PTT), and subsequent longer-term immunotherapy. Methods: The morphology, phase, and stability were first characterized to evaluate the biocompatibility of this material. The upconversion and near infrared II luminescence properties of the material and its stimuli-response effect were assessed from the absorbance and photoluminescence spectra. Phototherapy including PDT and PTT was demonstrated in vitro and in vivo, and immunotherapy was used to enhance the phototherapy. This study was approved by the School of Pharmacy's Ethics Committee of Tumor Hospital of Shaanxi Province, Xi’an Jiaotong University, China (approval No. XJTULAC2020-585) on April 2, 2020. Results: The nanoplatform showed good PDT and PTT effects with high upconversion luminescence, and exhibited a more sensitive glutathione response (detection limit: 55 μg/mL) using fluorescence recovery than that based on absorbance recovery, with the detection range extending up to 1.2 mg/mL. When the surface of the composite particles was modified with an anti-PD-L1 immune checkpoint inhibitor, it targeted A549 lung cancer cells. The resulting immune response enhanced the long-term anti-tumor effect of the therapy, especially in lung cancer patients with high PD-L1 expression. Conclusion: The designed composite can be simultaneously used to detect the glutathione concentration based on luminescence recovery in the tumor cells and as a theranostic nanoplatform for synergistic immuno-phototherapy when combined with an antibody.

A commentary on ethical decision-making in the pharmacy profession and the APhA Code of Ethics

The American Pharmacists Association Code of Ethics (“Code”) was established in 1852 and has undergone 5 modifications, most recently in 1994. As point of care shifts from product to cognitive clinical service, pharmacists are expected to encounter an increasing quantity and complexity of ethical and moral dilemmas. In view of this professional transformation and current worldwide challenges, this seems an appropriate time for dialogue on a modification of the Code. The 3 important questions before the profession are as follows:(1) Is the scope of available ethical guidance adequate?(2) Are pharmacists competent in ethical decision-making?(3) Is current pharmacy education and training adequately preparing students for ethical decision-making?The first question is included as part of the Pharmacy Law, Ethics, and Risk course at the University of Utah College of Pharmacy. The following commentary is based on a student’s persuasive paper that the Code should remain unmodified owing to the following factors: greater detail does not ensure improved guidance, and modification may lead to confusion in professional role and responsibilities and may not consider patients’ values and preferences in decision-making. To improve ethical decision-making in the pharmacy profession, this commentary further suggests that questions 2 and 3 are key to facilitating improved readiness and competency in pharmacists’ ethical decision-making. Pharmacy students should be given a more thorough education in ethics, and practicing pharmacists should continually expand their knowledge and continued professional development in ethics.

Towards HCV elimination among people who inject drugs in Hai Phong, Vietnam: study protocol for an effectiveness-implementation trial evaluating an integrated model of HCV care (DRIVE-C: DRug use & Infections in ViEtnam–hepatitis C)

IntroductionIn Vietnam, people who inject drugs (PWID), who are the major population infected by hepatitis C virus (HCV), remain largely undiagnosed and unlinked to HCV prevention and care despite recommended...

Ethics Education for Contemporary Clinical Pharmacy Practice in Nigeria: Shortfalls and Needs

The past decade has witnessed a shift in the ambitions of pharmacists away from the core role of dispensing medicines towards more interesting and rewarding relationships and responsibilities with other healthcare providers and patients. The patient-centred role of pharmacists has allowed ethical issues experienced in medical practice to surface in pharmacy practice, resulting in an increase in the number and variety of ethical dilemmas that pharmacists face in their routine pharmacy practice. Pharmacy education prepares pharmacy students for practice and must be in tune with the professional dynamics. Many countries that provide patient-centered pharmacy services have redesigned pharmacy ethics education while others are in various stages of revision of their curriculum in order to adequately equip future pharmacists with the rudiments required to handle ethical issues in clinical pharmacy practice. In contrast, in Nigeria, little or no pharmacy ethics is taught to pharmacy students and the challenge lies with the curriculum design and method of teaching.