1 to make difficult decisions regarding a

1978, a report passed in response to a public concern over the Tuskegee study that
ran from 1932 to 1972. This is known as the Belmont Report. 1According
to the Alzheimer Europe website (2010), the Belmont Report includes “ethical
principles and guidelines for the protection of human subjects of research
which outlines the three most important principles comprising of autonomy,
beneficence and justice” that are appropriately considered when dealing with
the well-being of the population. 1Throughout our health career
there will be situations that will cause us to make difficult decisions regarding
a limited amount of resources to be shared among a group of people. As the
director of pharmacy and a member of the Pharmacy & Therapeutic Committee,
it is my responsibility to decide on the administration of an antidote for the
population with lethal CUL (Cough Up a Lung). Half of the Committee members propose
a criterion to not administer the agent to the patient over the ages of 70
since the US average life expectancy is 78 years of age and the other half
opposes to this criterion. Based on the three principles of the 1978 Belmont
Report: autonomy, beneficence and justice, I personally oppose to the propose


First of all, I stand with the other half of
the Committee members to stretch the use of the available antidote by opposing
to the proposed criterion to not administer the agent to anyone over the ages
of 70 due to autonomy of all patients. 1 Autonomy defines as a
person’s ability to make a decision concerning his or her health without undue
influence but in full knowledge and understanding of the relevant information. People
have unconditional worth and should be given the respect they deserve. I believe
that I am responsible to obtain patient permission for treatment. Even in the
cases where the patient over the ages of 70 has dementia which involves a
deterioration of mental power, a power of attorney should be able to decide on
behalf of the patient. Thus, the autonomy of the patient is fully respected and
considered accordingly. Therefore, their treatment should not depend on the
decision of the members of the Pharmacy and Therapeutics Committee. In my
opinion, leaving out the patients 70 years and above do not have the chance of
making a decision when it comes to the treatment options. Thus, their autonomy
is not taking into consideration.

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Not only is not taking the patient’s autonomy
into consideration if the committee decides not to administer the agents to
anyone over the ages of 70 but also there is less benefit provided causing more
harm to the population. 5 In the New England Journal of Medicine’s
article concerning a lung herniation that was cause when the woman coughed to
hard leading her cough her lungs up. 5 The woman that had this
disease was 40 years of age. It could be that the majority of the population
with the lethal CUL could be in their late 40 and beyond. This will cause majority
of the population to suffer due to their age. 4 Also, in the oath of
pharmacy, as pharmacist we pledge to consider the welfare of humanity and
relief of suffering as our primary concern and also apply our knowledge,
experience and skill to the best of our ability to assure optimal outcomes for
our patients. Considering the proposed criterion of not administering the
agents to the population over the ages of 70 years old, the population do not
have the opportunity to make a choice in order to grant them the optimal care
they require. It is against our primary concern if the patients over the ages
of 70 are excluded from the treatment.


Last but not the least, the proposed criterion to
not administer the antidote to patients above the ages of 70 years old is
unjust. Justice defines as the way of treating a population fairly regardless
of the race, age or any other factor. According to the Alzheimer Europe website
(2010), in evaluating justice, there are three main areas required to consider
which include 3 “fair distribution of scarce resources, respect for
people’s right and respect for moral acceptable laws”. Through careful analysis
of the proposed criterion to not administer the agent to patient over the ages
of 70 years old, it does not appropriately consider fair distribution of scarce
resources. This is because to fairly distribute the antidote to the whole
population it is our responsibility to involve patients that are over the ages
of 70 years old even though they may have a very short time to live. The
patients over the ages of 70 have the right to be treated equally and in this
particular case they should be given equal access to treatment as the patients
younger than 70 years of age. The only exception includes a refusal to
treatment. In evaluating justice in this scenario, the people’s right should be
respected. In the United States constitution an amendment states, 3 “Access
to quality affordable health care is a basic human right that every American
deserves.” In the amendment, it emphasizes that “…is a basic human right that
every American deserves” which includes every single American whether they are
old or young. It does not discriminate by making the affordable healthcare only
accessible to a particular group in the population. In comparison to the
criterion proposed, I believe that we are infringing on the rights of the
patients over the ages of 70.


Not administering the antidote to patients over
the ages of 70 according to the Belmont Report established in 1978 shows
insensitivity of the will of the patients, contradicting the oath of pharmacy
and discrimination towards the older generation just because they have less
time to live. In my opinion, the patients that had an onset of the disease
earlier than others should be giving the antidote enabling the patients that
had a latter onset of the disease more time to wait for the new batch of
antidotes that will be later manufactured.































Alzheimer Europe. http://www.alzheimer-europe.org/Ethics/Definitions-and-approaches/The-four-common-bioethical-principles/Justice) Updated March 29 2009.

Accessed November 4, 2017.

are the Basic Principles of Medical Ethics. https://web.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of%20Making%20Babies/EthicVoc.htm) Accessed November 6,

release. United States Congresswoman Betty McCollum. (https://mccollum.house.gov/press-release/mccollum-introduces-america’s-right-health-care-amendment) Updated February 17,
2017. Accessed November 6, 2017.

of a Pharmacist. American Pharmacists Association. http://www.pharmacist.com/oath-pharmacist Accessed November 6,

M, Cleasby M. Lung Herniation after Cough-Induced Rupture of Intercostal
Muscle. The New England Journal of Medicine. 2012; 366:74