Exploring U.S. pharmacists’ willingness to fill prescriptions illegally, or not to fill prescriptions that are legal but morally offensive to pharmacists and the rationale behind their decision-making

  • Susan A. Hayes

Student thesis: Doctoral Thesis


The aim of this research was to determine the extent U.S. pharmacists are willing to fill ambiguous prescriptions or not fill legal prescriptions that may be morally offensive to the pharmacist, and the rationale behind their decision-making. Pragmatism is the research philosophy underpinning this study. The data was collected using an online survey of 5,839 U.S. pharmacists that yielded 362 responses. Five case studies and 21 moral statements were presented. Key findings of the case studies were that 612 (35.2%) decisions would have been to proceed illegally and 1,125 (64.7%) to proceed illegally. An ethical typology was assigned to each of the responses revealing no one ethical ideology with results evenly split between 638 virtue (35.9%), 570 deontological (32.1%) and 567 utilitarian/consequentialist (31.9%) responses. Training and corporate policies had little influence on ethical decision-making. With regard to the moral statements, respondents were most inconsistent concerning filling a placebo/assigning a price for an ineffective drug, breaching confidentiality to reveal to a patient the medication found in a spouse’s jacket and filling a fatal dose for a hospice patient. Respondents were most consistent in agreeing that PBMs do not pay enough for the work pharmacists perform.
The contribution of this research is an important one. Pharmacists are the gatekeepers of the national drug supply. Little academic research in the United States has been conducted in pharmacoethical and pharmacomoral decision-making and this research starts to fill that gap. Theory informs that providing pharmacists time and financial rewards for dispensing medication advice rather than solely dispensing products would reduce crime opportunities. Both decision-making and criminal justice theories that underpin this study were confirmed as ways pharmacists make decisions, that is, with an emphasis towards patient satisfaction above all else.
Date of AwardMay 2021
Original languageEnglish
Awarding Institution
  • University of Portsmouth
SupervisorBranislav Hock (Supervisor) & Mark Button (Supervisor)

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