Empirical Ethics The compliance of Iraqi pharmacists with ethical principles in applying the pharmaceutical care for diabetic patients Ehab Mudher Mikhael and Haydar F Al-Tukmagi Abstract Pharmacists play a central role in caring of diabetic patients. During patient-centered care, important ethical issues and conflicts may arise, which makes ethical skills for pharmacist important toward conflict-resolution so this study aimed to assess compliance of Iraqi pharmacists with ethical principles while providing their care to diabetic patients. A cross sectional study by a validated questionnaire format was given to a convenient sample of 95 community pharmacists in Baghdad—Iraq. The questionnaire assesses the ethical practices of each pharmacist by using indirect questions through a simulated case which is commonly encountered in private pharmacies in Iraq. Most participated pharmacists failed to respect patient autonomy and they are not encouraging their patients to participate in decision making about their treatment. Participated pharmacists also failed in applying ethical principle of veracity during educating the patient about serious drug side effects. Furthermore most pharmacists had financial conflict of interests that undermine the pharmacist ability to fulfill the primary professional and ethical obligation to ensure patient’s beneficence, justice and autonomy. Meanwhile most participated pharmacist may be good in maintaining their professional competence, yet the majority failed to develop their competence by keeping their knowledge up to-dated. In conclusion pharmacists failed to apply ethical principles during their usual care for diabetic patients. Keywords Diabetic patient, ethics, pharmaceutical care Introduction Diabetes mellitus (DM) is a heterogeneous metabolic disease with worldwide prevalence of more than 7.5%. 1–3 This prevalence is higher in Middle East coun- tries 4 approximating 20% in Iraq. 5 DM is associated with micro-vascular complications such as retinopathy, nephropathy and neuropathy; and macro-vascular complications such as myocardial infarction, hyperten- sion and peripheral arterial disease. 6 Control of blood glucose level is essential to prevent both acute and chronic complication of diabetes especially in newly diagnosed DM patients. 7 Pharmacists play a central role in caring for DM patients to ensure tight glycemic control through patient education about their drug usage and drug monitoring not only to assess drug safety and effectiveness but also to assess patient adher- ence to anti-diabetic medications. 8 As pharmacists move toward more patient-centered care, important ethical issues and conflicts may arise within the thera- peutic relationship, requiring the pharmacist to use ethical knowledge and skills for conflict-resolution. 9 With deeper understanding of the pharmacist to ethical principles and pharmacists’ code of ethics, an improved therapeutic outcome for the patient is likely to be achieved. 9 So this study aimed to assess the compliance of Iraqi pharmacists with the pharmacists’ code of ethics while providing their care to diabetic patients. Methods Sample size and study design A questionnaire was approved by ethical committee of Baghdad University—College of pharmacy (Appendix). The questionnaire was given to a sample of 95 community pharmacists who work in College of Pharmacy, Clinical Pharmacy Department, Baghdad University, Baghdad, Iraq Corresponding author: Ehab Mudher Mikhael, Baghdad 00964, Iraq. Email: ehab_pharma84@yahoo.com Clinical Ethics 0(0) 1–7 ! The Author(s) 2016 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1477750916657659 cet.sagepub.com Clinical Ethics OnlineFirst, published on July 14, 2016 as doi:10.1177/1477750916657659 by guest on July 17, 2016 cet.sagepub.com Downloaded from