Ethical dilemma in medication risk and patient informed cons…

While rounding with a cardiology team in the hospital, I encountered an ethical dilemma involving medication risk and patient understanding. During rounds, a cardiologist recommended starting a newly approved anticoagulant for a patient with stable atherosclerotic vascular disease. The patient shared concerns about bleeding. In response, the cardiologist emphasized the benefits of the medication based on a recent clinical trial but did not explain that the same study showed a significantly higher rate of major bleeding. Because I was familiar with this study, I recognized that the patient may not have been given complete information needed to make an informed decision (Eikelboom et al., 2017). This situation raises ethical concerns related to patient safety, honesty, and informed consent. This ethical dilemma involves the patient, the cardiologist, the pharmacy student, and the hospital team. The main issue is that the patient is being asked to agree to treatment without full and fair disclosure of risks. When important information is left out, it is difficult to ensure that the patient truly understands what they are consenting to. This places the pharmacy student in a challenging ethical position of deciding whether to remain silent or speak up to protect the patients safety and understanding. Several bioethical principles apply in this case. Autonomy is affected because informed consent requires patients to receive complete and truthful information. Beneficence is present because the cardiologist is attempting to improve the patients cardiovascular outcomes. Non-maleficence is involved because anticoagulants carry a risk of serious bleeding, and failure to discuss this risk may lead to harm (Kaatz et al., 2015). Justice also applies, as all patients deserve honest and balanced information when starting high-risk medications (Beauchamp & Childress, 2019). To navigate this ethical challenge, there are several possible courses of action. One option is to remain silent and allow the cardiologist to continue the discussion without intervention. Another option is to speak directly to the patient and explain the bleeding risk, which could create confusion or interfere with the physicianpatient relationship. A third option is to speak privately with the cardiologist and discuss the missing risk information in a respectful and professional manner. The most appropriate course of action would be to privately speak with the cardiologist. This approach allows concerns about bleeding risk to be addressed without undermining professional relationships. It also gives the cardiologist the opportunity to provide balanced information so the patient can make an informed decision. This decision aligns with ethical expectations related to informed consent and respect for patient autonomy (AMA Journal of Ethics, 2012). Although this approach is appropriate, challenges may still exist. The cardiologist may feel the benefits outweigh the risks, or the patient may decide not to start the medication after learning about the bleeding risk. However, ethical practice requires respecting patient decisions when they are made with complete and honest information (Beauchamp & Childress, 2019). In conclusion, this ethical dilemma highlights the importance of transparency and patient advocacy in healthcare. By respectfully addressing the concern with the cardiologist, the pharmacy student supports patient safety, informed decision-making, and professionalism within the healthcare team. References Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 8th ed. Oxford University Press; 2019. Eikelboom JW, Connolly SJ, Bosch J, et al. Rivaroxaban with or without aspirin in stable cardiovascular disease. New England Journal of Medicine. 2017;377(14):13191330. Kaatz S, Ahmad D, Spyropoulos AC, Schulman S. Definition of major bleeding in clinical investigations of antihemostatic medicinal products. Journal of Thrombosis and Haemostasis. 2015;13(11):21192126. AMA Journal of Ethics. What should physicians disclose to patients? AMA J Ethics. 2012.