saves cognitive resources in stressful environments, a situation healthcare professionals often find themselves in (Hall, 2017). Drawing on these stereotypes enables the healthcare professional to make timely decisions based on the minimal information available in times of fatigue, tiredness, heavy workload, uncertainty and inadequate support (Stone and Moskowitz, 2011). Nonetheless, it remains that there is a clear link between IB and the quality of care delivered and how it potentially influences the healthcare professionals ability to engage in person‐centred care (Merino et al., 2018). Fitzgerald and Hurst (2018) stated that a healthcare professionals IB behaviour towards marginalised groups can impact on the service user's access to healthcare service by producing false diagnoses, non‐referral to appropriate services, limiting treatment options or withholding of treatment. Goyal et al. (2015) detailed how IB may have contributed to the creation of health disparities, as African‐American children were less likely to receive adequate pain management post‐appendectomy than their white counterparts. IB influences within clinical interactions can leave the service user feeling uncomfortable as they pay attention to the healthcare professionals non‐verbal mannerisms, such as eye contact, physical closeness and speech errors which can demonstrate the healthcare professionals dislike or unease of dealing with particular clientele (Stone and Moskowitz, 2011). This in turn may not only impede patient–healthcare professional communication, but may also affect patient concordance and willingness to seek future care.
Puddifoot (2017) highlighted that IB can cause an ethical dilemma, demonstrated earlier, as there is potential to do harm within these client groups through the healthcare professionals judgment and behaviour based on their IB. Positive beneficence requires the healthcare professional to consider benefits for others alongside balancing the risks (Baillie and Black, 2015), which is compromised through the harbouring of IB. Such behaviours are in direct contradiction of the professional regulatory bodies' codes of professional performance; therefore, the healthcare professional should reflect upon how they interact with certain client groups to develop awareness of any implicit biases they may have (Lang et al., 2016). Additionally, Stone and Moskowitz (2011) recommend learning courses to expand the healthcare professionals cultural competence by learning about IB.
There are a number of guidelines set out by various professional bodies in relation to pharmacology. The General Medical Council (GMC) have outlined expectations of doctors' ethical prescribing practices which aim to provide more detailed advice on how to apply ethical principles when prescribing and managing medicines (2013). Additionally, largely in response to the withdrawal of the Medicines Management standards by the NMC (2015), the Royal Pharmaceutical Society and the Royal College of Nursing collaborated in developing the ‘Professional Guidance on the Administration of Medicines in Healthcare Settings’ (2019). These standards seek to promote patient safety in relation to the administration of medicines by acknowledging the importance of guidance for health professionals that is enabling and supportive while being clear and concise. The document recognises the importance of a commitment to ethics, values and principles which put patients first. It is incumbent upon the individual healthcare professional to ensure that they are familiar with the most current guidance related to their own sphere of practice to ensure that ethical and legal considerations are applied.
Clinical considerations
All healthcare professionals have a responsibility to ensure that they are familiar with legislation related to the prescribing, storage and administration of medicines within their sphere of practice. A list of key documents that will support you in the development of knowledge in this area is offered in the Further Reading section.
Research
The legal and ethical standards which govern research into pharmacological treatments are very specific to the context of clinical drug trials. During the Second World War, Jewish prisoners in Nazi concentration camps were used as subjects in medical experiments against their will, leading to permanent disfigurement, disability, trauma and in many cases death. In response to these atrocities, the Nuremberg Code (1947) was developed as international guiding ethical principles for the conduct of research involving human participants. They include principles of informed consent, non‐coercion and the right to withdraw, as well as the importance of robust protocols underpinned by beneficence. These principles were later encapsulated within the Declaration of Helsinki (World Medical Association, 2008) and further legislation has evolved to ensure the safety of human participants in clinical trials including: Data Protection Act (2018), Human Tissue Act (2004) and the Medicines for Human Use (Clinical Trials) Regulations (2004) as well as the Human Rights Act (1998).
Research is an important mechanism for healthcare professionals to ensure that the drug treatments we offer patients are thoroughly tested for safety and efficacy. Additionally, there is strong evidence emerging that research‐active hospitals have better patient outcomes, highlighting the importance and the responsibility healthcare providers have to offer their service users the opportunity to be involved in clinical trials (Ozdemir et al., 2015). It is essential that legislation enables clinical researchers to conduct clinical trials in the endeavour of medical advancement, while ensuring that participants are fully informed of the potential risks and benefits, are not coerced into consenting to participate, and are aware of their right to withdraw from participating at any time. The guiding principle is that the wellbeing and safety of the participants is paramount and takes priority over any other consideration.
Research Ethics Committees (RECs) have the remit to review any proposed research that involves human participants. Made up of a number of lay‐people and professionals experienced in their own field, it is the responsibility of the REC to interrogate the research protocol and to identify any aspects of the research consent and treatment processes which may pose an unacceptable risk to participants or the public. Approval from a REC is essential before a trial can go ahead. As the trial progresses, researchers will also need to seek ethical approval to make any amendments to the protocol, which may be something as minor as a change of wording within a participant information sheet, to something more substantial such as a change in the dose of medication to be administered. These changes will be implemented in line with Good Clinical Practice (GCP) principles (MHRA, 2012).
Despite these safeguards, there are notable incidences that have occurred in recent years related to the conduct of some clinical trials. For example, in 2006, volunteers in an early phase drug trial at the Northwick Park Hospital became seriously ill. The story became headline news after six participants reacted badly to the medication, suffering a severe immune response leading to organ failure and one participant requiring the amputation of his fingers. This led to a full investigation and the resulting report changed a number of practices in the running of drugs trials which sought to prevent this from happening again (Expert Scientific Group on Phase One Clinical Trials, 2006).
Fortunately, however, the ethical and legal frameworks which surround clinical research, limit these incidents and provide principles and guidance for the safe conduct of research and researchers.
Skills in practice: How to use medical ethics
Not all decisions are made easily, and, in some cases, there are multiple factors that influence decision‐making, such as personal experience, religion, regulatory codes, legal issues and so on. In practice, a practitioner will use a combination of all such factors to reach a decision; this is sometimes described as a systematic study of moral choices. In the first instance, the code of behaviour or conduct presented by a regulatory body is considered correct. Within healthcare, there are many examples of ethical decision‐making process which include varying numbers of steps to follow. Overall, there is the general adoption of principle‐based ethics to guide decision‐making practice within healthcare, which is evident in this example.
Step 1 – Ability to recognise an ethical issue. Ask yourself: could this scenario or decision cause harm or damage to someone or some group? Are there choices between different alternatives; for example, a good
