Rules are made to be broken

Do rules make us dumb?

One of my responsibilities is to destroy medications, specifically narcotics and controlled medications that are no longer required at the nursing homes or retirement homes. No, this is not the favorite part of my job but it is a necessary part that needs to be done. So I gladly oblige.

But the job did get exciting one day when I was informed to destroy some cookies, specifically cookies made with marijuana by a granddaughter for her grandmother living at the nursing home. I assume the rationale was that these marijuana cookies were not “prescribed” by the physician and as such, they were to be removed from the resident.

The process of destroying the cookies was easy but I did think about the ethical implication of denying the resident of cookies baked with love by her granddaughter. After all, marijuana will become legal soon, exactly how we implement and enforce the use of marijuana remains to be unraveled, especially in an institution setting.

So we don’t really have any rules to guide us in this situation? We decided to take the easy route to destroy the cookies.

These scenarios will only become more common – so how should we handle these requests? Are they drugs? Are they non-drugs? How do we monitor their use? When should a pharmacist become involved?  There are many questions but so little answers at this point.

Rules are developed  to help guide us consistently in what we need to do in the majority of the situations.  Usually it works to prevent harm, to improve efficiency and to avoid missing critical steps that may lead to other undesirable consequences.  But sometimes we use rules to explain our actions when we should really exercise our judgment, assess the situations carefully and hopefully coming up with a better solution. But by applying the “follow the rules” logic, we have shut off the creative part of our brain to come up with a better solution, a better way.

In this case, should we destroy those cookies?  Or should we politely return them to the family? What rights do we have to destroy those cookies? If the resident is not eating well and those cookies made with marijuana may offer some hope to improve her appetite, are we denying the resident of these potential benefits, simply because of the lack of rules to guide us in these situations?

It is more important to ask ourselves if our actions are guided genuinely by the best interest for the residents, or simply for convenience sake to follow the rules.  Rules are written to help us but we should remember rules can’t guide us in every single situation.

When there appears to be a lack of rules to guide us in a situation, we are capable of  and should exercise our judgment to come up with a better way, a better solution, focusing on what is in the best interest for the resident, not what is convenient for us.

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drugopinions

My name is Cynthia Leung and I am a practicing pharmacist in Kingston Ontario, Canada. This blog is for me to share my ideas, opinions and perspectives on how medications are used in our health care system. Note that these posts are my own opinions and do not represent the opinions of my current or former employers and / or organizations that I may belong to. Any possible case scenarios described in my posts would be modified to maintain patient confidentiality. This blog is not a platform for professional advise for patients or health care providers and the content is not meant to support any clinical decisions or replace professional opinions. Also the images are either taken or created by the author, or adapted with permission. I hope you will enjoy reading my posts!

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