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How organizational context affects bioethical decision-making: Pharmacists' management of gatekeeping processes in retail and hospital settings

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  • Chiarello, Elizabeth

Abstract

Social science studies of bioethics demonstrate that ethics are highly contextual, functioning differently across local settings as actors make daily decisions “on the ground.” Sociological studies that demonstrate the key role organizations play in shaping ethical decision-making have disproportionately focused on physicians and nurses working in hospital settings where they contend with life and death issues. This study broadens our understanding of the contexts of ethical decision-making by empirically examining understudied healthcare professionals – pharmacists – working in two organizational settings, retail and hospital, where they act as gatekeepers to regulated goods and services as they contend with ethical issues ranging from the serious to the mundane. This study asks: How do organizations shape pharmacists' identification, negotiation, and resolution of ethical challenges; in other words, how do organizations shape pharmacists' gatekeeping processes? Based on 95 semi-structured interviews with U.S. pharmacists practicing in retail and hospital pharmacies conducted between September 2009 and May 2011, this research finds that organizations influence ethical decision-making by shaping how pharmacists construct four gatekeeping processes: medical, legal, fiscal, and moral. Each gatekeeping process manifests differently across organizations due to how these settings structure inter-professional power dynamics, proximity to patients, and means of accessing information. Findings suggest new directions for theorizing about ethical decision-making in medical contexts by drawing attention to new ethical actors, new organizational settings, an expanded definition of ethical challenges, and a broader conceptualization of gatekeeping.

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  • Chiarello, Elizabeth, 2013. "How organizational context affects bioethical decision-making: Pharmacists' management of gatekeeping processes in retail and hospital settings," Social Science & Medicine, Elsevier, vol. 98(C), pages 319-329.
    • Handle: RePEc:eee:socmed:v:98:y:2013:i:c:p:319-329
    DOI: 10.1016/j.socscimed.2012.11.041
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    1. Bachman, Keith H. & K. Freeborn, Donald, 1999. "HMO physicians' use of referrals," Social Science & Medicine, Elsevier, vol. 48(4), pages 547-557, February.
    2. MacIntosh, Robert & Beech, Nic & Martin, Graeme, 2012. "Dialogues and dialetics: Limits to clinician–manager interaction in healthcare organizations," Social Science & Medicine, Elsevier, vol. 74(3), pages 332-339.
    3. Davidson, Laura A. & Pettis, Clare T. & Joiner, Amber J. & Cook, Daniel M. & Klugman, Craig M., 2010. "Religion and conscientious objection: A survey of pharmacists' willingness to dispense medications," Social Science & Medicine, Elsevier, vol. 71(1), pages 161-165, July.
    4. Kälvemark, Sofia & Höglund, Anna T. & Hansson, Mats G. & Westerholm, Peter & Arnetz, Bengt, 2004. "Living with conflicts-ethical dilemmas and moral distress in the health care system," Social Science & Medicine, Elsevier, vol. 58(6), pages 1075-1084, March.
    5. Jecker, Nancy S. & Berg, Alfred O., 1992. "Allocating medical resources in rural America: Alternative perceptions of justice," Social Science & Medicine, Elsevier, vol. 34(5), pages 467-474, March.
    6. Shulman, S.R., 1989. "The broader message of Accutane," American Journal of Public Health, American Public Health Association, vol. 79(11), pages 1565-1568.
    7. Arber, Sara & McKinlay, John & Adams, Ann & Marceau, Lisa & Link, Carol & O'Donnell, Amy, 2006. "Patient characteristics and inequalities in doctors' diagnostic and management strategies relating to CHD: A video-simulation experiment," Social Science & Medicine, Elsevier, vol. 62(1), pages 103-115, January.
    8. Riley, Robin & Manias, Elizabeth, 2009. "Gatekeeping practices of nurses in operating rooms," Social Science & Medicine, Elsevier, vol. 69(2), pages 215-222, July.
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