RESEARCH ARTICLE: Pharmacy students' perceived professionalism and application of bioethical principles: Implications for teaching pharmacy ethics for patient-centred pharmacy practice


  • Roland N Okoro University of Maiduguri, Nigeria
  • Aminu A Biambo Usumanu Danfodiyo University, Nigeria



Professionalism, Ethical Dilemmas, Bioethics Principles, Final-year Pharmacy Students, Nigeria


Context: Pharmacists providing pharmaceutical care are often confronted with a variety of professional issues, ethical dilemmas and moral problems that require professionalism to appropriately address. Aims: To investigate undergraduate fifth- year (final-year) Bachelor of Pharmacy (B. Pharm.) students’ views on professionalism, ethical dilemmas, and their application of bioethical principles, and to compare responses of various groups (pharmacy schools, age, gender, and religion).

Methods: This was a cross-sectional survey of the final-year B.Pharm. students in two pharmacy schools in northern Nigeria. The descriptive and inferential statistics (Chi-square or Fisher’s exact tests and Independent-sample t-test) were utilised to analyse the study data. Statistical significance was considered at p<0.05.

Results: Ninety-five students, corresponding to 49.5% response rate, participated in the study. More than 79% of the students strongly agreed that their actions as future pharmacists could affect how the profession is viewed by patients and other healthcare providers. Patients’ right to autonomy and non-maleficence were the most utilised bioethical principles by the participants.

Conclusions: The study shows that the participants had good overall perceived professionalism and fair bioethical reasoning. Different bioethical principles were used by various groups considered to support how they would deal with each ethical dilemma. New strategies in teaching pharmacy practice courses by pharmacy educators in these schools are necessary to improve students’ bioethical reasoning which will maximise the quality of their future practice.

Author Biographies

Roland N Okoro, University of Maiduguri, Nigeria

Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy

Aminu A Biambo, Usumanu Danfodiyo University, Nigeria

Department of Clinical Pharmacy and Pharmacy Practice



Abdu-aguye, S.N., Yusuf, H., Agbale, E.O., Auwal, F.I., & Ma’aji, H.U. (2019). Connections between classroom theory & real world practice: Exploring the perspectives of undergraduate students at a Nigerian faculty of pharmacy. Pharmacy Education, 19(1), 185-189

Beauchamp, T., & Childress, J. (2001). Principles of biomedical ethics. New York: Oxford University Press

Benson, A., Cribb, A., & Barber, N. (2009). Understanding pharmacists’ values: a qualitative study of ideals and dilemmas in UK pharmacy practice. Social Science & Medicine, 68(12), 2223-2230.

Buchanan, R. (2017). Cases of unethical behavior in pharmacy (online). Available at: breck-shampoo-.html

Chaar, B., Brien, J. & Krass, I. (2005). Professional ethics in pharmacy: the Australian experience. International Journal of Pharmacy Practice, 13(3), 195-204. 13.3.0005

Cooper, R.J., Bissell, P., & Wingfield, J. (2007). A new prescription for empirical ethics research in pharmacy: a critical review of the literature. Journal of Medical Ethics, 33(2), 82-86. https://

Cooper, R.J. (2007). Ethical problems and their resolution amongst UK community pharmacists: a qualitative study. PhD thesis, University of Nottingham (online). Available at:

Cooper, R.J., Bissell, P., & Wingfield, J. (2008). Ethical decision- making, passivity and pharmacy. Journal of Medical Ethics, 34(6), 441-445.

Donaldson, T.M., Fistein, E., & Dunn, M. (2010). Case-based seminars in medical ethics education: how medical students define and discuss moral problems. Journal of Medical Ethics, 36(12), 816-820.

Erah, P. (2011). The PharmD Programme; Prospects and challenges in Nigeria. Nigerian Journal of Pharmaceutical Research, 9(1), 30-48

Fakeye, T., Adisa, R., & Erhun, W. (2017). Developing a model for teaching and learning clinical pharmacy component s of the pharmacy curriculum in Nigeria. Pharmacy Education, 17(1), 60-66

FIP [International Pharmaceutical Federation]. (2013). Reference Document - Pharmacist Ethics and Professional Autonomy: Imperatives for Keeping Pharmacy Aligned with the Public Interest. International Pharmaceutical Federation (online). Available at:

Frunză, M. (2011). Case studies in teaching euthanasia: ethical and pedagogical aspects. Revista Romana De Bioetica, 9, 108-113

Gallagher, C.T. (2011). Assessment of levels of moral reasoning in pharmacy students at different stages of the undergraduate curriculum. International Journal of Pharmacy Practice, 19(5), 374-380.

Hanna, L., Gillen, J., & Hall, M. (2017). An investigation of final year pharmacy students' moral reasoning ability, and their views on professionalism and fitness to practice panel determinations: A questionnaire study. Current in Pharmacy Teaching and Learning, 9(4), 652-659.

Henning, M.A., Malpas, P., Ram, S., Rajput, V., Krstić, V., Boyd, M., & Hawken, S.J. (2016). Students’ responses to scenarios depicting ethical dilemmas: a study of pharmacy and medical students in New Zealand. Journal of Medical Ethics, 42(7), 466-473.

Hibbert, D., Rees, J.A., & Smith, I. (2000). Ethical awareness of community pharmacists. International Journal of Pharmacy Practice, 8(2), 82-87. tb00990.x

Hurley, R. (2020). Assisted dying: your vote counts. British Medical Journal, 368(m646).

Ibrahim, R.M., & Sharif, S.I. (2018). Teaching professionalism and ethical reasoning to pharmacy students: How important it is? Global Drugs Therapy, 3(5), 1-1.

Ikhile, I.J., & Chijioke-Nwauche, I.N. (2016). Pharmacy education in Nigeria: The progression. World Journal of Pharmaceutical Research, 5(7), 258-272

Johnson, J.A., & Bootman, J.L. (1995). Drug-related morbidity and mortality: A cost-of-illness model. Archives of Internal Medicine, 155(18), 1949-1956.

Johnson, J.A., & Bootman, J.L. (1997). Drug-related morbidity and mortality and the economic impact of pharmaceutical care. American Journal of Health-System Pharmacy, 54(5), 554-558.

Kalvemark, S., Hoglund, A.T., Hansson, M.G., Westerholm, P., & Arnetz, B. (2004). Living with conflicts–ethical dilemmas and moral distress in the health care system. Social Science & Medicine, 58(6), 1075-1084. 9536(03)00279-X

Kangasniemi, M., Pakkanen, P., & Korhonen, A. (2015). Professional ethics in nursing: An integrative review. Journal of Advance Nursing, 7(8), 1-14.

Kihlbom, U. (2008). Autonomy and negatively informed consent. Journal of Medical Ethics, 34, 146-149. jme.2007.020503

Kruijtbosch, M., Göttgens-Jansen, W., Floor-Schreudering, A., Leeuwen, E. & Bouvy, M.L. (2018). Moral dilemmas of community pharmacists: a narrative study. International Journal of Clinical Pharmacy, 40(1), 74-83.

Latif, D.A. (2001). The relationship between pharmacists’ tenure in community setting and moral reasoning. Journal of Business Ethics, 31(2), 131-141.

Latif, D.A. (2003). Moral reasoning and its implications for pharmacy education. Pharmacy Education, 3(1), 1-6

Latif, D.A. (2004). An assessment of the ethical reasoning of United States pharmacy students: a national study. American Journal of Pharmaceutical Education, 68(2), Art. 30. https://

Lindsey, W.T., & Olin, B.R. (2014). Student responses to legal and ethical scenarios in drug information. Journal of Pharmaceutical Care & Health Systems, S1-006.

McCormick, T.R. (2018). Principle of Bioethics (online). Available at: bioethics-topics/articles/principles-bioethics

Ogaji, J.I., & Ojabo, C.E. (2014). Pharmacy education in Nigeria: The journey so far. Archives of Pharmacy Practice, 5(2), 47-60.

Okoye, O., Nwachukwu, D., & Maduka-Okafor, F.C. (2017). Must we remain blind to undergraduate medical ethics education in Africa? A cross-sectional study of Nigerian medical students. BMC Medical Ethics, 18(1), 73.

Resnik, D.B. (2005). The patient’s duty to adhere to prescribed treatment: An ethical analysis. Journal of Medicine and Physiology, 30, 167-188. 26849

Schlesselman, L.S. (2014). A cross-sectional study of applied bioethical reasoning in pharmacy students and preceptors. Pharmacy Practice, 12(2), 401-410. 36552014000200007

Sharif, P.S., Javadi, M., & Asghari, F. (2011). Pharmacy ethics: evaluation pharmacists’ ethical attitude. Journal of Medical Ethics and History of Medicine, 4(5)

Slomka, J., Quill, B., desVignes-Kendrick, M., & Lloyd, L.E. (2008). Professionalism and Ethics in the Public Health Curriculum. Public Health Reports, Sup2(123), 27-35.

Smith, M.G., & Dinkins, M.M. (2015). Instructional design and assessment: early introduction to professional and ethical dilemmas in a pharmaceutical care laboratory course. American Journal of Pharmaceutical Education, 79(10), Art. 156.

Tekiner, H. (2017). Why Teach Pharmacy Ethics Through Literary Fiction? World Journal of Pharmaceutical Sciences, 5(6), 203-206

University of Greenwich. (2015). Introduction to Pharmacy Professional Skills, Law and Ethics (online). Available at:

Vivian, J.C. (2010). Rogue Pharmacists. US Pharm, 35(10), 120-123

Warren, T.J. (2011). The 4 basic ethical principles that apply to forensic activities are respect for autonomy, beneficence, nonmaleficence, and justice. Journal of Chiropractic Medicine, 10(3), 225-226.

WHO. (1999). Guidelines for Drug Donations. Available at:

Wingfield, J., Bissell, P., & Anderson, C. (2004). The scope of pharmacy ethics: an evaluation of the international research literature, 1990–2002. Social Science & Medicine, 58(12), 2383-2396.





Research Article