{"doi":"10.3389/fmed.2025.1536044","title":"Ethical interventions: revisiting the assessment tools for health-system pharmacists","abstract":"Pharmacist interventions (PIs), which are any actions by pharmacists that can directly change the patient management or therapies, 1 play a crucial role in improving patient outcomes by mitigating adverse drug events.Multiple tools have been developed to assess the significance of these interventions, with the primary focus on the clinical and economic impacts. 2 Typically, PI assessment is an independent process from PI conduct. In specific, after the pharmacists make the PIs, an expert (or group of experts) will review the PIs and assess them multidimensionally using pre-existing tools. These assessments may be used for revising the hospital policies or protocols to balance the hospital operations and patient outcomes. Despite progress in the development of PIassessing frameworks, the ethical impact of PIs has largely been neglected in the current assessment tools.Ethical considerations are pivotal in healthcare decisions, 3 yet remain underrepresented in evaluation frameworks for PIs. One contributing factor is that PIs are not medical orders but are considered consultations for healthcare providers. Hence, many believe PIs do not have direct ethical impacts on patient treatment or healthcare. 4,5 However, ethical issues in healthcare require an inter-professional approach, 6 including the active engagement of pharmacists. This poses an ethical requirement for PIs, 7 especially regarding drug-related problems (DRPs).Given the limited inclusion of this aspect in the PI-assessing tools, 2 there are concerns about the breadth of these frameworks. The lack of focus on incorporating the ethical dimension in existing tools hinders the recognition of pharmacist contributions, particularly in scenarios where ethical considerations are central to decision-making.In this paper, we aimed to highlight this issue and potential approaches to integrate ethics into assessment tools for PIs. While there are many approaches to exploring ethical considerations in clinical practice, this paper focuses on the core principles of medical ethics, i.e., autonomy, non-maleficence, beneficence, and justice. 3 These principles are the minimum acceptable criteria to ensure ethical standards in clinical practice. Given the major role of health-system pharmacists in addressing DRPs, 2 we only comment on DRP-targeted PIs.Pharmacist-initiated orders have stringent regulations and, thus, are outside the scope of most assessment tools.To avoid confusion, we also would like to re-emphasize that this paper does not imply any changes to the practice of health-system pharmacists but only focuses on revising the assessment tools for PIs.PIs are performed to address DRPs, 2 therefore, the clinical impacts of PIs should correlate with the severity of DRPs, 8 not a stand-alone index as in previously proposed assessment tools. 2 For instance, in pain management for patients with cancer, overdoses (with a 20% increase in standard dosing) are flagged in a similar manner for both opioids and acetaminophen (also known as paracetamol). However, patient outcomes could differ significantly if these DRPs are not intervened. Addressing acetaminophen overdose is simply keeping the total dose per day below a well-defined threshold, e.g., 4 g for patients without liver impairment. However, it is more complicated to monitor and prevent overdose of medications without ceiling effect like opioids. 9 Consequently, if we only use the current assessment tools to evaluate these overdosing DRPs, the 2 PIs should implicate similar clinical impact (resolving overdose). Compared with the PI for acetaminophen overdosing, the PI for opioid DRP is underestimated and implicitly documented as inadequate compliance with the beneficence principle of medical ethics.More importantly, if the patients and providers are not in agreement on the goals of treatment, all medical orders and PIs should respect the autonomy of the patients. 10 Disregarding patient choices or decisions can breed controversy o","journal":"Frontiers in Medicine","year":2025,"id":552339,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9545,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1448475,"name":"Ronald L. Castelino","orcid":"0000-0002-5128-7115","position":1,"is_corresponding":false},{"id":685213,"name":"Tyree H. Kiser","orcid":"0000-0001-7415-3999","position":2,"is_corresponding":false},{"id":780375,"name":"Toby C. Trujillo","orcid":"0000-0001-9377-4045","position":3,"is_corresponding":false},{"id":1448788,"name":"Megan K. Fischer","orcid":null,"position":4,"is_corresponding":false},{"id":1448476,"name":"Kim‐Huong Truong‐Nguyen","orcid":"0009-0004-6503-2756","position":5,"is_corresponding":false},{"id":1448789,"name":"Bao-Chau Truong-Nguyen","orcid":null,"position":6,"is_corresponding":false},{"id":1448477,"name":"Minh‐Hoang Tran","orcid":"0000-0003-1351-8442","position":7,"is_corresponding":false},{"id":1448474,"name":"Hong Tham Pham","orcid":"0000-0002-2366-629X","position":0,"is_corresponding":true}],"reference_count":15,"raw_metadata":null,"created_at":"2026-07-19T02:54:33.203144Z","pmid":"40291025","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}