Debate centers on pharmacists’ rights, state laws

[Thom Little]

Politicians and activists have staked out their claims. Illinois Gov. Rod Blagojevich earlier this year signed a law making it a violation for pharmacies to refuse prescriptions for the morning-after pill. Last week, Walgreens suspended four Metro East pharmacists for failing to pledge to abide by the Illinois law. Across the river, Missouri Gov. Matt Blunt promises a law doing the opposite - protecting pharmacies for refusing to dispense the pill.

But aside from the rhetoric, the morning-after pill threatens to poison the relationship between pharmacist and patient. Some pharmacists say they have a right to refuse a prescription they find morally or religiously objectionable. The issue first arose with physician-assisted suicide - using drugs dispensed at pharmacies - in Oregon. But that was a limited scenario. Only recently, with the federal debate over whether the morning-after pill should be sold over the counter, did the issue reach a national scale.

"I think it's a true ethical dilemma," said Dr. Evelyn Becker, who teaches a biomedical ethics class at the St. Louis College of Pharmacy. "It undermines the trust issue. It is really difficult."

Becker said pharmacists deciding which prescriptions to fill based on their personal beliefs conflicts with the pharmacist's mission. A pharmacist may hold very strong beliefs, Becker said, "but on the other hand, you have to look at the rights of patients to have a legitimate prescription filled. We have to put the patient ahead of any moral issues."


http://www.stltoday.com/stltoday/news/stories.nsf/newswatch/story/E43057856F1AF446862570CC0079F21F?OpenDocument

[TallahasseeGrannie]

1. So she could hand it off to the next pharmacist,

couldn't she?

It appears to me there has to be some level of compromise on this situation. Doctors are not forced to perform abortion and abortions are available.

I was once ordered to give a medication to a child and I refused because I didn't want any part of it. (I'm a teacher..I know that is a different situation).

I would think there has to be some way to handle this ethical dilema without either/or 's.

[Bunny]

3. What if there is no "next pharmacist" available?

Or what if the "next pharmacist" is in the next town, 30 miles away? Not very convenient for the patient, is it? And why should the patient be further inconvenienced?

If the pharmacist wants to override the legally prescribed medication, perhaps he/she should become a physician and then refuse to issue the prescription in the first place.

And, I have yet to hear of the pharmacist who refused to fill a prescription for boner pills. What then?

[TallahasseeGrannie]

6. Boner pills. I like that

much better than viagra.

Here's where I think a compromise is in order. The employer (as in Walgreen, whatever) needs to know that a particular pharmacist has a problem with a medication and staff the shift accordingly.

I don't see it as a black and white situation.

I understand your impatience with it, but if you use some imagination, perhaps there will one day come out a pill that... oh, let's see. Maybe one that makes you believe in a RW philosophy. Would a pharmacist have a right not to fill that?

My example is a joke, of course, but maybe some day better living through better chemistry is going to cross over more lines in both directions. Wouldn't it be better to have a mechanism in place that allows for personal belief systems?

[Mandate My Ass]

8. better to have a mechanism in place that allows for personal

belief?

Yeah, maybe next time his doctor can insist that his personal beliefs demand that he conduct the annual rectal exam while on the patient while the patient is sitting in a crowded church on Sunday.

There is no place in a pharmacy for religion, there is no place in church to conduct medical practice.

[TallahasseeGrannie]

11. I hear you

but would you humor me and look at the theoretical in my last post?

Right now the meds that are the most objectionable are the ones that folks on the right have a problem with, while most of us on the left are fine with then.

What if someday meds come out that do something really extreme..let's say a pill or treatment that "cures" homosexuality? And suppose some private businesses forced this treatment, which given the current political climate is not that far outside the realm of possibility.

Now, my refusal to give it would not be based on my religion, but on a belief that homosexuality is not a disorder and that a person can do what they like with their private parts.

Am I making any sense?

I think you are too angry, perhaps, at the thought that anyone here on du might look for compromise here because your example of the rectal exam in church, while intruguing, was a bit off the wall and kneejerk.

Care to think of this issue more globally and actually discuss it?

[Mandate My Ass]

14. You're wrong, I'm not angry at all. That's just a b.s. ploy

What if someday meds come out that do something really extreme..let's say a pill or treatment that "cures" homosexuality? And suppose some private businesses forced this treatment, which given the current political climate is not that far outside the realm of possibility.

Now, my refusal to give it would not be based on my religion, but on a belief that homosexuality is not a disorder and that a person can do what they like with their private parts.

You're just proving the point that certain people should never belong in positions of power over others. You have no right whatsoever to interfere in the medical care and treatment that a doctor and patient have agreed upon, no matter how repugnant it is to you. There are no "special circumstances" in this case. Period.

Just do not take a job in which your personal belief system would ever be the basis of interfering in life-altering decisions made by others which have no impact on you, no matter what impact if may have on their private parts.

[TallahasseeGrannie]

15. Well, you are probably right

I would make a lousy pharmacist.

I'm interested in whether you extend this to other professionals. For example, I have in my career refused to hit a child. I was reprimmanded for this. (Corporal punishment is legal in FL)

What about doctors and abortions?

Nurses ordered to give lethal injections?

By virtue of being in a profession, do we have to do as told in every circumstance?

Can you think of any exceptions? This sounds argumentative but I really am asking honestly.

[Mandate My Ass]

17. performing vs withholding

What about doctors and abortions? As noted above doctors do not have to perform abortions. And I've never heard of one who held a position in an abortion clinic who refused to do so. A doctor's practice can be as limited in scope as s/he wants. A pharmacist's must not.

Nurses ordered to give lethal injections? Lethal injections are done by volunteers, and there is no shortage of volunteers that would compel anybody to order a nurse to provide a lethal injection.

By virtue of being in a profession, do we have to do as told in every circumstance? If you even suspect that your job might entail performing an act that goes against your conscience or ethics, but is a condition of employment, don't take the job!

Pharmacists are not performing, they are denying a perfectly legal, legitimate medical service that they find personaally objectionable without taking into account the life-altering consequences that withholding that prescription entails. They knew when they took the job what it meant.

And I might add, it seems odd to me that someone in a medical field rewrites the definition of conception. A woman has not conceived until the egg implants itself on the uterine wall. They pretend it begins with fertilization. The "life begins at fertilization" fallacy is a religious belief, it is not medical science. So they are wrong technically, as well as ethically, if they refuse to dispense something that is birth control.

[TallahasseeGrannie]

18. Thanks for answering

thoughtfully. I find myself agreeing with most of your points. It isn't like the morning after pill was just invented. We've known it was on the legal horizon for many years.

[oldcoot]

20. There is such a mechanism

Some large pharmacies do allow pharmacists to hand off prescriptions that they do not want to fill to other pharmacists. However, some of these holier-than-thou individuals refuse to do even that because they think that the prescription and,in some cases, the customer are immoral. Clearly, they are not interested in compromise.

Frankly, I do not feel that we need to cater to these individuals since there is a mechanism in place that allows these individuals to follow their beliefs. Any one who morally opposes a product provided by a business does not have to work at that particular business. If you believe it is immoral for people to consume alcohol, that you should not work at liquor store. If you believe it is immoral to prescribe prescriptions for birth control, you should not work for a business that sells that product. It is that simple.

If you choose to work for such a business, than you should realize that part of the money that pays your salary comes from the sale of the "immoral" product. If you still decide to work for the business after that realization, then you have no business whining about how you do not want to sell the product.

[NanceGreggs]

2. And what about the 'other' human life ...

... that of the woman who wants the prescription?

If you're not willing to DO THE JOB (dispensing medicine based on a doctor's prescription), then DON'T TAKE THE JOB!

End. Of. Discussion.

[donkeyotay]

16. the "other" human's morality is presumed to be lacking

Thus the pharmacist must assert his superior ethics. Of course, it seems boneheaded for a business to allow its employees to become freelance activists. What a slippery slope! A gas station attendant could refuse to fill up SUVs on moral grounds. A cashier could refuse to sell you Twinkies. And a heart surgeon could surely refuse to do a triple bypass on, oh say, Dick Cheney.

It's not really morality; it's meddling in another's affairs.

I hope female activist pharmacists stop selling woody pills because it's the same rationale for not selling the morning after pill: if life at conception is sacred, thus pharmacists should - ethically - not sell pills for recreational ejaculation.

[Crunchy Frog]

22. Sex outside of marriage is sinful

so pharmacists should have the right to refuse to sell woody pills to men are not wearing wedding rings, or who they know are not married.

For that matter, people who work in restaurants should be able to refuse to serve various foods to people for whom they feel those foods might be harmful. If I think you're too fat, I'll refuse to serve you anything fattening. If you don't like it, you can always go to another restaurant.

[ret5hd]

4. i think i'm going to become a 7th Day Adventist...

get my pharmacists degree...

then bring a book to work...cause i aint gonna fill ANY prescriptions.

[DELUSIONAL]

26. wrong religion -- the SDAs have med schools and hospitals

and I NEVER thought I would ever defend SDAs.

[Crunchy Frog]

5. Maybe there will be a run on the pharmacy profession

by Scientologists who can refuse to fill any prescription for psychiatric medication, since it violates their beliefs, and Christian Scientists who can refuse to fill any prescriptions at all.

Imagine getting hired for a job that you then don't have to do because it violates your religious beliefs. Maybe people who keep the Sabbath holy (Saturday or Sunday, depending on what belief you subscribe to) can get part time jobs for that day, and then get paid for not showing up because of their religious beliefs. Maybe they could start hiring cops who are morally opposed to carrying guns or using physical force. The list goes on and on. I wonder where these people think it's appropriate to draw the line. (What a stupid question, the line only includes what goes on inside a woman's reproductive tract. Duh!)

[dogfacedboy]

7. A pharmacist has no actual or percieved right

to refuse to fill a prescription. If their employer directs them to fill it, they must, or face whatever disciplinary issue may arise. As an employee, a person is required to do the job that they were hired to do.

Gov. Blagojevich made the correct move. Would this also apply to a pharmacist that OWNS the pharmacy?

[Journeyman]

23. A friend of mine owns his pharmacy. . .

and does not wish to dispense morning-after pills. Rather than get into any sort of debate about it, he informs his patients he doesn't carry them in inventory because there's little demand for them at his location. He then directs the client to one of a handful of local pharmacies nearby who do dispense the pills. In fairness to this debate, this is in a major metropolitan area with many alternatives available.

As my friend notes, any governmental requirement to stock the pills will meet with some resistance, at least from the smaller pharmacies, because of cost considerations. I don't remember the numbers, but he explained there are a couple of manufacturers of the pills and for him to carry them all in stock would necessitate expenditure of a few hundred dollars of operating capital. Since there isn't a big demand for them at his location, it would be a needless expense for him to carry the pills. It's the same reason he doesn't keep certain cancer drugs on hand, since they are incredibly expensive and he can't justify the outlay. If needed, he gets the cancer drugs delivered in short order (same as he could with the morning after pills), but he chooses to not make that service available for the morning-after pills.

It's my friend's belief that morning-after pills should be available over-the-counter, or through the offices of the prescribing physician, and this debate would fade away.

[depakid]

30. Dunno whether that was part of the debate at the FDA on OTC

probably not on the surface- but I'd bet that's one HUGE reason why the staff recommendation to go ahead with Plan B over-the-couter was overruled.

Yet another needless problem caused by the incompetant ideologues in charge of this country.

[FreedomAngel82]

9. So what about my rights as a patient??

[Straight Shooter]

10. So the whim of the pharmacist supersedes the judgment of the physician?

Setting aside for a moment that the ultimate decision belongs to the woman, the fact remains that she got a prescription from her physician. What right does any pharmacist have to override the judgment of a physician?

Those holier-than-thou pharmacists need to form their own group and donate half their salaries as a fund to be used for women who are denied the MA pill and eventually give birth. Those funds can be used for prenatal care, birthing expenses, and as a form of child support until the child reaches the age of 18. Since those physicians are acting in such a paternalistic manner, let them put their money where their big mouth is and contribute like a father should.

All talk. No walk. Same old hypocritical story. Disgusting.

[anotherdrew]

12. how long would a vegetarian at mcdonalds who refuses to cook meat work?

these pharmacists have the right to do their jobs, if they can't, they need to work elsewhere.

[oldcoot]

21. The vegetarian would not only be fired but conservatives

would use the vegetarian as an example of political correctness gone too far.

[jaxx]

13. Talk about some faith-based voodoo

These pharmacists are assuming an egg has met a sperm and decided to join up in the parental progress parade. Not every sexual encounter makes a fetus to be, but these do-gooders are going on the premise that if you want the morning after pill, you are already pregnant. Just one more way for the anti-abortionists to force their beliefs into your life. These people need to be stopped. Either do the job and fill all prescriptions or get the hell out of the business.

[depakid]

19. "I think it's a true ethical dilemma," said Dr. Evelyn Becker

Bullshit.

Ethical dilemmas aren't based on outright lies. Has this supposed "professor" ever heard of evidence based medicine?

Seems to me that the prof is herself SERIOUSLY ethically challenged- and perpetuating a myth that's causing problems for patients (and ironically- for pharmacists) all over the bible belt.

Emergency contraception IS NOT ABORTION. THAT'S NOT HOW IT WORKS.

See: Plan B: Ignore the Science

http://www.wired.com/news/medtech/0,1286,67432,00.html?tw=wn_story_related

Seems to me that ANY pharmacist who's not intelligent enough to undertand that shouldn't have a license to be prescribing pharmaceuticals in the first place.

[Sgent]

24. It is abortion (as defined theologically)

To many Catholics and Protestants, a morning after pill is morally equivalent to an abortion. Many feel the same way about birth control. Their sincerely held beliefs equate the use of those to infantacide. Opposing them in such terms does not accomplish anything.

[noamnety]

28. That's incorrect.

Even theologically, it's not an abortion.

1) It prevents fertilization.
2) It reduces the chances that a fertilized egg will be destroyed.

[depakid]

29. What they feel- and empirical evidence are two different things

If I were a scientologist, I might "feel" that all psychiatric medications were the equivalent of a lobotomy. That doesn't mean my being "compelled" to dispense them to a patient raises bona fide ethical issues.

[DELUSIONAL]

25. They don't have "rights" they have a job to do.

If they don't want to do the job -- get into another line of work -- like grave digger.

[MasonJar]

27. Perhaps these pharmacists should find a new profession.

[Democat]

31. They have every right to find another career

:)