How can this be?? This is America!

[lisas3575]

Some pharmacists are refusing to fill bcp prescriptions because they are personally against contraception. (http://news.yahoo.com/news?tmpl=story&u=/usatoday/20041109/pl_usatoday/druggistsrefusetogiveoutpill)

I'm speechless. Flabbergasted. Shocked and dismayed.

[Grace]

Hi Lisa...

We discussed this topic once - here's the thread which makes for some interesting reading.

http://community.cookinglight.com/showthread.php?s=&threadid=60404&highlight=pharmacist

[Gilgamesh37]

As disturbing as I find this (and I weighed in on the original discussion) I was more dismayed to learn that GWB appointed W. David Hager, a physician and anti-abortion activist, to an FDA committee on reproductive drugs. (the appointment took place a while ago, but I only heard about it last week, just post-election) Dr. Hager reportedly while in private practice refused to prescribe birth control pills to unmarried patients. While I agree that as a private practitioner he was free to decide that he was not going to offer a particular treatment (though I really question it if he's only denying it to unmarried women) I have grave concerns that his personal beliefs are going to tinge his professional decisions on this committee, which will directly impact what drugs are approved for use ANYWHERE by ANYONE.

(here's the Snopes link if anyone wants: http://www.snopes.com/inboxer/outrage/hager.htm )

[DmOrtega]

Man.... that's not a smart choice. Isn't preventing pregnancy better than abortion? Take away the option and abortions, legal or not, will escalate.

[honeygirl1971]

I have worked in medical education and with a lot of docs, and I have a lot of friends who are docs too, and they were all HORRIFIED by the Hager appointment. But that's the trend in this country. Conservative Christianity is now a major factor of our political life, our medical system, and so on. I read about the pharmacists a while ago, and have read a lot of articles on the topic on both sides, and I still agree with Lisa--it's shocking. And scary.

[Ms. Chevious]

Originally posted by Gilgamesh37
As disturbing as I find this (and I weighed in on the original discussion) I was more dismayed to learn that GWB appointed W. David Hager, a physician and anti-abortion activist, to an FDA committee on reproductive drugs. (the appointment took place a while ago, but I only heard about it last week, just post-election) Dr. Hager reportedly while in private practice refused to prescribe birth control pills to unmarried patients. While I agree that as a private practitioner he was free to decide that he was not going to offer a particular treatment (though I really question it if he's only denying it to unmarried women) I have grave concerns that his personal beliefs are going to tinge his professional decisions on this committee, which will directly impact what drugs are approved for use ANYWHERE by ANYONE.

(here's the Snopes link if anyone wants: http://www.snopes.com/inboxer/outrage/hager.htm )

That Hager email has been around for ages and most of it is pretty offbase (the part about refusing contraception to unmarried women for one and his problems with RU486, they were safety related, not moral issues)- usually Snopes is pretty good so I'm surprised. This is much more thorough explanation of how the facts were twisted: http://www.truthorfiction.com/rumors/h/hager.htm

(Not saying I support him just that its spam like any other and should be taken with a pound of salt.)

[stefania4]

The traditional idea of America being a land of freedom and opportunity still holds true. Oh, unless you're female, in which case your rights are in serious danger...

[honeygirl1971]

Originally posted by Ms. Chevious


That Hager email has been around for ages and most of it is pretty offbase ...

Ms. Chevious--my doctor friends were horrified that he was chosen, that's what I know. I'm not disputing your website (which is a personal one), but did you notice that every counter claim began "He says..."? He can say what he wants, it's what he DOES that is at issue...

In any case, I don't know enough about him, and everything on your link may be totally true. Still, Time has also written some troubling things about Hager: http://www.time.com/time/nation/printout/0,8816,361521,00.html

[honeygirl1971]

Here's the article I was referring to, just in case the link doesn't work for everyone:

TIME http://www.time.com/time/nation/printout/0,8816,361521,00.html
Saturday, Oct. 05, 2002
Jesus and the FDA
By KAREN TUMULTY

A quiet battle is raging over the Bush Administration's plan to appoint a scantily credentialed doctor, whose writings include a book titled As Jesus Cared for Women: Restoring Women Then and Now, to head an influential Food and Drug Administration (FDA) panel on women's health policy. Sources tell Time that the agency's choice for the advisory panel is Dr. W. David Hager, an obstetrician-gynecologist who also wrote, with his wife Linda, Stress and the Woman's Body, which puts "an emphasis on the restorative power of Jesus Christ in one's life" and recommends specific Scripture readings and prayers for such ailments as headaches and premenstrual syndrome. Though his resume describes Hager as a University of Kentucky professor, a university official says Hager's appointment is part time and voluntary and involves working with interns at Lexington's Central Baptist Hospital, not the university itself. In his private practice, two sources familiar with it say, Hager refuses to prescribe contraceptives to unmarried women. Hager did not return several calls for comment.

FDA advisory panels often have near-final say over crucial health questions. If Hager becomes chairman of the 11-member Reproductive Health Drugs Advisory Committee, he will lead its study of hormone-replacement therapy for menopausal women, one of the biggest controversies in health care. Some conservatives are trying to use doubts about such therapy to discredit the use of birth-control pills, which contain similar compounds. The panel also made the key recommendation in 1996 that led to approval of the "abortion pill," RU-486a decision that abortion foes are still fighting. Hager assisted the Christian Medical Association last August in a "citizens' petition" calling upon the FDA to reverse itself on RU-486, saying it has endangered the lives and health of women.

Hager was chosen for the post by FDA senior associate commissioner Linda Arey Skladany, a former drug-industry lobbyist with longstanding ties to the Bush family. Skladany rejected at least two nominees proposed by FDA staff members: Donald R. Mattison, former dean of the University of Pittsburgh School of Public Health, and Michael F. Greene, director of maternal- fetal medicine at Massachusetts General Hospital. Despite pressure from inside the FDA to make the appointment temporary, sources say, Skladany has insisted that Hager get a full four-year term. FDA spokesman Bill Pierce called Hager "well qualified."

[lisas3575]

Thanks for the link, Grace. I missed that earlier thread. Strange how this story surfaced in the news again, four months later. :confused:

[LonghornGal]

Originally posted by lisas3575
Some pharmacists are refusing to fill bcp prescriptions because they are personally against contraception. (http://news.yahoo.com/news?tmpl=story&u=/usatoday/20041109/pl_usatoday/druggistsrefusetogiveoutpill)


Part of personal freedom is the choice not to dispense the prescription. Just as part of personal freedom is the ability to choose bcp or a different pharmacist. The pharmacist is exercising their freedoms.

btw, if I had such a pharmacist, I'd switch!

[honeygirl1971]

This was discussed on the other thread, but not everyone has the choice to switch...if you live in a small town with only one pharmacy, or are limited in some other way, you might see the issue a little differently.

[HejazSunKat]

Originally posted by LonghornGal
Part of personal freedom is the choice not to dispense the prescription. Just as part of personal freedom is the ability to choose bcp or a different pharmacist. The pharmacist is exercising their freedoms.

While I agree that he has the right to exercise his personal freedom and behave in accordance with his conscience if he cannot or will not perform the duties of his job then he should find another profession where he will not have these crises of conscience which effect the lives of other people. I agree with Honeygirl: Where does that leave the woman who cannot, for whatever reason, go to a different pharmacy? That to me amounts to imposing his personal brand of morality on other people.

[LonghornGal]

I went and read the other thread as well.

I am part of the camp that believes that life is full of choices and that our personal choices have an impact on many aspects of our lives. I won't clog bandwidth by repeating the debate, as neither of us is likely to convince the other that we're correct. I respect your opinion, but don't agree.

[RunnerKim]

It's rather difficult to choose another pharmacist if the original one won't return or transfer the prescription.

Kim

[honeygirl1971]

Originally posted by LonghornGal
I am part of the camp that believes that life is full of choices and that our personal choices have an impact on many aspects of our lives.

That sounds all well and good, but he would be imposing HIS choice on me, thereby taking away MY personal choice. If he feels that strongly about it, he shouldn't be in a profession where he is required to dispense birth control. THAT choice is up to him.

People talk about the "free market" and "the right to refuse service" and so on, but medicine is not a profession and/or business like any other, and we wouldn't want it to be.

[DmOrtega]

Originally posted by RunnerKim
It's rather difficult to choose another pharmacist if the original one won't return or transfer the prescription.

Kim


Get a new prescription from your doctor.

[ktg0930]

Originally posted by RunnerKim
It's rather difficult to choose another pharmacist if the original one won't return or transfer the prescription.

Kim

As far as I know, a pharmacy can't refuse to transfer a prescription when they are called by another pharmacy which requests the transfer.

[Kathy B]

Originally posted by honeygirl1971


That sounds all well and good, but he would be imposing HIS choice on me, thereby taking away MY personal choice. If he feels that strongly about it, he shouldn't be in a profession where he is required to dispense birth control. THAT choice is up to him.

People talk about the "free market" and "the right to refuse service" and so on, but medicine is not a profession and/or business like any other, and we wouldn't want it to be.

Actually, even in the hospital where I work, all staff have the right to be excused from caring for a patient if something about that patient's situation conflicts with their personal beliefs. They can't just walk off the job, but they can ask for a different assignment, and arrangements have to be made to accomodate them ASAP. Some examples might be giving a blood transfusion to a patient if you don't believe in them (Jehova Witness) or participating in withdrawal of life support.

People will always have some beliefs that conflict with those of others. We can't realistically expect that one can anticipate them all when choosing an occupation. I also don't think people can be expected to check their beliefs at the time clock when they go to work.

However, just as we can't walk away from a patient care situation until a replacement is found, the pharmacist should at least be able to direct customers to another pharmacy source if he cannot personally help them. If he is the only pharmacist in a small town and won't fill BC prescriptions, there will be many people affected. The doctor(s) in that town would no doubt be aware of it before long, and could help figure out a plan. (For example, mail order).

[honeygirl1971]

Kathy, a key aspect of your example is that the patient must be accomodated. The caregiver doesn't get to impose their beliefs on the patient. The caregiver's beliefs are respected, but not at the expense of the patient's. I think that's what upsets people about this situation--that it's the pharmacist's religious beliefs (or doctor's, in the case of Hager) trump the wishes of the patient.

Also, I would think that the pharmacist would be aware that dispensing birth control is a pretty routine aspect of being a pharmacist--it's not like some unpredictable thing that comes up rarely and all of a sudden. It's also not the doctor's responsibility to find replacement pharmacists etc. for routine prescriptions--that's putting an undue burden on the physician.

[ClaraB]

Originally posted by honeygirl1971


That sounds all well and good, but he would be imposing HIS choice on me, thereby taking away MY personal choice. If he feels that strongly about it, he shouldn't be in a profession where he is required to dispense birth control. THAT choice is up to him.

People talk about the "free market" and "the right to refuse service" and so on, but medicine is not a profession and/or business like any other, and we wouldn't want it to be. No, medicine isn't a business like any other, but why should we force medical providers to throw their beliefs out the window? By your logic, if pharmacists should be forced to dispense PCPs, doctors should be forced to prescribe them or the morning-after pill, OB/GYN's should be forced to perform abortions, nurses should be forced to withdraw life-support equipment, and so on. What I'm saying is, your right to convenient healthcare doesn't trump my right to freedom of conscience. In other words, I shouldn't be forced to do something I feel morally opposed to, just to save you from driving 50 miles.

(Disclaimer - before anyone jumps to any conclusions, I used BCPs for 10 years before I had my first child, so I'm not personally opposed to them, but as a healthcare provider myself, I fully support a healthcare provider's freedom of conscience.)

[syzygy]

What's really disturbing about this is that bc pills are often prescribed for reasons other than simple birth control. Since when does the pharmacist have the right to know why they are being prescribed? If a single woman has health problems that aren't being met because the pharmacist makes an assumption, that is just morally wrong. Especially if the woman cannot use another pharmacy, for whatever reason.

[honeygirl1971]

I know several people (a nurse, a doctor, and several philosophers) who do ethics consultations at local hospitals. According to them, here are the general problems with the arguments provided by Clara et al:

1. Physicians have a monopoly on medical care and are therefore obligated to provide care generally.
2. Patients have a right to treatment, regardless of their religious beliefs, race, ethnicity, gender, sexual orientation, etc

To try to claim that MDs (or pharmacists) have a right not to provide "care" seems to contradict 1 and 2.

I found an interesting article about a physicians' group that faced this exact problem vis à vis BCPs: http://www.aafp.org/afp/20020315/curbside.html

Some interesting points made in the article:
"First, the ethics of informed consent require that women of child-bearing potential, as a matter of routine in their primary care, be offered information about medically reasonable alternatives for preventing pregnancy, including contraception. Second, pregnant women have the right to know that abortion before viability is a legal option. Legitimate moral objections to the performance of contraceptive or abortion services, based on individual conscience, require that women who desire contraceptive or abortion services have access through appropriate referral to health professionals who can meet their medical needs."

So, I'd be willing to say that a physician can opt out of prescribing BCPs etc IF they can give the patient access and/or referral to someone who can. If not, then you have an ethical violation.

[Kathy B]

Originally posted by honeygirl1971
I know several people (a nurse, a doctor, and several philosophers) who do ethics consultations at local hospitals. According to them, here are the general problems with the arguments provided by Clara et al:

1. Physicians have a monopoly on medical care and are therefore obligated to provide care generally.
2. Patients have a right to treatment, regardless of their religious beliefs, race, ethnicity, gender, sexual orientation, etc

To try to claim that MDs (or pharmacists) have a right not to provide "care" seems to contradict 1 and 2.
........

It's interesting that this topic should come up, as we had a lecture on "Ethics" at our unit update last week given by the chair of the hospital ethics committee.

Among other things, he cited the "Big Four Priciples" as autonomy, beneficence, non-malfeasance and justice.

Under the principle of autonomy, he stated that patients have the right to "seek and accept treatment", but they "cannot demand treatment". I know this concept is followed at our hospital, because I have seen cases where surgeons have refused to do a particular surgery on a patient because they felt it was futile, even though the family wanted it.

It would appear that even the ethics of different institutions are not always in agreement.


So, I'd be willing to say that a physician can opt out of prescribing BCPs etc IF they can give the patient access and/or referral to someone who can. If not, then you have an ethical violation.

That is why I mentioned that the pharmacist should be willing to transfer the prescription or in some other way direct them to another source of help. If the doctor is aware of the situation, he may be able to assist.

[honeygirl1971]

But the doctor has to have a good reason to deny treatment as well. The surgery example is easy, because if in the doctor's medical opinion the surgery is futile, then the risks of surgery clearly outweigh the benefits. There is no ethical dilemma there at all. But for a doctor to deny a woman BCPs because she is not married is very, very different. That is discrimination and unethical.

[Kathy B]

Maybe I should have elaborated...the family wanted the surgery as a means of saving their loved one's life. The surgeon would not perform it, because in his opinion, the outcome would not change. His belief was that he wouldn't perform surgery if there was nothing to be gained. (To him, that would be unethical). The family believed that every possible avenue should be taken to save the person, and they DID think the surgery might help. The risk of surgery shouldn't enter into it, because the outcome in the surgeon's opinion would not change.

On the other hand, the family could go elsewhere if they found someone who WOULD do the surgery, and our hospital would help make arrangements to transfer.

[honeygirl1971]

Right, I totally understand, but again, the reason it would be unethical to perform futile surgery (and it would be, IMO) is because a doctor is supposed to do no harm, and performing a futile surgery is doing harm. The family members are not doctors, so to me their medical opinion is irrelevant. But, of course, they are entitled to a second opinion, and if they find a doctor who will do it then it is only right for your hospital to help them transfer the patient.

[Kathy B]

Originally posted by honeygirl1971
But for a doctor to deny a woman BCPs because she is not married is very, very different. That is discrimination and unethical.

Again, I think whether it is unethical or not is open to interpretation by the institution. There is one hospital in our area that will no longer provide "in vitro fertilization" to unmarried women. It caused an uproar when they first changed their policy, but they stood by their decision as they felt to do otherwise went against their mission. If unmarried women want that service, they go somewhere else.

[BarbaraL]

An interesting thing to note in the article (if the article is true), is that Dr. Hager is reported to refuse to prescribe contraceptives to unmarried women. This implies he'd prescribe them to married women, and the issue isn't whether or not birth control pills prevent implantation of a viable embryo (thus "killing" it). The issue is whether or not unmarried women should have sex.

He recommends prayer to women with PMS? What makes PMS a special target for prayer? Sounds like he doesn't consider it a medical condition so much as an emotional one. Does he recommend prayer for men with problems relating to hormones? An OB/GYN who thinks PMS is all in a woman's mind -- wonderful.

A peeve of mine is that many groups who are zealously pro-life disappear once the baby is born. No support services for the mother or baby. How "moral" is it to advocate that these children be born, but then have no concern for their survival, development, quality of life?

Off my soapbox now.

[honeygirl1971]

There are different kinds of ethics...medical ethics, religious ethics etc. Some institutions, and individuals, conflate them.

[Kathy B]

Looking up conflate.....:D

[honeygirl1971]

LOL Kathy...
from Merriam-Webster online:
Main Entry: con·flate
Pronunciation: k&n-'flAt
Function: transitive verb
Inflected Form(s): con·flat·ed; con·flat·ing
Etymology: Latin conflatus, past participle of conflare to blow together, fuse, from com- + flare to blow -- more at BLOW
1 a : to bring together : FUSE b : CONFUSE
2 : to combine (as two readings of a text) into a composite whole

I was saying, in a sort of shorthand, that it sounded like that institution might have merged religious ethics and medical ethics into the same thing when they made that decision (although, I can't say for sure, not knowing what they see as their "mission.") And I think people like Hager do the same thing. Just to clarify, I was NOT saying that you were doing this. ;)

[Kristilyn1]

Originally posted by honeygirl1971
I know several people (a nurse, a doctor, and several philosophers) who do ethics consultations at local hospitals. According to them, here are the general problems with the arguments provided by Clara et al:

1. Physicians have a monopoly on medical care and are therefore obligated to provide care generally.
2. Patients have a right to treatment, regardless of their religious beliefs, race, ethnicity, gender, sexual orientation, etc

To try to claim that MDs (or pharmacists) have a right not to provide "care" seems to contradict 1 and 2.

I found an interesting article about a physicians' group that faced this exact problem vis à vis BCPs: http://www.aafp.org/afp/20020315/curbside.html

Some interesting points made in the article:
"First, the ethics of informed consent require that women of child-bearing potential, as a matter of routine in their primary care, be offered information about medically reasonable alternatives for preventing pregnancy, including contraception. Second, pregnant women have the right to know that abortion before viability is a legal option. Legitimate moral objections to the performance of contraceptive or abortion services, based on individual conscience, require that women who desire contraceptive or abortion services have access through appropriate referral to health professionals who can meet their medical needs."

So, I'd be willing to say that a physician can opt out of prescribing BCPs etc IF they can give the patient access and/or referral to someone who can. If not, then you have an ethical violation.



umm, your examples are all physicians. Pharmacists are not physicians, though I'm sure you know that being in the medical field. As someone who has also been in the medical field, we had one of the few doctors in the area that would perform abortions. Many of the OB's in this area have chosen to not offer the service. Period. I think it's important to remember that birth control is a controlled drug and one of the reasons is that it does have the potential for serious health risks. How about if you were a doctor and you knew your patient was a heavy smoker? It's pretty clear that there are serious health risks associated with birth control and smoking. I think at least for some people (who shall remain nameless and are ignoring me anyway) that this thread is just another chance to use scare-mongering tactics and be disrespectful of people and their faith--also to imply that such displays of faith are somehow new and as a direct result of the last two presidential elections. I for one am very tired of hearing how suddenly we don't have the right in this country to refuse to do something that we don't want to do. There IS recourse. If the pharmacy does not agree with the pharmacist--they can fire him/her. If the town is up at arms about it, an enterprising person can open a new pharmacy. With the boom in mail-order pharmacies I can't imagine that people would suddenly be without their prescription for birth control. Somehow, we can all make choices, unless that choice is a result of faith. There are some valid points to be made about someone imposing their faith on a person, but I think the argument gets flogged to death and trotted out for every example of someone not doing something that a whole bunch of people think they should.

As an interesting aside: for states that will someday in the future have laws supporting physician assisted suicide--should a doctor have to do this if someone wants it? How about if they are the only doctor around for 100 miles? Or another example: medicinal marijuana. Should a physician have to prescribe it? How about doctors that don't believe in treating ear infections with antibiotics? Should they have to?

Kristi

[RunnerKim]

Originally posted by Kristilyn1
I think it's important to remember that birth control is a controlled drug and one of the reasons is that it does have the potential for serious health risks.

Just an FYI in Washington there's been a trial of making birth control pills available over the counter. Person has to answer a survey at the pharmacy counter, but can get the pills without a doctor's prescription. Of course the pharmacist is still involved so it's not like picking up tylenol.

Kim

[leebee]

And there are other reasons for taking BCPs. I was put on them when I was 16, not for birth control, but for painful, heavy, long periods. I took them for a very, very long time before becoming sexually active, and then they were not my only form of birth control (sorry if TMI!!). I took BCPs until my husband & I decided to start a family, and while they were a reliable birth control method, it was never the reason I took them. For someone to deny me a perscription because I was unmarried at any point would have been doing harm. It's not up to a pharmacist to determine that. It's between me & my doctor.

[Kathy B]

Originally posted by honeygirl1971
from Merriam-Webster online:
Main Entry: con·flate
1 a : to bring together : FUSE b : CONFUSE
2 : to combine (as two readings of a text) into a composite whole

I was saying, in a sort of shorthand, that it sounded like that institution might have merged religious ethics and medical ethics into the same thing when they made that decision (although, I can't say for sure, not knowing what they see as their "mission.") And I think people like Hager do the same thing. Just to clarify, I was NOT saying that you were doing this. ;)

Thanks for the definition....darn kids have run off with my dictionary again! :p

You are most likely right that the instition is combining religious and medical ethics...that particular one is a Catholic hospital.

[ktg0930]

On one hand, I can appreciate that a pharmacist can refuse to dispense a medication that he/she is opposed to as a result of faith. That is their right to act according to their conscience. And several states were considering laws to protect pharmacists when they exercise that right. On the other hand, when the patient brings a prescription to the pharmacy, the physician has presumably evalauted the patient and decided that this is appropriate treatment for the patient. It is not my role as a pharmacist to question the physician's judgement, unless there is a case of drug interaction or other risk to the patient.

In the previous thread about this topic, I recall that there was an example in an article where the pharmacist not only refused to fill a script for a medication, but also refused to give the script back to the patient to take somewhere else. In my opinion, that's going too far. It's one thing to refuse to fill it because of your beliefs, but it's another thing to prevent the patient from filling the script anywhere because it conflicts with your beliefs.

[colleency]

Originally posted by BarbaraL
He recommends prayer to women with PMS? What makes PMS a special target for prayer?

To be offered this as medical advice would make me exceedingly angry.

[Lauren]

Originally posted by leebee
And there are other reasons for taking BCPs. I was put on them when I was 16, not for birth control, but for painful, heavy, long periods. I took them for a very, very long time before becoming sexually active, and then they were not my only form of birth control (sorry if TMI!!). I took BCPs until my husband & I decided to start a family, and while they were a reliable birth control method, it was never the reason I took them. For someone to deny me a perscription because I was unmarried at any point would have been doing harm. It's not up to a pharmacist to determine that. It's between me & my doctor.

My thoughts exactly! And I feel the same way about abortion. It's a choice that the government has no business being in. This thread is the reason I voted for Kerry. :rolleyes: I'm horrified about Hager's appointment.

[ellamay]

Pharmacists are physicians. My aunt just received her licensure and is a pharmacist in a large hospital. She was in medical school for 6 years and had to undergo a residency, take boards and become licensed, just like a doctor would. The degree she holds is Doctor of Pharmacy.

[Gecko]

Originally posted by ktg0930
On one hand, I can appreciate that a pharmacist can refuse to dispense a medication that he/she is opposed to as a result of faith. That is their right to act according to their conscience. And several states were considering laws to protect pharmacists when they exercise that right. On the other hand, when the patient brings a prescription to the pharmacy, the physician has presumably evalauted the patient and decided that this is appropriate treatment for the patient. It is not my role as a pharmacist to question the physician's judgement, unless there is a case of drug interaction or other risk to the patient.

In the previous thread about this topic, I recall that there was an example in an article where the pharmacist not only refused to fill a script for a medication, but also refused to give the script back to the patient to take somewhere else. In my opinion, that's going too far. It's one thing to refuse to fill it because of your beliefs, but it's another thing to prevent the patient from filling the script anywhere because it conflicts with your beliefs.

Ditto. My thoughts are that they have the right to refuse to fill the script if that is their belief but they do not have the right to refuse to hand back the Rx so that the patient may go elsewhere.

[HejazSunKat]

Originally posted by DmOrtega
Get a new prescription from your doctor.

Why on earth should one have to go to that trouble? If he doesn't want to do his job and fill a customer's prescription he should hand it back. What exactly does he think he is accomplishing by refusing to give the patient back the prescription?

[angelamaria]

ummmm... a pharmacist is not a physician. they may go to a school of pharmacy affiliated with a med school but a physician has an MD or DO. just wanted to clarify. however a pharmD is very well educated in their field.
maybe someone more computer savvy than me can post a link to an editorial on this very subject that appeared in the nov 4 New England Journal of Medicine. it was very thought provoking and delved into the ethics of it all from both viewpoints.

[Kristilyn1]

Originally posted by ktg0930


In the previous thread about this topic, I recall that there was an example in an article where the pharmacist not only refused to fill a script for a medication, but also refused to give the script back to the patient to take somewhere else. In my opinion, that's going too far. It's one thing to refuse to fill it because of your beliefs, but it's another thing to prevent the patient from filling the script anywhere because it conflicts with your beliefs.

I would have to wholeheartedly agree with this!

Kristi

[Kristilyn1]

So then:

does someone have the right to refuse to do something in their job, if they don't believe it to be right? Keeping in mind that if they do refuse, there is a legitimate reason to fire their butts afterward?

Such as:

businesses that refuse to sell alcohol or cigarettes
doctors that refuse to do abortions or like I mentioned before, assist in patient suicides, when/if they become legal
a plastic surgeon refusing to do butt implants
or if the guy who did Michael Jackson's face work had refused to do it (am I the only one who wishes he had?)
or even better, the plastic surgeon who refuses to do breast implants on patients younger than 18, not because of the risks, but because he/she thinks it's wrong?
Or like my ex-boyfriend's doctor who refused to do a vasectomy on him because he was unmarried and under 30 (he felt that he might change his mind later)


Or is it a case of, it depends on what they refuse or who refuses? I'm very confused as to the argument that BCP is used for things other than birth control. I'm not sure where that fits into the argument. Either someone can refuse to do something they think is wrong or they can't, right? Does it really matter if the product is used to stop you from getting pregnant or if it's used to regulate your period? Do you only get to refuse if you have a good reason for it? If so, what is deemed a good reason?

Just for the record, I used BCP's for many years and actually wish more people would.

Kristi

[Kristilyn1]

whoops, just wanted to add that I brought up the fact that BCP's are a controlled drug--which may cloud my argument above. I was just pointing out that it's not like it's candy, though it really isn't pertinent to MY argument.

Kristi

[Gilgamesh37]

Kristilyn, I won't presume to speak for everyone else, but I think where I draw the line is whether you are the owner/business entity, or a paid employee.

If I'm a doctor (either sole practitioner or LLP) and I decide that in my practice I'm not going to offer X services, I think that's fine as long as that information is public.

If I'm a grocery store owner and I decide I don't want to carry cigarettes or booze, that's fine too.

Where I have the problem--and it would be hte parallel to this situation--is where I'm an employee and I refuse to perform an essential function of my job because it conflicts with my conscious--say I'm a cashier in the grocery store and I refuse to sell you cigarettes or liquor or twinkies or cake mix--not because I think you're underage (in the first two exmaples) but just because I think these items are wrong or that for some reason you personally shouldn't have them. THAT'S where I have a problem. Everyone is free to act according to their conscience, but don't accept employment where you know that you can't fulfill all the functions of hte job. Go find a job somewehre else. It's absurd to me that anyone thinks an employer should be expected to accomodate an employee who accepts a job knowing that he can't and WON'T perform all aspects of it.

[jellyben]

My .02 for what it's worth.

I think that legally a pharmacist should be required to fill all prescriptions. But I also see no need to force a person to violate his own morality. If I can go to the pharmacy across the street, I will.

[stefania4]

It seems to me that medicine is rife with ethical choices, and this pharmacist has chosen BCP and ignored others. What about filling a Ridalin prescription for a toddler who may simply be energetic, not clinically ADD? What about selling laxatives to someone who is clearly and dangerously underweight? What about prescription drug abuse? If he has a stand on these issues, it hasn't been reported.

As far as I'm concerned, if you're hired to dispense prescription medication then you're not doing your job if you don't dispense medication. If the entire company/store/whatever is in agreement about certain issues, they should be clearly posted at the onset. Years ago when I was battling raging endometriosis and uterine fibroids, I was sure to tell my friends and a trusted co-worker that if I ever had to go to the ER they were to avoid the Catholic hospital at all costs, because of the Catholics' policies about restricted health care for gynecological issues. Obviously I don't agree with prizing the health of the uterus above the health of the entire person, but at least I knew about it ahead of time and could avoid the situation entirely.

[ClaraB]

Originally posted by stefania4
It seems to me that medicine is rife with ethical choices, and this pharmacist has chosen BCP and ignored others. What about filling a Ridalin prescription for a toddler who may simply be energetic, not clinically ADD? What about selling laxatives to someone who is clearly and dangerously underweight? What about prescription drug abuse? If he has a stand on these issues, it hasn't been reported.

As far as I'm concerned, if you're hired to dispense prescription medication then you're not doing your job if you don't dispense medication. If the entire company/store/whatever is in agreement about certain issues, they should be clearly posted at the onset. Years ago when I was battling raging endometriosis and uterine fibroids, I was sure to tell my friends and a trusted co-worker that if I ever had to go to the ER they were to avoid the Catholic hospital at all costs, because of the Catholics' policies about restricted health care for gynecological issues. Obviously I don't agree with prizing the health of the uterus above the health of the entire person, but at least I knew about it ahead of time and could avoid the situation entirely. I don't think the pharmacist has ignored other situations - my assumption is that he's not refusing to dispense BCPs because of their health risks to the woman, but because they are potential abortifacients. To him, it doesn't matter whether they are used primarily for birth control or to control painful menses, that potential is still there, and that's why he doesn't dispense them. I agree that refusing to return or transfer the prescription does go too far, and violates the woman's right to healthcare, but I don't see why the pharmacist should be forced, by dispensing the drug, to participate in what he considers to be murder, so the woman won't be inconvenienced by having to find another pharmacy. If the pharmacist is an employee of a pharmacy, then his refusal to dispense BCPs is an employment issue to be dealt with by his employer. As in a hospital, if there's another pharmacist on duty, he should transfer the responsibility for filling the script to the pharmacist who doesn't have moral reservations about it. But again, that's an issue to be settled between the employer/employee.

Just for the record, not all Catholic hospitals are so restrictive when it comes to women's health issues. I work at a Catholic hospital on their women's surgery unit, and believe me, the docs here have no problems with removing uteri and ovaries :o . Tubal ligations aren't done here, however. I know your point was about being open with healthcare policies, but I didn't want anyone thinking all Catholic hospitals would refuse to do hysterectomies.

[honeygirl1971]

Originally posted by ClaraB
I don't think the pharmacist has ignored other situations - my assumption is that he's not refusing to dispense BCPs because of their health risks to the woman, but because they are potential abortifacients. To him, it doesn't matter whether they are used primarily for birth control or to control painful menses, that potential is still there, and that's why he doesn't dispense them. I agree that refusing to return or transfer the prescription does go too far, and violates the woman's right to healthcare, but I don't see why the pharmacist should be forced, by dispensing the drug, to participate in what he considers to be murder, so the woman won't be inconvenienced by having to find another pharmacy.

By refusing to fill a prescription for anything other than medical reasons is, to me, the same thing as violating my right to healthcare. There are a lot of reasons why I might not be able to go to another pharmacy, and if indeed I cannot, then the pharmacist is in fact denying me healthcare. He's not taking the pill, I am, so I don't see where his religious beliefs come into it.

And in the Hager example, he did still prescribe BCPs to married women, so the so-called abortifacient argument doesn't apply.

[honeygirl1971]

The NEJM article is about emergency contraception (the morning after pill), so it is related but not exactly the same thing. The link to the article won't work here, but here are some excerpts. To be fair, I'm posting the central argument on both sides, but I find the argument for the right to refuse to be totally unsound, and to disregard the pharmacist's ethical obligations to a patient entirely.

For the pharmacists' right to refuse:
Pharmacists Can and Should Exercise Independent Judgment

Pharmacists, like physicians, are professionals. They complete a graduate program to gain expertise, obtain a state license to practice, and join a professional organization with its own code of ethics. Society relies on pharmacists to instruct patients on the appropriate use of medications and to ensure the safety of drugs prescribed in combination. Courts have held that pharmacists, like other professionals, owe their customers a duty of care.19 In short, pharmacists are not automatons completing tasks; they are integral members of the health care team. Thus, it seems inappropriate and condescending to question a pharmacist's right to exercise personal judgment in refusing to fill certain prescriptions.

Professionals Should Not Forsake Their Morals as a Condition of Employment

Society does not require professionals to abandon their morals. Lawyers, for example, choose clients and issues to represent. Choice is also the norm in the health care setting. Except in emergency departments, physicians may select their patients and procedures. Ethics and law allow physicians, nurses, and physician assistants to refuse to participate in abortions and other reproductive services.14,20 Although some observers argue that active participation in an abortion is distinct from passively dispensing emergency contraception, others believe that making such a distinction between active and passive participation is meaningless, because both forms link the provider to the final outcome in the chain of causation.

Conscientious Objection is Integral to Democracy

More generally, the right to refuse to participate in acts that conflict with personal ethical, moral, or religious convictions is accepted as an essential element of a democratic society. Indeed, Oregon acknowledged this freedom in its Death with Dignity Act,21 which allows health care providers, including pharmacists, who are disquieted by physician-assisted suicide to refuse involvement without fear of retribution. Also, like the draftee who conscientiously objects to perpetrating acts of death and violence, a pharmacist should have the right not to be complicit in what they believe to be a morally ambiguous endeavor, whether others agree with that position or not. The reproductive-rights movement was built on the ideal of personal choice; denying choice for pharmacists in matters of reproductive rights and abortion seems ironic.



Against the pharmacists' right to refuse:


Pharmacists' Objections Significantly Affect Patients' Health

Although religious and moral freedom is considered sacrosanct, that right should yield when it hinders a patient's ability to obtain timely medical treatment. Courts have held that religious freedom does not give health care providers an unfettered right to object to anything involving birth control, an embryo, or a fetus.28,29 Even though the Constitution protects people's beliefs, their actions may be regulated.30 An objection must be balanced with the burden it imposes on others. In some cases, a pharmacist's objection imposes his or her religious beliefs on a patient. Pharmacists may decline to fill prescriptions for emergency contraception because they believe that the drug ends a life. Although the patient may disapprove of abortion, she may not share the pharmacist's beliefs about contraception. If she becomes pregnant, she may then face the question of abortion — a dilemma she might have avoided with the morning-after pill.

Furthermore, the refusal of a pharmacist to fill a prescription may place a disproportionately heavy burden on those with few options, such as a poor teenager living in a rural area that has a lone pharmacy. Whereas the savvy urbanite can drive to another pharmacy, a refusal to fill a prescription for a less advantaged patient may completely bar her access to medication. Finally, although Oregon does have an opt-out provision in its statute regulating assisted suicide, timing is much more important in emergency contraception than in assisted suicide. Plan B is most effective when used within 12 to 24 hours after unprotected intercourse.31 An unconditional right to refuse is less compelling when the patient requests an intervention that is urgent.

Refusal Has Great Potential for Abuse and Discrimination

The limits to conscientious objection remain unclear. Pharmacists are privy to personal information through prescriptions. For instance, a customer who fills prescriptions for zidovudine, didanosine, and indinavir is logically assumed to be infected with the human immunodeficiency virus (HIV). If pharmacists can reject prescriptions that conflict with their morals, someone who believes that HIV-positive people must have engaged in immoral behavior could refuse to fill those prescriptions. Similarly, a pharmacist who does not condone extramarital sex might refuse to fill a sildenafil prescription for an unmarried man. Such objections go beyond "conscientious" to become invasive. Furthermore, because a pharmacist does not know a patient's history on the basis of a given prescription, judgments regarding the acceptability of a prescription may be medically inappropriate. To a woman with Eisenmenger's syndrome, for example, pregnancy may mean death. The potential for abuse by pharmacists underscores the need for policies ensuring that patients receive unbiased care.

[honeygirl1971]

And here is what the NEJM article suggested as a solution:

Although we believe that the most ethical course is to treat patients compassionately — that is, to stock emergency contraception and fill prescriptions for it — the totality of the arguments makes us stop short of advocating a legal duty to do so as a first resort. We stop short for three reasons: because emergency contraception is not an absolute emergency, because other options exist, and because, when possible, the moral beliefs of those delivering care should be considered. However, in a profession that is bound by fiduciary obligations and strives to respect and care for patients, it is unacceptable to leave patients to fend for themselves. As a general rule, pharmacists who cannot or will not dispense a drug have an obligation to meet the needs of their customers by referring them elsewhere. This idea is uncontroversial when it is applied to common medications such as antibiotics and statins; it becomes contentious, but is equally valid, when it is applied to emergency contraception. Therefore, pharmacists who object should, as a matter of ethics and law, provide alternatives for patients.

Pharmacists who object to filling prescriptions for emergency contraception should arrange for another pharmacist to provide this service to customers promptly. Pharmacies that stock emergency contraception should ensure, to the extent possible, that at least one nonobjecting pharmacist is on duty at all times. Pharmacies that do not stock emergency contraception should give clear notice and refer patients elsewhere. At the very least, there should be a prominently displayed sign that says, "We do not provide emergency contraception. Please call Planned Parenthood at 800-230-PLAN (7526) or visit the Emergency Contraception Web site at www.not-2-late.com for assistance." However, a direct referral to a local pharmacy or pharmacist who is willing to fill the prescription is preferable. Objecting pharmacists should also redirect prescriptions for emergency contraception that are received by telephone to another pharmacy known to fill such prescriptions. In rural areas, objecting pharmacists should provide referrals within a reasonable radius.

Notably, the American Pharmacists Association has endorsed referrals, explaining that "providing alternative mechanisms for patients . . . ensures patient access to drug products, without requiring the pharmacist or the patient to abide by personal decisions other than their own."33 A referral may also represent a break in causation between the pharmacist and distributing emergency contraception, a separation that the objecting pharmacist presumably seeks. And, in deference to the law's normative value, the rule of referral also conveys the importance of professional responsibility to patients. In areas of the country where referrals are logistically impractical, professional obligation may dictate providing emergency contraception, and a legal mandate may be appropriate if ethical obligations are unpersuasive.

[emphasis mine]

[angelamaria]

thanks honeygirl! i am so computer stupid. i forgot when i originally posted that the editorial was regarding emergency contraception but i think the ethical considerations are similar and i felt it was well written from both points of view.

i personally do not think of bcps as abortifacients if used regularly since they prevent ovulation from happening. however emergency contraception could theoretically prevent implantation of an embryo in the uterine lining so i guess it would be the more distressful thing to fill to a pharmacist who does not believe in the right to choose. why a pharmacist would resist filling a normal bcp rx is beyond me unless he is Catholic and doesn't want to assist anyone in preventing ovulation. the problem is how would he even know it is being used to prevent pregnancy? the doctor may be prescribing it to treat a gynecological or dermatological disorder and in fact i have given it to several virginal teens over the years for menstrual issues. i feel like if the pharmacy refused to fill it they are stepping on my toes and replacing my medical decision with their own.

[Kristilyn1]

I don't know about anyone else, but I am exhausted trying to find where the Constitution refers to "right to healthcare". Maybe it's further broken down into "right to receive convenient contraception"?

And just in case I get accused of being the religious right again, personally if it was my pharmacy I would fire someone who refused to fill prescriptions, though I would certainly be pretty impressed with someone who would actually stands by their morals. That's what being "free" really means. You get to do what you want, but you also have to deal with the consequences of those choices.

Kristi

[Kathy B]

Originally posted by Kristilyn1
And just in case I get accused of being the religious right again, personally if it was my pharmacy I would fire someone who refused to fill prescriptions, though I would certainly be pretty impressed with someone who would actually stands by their morals. That's what being "free" really means. You get to do what you want, but you also have to deal with the consequences of those choices.

Kristi

I agree with the last part of your comments, although I would not fire the person. I think that is one thing I appreciate so much about the hospital where I work. They consider everyone's beliefs to be worthy of respect, and they have a system in place to help employees who find themselves in situations that compromise their beliefs or values (see earlier post), just as they do whatever they can to accomodate the beliefs of patients and their families.

[jmarie]

Many years ago, I suffered with horrible cramping. I had heard of a new medication, Motrin 500 or something new (That ages me, huh?) that you could get via prescription. That is what I wanted.

My doctor prescribed birth control pills. I told him that I didn't want to take birth conttrol pills. Could I just please have the other stuff. He got angry, told me he could not treat me and ordered me out of his office.

This man was a Sunday School teacher in the Southern Baptist church and went on to write quarterly lessons that were taught in the Adult Sunday School classes, nationwide.

One Christian refuses to honor prescription

Another Christian refuses to order anything else but the BC pills.

To answer your question...
Yes this is America.
God bless the USA:D

PS Yes, I am still angry at that doctor.