How can this be?? This is America!

[lisas3575]

Some pharmacists are refusing to fill bcp prescriptions because they are personally against contraception.

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/sh...ght=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/prin...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/prin...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.

[LonghornGal]

Originally posted by lisas3575
Some pharmacists are refusing to fill bcp prescriptions because they are personally against contraception.

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 � 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.