Pharmacists’ refusal to fill legally written prescriptions has recently become a topic of debate among healthcare providers, employers, lawmakers, and the general public.
The issue is often framed as a question of patient rights vs. pharmacist rights, due to the public controversy over the emergency contraceptive “Plan B” which has unfolded over the past decade. However, the issue carries broader implications, extending to drugs intended for abortion or immediate post-abortion care, lethal injection for use in the potentially abused medications such as narcotics.
The stakes are so high for interested parties that states across the country have been pressured to take a position for or against pharmacists’ refusal to fill through legislation and policy changes. As of November 2006, five states (AR, CA, GA, MS, SD) have chosen to codify the right of a pharmacist to refuse to fill a prescription on moral grounds, while four (IL, MA, NC, PA) have passed legislation requiring pharmacists to fill or transfer certain prescriptions.1
On March 23, 2007, Washington became the 5th state to take a stance against refusal to fill when their Board of Pharmacy amended policy to require that pharmacists make a good faith effort to fill any legal and medically appropriate prescription.2 At the same time, the Board set standards defining and mandating professional behavior in cases when declining to fill is unavoidable. Specifically, pharmacists may not destroy or refuse to return a lawful prescription, violate patient privacy or rights under federal anti-discrimination laws, or intimidate or harass a patient.
Some states’ laws are broad in scope, applying to all medications, while others apply only to certain controversial prescriptions. Unfortunately, in each of the states mentioned above one group loses out, with the needs of either patients or objecting providers remaining entirely unaddressed.
For patients wishing to fill a controversial medication, the inability to access a willing healthcare provider is a barrier to care. Sometimes that barrier can be overcome by simply seeking out an alternate care provider. In other cases, no alternate is available. Some patients may be unable to access an alternate due to personal limitations such as transportation, insurance coverage, finances, prior time commitment to an employer, or lack of knowledge about where and how to access alternate care.
As with emergency contraception or pain medication, timely access to medication may be crucial, so a temporary delay may be undesirable, despite the presence of other accessible medication providers. Regardless of the feasibility of seeking care elsewhere, many patients are simply upset that a third party would have the power to refuse to fill a valid prescription when they have a legitimate medical need.
Often, refusal to fill is an issue of professional discretion, basic moral freedom, or practice of religion. Some practitioners feel that they should be able to decline any prescription for any reason because imposition of any limitations would impinge upon their professional discretion. This is a legitimate concern, as even legally written controversial medications may be inappropriate due to medical contraindications.
Others feel that because their license is on the line every time they fill a prescription they should be the one to decide when not to fill a medication. Independent pharmacy owners and those who have chosen to practice in religiously affiliated healthcare systems may be especially adamant about the right to determine their own scope of pharmacy practice, limiting it to those items which they can dispense in good conscience.
A mandate to participate would harm some practitioners, forcing them to choose between religious or moral convictions and their perceived professional duties. Where religious freedoms are denied, such legal statutes may be unconstitutional. Ironically, such laws could make lawbreakers out of otherwise good practitioners who refuse to stand down on the issue. The situation is especially frustrating for providers with religious or moral objections, as many entered the profession before the advent of controversial medication such as emergency contraception and are now confronted by a dilemma they could not have foreseen.
While some pharmacists are adamant about the right to refuse to fill a legally written prescription on moral grounds, there is no consensus on the issue within the profession. Many pharmacists disapprove of refusing to fill a prescription on moral grounds, citing that it is an unprofessional imposition of one’s personal morality on the patient. A handful believe that this offense is egregious enough to warrant dismissal from the profession.
Others support the right of a pharmacist to refuse to fill so long as the patient is able to obtain the medication elsewhere. It may be considered essential that the medication be provided by someone on-site, or acceptable to refer the patient to a provider at a different location.
To further complicate matters, individual pharmacists may be willing to accept some moral objections, but not others. For example, most pharmacists consider it not only acceptable but morally responsible to decline early refills on narcotic medication. For no definable reason, others may be willing to accept religious objections when it comes to abortifacients, but not when it comes to the emergency contraceptive, Plan B. The only uniting thought seems to be disgust and frustration at the negative media attention brought on the profession by the refusal to fill issue.
Refusal to fill will continue to be an issue until controversial medications are readily available to those who seek them. To those who see refusal to fill legislation as an easy fix – on either side of the dilemma – I submit that it is no fix at all. Only by making an abundance of willing providers available to the public can we truly eliminate this dilemma.
Instead of berating those who do not feel comfortable dispensing controversial medications, we should be working to improve the number of access points. Prescribers of known controversial medications can help improve patient access by suggesting to their patients at least one pharmacy that is known to stock and dispense the prescribed medication. If no local dispensing sites are known, in-office dispensing should be considered.
Pharmacists can help by making themselves known to key providers as dispensers of controversial medications and by placing themselves on provider lists where they exist, such as the national Plan B registry administered by Princeton University.3 Development of local provider registries by public health departments or public minded healthcare providers can also promote access to controversial medications.
Those of us who gladly dispense controversial medications need to step up and announce our presence. Only when the public knows who we are and how to access our services will the controversy be over.
References
1) Hopkins, Denise and Marsha Boss. “Pharmacists Right to Refuse to Dispense
Prescriptions Based on Moral Grounds: A Summary of State Laws and
Regulation.” Hospital Pharmacy. 41 (2006): 1176-1179.
2) “Professional Responsibilities of Pharmacists & Pharmacies.” WAC 246-863-095,246-
869-010. 2007. Washington State Board of Pharmacy. 27 February 2007.
3) Office of Population Research. “Emergency Contraception” 2007. Princeton
University. 4 April 2007.
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While I agree that pharmacists should work together as a whole to provide all possible options for their patients to obtain legally prescribed medications, I disagree with the notion that those pharmacists who are willing to provide certain controversial medications should advertise such practices. One problem healthcare providers must deal with, even in modern times, is religious persecution for their actions. The last thing that any pharmacist needs to be worrying about is creating a target for anti-abortionists. What is to stop certain radicals from bombing local pharmacists just as they kill physicians who perform abortions? It is an unfortunate fact that these groups are able to practice violence and terror in order to further their religious beliefs. I would ask anyone and everyone in the medical community to work together to deal with this controversial moral dilemma that faces not only physicians, but pharmacists also.
So taking this issue to the logical conclusion…
What happens when a pharmacist refuses to fill a prescription for esomeprazole when omeprazole is available OTC and has never been proven to be inferior? Why charge an insurance company the extra brand-name cost when a generic alternative is available? Isn’t this a “moral argument” also?
Or what about filling a prescription for HRT given the results of the WHI?
When I write a prescription, I expect it to be error checked, properly counted, the patient’s questions answered, and I expect it to be filled. I do not expect it to have to pass some sort of moral litmus test.
First of all to advertise you are willing to fill a prescription is a very odd approach. Medications are not something to be taken lightly as if saying you are selling a common commodity on sale.
This debate was seen in Connecticut last year when a catholic hospital refused to dispense plan B. Senator Liberman felt that it isn’t a very far drive to another hospital in the state. That is a blame the victim approach. To allow one’s own religious/moral issues to stop you from dispensing a legal prescription is a dangerous line to cross. What if you have a Christian scientist that is against vaccinations. Should they have the right to deny a patient their fundamental injections?
What if I feel extending the length of life but not improving the quality of life during those years was immoral? Would anyone agree for me to do away with diabetic, blood pressure, and cancer treatment medications?
Was it ok for the pharmacist a few years back in Missouri to dilute the cancer treatment drugs since the person was terminal anyway?
For those of us that live in a large city with a pharmacy every other block it may seem like no big deal to just go down the street. What of areas with a single pharmacy? Once you open up the box, there is no going back.
Refusing to fill a prescription on the grounds that the pharmacist questions authenticity or validity is one matter. When a pharmacist refuses to fill a valid prescription due to moral or ethical reasons is absolutely wrong. I would not (and could not) refuse to treat a patient who presents to the Emergency Room based on moral issues. Pharmacists should be held to the same standard. I agree with the above comment. A prescription is given to a patient because a physician or healthcare professional with a valid DEA has deemed the medication necessary for this patient. It should be checked for authenticity, dosage accuracy and cross referenced with other medications the patient might be taking. The pharmacist is the final check in the process to ensure patient safety. They are not, and should not be moral gatekeepers preventing a patient from attaining medical care that was deemed necessary by another medical professional. Some pharmacists argue that their license is on the line with every prescription that comes across their counter, which is absolutely true. But if the script is a valid one and error checked then there is no place for the pharmacist to worry. I find this issue an interesting one. I am married to a pharmacist who employs and works with pharmacists who feel it is their right to deny any prescription for any moral reason they see fit. She disagrees with that idea as well. If pharmacists are allowed to use moral objection as a reason for refusal to fill, whats next? RNs refusing to offer care to patients with HIV contracted from gay sex…physicians refusing to treat patients who are of another ethnicity…or perhaps entire medical institutions refusing to admit patients based on religion. Sounds obsurd when it is extrapolated to the extremes but personally I see no difference.
Being a pharmacist, I agree with the above posts. I can not entertain the thought of refusing a Rx on moral grounds. Who am I to force my religion upon patients? On the other hand, we are the final step in patient safety. I will refuse Rx that I believe are of danger to my patients. I think this raises interesting questions. Do other health care providers shy away from procedures and/or treatment based upon what they believe? I don’t have the answer to that, but I would speculate that some providers do. Finally, I a previous post regarding terroism or bombings is also another valid point, although I do not believe this will play a key role in right to refuse.
[i]“What happens when a pharmacist refuses to fill a prescription for esomeprazole when omeprazole is available OTC and has never been proven to be inferior? Why charge an insurance company the extra brand-name cost when a generic alternative is available? Isn’t this a “moral argument” also?…”[/i]
[i]“If pharmacists are allowed to use moral objection as a reason for refusal to fill, whats next? RNs refusing to offer care to patients with HIV contracted from gay sex…physicians refusing to treat patients who are of another ethnicity…or perhaps entire medical institutions refusing to admit patients based on religion. Sounds obsurd when it is extrapolated to the extremes but personally I see no difference.”[/i]
Oh, c’mon. I’m not Catholic, and I would dispense this med if a patient asked for it. That having been said, the objection these phamacists have toard filling this prescription is both obvious and, I think, perfectly sensible: it may very well kill a (teeny tiny) human being. That is to say, they are concerned that the dispensation of this drug constitutes morbid malfeseance. And, as I said, technically they are probably correct.
I saw a post from a DO a few weeks ago that said something to the effect of, “I went into medicine to help people, not kill them.” And, indeed, I would hope that this is why most of you went into med/pharm. The examples given above of generic meds is one of cost savings, a completely different ethiccal concept from malfeseance. Likewise, this argument could never be used to object to treating a gay patient or one of a different ethnicity/religion because treating any such patient would not constitute a threat to other human life.
Frankly, while I do not share the perspective of these pharmacists, I admire their stance. What is our first obligation as physicians? Is it to “do no harm” or is it to “do whatever the patient wants”? That is, must we be responsible to the patient first, or to general society first?
I would argue that, given the medical profession’s propensity for and history of various “medical” atrocities in the ancient and recent past, we’d best stick to “first, do no harm.”
I think the discussion would be much different if Plan B actually had anything to do with “the teeny tiny” possible human being. When in fact Plan B has no affect on already pregnant women (although it is often confused with the so-called abortion pill RU-486). Thus the threat to human life argument is moot.
That being said, the debate over this Contraceptive, is often not only misguided and ill-informed, but introduces moral and religious ideologies into a debate that should really be focused on a patient access.
“I think the discussion would be much different if Plan B actually had anything to do with “the teeny tiny” possible human being.”
Not so, readup. If you’ll check the lit on EC, you’ll find that it may affect the endometrium such that the embryo can’t implant. If you’re someone who believes that life truly begins at coception, this would be like altering an 8 year old’s surrounding so that the child was placed into a giant, metal funnel with a 100 foot drop at the end. You would argue that you didn’t do anything to the child– all you did was change his environment. However, we both know that by changing the environment such that he would inevitably die by sliding down the funnel and falling into the 100 foot drop, so too does the embryo die by being unable to implant and “sliding” out of the uterus.
The truth of the matter is that EC sometimes acts as neither a true contraceptive nor an abortifacient. When it works to prevent implantation, it is not a contraceptive because (1) cotraceptives by definition prevent conception and (2) conception has already taken place! Neither is it abortifacient, since implantation (pregnancy) has not occurred. Nevertheless, since it can clearly act to contribute to the death of an embryo, concern seems to me to be justified.
And finally, I return to your last sentence, that the “debate should really be focused on patient access.” Again, I challenge you to explain what is more important in medicine: nonmalfeasance or patient service? You are welcome to purport that patient service > nonmalfeasance, but you will have to support your arguement.
Remember, too, that EC is hardly the end of this story. In some European countries (Belgium, the Netherlands), euthanasia of disabled children is now perfectly legal. If this comes to the US, will you be prepared to give a deadly medicine so as not to hinder patient access? Why or why not?
“If you’re someone who believes that life truly begins at coception, this would be like altering an 8 year old’s surrounding…”
Well, if a person DOESN’T believe that life begins at conception, then this analogy becomes a very poor one. Whether a few cells stuck together at pre-implantation stage traveling down the oviduct constitutes life is open to discussion. Until then, let’s try and not impose your beliefs about life on other people.
Levonorgestrel is not the only drug out there with teratogenic potential. Should we ban all drugs in pregnancy category C, D and X because of the potential to cause harm?
Remember that the primary intention is to prevent ovulation, not prevent a fertilized egg from implanting. Sure, it would be nice if we could narrow a drug down to only doing the former, but hormones are weird that way–they do all kinds of things. Levonorgestrel is not intended to cause anything remotely like an abortion. Any pharmacist should know this.
And keep this in mind: you can refuse to fill a prescription for contraception, but you can’t prevent a woman from obtaining an abortion. Surely it’s better to take that tiny risk of a fertilized egg not implanting rather than risk a woman getting pregnant and aborting a much older fetus.
“Well, if a person DOESN’T believe that life begins at conception, then this analogy becomes a very poor one.”
Clearly, you would then prescribe Plan B. As I’ve said, I would also prescribe Plan B. I’m simply noting that for anyone who does believe that life begins at conception (which, given what most microbio books say is a perfectly reasonable stance), prescribing this pill would be impossible.
“Until then, let’s try and not impose your beliefs about life on other people.”
Exactly. In the future, try not to impose your beliefs about when life begins on other medical professionals.
“Well, if a person DOESN’T believe that life begins at conception, then this analogy becomes a very poor one. Whether a few cells stuck together at pre-implantation stage traveling down the oviduct constitutes life is open to discussion. Until then, let’s try and not impose your beliefs about life on other people.”
If he’s the pharm, he isn’t imposing his beliefs, he’s simply refusing someone else imposing their belief that life doesn’t begin then on him! I know doctors can refuse to provide an abortion if they make a referral to someone who will, so why can’t a pharmacist do the same as long as he makes a referral?
“If he’s the pharm, he isn’t imposing his beliefs, he’s simply refusing someone else imposing their belief that life doesn’t begin then on him! I know doctors can refuse to provide an abortion if they make a referral to someone who will, so why can’t a pharmacist do the same as long as he makes a referral?”
I don’t see it at the same. In the case of the doctor, if they lack the proper skills to perform a procedure, it is not something that person should be attempting. Then pharmacist has the ability to dispense a medication if the pharmacy has it in stock. Another difference between the two is the time situation. The window of being able to take the medication is much smaller than the abortion.
Letting someone deny treatment based on personal feelings leads down a dangerous road. Along the same lines, would people feel comfortable with a doctor refusing emergency surgery on a woman with a zygote implanting into the fallopian tubes and causing internal bleeding? If the argument would be “you are saving the mother’s life”, then I ask how do you justify killing one individual to save another?
“Letting someone deny treatment based on personal feelings leads down a dangerous road.”
It’s not about leading down a “dangerous road.” Rather, it’s about being unwilling to put a single foot on the road! Each of us bears the moral responsibility for what WE do. This includes our patients… but it also includes us.
As I’m sure you recall, one of the defenses used in the Nazi tribunals was, “I was just following orders.” As a result, the UN has now declared that (1) all persons have the right of conscience and (2) “I was just following orders” is no longer a defense unless the perpetrator was being threatened with moratl danger.
The upshot of all of this is that, unless your patient sticks a gun in your face, you are morally responsible for each action that you take. “I was following orders” is not a defense. It suggests that, when we put on the white coats, we are no longer humans, but machines. However, the Nazi docs were held morally responsible for what they did under orders whit their white coats on— and so are we.
Now I am in no way suggesting that administering this pill is akin to being the next Goebbels. Far from it! What I am saying, though, is that we all bear moral responsibity for our actions, whether the white coat is on or whether it is off. Thus, if you are someone who is earnestly convinced that the administration of a given pill can contribute the the death of a human being, then– unless someone has a gun to your head– you are morally responsible for any such deaths that occur due to your administration of this pill.
To compare the situation of the concentration camps to the pill is misleading. I am not talking about the brutality part but the moral belief of the world is genecide is illegal and immoral. Our society has not made abortion illegal and we have approved the use of the medication.
Your argument also could allow for a pharmacist to refuse any medication based on a personal belief. Would it be ok for me to refuse to dispense antibiotics for STDs since I believe sex before marriage is immoral and that person is being punished for their adultry?
What about the more extreme that I feel a human being should be responsible for their own health and refuse to fill any medication for a drug that is used to treat a person that doesn’t take care of themselves (i.e. poor diet)
“In the case of the doctor, if they lack the proper skills to perform a procedure, it is not something that person should be attempting.”
It has nothing to do with skill. A doctor can refuse to give an abortion if it is against their moral beliefs, as long as they make a referral, and it isn’t an emergency situation. I propose the same should apply to a Pharmacy. The window of time is irrelevent unless we are talking a situation involving the life of the mother, in which case the same rules should apply as for the doc…so its really not relevent here other than as a red herring.
“Letting someone deny treatment based on personal feelings leads down a dangerous road.”
Actually, the opposite is true, and I hope we never come to a day when the ethical judgement of the provider is swept aside.
“To compare the situation of the concentration camps to the pill is misleading. I am not talking about the brutality part but the moral belief of the world is genecide is illegal and immoral.”
Well, we have *now* decided that genocide is illegal and immoral. But in 1940s Germany, not only was it legal, but it was touted as the most moral thing mankind could do- create a true Master Race. Thus we see that blind submission to the moral fashions of a time period are not an appropriate way to make moral decisions.
“Your argument also could allow for a pharmacist to refuse any medication based on a personal belief. Would it be ok for me to refuse to dispense antibiotics for STDs since I believe sex before marriage is immoral and that person is being punished for their adultry?”
Actually, my argument could not allow for this. Failure to dispense antibiotics to someone with an STD could directly result in infertility or even death. Since (1) we are to “first, do no harm,” and (2) infertility and dealth are clearly harmful, such behavior could not be justified. It’s all about putting nonmalfeasance first.
“If you’re someone who believes that life truly begins at coception [sp]…”
You just summed up my entire argument with your own comment.
If you BELIEVE.
Medical fact out the window, a persons BELIEF and moral convictions are dictating appropriate medical care.
Slippery slope my friends…very slippery slope.
None of these controversial medications are ever medically necessary. They do not constitute health care. They amount to the equivalent of a cosmetic procedure. They go against the values that we, as medical professionals, vow to adhere to. Taking a life is not the objective of healthcare and any person in a healthcare job should be allowed to refuse to participate in murder. They should not be compelled to refer a “patient” to someone with no morals or ethics, either.
What I don’t understand is how some of you can argue that your right to judge your patients supercedes the obvious needs of the patient. The truth is: It is not about you— it is about the patients. It’s a simple as that. And, as long as oral contraceptives and Plan B are legal, it is your professional responsibility to fill the Rx. If you don’t feel comfortable doing it, I have to wonder why you became a pharm in the first place. The problem with saying that you will give the patient a referral, is that in some states this is easier said than done. You might have to drive and drive and drive before you get to another pharmacy and then be denied the medication all over again. This is totally inappropriate for a patient who might need the medication ASAP. At minimum, there should always be one pharm. on staff at each pharmacy who is available 24/7 to dispense these meds.
When a pharmacist not dispensing Plan B is not really akin to a doctor not wanting to perform an abortion. A pharmacist did not do a physical exam on the patient, did not get a history, did not order tests, and did not make a diagnosis. The doctor did. How can a pharmacist claim to know what’s best for the patient when he/she knows relatively little about the patient?
I am having a hard time getting through these posts filled with contradictions. I do believe that it is your job to take care of your patient and “Do No Harm”.. so what is the problem here.. I do believe that the person filling the script IS your patient not the clump of cells SOME might THINK is life. Also don’t ALL drugs have side effects ??
“How can a pharmacist claim to know what’s best for the patient when he/she knows relatively little about the patient?”
Thats the problem…they arent claiming to do what is best for the patient.
They are doing what is best for themselves.
Selfish, unprofessional and irresponsible.
While this is probably an argument that will never be solved, I feel the need to put in my two cents. In my opinion, telling a pharmacist he MUST dispense plan B is like telling a doctor he must prescribe plan B if it is asked for by the patient. It’s really not a problem that can be fixed. If all states outlaw the pharmacists right not to dispense, Some pharmacies will choose not to have some medications as part of their formulary. Then, they might forget to include it in their next day order. Again, it would be the same thing as a physician saying that he will not prescribe Plan B because of what he believes religiously. We are health care providers, and we must strive to work together.
Also, in case you didn’t guess. When I become a pharmacist. I will not dispense Plan B if I can help it.
“Medical fact out the window, a persons BELIEF and moral convictions are dictating appropriate medical care.”
What, then, is the medical fact? That life begins at childbirth?
To be true, there is no medical fact in respect to when life begins. It is a philosophical position, much like the whole of medicine and every decision that underlies medical treatment.
Since it is a philosophical position, then philosophical considerations must govern what constitutes correct action and what does not.
To assert, then, that we should behave corresponding to fact (the “should” here is what you should focus on, since the “should” is the basis of ethical questions, not factual ones) is to say exactly nothing, except — if one lacks the intellectual fortitude to make a real argument — simply a feeble “just look at reality; it’s obvious” catchphrase.
“The truth is: It is not about you— it is about the patients. It’s a simple as that.”
But it IS about you. You bear the moral responsiblity for every single action you take. So if you give a medicine that kills a human life, then you are responsible for that act of killing.
““If you’re someone who believes that life truly begins at coception [sp]…”
You just summed up my entire argument with your own comment.
If you BELIEVE.
Medical fact out the window, a persons BELIEF and moral convictions are dictating appropriate medical care.
Slippery slope my friends…very slippery slope.”
Well…aren’t you simply saying what YOU believe? There is no medical facts about life at this stage, its all one belief versus another. You can’t discount him for having his beliefs because in the end all you have is your beliefs too. The slippery slope argument is a fallacy, always has been, take a logic class please! We as a society would be hopeless if we believed in every instance that a step in one direction necessarily dictates more steps in the same direction. Simply because you don’t believe its life doesn’t mean you can force that belief upon others.
i get extremely upset at the pharmacists who “object” to prescriptions that i and other members of our team write on the basis of some isolated rule in a book…they are not seeing the patient, and unfortunately know the patient very little. a wrong dosage, etc, etc are definitely important things that they do pick up on, as well as suggesting alternatives for medications that are not available. i guess a pharmacist rejecting an rx for plan b is the same as a physician not accepting a patient for a variety of reasons (no insurance, annoying, etc)…but it is that doctor’s responsibility (be it md, do, pharmd, whatever) to set up a referral immediately depending on the acuity of the situation…and of course, emergencies are a no-transfer thing – you’ve got to take the patient. the simple way to handle this debate is to have plan B available at the offices of the doctors who prescribe them. this is so often the case for other drugs, implementing this should be easy. these “questionable drugs” are few in number compared to most others, and they should be kept on hand by docs, especially in areas where the provider knows it may be hard for the rx to get filled.
All we have going on here is an attempt to divorce Faith from Reason. Neither can stand on their own on this question of life.
Reason cannot tell us with certainty when life begins. Faith cannot tell us exactly when life begins. Both are gifts and smart people who have the gift of faith have both weapons in their decision making arsenal. They are simply at an advantage.
Some think religious people should hide their Christianity when they head to work each day…are you that person?
As Chesterton once said: Tolerance is the virtue of the man without convictions.
I don’t want a tolerant person caring for me.
“The slippery slope argument is a fallacy, always has been, take a logic class please! We as a society would be hopeless if we believed in every instance that a step in one direction necessarily dictates more steps in the same direction”
I don’t know what society you believe in but there are always people that if you give an inch they will try to take a mile. If you allow exceptions to certain medications to be denied, how can you justify telling a pharmacist they don’t have the right to deny access to any medication they want based on the same exact logical argument? The reason it is a slippery slope is because there will always been a more radical individual trying to push it farther and farther.
Also no one is telling anyone they have to give up their religious beliefs. Those that say that the pharmacist should just direct the person to a person that would fill the perscription. What a hypocritical idea that would be!! If you believe it is murder, how can you say I won’t personally do it but I know a guy down the street that will.
On the same lines, are you totally fine with parents that refuse to give their children immunizations based on their personal beliefs? What if one of those children then dies from the infection?
“Some think religious people should hide their Christianity when they head to work each day…are you that person?”
First of all it isn’t just a Christianity debate. Second based on your argument, we must respect a scientologist beliefs and grant them the ability to refuse psychiatric medications. If Tom Cruise was a pharmacist, he’d argue that very point.
I am shocked at the willingness of most posters here to deny the right of physician/pharmacist autonomy in favor of subjugating them to the whims of their patients. Physicians and pharmacists are their own people, they have their own moral convictions and they have their own responsibilities.
At the end of the day, it comes down to two groups of patients: patients and care providers. They are each autonomous, and they must make their own decisions, based on what they think is right. There is no reason why a patient should be forced to do an abortion, and there is no reason a physician should be forced to perform it. Apply the same to pharmacists who have their own moral convictions and autonomy as well.
This argument will have no real conclusion. At the end of the day, as the patient’s physician and health advocate, you have to make certain that the drug you’re prescribing is accessible in the time frame you’d like the patient to use it in. This takes away most of the issues from the pharmacists’ end of things. If there are pharmacists that provide the medications you prescribe, great. If not, it should be your responsibility as the doctor to make sure the drug is available. Again, pharmacists never directly treat the patients. In essence, pharmacists are much like other “doctor’s doctors” in that they provide a service to the clinical physician – in this case, the accurate dispensing of the drug on the prescription that was written. If doctor’s can’t rely on those who are effectively their consultants, they must cut them out and find other ways to get done and perform what THEY feel is the right thing to do for the patient. It’s unfortunate to think of it this way, but for example if a cardiologist I consult repeatedly erroneously clears my patients for surgery and patients have adverse outcomes, I will stop consulting that physician. The same is true on a less discrete level with pharmacists. While we don’t formally consult outpatient pharmacists, these sorts of incongruencies amongst health care providers will eventually lead to a system where there will be directed Rx filling at known places. Most academic centers’ pharmacies dispense almost all meds without the “moral agenda” involved, but this is definitely an ivory tower luxury for the doctors…we must be aware that when the patient leaves that place, they must feel confident that the care and decisions you have given them was not a farce because of someone else’s moral judgment – such a thing undermines the very bond between physican and patient.
“So if you give a medicine that kills a human life, then you are responsible for that act of killing.”
So then, the gun dealer who sells the weapon later used in a homicide, is responsible for the death?
The grocery store that sold the 12 pack, later ingested by a drunk driver who killed a pedestrian is also reponsible??
Hmmmm
I think the difference is that an abortion drug ALWAYS is used to end a human life. Whereas a gun is not necessarily used in an immoral action. Beers are not necessarily used to crash a car.
One needs knowledge and responsibility to be morally complicit in any action. If I know the drug will be used to end human life and I am responsible for dispensing it. Then I am morally complicit in the action.
“I am shocked at the willingness of most posters here to deny the right of physician/pharmacist autonomy in favor of subjugating them to the whims of their patients. Physicians and pharmacists are their own people, they have their own moral convictions and they have their own responsibilities.”
I agree with Piorus about supporting individual autonomy. The issue isn’t about the pharmacist imposing his will upon the patient, rather he is exercising his own will and we should protect that. Don’t forget that a pharmacy is a business much like a clinic or hospital. Though moral obligations to patients predominantly determine treatments offered, the rights of the business owner to decide what services to offer to the public are still present. Some exceptions exist that force people to do things, such as life saving treatment in an ER, but refusing to fill a prescription for a non life saving drug shouldn’t be one of those exceptions.
I’d hate to see pharmacists denied the right to preserve their own moral conscious while at work. Personally, I’d hate a work situation where I had to do something I considered immoral.
If you feel so strongly against certain medications, why did you become a pharmacist at all? Why put yourself in a situation where you know that you wouldn’t be able to fulfill your duties? If you got into pharmacy because you thought you could make a positive difference in people’s lives and help them, then you should realize that you are judging what you think is helping them, not what truly is going to help them.
“Though moral obligations to patients predominantly determine treatments offered, the rights of the business owner to decide what services to offer to the public are still present.”
You mean like before the civil rights movements where it was ok to not give services to select groups of people because of your personal beliefs? If a pharmacist works for another person’s business do they still have the right to say no to the services that are being offered?
“If you feel so strongly against certain medications, why did you become a pharmacist at all? Why put yourself in a situation where you know that you wouldn’t be able to fulfill your duties?”
I tend to agree with this. It would be no different than someone being so strongly against the Iraq war, yet then joins the military to go fight in the war and then complains about it.
Looks like this argument is never going to end… As long as the pt has access to healthcare they need through direct care or if denied then being referred to someone who can provide that care then there should be no problem… If the pt is in a town where the only pharmacy/medical clinic/hospital can’t provide their care and the referred place is not accessible to the pt then too bad so sad… Can’t we all just get along?
One more comment from me…
First of all I agree with the idea that physicians should be able to dispense Plan B. That way they are taking all of the respondsibility for the action they are taking. It is already an OTC drug for those over 18. So, why should we insist that those 17 and under see two providers to recieve their medication?
Also, comparing this to the Iraq war is a little off. That would also be like saying you shouldn’t be a doctor if you wouldn’t be willing to perform an abortion. It would only be an effective analogy for those who do not believe in any modern drug treatment. Like those who do not believe that they should be taking any drugs. If they were a pharmacist, that would be the correct paradox.
You say that it is our duty to dispense what we believe will kill a human life. Most of us will sat that it is our duty to serve the health and wellbeing of those who come into our pharmacy. We simply do not believe that that duty excludes the unborn.
Abortion is never health care. (okay in .01% of cases its about the health of the mother).
Bob and Anonymous really missed the point.
“If you feel so strongly against certain medications, why did you become a pharmacist at all? Why put yourself in a situation where you know that you wouldn’t be able to fulfill your duties?”
BOB: Nothing wrong with someone going into pharmacy even though they don’t agree with a few medications on the market, especially when said pharmacist entered the career before some of these medications were released. Your bad logic could be incorrectly applied to most careers in the US. Pharmacists aren’t imposing this on themselves, it’s being imposed upon them.
“You mean like before the civil rights movements where it was ok to not give services to select groups of people because of your personal beliefs?”
ANONYMOUS: What do you think? Of course I don’t mean like before civil rights. Don’t go to the extreme you’ll never find the answer there. Does my local hardware store have the right not to carry metric tools for whatever reason? Yes, that’s an example of a business owner deciding what services he wants to provide. This isn’t prejudice against any group of people, rather it’s the pharmacist respecting and standing up for his own rights.
What reason do we have to tell the pharmacist he HAS to carry and sell every single drug on the market? This isn’t an issue of meeting an emergent health care issue, its closer to that of meeting extreme convenience. If he decides he doesn’t want to carry and sell RU-486 or Plan B then that’s a right we should respect. I’ve said all this considering the rule of thumb for this issue and not the exceptions.
rube: “abortion is never healthare except in 0.01% of cases”??? you should really not be a part of this debate and, if anything, your obtuse mentality underlies many of the frustrations we have in our current health care system. Interesting story: a patient today on the trauma service had just had sex prior to her MVC and wanted Plan B. I called it in and, ironically, the pharmacist actually tried to give me the run-around. She was “against” Plan B, and when I asked for another pharmacist, I got put on hold for 10 minutes. WELL…I walked down to the inpatient pharmacy, asked to speak to the supervising pharmacist, and when I entered the “room o’pharmacists” and tried to find who I had spoken with and no one chimed in, I went through the operator logs and found out who it was. I then proceeded to yell at her regarding her clear disregard for patient care and the untimely way she “transferred” me to another pharmacist. She’s now on probation. In bum-fudge USA, you can try to pull this crap…but don’t do it at a hospital where patients have the right to choose what happens to them. Otherwise, get prepared for some real issues.
surg rez: good for you…keep fighting the good fight…
patients have every right to choose in the health care setting…shame on that pharmacist for playing games, and letting her own beliefs stand in the way of pt care…
several months ago, we had a pregnant jane doe come in through the trauma room…she quickly was taken to the OR and her baby was delivered via c-section. mom was circling the drain, baby was okay…blood transfusions were started on mom during subsequent surgery…husband shows up in the ED, states he is a jehova’s witness…he demands we stop the transfusions, we do, she dies…Did i think he was crazy?
hell yes! but it was NOT our call, only his, and he had every right to choose this.
he thanked us and went to the NICU to visit his newborn…
respect your patients’ wishes, period!
Being a pharmacist, I agree to most points in the article. I respect the individual’s moral or religious beliefs but I think the patient’s interests should superceed all. However when it comes to narcotic early refills or illegitimate narcortic prescriptions, I stand my ground since these have nothing to do with my religious or moral standards but they are just not in the best interest of the patients and I do become liable once I sign off on those prescriptions.
surg rez, I’m sorry you felt inconvenienced by your 10 minute wait. Do you not think it was the pharmacist’s right to exercise their moral concience? What about your classmates that don’t want to do rotations where they perform abortions? Did you believe that was their right too?
Is there a slippery slope the other way? I mean will one day pharmacists be required to give patients drugs to induce late term abortions just because a patient demands it?
first off, surg rez, you can be my surgeon anytime. i think that your actions display a commitment to patient care & professionalism that showcase the best that health care can be.
second off, i’m a bit dismayed at the lack of basic biological knowledge that some of these posts display (and i’m just an undergrad): plan b’s primary mode of action is to prevent ovulation; the prevention of implantation is speculative. the whole “life begins at conception” meme is quite aggravating: if the soul enters at the exact point of sperm fusing with egg, are identical twins sharing one soul? Does the life start when the sperm enters the egg or several divisions later, when the genetic material actually fuses? what about siamese twins, do they have one soul or two? what if one twin never completely formed, does that twin have a soul? the application of “soundbite morality” to such a complex situation is asking for trouble.
in plan b administration, time really is of the essence, so not filling prescriptions does in fact “do harm”. reproductive care is health care, too.
I’m in an urban area where corner pharmacies are a dime a dozen, so access is not a problem. But if I were in a situation, like using the hospital’s pharmacy, where a single pharmacist’s refusal to fill Plan B would create a significant inconvenience or delay in treatment, I’d just turn around and order a pack of regular birth control pills. Then tell the patient to take the appropriate quantitiy of active pills immediately, and another again 48 hours later. Exact same effect.
Or do we have pharamcists nowadays who refuse even to dispense the pill?
According to the textbook Biology, by Campbell and Reece (undergrad textbook used at many schools) the definition of conception is “The fertilization of the egg by a sperm cell.” Plan B does not work if the egg has already been fertilized. It can only prevent fertilzation, and therefore prevent conception. It is not killing anything if nothing is there. I know it sounds blunt, but that is just a plain fact.
Why is women’s health such an issue? Why can’t people debate the dispensing of Viagra? The ability of a male to become erect effects his ability to impregnate a woman, and therefore produce a life. And, I incorrect? Have I taken the argument out of context?
What if a women had sex without her consent? Doesn’t she have a right to Plan B? The reason the woman is filling a prescription for Plan B is not the business of the pharmacist. Obviously if she has a vaild prescription, the doctor already evaluated her situation.
No one is making the pharmacist take Plan B. The doctor is just asking them to do their job and prescribe it. If Plan B has been approved to be safe, then it is ok to prescribe.
Oops! I amde a mistake above. I meant to write: “The doctor is just asking them to do their job and FILL it. If Plan B has been approved to be safe, then it is ok to prescribe.”
I believe that the biological and bioethical argument in support of mandating pharmacists to fill Plan B prescriptions has been well defended in this thread. From the legal perspective, however, I want to quickly extend previous arguments to dispute the original author’s curious assertion that
“A mandate to participate would harm some practitioners, forcing them to choose between religious or moral convictions and their perceived professional duties. Where religious freedoms are denied, such legal statutes may be unconstitutional. Ironically, such laws could make lawbreakers out of otherwise good practitioners who refuse to stand down on the issue.”
It is legally indefensible to argue that it is unconstitutional for states to produce a statute which renders illegal the refusal of a pharmacist to fulfill his or her professional responsibilities in filling a prescription on grounds of the 1st amendment free exercise clause. As articulated above, ensuring the private exercise of one’s religious beliefs does not grant a blank check for people to practice those beliefs at the expense of other people’s physical welfare (a simple but sound application of the harm principle best articulated by JS Mill, a fallible logic but nonetheless a consitutionally sound one which was endorsed by the Founding Fathers). The license of pharmaceutical practice imbues one with privileges of that practice as defined by the state, while the negative liberty to determine the rightness or wrongness of action is strictly ensured by the constitution on an individual basis. Neither professional privilege nor the right of personal moral choice may infringe upon the patient’s right to physical wellbeing.
Religious conviction has no place in carrying out one’s professional responsibilities as a pharmacist, and refusing to fulfill these clearly defined responsibilities is both professional unethical and potentially threatening to the patient’s right to his or her own health and welfare. Just as the constitutionality of statutes prohibiting assault are not conditional upon the religious beliefs held by assailants, the constitutionality of statutes prohibiting the refusal of pharmacists to provide prescribed medications must not be conditional upon the religious convictions of the pharmacist in question.
I therefore believe it is constitutionally appropriate for states to develop legislation which places restrictions on the privileges of a pharmacist to refuse to fill Plan B prescriptions.
I trust this puts the legal argument to rest.
I apologize if this is considered off topic. My question has to do with a doctor refusing to prescribe viagra not a pharmacy filling it.
My boyfriend has been seeing a doctor and has asked him for viagra. The doctor has stated in every appointment that he will not prescribe it due to his high blood pressure. The doctor told him that if he gets his b. pressure down to the 140’s he would give it to him. After many months of working at getting it down, going in to appts to get checked and repeatedly asking for it, today, he went in and it was at 144. When the doctor walked in his head was down, boyfriend said “doc, you said you’d give it to me and i’m at 144″.
Unbelievably, the doctor goes into some speech that he will not prescribe to unmarried men due to his belief.
What sort of crap is this? The doctor has known for MONTHS that was his goal! If he didn’t prescribe it he should have told him from the first time it was brought up. Instead he has gotten paid and paid for every appointment. What a hypocrite. Such how moral standards yet he’s been taking his money knowing he would deny him.
My question is…IS THIS LEGAL??!! The doctor also went on to tell him that he’s been sued before and they’ve lost, he told him to go ahead and sue him.
I feel so bad for him and I’m angry seeing his disapointment. Any input or advice would be appreciated.
I have dispensed hundreds of Plan Bs to Christian girls and will gladly do so for the remainder of my pharmacy career.
I don’t see what the problem is. Each state has its own policies on whether pharmacists have a say on dispensing morally objectionable drugs. Just like how each institution, whether it be a hospital or drug store, has its own policies and procedures that pharmacists have to abide to. You can interpret the pharmacist’s code of ethics anyway you want. You can argue both ways how administering plan B is in the best interest of the patient or how it isn’t. The point is if you have a huge problem with the policies of an institution, you shouldn’t be working there. It’s the pharmacist’s responsibility for finding a workplace that he or she is comfortable with. Otherwise, you pretty much have to abide by the rules of where you work. Isn’t that how America works?
I am interested to know if anyone has an answer for Samantha. What that doctor/thief did seems to me, at the very least, extremely unethical.
i am wondering about the rights to fill or not fill a prescription. i had 1 refill left on my pain meds and had to see my dr. they wrote me a new prescription and i filled it then remembered i had 1 more refill on the old prescription. can they refuse to fill it because my insurance will not pay for it. i offered to pay for it without my insurance but they refused to fill it.
i thought i would keep them for back up because i travel out of town on my job and sometimes i am gone for several weeks at a time. is this illegal for me to try to get this filled?
thank you
I live in the state of Ohio. We are now facing an epidemic of Pharmacy Refusals in Toledo and some of our suburbs. There have been a large number of incidents reported to us where pharmacies and pharmacists are refusing to fill legally obtained prescriptions. Most of these refusals are not only causing undue hardship to these patients, but they are also establishing to us a pattern. This is discrimination. Almost all of the reported cases are low income people who are people of color as well as people who have government insurances, and alot of the prescriptions are not typically covered or paid for by their prescription/insurance coverage/plans. These Toledo area pharmacies are ranging from small local pharmacies to large chain pharmacy companies, such as Walgreens Pharmacies, Food Town, Walmart Pharmacies, K-Mart Pharmacies and some others. Our small law firm came accross these refusal complaints because we handle Social Security/Disability claims and represent a large number of low income, disabled, & some unemployed clients. These refusals have really hit these people hard because most don’t have the option to drive outside of the city, or go to several different pharmacies until they find a place that they may obtain their prescribed medication. It’s extremely prejudice & there has to be a resolution to this problem because the current status of it is not acceptable.
Here in Toledo we are going to start seeking further legal solutions, in the sense of monitary damages if these acts are not rectified by these pharmacies and pharmacists.
I hope that all of the pharmacists and health care providers reading these blogs come to understand the hardships they cause. Yet, they continue, with these acts of discrimination in which they impose their judgements upon people who are in need of their entitled health care. They should come to realize that if the tables are turned and they themselves are at the pharmacy counter with a migraine seeking relief through use of Imitrex, or if they had cancer and were seeking pain relief through use of their prescribed OxyContin, and their pharmacist denied them access with no legal justification, only the pharmacists personal opinion about them, they then would see how it is to need the medication but not to have their rightful access to it.