On pharmacists and the right to deny the Pill

[Fire Fly]

I'm looking to inquire if there is any flaw in the logic behind pharmacists being able to refuse contraceptives based on religious objections. I'm not looking for arguments like "if you can't do the basics of your job you should get out of it." I'm looking for well constructed arguments that are reasonable. I'm well aware of the guidelines concerning what a pharmacist may or may not do; what I am interested in is if these guidelines are flawed.

Recently, I had a discussion with a young doctor friend of mine (he's agnostic but went to a Catholic oriented medical school) and inquired as to what his position was regarding pharmacists that are morally offended at distributing the Pill. His stated position was that it was ok for the pharmacist to refuse to give out the Pill because the customer can always go to another pharmacy. My response was that that was a red herring: that still doesn't address the issue of whether the pharmacist can deny the drugs but I asked anyway what if the pharmacy was the only place in town and that no other pharmacy existed for several miles. He replied that pharmacies are like any other stores; it is up to the customer to research whether the pharmacy carries any drugs of interest.

Alright, I can see he is obviously dodging the issue and thus presented the situation in a more black and white fashion. I inquired: what is the difference between a Jehovah's Witness doctor denying a patient a blood transfusion or a Scientologist pharmacist denying a customer psychiatric drugs and a pharmacist denying a rape victim the Pill? He responded that in one situation, the the patient/customer will be adversely affected by the denial of service whereas in the other (the rape situation) the customer will not be adversely affected; the adversity determines whether the doctor/pharmacist should suspend their religious beliefs in light of what is better for the patient. I was a little astounded by this statement since I would consider a rape to be an unusual circumstance with possible adverse effects to the victim. He stated that denying the Pill to a rape victim does not constitute the medical urgency needed compared to a blood transfusion and therefore, the pharmacist does not need to suspend his religious beliefs. Well, again I was a little astounded but I understood the medical urgency argument: getting raped isn't going to exactly kill you, usually. I inquired as to the moral nature of forcing a woman to bear an unwanted pregnancy, especially in terms of financial and emotional costs. His response was that the emotional trauma had already been done and that costs of the pregnancy will be paid for by Medicaid if she cannot afford it; I asked about the cost of gestation but he didn't reply to that.

By this point, I terminated our discussion because we're both getting heated and each side's argument isn't obviously going to persuade the other. I ended by saying that it was ok for a pharmacist to refuse to provide the Pill so long as the pharmacist provides an alternative provider; denial of service and denial of referral should not possible. My friend essentially said that a pharmacy is like any other store and that the pharmacist can refuse service; the onus is on the customer to find out what pharmacy will provide the Pill.

[Broomstick]

Recently, I had a discussion with a young doctor friend of mine (he's agnostic but went to a Catholic oriented medical school) and inquired as to what his position was regarding pharmacists that are morally offended at distributing the Pill. His stated position was that it was ok for the pharmacist to refuse to give out the Pill because the customer can always go to another pharmacy. My response was that that was a red herring: that still doesn't address the issue of whether the pharmacist can deny the drugs but I asked anyway what if the pharmacy was the only place in town and that no other pharmacy existed for several miles. He replied that pharmacies are like any other stores; it is up to the customer to research whether the pharmacy carries any drugs of interest.

It doesn't matter if the pharmacy carries the drug in stock if the pharmacist won't dispense it!

Also spoken like someone who has always been upper middle class with easy access to transportation. If the pharmacy is the only pharmacy in town and yet the women does not have access to transportation to another town she has no choice in the matter.

He responded that in one situation, the the patient/customer will be adversely affected by the denial of service whereas in the other (the rape situation) the customer will not be adversely affected; the adversity determines whether the doctor/pharmacist should suspend their religious beliefs in light of what is better for the patient.

Your mistake was couching this in terms of rape. In fact, the Pill is used for more than just birth control. It is also used at times to control endometriosis, polycystic ovary disease, and other medical conditions. It is used to prevent conception in women for whom pregnancy would be a serious or even life threatening condition. A woman can not use retin A or thalidomide (which does have a legitimate use in treating leprosy, a medical condition) without ALSO being on hormonal birth control. A pharmacist is not a doctor and not qualified to pass judgment on what medications are appropriate for a woman's medical needs. Doing so oversteps his professional bounds.

I was a little astounded by this statement since I would consider a rape to be an unusual circumstance with possible adverse effects to the victim. He stated that denying the Pill to a rape victim does not constitute the medical urgency needed compared to a blood transfusion and therefore, the pharmacist does not need to suspend his religious beliefs. Well, again I was a little astounded but I understood the medical urgency argument: getting raped isn't going to exactly kill you, usually. I inquired as to the moral nature of forcing a woman to bear an unwanted pregnancy, especially in terms of financial and emotional costs. His response was that the emotional trauma had already been done and that costs of the pregnancy will be paid for by Medicaid if she cannot afford it; I asked about the cost of gestation but he didn't reply to that.

He is an ignorant tool and I hope he is not heterosexual so as not to impose his asshattery ona female human being. It is sad that he is a doctor but has no understanding that the trauma of rape does not end when the rapist's semen is dribbling down the woman's legs and the attacker has departed. He clearly has no clue of the emotional costs of bringing a rapist's child to term. Not to mention that in some cultures a woman bearing any child other than a husband's may be cast out or even killed for "honor". In which case denying birth control can very much put a woman's life at risk.

He's also pretty fucking clueless about how medical care is paid for. It is entirely possible for a woman to be poor AND ineligible for Medicaid, even if pregnant.

My friend essentially said that a pharmacy is like any other store and that the pharmacist can refuse service; the onus is on the customer to find out what pharmacy will provide the Pill.

Og help us - medical care as any other product/service and human beings as "consumers", as if this was as optional as hair coloring or new hubcabs on the car.

[Samuel]

Well, Broomstick was pretty through. I'll add some more.

I'm looking to inquire if there is any flaw in the logic behind pharmacists being able to refuse contraceptives based on religious objections.

Religious rationales are not allowed to override the law. Otherwise many people would convert to religions that argue that paying taxes is evil

His stated position was that it was ok for the pharmacist to refuse to give out the Pill because the customer can always go to another pharmacy.

1) What if all the pharmacies refuse to provide the pill?
2) This discriminates based on gender and class.
3) If there is alternatives, it arbitrarily increases hastles for people for no good reason. Longer drives cost more and are more dangerous.

He replied that pharmacies are like any other stores; it is up to the customer to research whether the pharmacy carries any drugs of interest.

Yes, many poor people are gifted with the ability to see into the future and discover what drugs they will need. After all, it isn't like diseases could happen unexpectadly to individuals- or that medicine is a public good.

He responded that in one situation, the the patient/customer will be adversely affected by the denial of service whereas in the other (the rape situation) the customer will not be adversely affected; the adversity determines whether the doctor/pharmacist should suspend their religious beliefs in light of what is better for the patient.

How did this man get through med school without becoming familiar with basic psychology?

Well, again I was a little astounded but I understood the medical urgency argument: getting raped isn't going to exactly kill you, usually.

So a Scientologist can refuse to dispence anti-depressants?

His response was that the emotional trauma had already been done and that costs of the pregnancy will be paid for by Medicaid if she cannot afford it; I asked about the cost of gestation but he didn't reply to that.

Does he not realize that being pregnant is nauseating, can prevent you from working AND has a chance of killing you?

By this point, I terminated our discussion because we're both getting heated and each side's argument isn't obviously going to persuade the other.

He is anti-abortion. And an idiot. But I repeat myself.

I ended by saying that it was ok for a pharmacist to refuse to provide the Pill so long as the pharmacist provides an alternative provider

You can go to this provider. They are in Antartica. Good luck!

My friend essentially said that a pharmacy is like any other store and that the pharmacist can refuse service; the onus is on the customer to find out what pharmacy will provide the Pill.

I'm sorry- the police in your area refuse to work on the Sabbath. You should have found that out before moving. It is YOUR fault for not doing so and as you lay dying from your stab wounds just remember that.

[Kanastrous]

The Pharmacist Code of Ethics

I. A pharmacist respects the covenantal relationship between the patient and pharmacist.

Considering the patient-pharmacist relationship as a covenant means that a pharmacist has moral obligations in response to the gift of trust received from society. In return for this gift, a pharmacist promises to help individuals achieve optimum benefit from their medications, to be committed to their welfare, and to maintain their trust.

If the covenant is anything along the lines of "a doctor says that I need this, and your professional role is to safely place it in my hands," then perhaps picking and choosing which medicines your customers may have, violates the spirit of said covenant. After all, society gifted the pharmacist with the trust required to handle and dispense medications, not pass moral judgments regarding their use. Not to mention the violation of trust, committed when a patient asks for a legal prescribed medication, and you withold it from them. By witholding a prescription, you withold its 'optimum benefits,' and you are clearly operating on priorities having nothing to do with your patient's trust or welfare.

II. A pharmacist promotes the good of every patient in a caring, compassionate, and confidential manner.

Is it even necessary to observe that obstructing a patient's access to a prescribed and legal medication, is neither caring nor compassionate? And, if you essentially invite your pastor's opinion as to which medications patients with an expectation of privacy in their treatment may have, I wonder if that couldn't be construed as a breach of confidentiality, too.

A pharmacist places concern for the well-being of the patient at the center of professional practice. In doing so, a pharmacist considers needs stated by the patient as well as those defined by health science. A pharmacist is dedicated to protecting the dignity of the patient. With a caring attitude and a compassionate spirit, a pharmacist focuses on serving the patient in a private and confidential manner.

If you are denying a patient prescribed medications on your personal, private moral grounds, then you have placed your personal opinions at the center of your practice, and have relegated the patient to secondary - at best - stature. The morality of contraception etc is not defined by health science, so that's a violation, too. And forcing patients to run from store to store in the hopes that maybe someone will condescend to fill their legal prescription certainly does not protect their dignity.

III. A pharmacist respects the autonomy and dignity of each patient.

A pharmacist promotes the right of self-determination and recognizes individual self-worth by encouraging patients to participate in decisions about their health. A pharmacist communicates with patients in terms that are understandable. In all cases, a pharmacist respects personal and cultural differences among patients.

Telling your patient they must look elsewhere for a legal prescribed drug because you believe that their choice of remedy is immoral, is an absolute rejection of the patient's self-determination. Riding roughshod over their moral priorities, is a rejection of their self-worth. And shoving your personal and cultural preferences down your patient's throat does not appear to be in keeping with the letter of the code, either.

IV. A pharmacist acts with honesty and integrity in professional relationships.

Denying other people treatment for the sake of one's own personal prejudices does not impress me as a display of professional integrity. Your mileage may vary.

A pharmacist has a duty to tell the truth and to act with conviction of conscience. A pharmacist avoids discriminatory practices, behavior or work conditions that impair professional judgment, and actions that compromise dedication to the best interests of patients.

This one's sticky, I guess, because the argument could be offered that 'conviction of conscience' might cover denial of prescribed drugs whose use the pharmacist finds objectionable. Although 'discriminatory practices (and) behavior' that 'impair professional judgment' sure sounds like witholding a prescription of religious grounds, to me.

V. A pharmacist maintains professional competence.

A pharmacist has a duty to maintain knowledge and abilities as new medications, devices, and technologies become available and as health information advances.

I'd argue that someone with beliefs that impair their ability to fill every and any legal prescription, is not professionally competent. If I need digitalis, it doesn't matter if I die for the lack of it as a result of someone not believing I should have it, versus as a result of them not knowing what it is. If new technologies or treatments become available, your personal beliefs should not interfere with your patients' access to them.

VI. A pharmacist respects the values and abilities of colleagues and other health professionals.

When appropriate, a pharmacist asks for the consultation of colleagues or other health professionals or refers the patient. A pharmacist acknowledges that colleagues and other health professionals may differ in the beliefs and values they apply to the care of the patient.

A one-two punch. (1) It's tough to imagine a more succinct expression of contempt for a physician - your fellow health professional - than refusing to fill a prescription that said physician deems proper for his patient. (2) I suspect that 'acknowledging that colleagues and other health professionals may differ in the beliefs and values' probably means setting aside your own personal beliefs and values, in the service of treating the patient, rather than basically saying I respect your beliefs and values, now fuck you and your patient, get your scrip filled someplace else.

VII. A pharmacist serves individual, community, and societal needs.

The primary obligation of a pharmacist is to individual patients. However, the obligations of a pharmacist may at times extend beyond the individual to the community and society. In these situations, the pharmacist recognizes the responsibilities that accompany these obligations and acts accordingly.

The society and community legally permit the prescription and use of contraceptive drugs. Societies encode their perceived needs as law. Therefore a pharmacist serves the society's and community's needs, along with those of the patient, by filling any legal prescription they are handed.

VIII. A pharmacist seeks justice in the distribution of health resources.

When health resources are allocated, a pharmacist is fair and equitable, balancing the needs of patients and society.

Nothing 'fair and equitable,' about deciding that people who come in for one particular class of drug must receive different - and disabled - service, from everyone else coming in for any other sort of drug, on your own personal say-so.





Oath of a Pharmacist

At this time, I vow to devote my professional life to the service of all humankind through the profession of pharmacy.

I will consider the welfare of humanity and relief of human suffering my primary concerns.

I will apply my knowledge, experience, and skills to the best of my ability to assure optimal drug therapy outcomes for the patients I serve.

I will keep abreast of developments and maintain professional competency in my profession of pharmacy. I will maintain the highest principles of moral, ethical and legal conduct.

I will embrace and advocate change in the profession of pharmacy that improves patient care.

I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.

*adopted by the membership of the American Pharmacists Association October 27, 1994.

---

Seems to me that - if these had the binding force of law - those pill-witholding pharmacists would be on unemployment so fast, their little heads would spin.

I mean, look at it this way: if a diabetic went to a pharmacy and was denied insulin because the pharmacist is an animal-rights activist (and insulin is in large part produced using animals), or was denied, say, a Baxter Biotech product because that pharmacist had political problems with Baxter, would we even need to have a conversation? Probably not. But because this has the aura of religion attached to it, these malpracticing pharmacists aren't immediately de-certified and kicked out into the street, where they belong.