<p>Indeed there are. I suspect most people’s attitudes on this issue are also nuanced. </p>
<p>Can’t you see that it’s possible for someone to be troubled at the possibility of pharmacists refusing to provide meds prescribed by a responsible doctor, without accusing that person of being someone who wants a vending machine for meds, never desires a single word of advice from a pharmacist, or who have zero respect for the discipline?</p>
<p>I’m not seeing a lot of appreciation for grey area in those kinds of retorts.</p>
<p>Should we withhold cutting edge therapies from needy patients because the legalities have not been fully explored and every eventuality has not been reduced to paper? I think not, but it is certainly debatable.</p>
<p>I wouldn’t call dispensing morning after pills or birth control pills cutting edge therapies, they have been around for years-.
But as they are legal as provided by a physcian, I see no reason why a pharmacist shall decide to control availablity, except to impose religious beliefs by withholding care.
I don’t expect the pharmacist to take the medication themselves if they feel it is immoral, but I have a problem with restricting someone elses access</p>
<p>Do you feel the same about a physician’s willingness or unwillingness to prescribe them? Or to perform abortions? etc.? Are physicians allowed to make ethical choices but pharmacists not?</p>
<p>I think my problem is that patients seem to be blindsided by the pharmacists decision.
For instance you go to a pharmacy that you have been getting prescriptions filled for months or years, and of course it isn’t the same pharmacist every time, sometimes as at Target it is even a temporary pharmacist who has not been officially hired as Target staff, so you go there just expecting to get your prescription filled and they refuse, they may give you a referral to another pharmacy or pharmacist or they might not.
Some women have had to skip birth control pills while they found another business, putting them at risk for pregnancy.
Say you are a young woman who is interested in birth control pills and you go to a obgyn to get them. It would be pretty strange if they refused you, since that is their area of care, but say they did refuse because of your unmarried status or age, I would also have a problem with that, being that they are there to provide care, are we also going to have doctors that deny care to blacks? to people who they suspect are homosexual? do we have a line? Are we willing to ostracize members of society because we feel they do not deserve same level of health care?</p>
<p>“are we also going to have doctors that deny care to blacks?”</p>
<p>Statistically, we do (I have TONS of data on patients with the same diagnoses, same insurance coverage, and same income level receiving different levels of care.) </p>
<p>“Are we willing to ostracize members of society because we feel they do not deserve same level of health care?”</p>
<p>As a society, yes we are. (Don’t like it, but yes we are.) But we allow physicians (and insurance companies) to do the ostracism, not the pharmacists, and that’s what I am calling into question. Why is a doctor not obligated to perform an abortion, but a pharmacist required to provide Plan B? (I really don’t mean that rhetorically - it is a serious question.)</p>
<p>Why is a doctor not obligated to perform an abortion, but a pharmacist required to provide Plan B? (I really don’t mean that rhetorically - it is a serious question</p>
<p>PLan B prevents pregnancy- it doesn’t cause an abortion
It is a contraceptive not an abortofacient
At least according to the FDA
Are you comfortable with pharmacists deciding who gets or doesn’t get birth control?</p>
<p>No. But I’m equally uncomfortable with doctors making the very same decision. You still haven’t told me why you think pharmacists (or nurses aides for that matter) should have less ethical sway than do physicians.</p>
<p>I don’t think physicians should be able to withhold care.
If you have a problem with the ethics of spending thousands of dollars on plastic surgery to stave off aging, dont become a plastic surgeon.
If you have a problem with defending people who are guilty, don’t become a criminal attorney.
If you have a problem with prescribing birth control to someone who doesn’t have a contraindication, don’t become a ob/gyn
and if you have a problem with filling a prescription written by a liscensed physican dont become a pharmacist</p>
<p>And an abortion for which there is no “contraindication”? A plastic surgeon who wants to help burn victims shouldn’t be allowed to practice because he won’t deal with eye wrinkles? An attorney who wants to work on appeals for defending people wrongly convicted shouldn’t be an attorney? I don’t follow.</p>
<p>Pharmacists for the most part don’t have “subspecialties”.</p>
<p>Mini, I think there is a distinct line between the major kind of procedures you are talking about and getting contraception - namely, the timeframe involved. Assuming one realizes that she is pregnant, there is usually significant time to get an abortion - months of time. Thus, one individual doctor refusing to perform such a procedure is not that big a deal - there is plenty of time to arrange a trip to another doctor, even if significant travel is required to do so.</p>
<p>Contrarily, if one is out of BC or needs the morning after pill, there is a MUCH smaller timeframe - for someone totally out of BC, they have not even a DAY of time to make alternate arrangements; for the morning after pill, at most 3 days to make alternate arrangements.</p>
<p>Consider, for instance, someone who has a condom break during sex and needs the morning after pill in a rural town (I emphasize rural towns because people in urban areas are a) going to have plenty of options in terms of pharmacies, etc. and b)less likely to run into the social conservatives that refuse to fill such prescriptions). If the only drugstore in town refuses to dispense said prescription, then the girl in question is basically screwed. She has no real options - she might not be able to get to another drugstore within the necesscary timeframe, etc. Contrarily, if she wants an abortion or plastic surgery or what have you, and the only doctor in town refuses, she has MUCH more time to arrange a trip to an area with more suitable physicians.</p>
<p>Pharmacists for the most part don’t have “subspecialties”.
Perhaps they should
Perhaps pharmacists who are not willing as I earlier posted to dispense prescriptions as written should have a binder on their liscensure obligating them to disclose their boundaries so that their workplace can either make arrangements to have someone else on duty who can cover for them, or so it is clear to someone trying to recieve services, which as luc pointed out, can be time critical.
I look at a pharmacist as similar to a nurse.
They are directed to make up a prescription as ordered by a doctor. How long would a nurse keep their job if they refused to follow their instructions?</p>
<p>I think that if the pharmacist has a concern that the drugs were not properly prescribed , the pharmacist should contact the prescribing physician before filling the prescription to air it. If the pharmacist thinks the physician is doing something unethical or stupid (over prescribing meds) - then the pharmacist should contact law enforcement authorities.</p>
<p>But the pharmacist should not second-guess the physician or stand in the way by refusing the fill the prescription. That is, if the pharmacist knows that patient X has battled heroin addiction, and patient X gets oral surgery and shows up with a prescription for vicodan – it is not for the pharmacist to decide that patient X has now forever forfeited her right to pain relief because of her history of drug addiction. </p>
<p>Again it would be appropriate to contact law enforcement authorities if the pharmacist suspected something fishy – but it isn’t the pharmacist who makes decisions whether or not to prescribe meds. It is the physician.</p>
<p>I am sure it happens all the time that pharmacist disagrees with the physician’s choice of meds for various reasons. But the pharmacist’s job is to fill the prescription, not act as a second barrier that must be overcome in order to obtain the drug.</p>
<p>“Mini, I think there is a distinct line between the major kind of procedures you are talking about and getting contraception - namely, the timeframe involved.”</p>
<p>I think you are misreading me. I understand that distinction perfectly well. What you are saying is that the doctor who has ethical qualms isn’t a problem because some other doctor will be willing to tromp all over his ethics in a reasonable timeframe, whereas a pharmacist who has an ethical qualm is more likely to see his ethical point of view hold up because of the time frame.</p>
<p>In other words, you support the doctor’s right to what he considers to be ethical behavior because other doctors can be depended on to act unethically, whereas for the pharmacist that may not be the case.</p>
<p>Now THAT’s a stickywicket. It should be interesting in South Dakota, now that doctors will have to send those seeking abortions over the border. If the doctor who believes in abortion (rape, incest, what-have-you) can’t legally carry out the procedure, is s/he ethically obligated to find someone who will?</p>
<p>(Let’s be clear: I support abortion rights, and contraceptive rights, as a political matter; I just don’t think anyone should be expected or obligated a priori to check their ethical conscientiousness at the door, and I don’t care whether they are physicians or nurses aides, and I see no basis for making a distinction between them. Does the pharmacist, seeing the doctor’s prescription, have recourse to the “only following orders” defense?)</p>
<p>As I posted above it is quite a dilemma- how do we balance the workers rights with the patients rights?</p>
<p>The First Amendment protects individual free exercise of religion, and pharmacists have a right to exercise their religion in the workplace.
The Fifth Amendment protects property, and the prescription is the patients property.
The Fifth Amendment prohibits deprivation of personal liberty without due process. Passing laws to allow individual pharmacists to refuse to refill prescriptions that offend their personal morals would deprive patients of their liberty without due process.</p>
<p>We each have to decide our own ethics, although laws may or may not reflect our ethics.</p>
<p>I don’t see finding a practitioner who doesn’t let his religion get in the way of providing appropriate medical care the same as " tromping all over his ethics", to the provider that wont.
I do see witholding medical services that could be considered “emergency” in the case of a morning after pill, to be "tromping " all over the patients rights.</p>
<p>Now THAT’s a stickywicket
Oh that reminds me I have to finish watching Lagaan :)</p>
<p>“I don’t see finding a practitioner who doesn’t let his religion get in the way of providing appropriate medical care the same as " tromping all over his ethics”,</p>
<p>His ethics are that abortions shouldn’t be provided, not that he shouldn’t perform 'em. The people of South Dakota, through their elected representatives, agree.</p>
<p>So I wonder how long it will take before Tim Eyman ( well not him) will decide that the people of South Dakota deserve a vote?</p>
<p>Indeed, in a poll taken last week after South Dakota Gov. Mike Rounds signed the abortion ban into law, 59 percent of respondents said they would not favor a similar law in their states. The poll was taken by Opinion Dynamics and released by Fox News, hardly a media outlet to trumpet data that shows favor toward womens reproductive rights.</p>
<p>It will be interesting to see if it holds up to the legal challenges</p>
<p>Mini, you are saying that because ONE doctor thinks abortions are unethical that he should be able to prevent others from getting them. It is not a doctor’s, or ANY one individual’s, place to decide ethics for others. If a doctor doesn’t want anyone to get abortions, he should try and do so through legislation (though I’d hope that even the now conservative-loaded courts would protect the right to choose).</p>
<p>My point is this: it is a doctor’s place to choose whether or not a particular course of action is ethical and to act accordingly. It is NOT his place to make that choice for others, and the timeframe issue effectively means that pharmacists, in many cases, are making ethical decisions for others and imposing their beliefs on them.</p>
<p>“Mini, you are saying that because ONE doctor thinks abortions are unethical that he should be able to prevent others from getting them. It is not a doctor’s, or ANY one individual’s, place to decide ethics for others.”</p>
<p>Doctors, hospitals, and insurance companies make that call all the time (and in areas having nothing do with abortion). Call it “corporate ethics” if you will, but their impact on the patient is the same. There are doctors who believe that abortions are not “appropriate medical care”, independent of the question of whether they should provide them. The issue evolves as technology evolves.</p>
<p>I have not put out any “shoulds” - I am just noting that if there is a doctor who happens to believe abortion is murder (which I don’t), it would be unethical for him to facilitate it by sending a patient requiring one to another doctor.</p>
<p>But, putting that aside - if it is the doctor’s ethical obligation not to do that which he believes causes harm, I fail to see how a pharmacist does not have a similar obligation, regardless of whether or not the patient can find another health care provider to cause the harm for her.</p>
No one has a right to “exercise” their religion in the workplace. They have a right to be free from religious discrimination - that’s a different thing. But in the workplace they must fulfill their duties. </p>
<p>For example, a Muslim or Orthodox Jew who works in a restaurant can’t decide to refuse to prepare or serve all items on the menu containing pork. M</p>
<p>My son is a strict vegetarian - I assume he has some ethical concerns about killing animals and meat production. When he was in high school he got a job at Round Table making pizzas – he had to prepare pizza with meat toppings all the time. He didn’t like it, but his personal no-meat ethics didn’t mean that he had a right to opt to refuse service to meat-eating customers. Once he took that job, he was obligated to fulfill all requirements of the job.</p>