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Forums > Social Discussion > Pharmacist and Physician Refusal

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Doc Lightning
GOLD Member since May 2001

Doc Lightning

HOP Mad Doctor
Location: San Francisco, CA, USA

Total posts: 13920
Posted:So Planned Parenthood is on about a recent trend of pharmacists refusing to fill prescriptions for contraception, including emergency contraception. These practicioners cite religious, moral and personal reasons for refusing to write/fill these prescriptions and have, in some cases, even refused to refer patients to another pharmacist/physician who would provide such services.

Illinois, a typically liberal state, has required all pharmacies that stock these medications to dispense them without delay. More information is available from Planned Parenthood.

So here's my view:

I believe in choice, and that means choice. It means that people who believe that abortion and contraception are immoral shouldn't be forced into providing such services and also shouldn't be forced out of a given career path based on a requirement to provide such services.

THAT SAID, the other side of the coin is that a patient who does desire such a service has the right to choose it.

I hope that nobody will ever write a law forcing me to do perform a procedure or prescribe a drug to which I'm morally opposed. Physician-assisted suicide is one such area. Legal or not, it is not a service I would ever provide, but I would be happy to refer a patient to a physician who provides such a service if it became legal. I sure hope that nobody ever passes a law forcing me to provide the service. Part of being a physician is moral responsibility, and I will not violate my morals.

But the line is crossed when the practitioner refuses to refer the patient to another practicioner who will provide the service.

In Michigan, when a physician feels that she cannot provide adequate care to a patient, the physician must refer the patient to no fewer than two other, equally-qualified physicians who may perform the service.

I believe that, for controversial issues like these, a pharmacist should have to have a sign posted informing patients that this pharmacy does not fill prescriptions for X, Y, and Z and that patients with prescriptions for these drugs may consider the following list of nearby pharmacies. That makes it so that the patient doesn't need to ask the pharmacist and endure the embarassment of a disaproving refusal.


-Mike )'(
Certified Mad Doctor and HoP High Priest of Nutella

"A buckuht 'n a hooze!" -Valura

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Pele
BRONZE Member since Dec 2000

Pele

the henna lady
Location: WNY, USA

Total posts: 6193
Posted:Going to disagree with you here love.



You claim this is about choice, well...



When you take a job such as this, or any, you tend to know up front there will be things you will object to. If you can not live with yourself for doing those things, then perhaps the job is not for you. They used their choice...they CHOSE to be in this profession, where they knew this was a possibility. Therefore I do not feel they have the right to decide who and what they will help.



To me it is the same as a vegan working in a McDonalds and then refusing to sell a Big Mac. They took the job, they have no right to complain or make the choices for someone else.



Or the religious science teacher in a public (not parochial) school who pitches a fit about evolution in the curriculum. It was not secret and they lost the right to complain about it when they *chose* to take the position.



If they feel moralistically they can not dish these drugs out (which is an issue that reaches back years and years, so it is not anything anyone can claim ignorance to in the field) then they should have come to that realization before they *chose* that job. If they can not function in such a place then they need to be working in another place or another career.



Work is work and personal is personal. Check it at the door and if you can't...make another choice. That is the beauty of our right to choose, we also tend to have the right to change our mind.


Pele
Higher, higher burning fire...making music like a choir
"Oooh look! A pub!" -exclaimed after recovering from a stupid fall
"And for the decadence of art, nothing beats a roaring fire." -TMK

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Icer
SILVER Member since Apr 2005

Icer

just a shadow of my former self...
Location: Christchurch

Total posts: 205
Posted:i can see both sides if this arguement, and its a tricky one. both u guys rasie good points, but i think i do lean more with pele here. everyone has choices an dif your in a medical profession like this then it isnt likly that you HAVE to take this job or starve (sorry for the steriotype, i know medical professionals struggle too), but one of the fundemental principles of western culture is choice. ppl need to be able to make their own minds up about things, the way to change ppls actions, if that is what you want to do, is thru education, not forcing or denying. a fault of the crusades in the early part of the millenium was that conversion at the point of a sword is not ttue conversion. if you think u have achieved something by denying a treatment you believe is wrong, you will be wrong, if anything you have pushed that person further away from the moral point of view you a trying to espouse. they will more than likely resent you for it. if you want to change a persons morals and ethics, dotn force them to do anything, do it thru education. i know thru expereince too, ive recently become a christian but would never dream of forcing my views on anyone else. you welcome to believe in whatever you want to believe in. im ignorant of the other viewpoints, i have a decree in zoology and ecology, so i know all about evolution and all that jazz, i still have alot of non-christian zoologist friends, we have good discussions and none of us try and force our views on the other. it becomes tricky when you dont want to condon behaviour you think is wrong, and to solve that i think you need to think long and hard about the profession you get involved in and why you are in that profession.

It took a while, but once their numbers dropped from 50 down to 8, the other dwarves started to suspect Hungry.

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Kyrian


Dreamer
Location: York, England

Total posts: 4308
Posted:I think doctors shouldn't have to do things against their moral standards because- I don't trust them if they do. What if they decide, conciously or unconsciously, that they can't do this.... they should have to give the referrals (I like two) and be on with it. I dunno about pharmacists.... I'm really much more towards thinking they should just have to do it and be done with it, but I guess if there's easy acess somewhere else than they might as well advertise that they don't fill those prescriptions and give a list.... Is a bit of a problem for people without cars sometimes tho!

But if you're going to be in an area where there isn't another easy option, there may need to be some thinking done. One pharmacy in a town? You have to dispense those drugs you don't agree with. One hospital in a town? You can't tell your patients that their only choice is to plan their pregnancy and birth with a helpful hospital staff member (Don't laugh... this is real- in a city of more than 50,000 the only hospital refuses to acknowledge that there is such a thing as abortion or birth control). When you apply for a job as the only qualified something in an area, then you have to set down your morals and start looking at everyone else's too.


Keep your dream alive
Dreamin is still how the strong survive

Shalom VeAhavah

New Hampshire has a point....

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onewheeldave
GOLD Member since Aug 2002

Carpal \'Tunnel
Location: sheffield

Total posts: 3252
Posted:If, legally speaking, anyone with a prescription is legally entitled to have it filled- and some pharmacists are refusing, then could it not be arranged that the surgery where they get the prescription could keep a stock of emergency contraception and dispense it directly?

"You can't outrun Death forever.
But you can make the Bastard work for it."

--MAJOR KORGO KORGAR,
"Last of The Lancers"
AFC 32


Educate your self in the Hazards of Fire Breathing STAY SAFE!

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Doc Lightning
GOLD Member since May 2001

Doc Lightning

HOP Mad Doctor
Location: San Francisco, CA, USA

Total posts: 13920
Posted:Written by: Pele

Going to disagree with you here love.

You claim this is about choice, well...

When you take a job such as this, or any, you tend to know up front there will be things you will object to. If you can not live with yourself for doing those things, then perhaps the job is not for you.



So... I'm anti-circumcision. I should be forced to circumcise babies, rather than refer them to someone else?

I'm anti-physician-assisted suicide. I should be forced to kill patients?

A Catholic OB/GYN should be forced to perform an abortion on a patient who has no medical need for such?

Medicine isn't teaching and it certainly isn't working at McDonald's. One thing that makes it special is the variety of moral and ethical standpoints that approach the field. To force people to perform abortions is to basically eliminate every Pro-Lifer from medicine and I'm not ready to be that draconian.


-Mike )'(
Certified Mad Doctor and HoP High Priest of Nutella

"A buckuht 'n a hooze!" -Valura

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Doc Lightning
GOLD Member since May 2001

Doc Lightning

HOP Mad Doctor
Location: San Francisco, CA, USA

Total posts: 13920
Posted:Written by: onewheeldave

If, legally speaking, anyone with a prescription is legally entitled to have it filled- and some pharmacists are refusing, then could it not be arranged that the surgery where they get the prescription could keep a stock of emergency contraception and dispense it directly?



Not with the way it works in the US. A physician can dispense free samples of a drug as given out by pharmaceutical reps, but it takes a pharmacist to actually fill prescriptions.


-Mike )'(
Certified Mad Doctor and HoP High Priest of Nutella

"A buckuht 'n a hooze!" -Valura

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vanize
SILVER Member since Aug 2001

vanize

Carpal \'Tunnel
Location: Austin, Texas

Total posts: 3899
Posted:as I see it, a pharmacist has no idea what the circumstances behind the presciption are, so he has absolutely no right to second guess the doctors recommendation.

as far as physician refusal, well, I can see better arguments for that and I'll stay neutral on that part.


-v-

Wiederstand ist Zwecklos!

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Pele
BRONZE Member since Dec 2000

Pele

the henna lady
Location: WNY, USA

Total posts: 6193
Posted:Written by: Doc Lightning

So... I'm anti-circumcision. I should be forced to circumcise babies, rather than refer them to someone else?

I'm anti-physician-assisted suicide. I should be forced to kill patients?

A Catholic OB/GYN should be forced to perform an abortion on a patient who has no medical need for such?

Medicine isn't teaching and it certainly isn't working at McDonald's. One thing that makes it special is the variety of moral and ethical standpoints that approach the field. To force people to perform abortions is to basically eliminate every Pro-Lifer from medicine and I'm not ready to be that draconian.



This isn't about you or doctors or things like assisted suicide that are not even legal yet, so it is, in my eyes, not relevant.

Most towns have two doctors that can be refered to, even the small ones, so you wouldn't be the only one there doing it. AND dr.'s aren't the only ones who do circumcisions, so there are always options for that. (btw, I don't believe in them either)

A Catholic OB/GYN wouldn't even make the choice to work someplace where there were abortions offered, so therefore that point is moot.

Most places don't have more than one pharmacist.

Yes...they still should be made to give it up. It is their job and to second guess a dr. based on their own moralistic needs is wrong. They are not in a position to make that, or any decision as such. AND how do they not know that what they are denying someone is not for a medical need? Those meds are given out to alot more than people who feel they have made a grave error in judgement.

And yes, they are all the same...when you take ANY job, you are making a choice to do it..including good and bad.
Passionate morality is there no matter what profession people choose, be it a working at McD's, a bartender, a teacher or a Dr.
When it comes to things like that...it is a level playing field and no one profession is more important than another, and I find it quite sad that you think it is. WHen it comes to morality such as we are speaking, everyone views it as saving a life or even more strongly a soul.

Now, as someone who has had to cross a picket line and have mini bibles and rosary beads pelted at my head, being called a murderer, for something I wasn't even doing, and wish that on no one else... I am going to again say...they *CHOSE* to do this job, knowing that these drugs are prescribed. They made their choice and must do thier job...or find another.

I am way too passionate about this topic and as such am removing myself from the conversation after this.


Pele
Higher, higher burning fire...making music like a choir
"Oooh look! A pub!" -exclaimed after recovering from a stupid fall
"And for the decadence of art, nothing beats a roaring fire." -TMK

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onewheeldave
GOLD Member since Aug 2002

Carpal \'Tunnel
Location: sheffield

Total posts: 3252
Posted:Written by: Doc Lightning

Written by: onewheeldave

If, legally speaking, anyone with a prescription is legally entitled to have it filled- and some pharmacists are refusing, then could it not be arranged that the surgery where they get the prescription could keep a stock of emergency contraception and dispense it directly?



Not with the way it works in the US. A physician can dispense free samples of a drug as given out by pharmaceutical reps, but it takes a pharmacist to actually fill prescriptions.




It's not the way it is in the UK either- I'm suggesting that it gets changed smile

Of course, mentioning 'change' is bound to be met with loads of objections about how impractical it is to alter the way things are done; so, below, I've posted a few thoughts about why it may well be more practical to change the system than to not change it.

-----------------------------------------

Having read the link you posted, two things are clear

1. being refused the emergency contraception prescribed to you by a doctor is outrageously unfair- it's the difference between getting on with your life, and having it irrevocably altered by the addition of a child you do not want.

2. for states to take the approach of legally compelling pharmacists to dispence contraception against their wishes, is going to cause difficulties.

The solution is clear- dispense it at surgeries.

And if you don't, then at some point, some of those individuals who have been refused their right to contraception and given birth as a result, will have the bright idea of getting a lawyer to take on their case for having their life ruined.

In that event, it could well be the state that has to cough up the money to cover it.

Given that people complain so much about the prevelance of suing and court cases in this day and age, maybe it's time they started to look at sensible ways of dealing effectively with the injusticies that generally precipitate them, so it doesn't get to that stage.

Because, if I were in the situation of being denied the means to avoid carrying, and bearing, a child I didn't want; then I would be very interested in making the people responsible, accountable; and I wouldn't be too convinced by claims that it was down to the pharmacists.

Yes, it is them who refused to dispense, but it was the state who neither legally obliged them to provide the service I am legally entitled to, or, alternatively, made provision for that service to be provided by others, who are willing.

As the link Lightning supplied says: -

------------------------

"3. REFUSAL CLAUSES ARE DISCRIMINATORY:

It is an act of discrimination to refuse to provide legal and medically prescribed family planning services like birth control and emergency contraception."

-----------------------

That sounds to me like grounds for court action, and, IMO, good luck to any victims of this that choose to take that option.

Unless I'm missing something, in which case it would be great if someone could point it out, then the idea of dispensing emergency contraception direct from surguries, is a superb solution to the problem, and one with which everyone will be happy-

1. the patient gets the medical supplies they are legally entitled to

2. the pharmacists don't have to dispence the stuff they object to

3. no-one gets sued

The alternatives involve forcing pharmacists to comply, in which case it's possible they could initiate court action against the state, on the grounds that they are denied the right to exercise their moral beliefs; or, patients being denied medical supplies and therefore possibly suffering the mental distress and financial loss associated with being forced to bear an unwanted child.


"You can't outrun Death forever.
But you can make the Bastard work for it."

--MAJOR KORGO KORGAR,
"Last of The Lancers"
AFC 32


Educate your self in the Hazards of Fire Breathing STAY SAFE!

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Doc Lightning
GOLD Member since May 2001

Doc Lightning

HOP Mad Doctor
Location: San Francisco, CA, USA

Total posts: 13920
Posted:Written by: onewheeldave

1. being refused the emergency contraception prescribed to you by a doctor is outrageously unfair- it's the difference between getting on with your life, and having it irrevocably altered by the addition of a child you do not want.



I don't think it's unfair to be told "Sorry, we don't dispense that here. There's a pharmacy down the street that does."

It *IS* unfair to be told "Sorry, we don't dispense that here and I won't tell you where to get it filled."

And that's the difference as I see it.

Similarly, in the US, pediatricians often do circumcisions. I'm opposed to circumcisions; I won't do it. By Pele's argument, I should be required to. I'm not sure I agree with that.

I do think that medicine is a profession that is different from many others. My degree gives me great power to alter the lives of others and there is always temptation to use that power for the wrong reasons. I can do a great deal of good, but I can also abuse the trust of my patients and do a great deal of harm. That's why I had to take an oath when I graduated. It's one of the few lines of work where you have to do that.

I'm pro-choice, vehemently pro-choice. But I'm pro-CHOICE. I think that mandating that no pro-lifer may go into pharmacy or medicine is incredibly unfair. But I think that refusing to refer a patient to someone who will offer the service that you don't wish to offer is just as bad as being forced to do something that goes against every fiber of your moral being.

Now, there's a limit. There was a physician who was up for the post of Surgeon General who refused to prescribe birth control and who prescribed prayer as a treatment for PMS. Refusing to prescribe birth control is fine with me. The patient can go to another physician.

But when it comes to the point of active (rather than passive) failure to practice evidence-based medicine (there is no evidence for prayer as an effective therapy for PMS, or for any condition, for that matter), someone needs to have their licensure re-examined. You want to practice non-evidence-based medicine, fine, but then the patients need to be informed.


-Mike )'(
Certified Mad Doctor and HoP High Priest of Nutella

"A buckuht 'n a hooze!" -Valura

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onewheeldave
GOLD Member since Aug 2002

Carpal \'Tunnel
Location: sheffield

Total posts: 3252
Posted:I still reckon it should be dispensed at surgeries; if the patients doctor has decreeed that they are entitled to, and in need of emergency contraception I see no reason why a middle-man with moral objections to the patients choice need be involved.

Most especially as it's possible that the patient could reside in a town with only one pharmacy, or could reside in a town with several pharmacies who all refuse to dispense contraception, or, are close to the time limit in which the emergency contraception can be taken and, quite rightly, don't wish to make the rounds of pharmacies till they find one that is willing to dispense the medicine they are entitled to.

While it can be argued that pharmacists can have moral opinions about the stuff they dispense, the fact remians that it is not their job to make moral judgements- their job is to accurately dispense prescribed medication.

As there is now a well documented problem concerning emergency contraception and some pharmacists, surely it's best to make another option available?


"You can't outrun Death forever.
But you can make the Bastard work for it."

--MAJOR KORGO KORGAR,
"Last of The Lancers"
AFC 32


Educate your self in the Hazards of Fire Breathing STAY SAFE!

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Stone
GOLD Member since Jun 2001

Stream Entrant
Location: Melbourne

Total posts: 2830
Posted:Some of this is reminiscent of 1950/60s Australia, when many Catholic pharmacies refused to sell contraception to people. This was especially a problem for people living in small towns with only one pharmacy in the region. I heard the stories, and wondered if these pharmacists ever considered the hardship they caused, perhaps indirectly, through unwanted pregnancies, coat hanger abortions and the lives they have destroyed.

I wouldnt expect anyone to go against their morals, but refusing referrals seems vindictive. I also think there is a world of difference between someone performing a procedure against their will, and someone dispensing medication. For a start, a person preforming an operation against their will might be distracted by the dilemma. Which I think is entirely different to a pharmacist, playing god, by using their power to dispense morals along with or without legally prescribed medication.

So, I suppose the classic question to ask about ethics is, is it morally right not to give a life-saving transfusion to a child, because the parents insist this procedure goes against their religious beliefs, and the child dies?


If we as members of the human race practice meditation, we can transcend our fear, despair, and forgetfulness. Meditation is not an escape. It is the courage to look at reality with mindfulness and concentration. Thich Nhat Hanh

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Stone
GOLD Member since Jun 2001

Stream Entrant
Location: Melbourne

Total posts: 2830
Posted:On reflection, I'll add that I dont think anyone is being forced out of their career path. I think the pharmacists moral argument is about as relevant as saying we dont serve coloured people.

If we as members of the human race practice meditation, we can transcend our fear, despair, and forgetfulness. Meditation is not an escape. It is the courage to look at reality with mindfulness and concentration. Thich Nhat Hanh

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