Refusing to Dispense

[ultracet]

This article came from CNN.com

Pharmacist says he feared 'spiritual pain'
Hearing considers refusal to fill birth control pill prescription
Tuesday, October 12, 2004 Posted: 9:01 AM EDT (1301 GMT)


MADISON, Wisconsin. (AP) -- A former pharmacist said Monday he refused to fill a college student's prescription for birth control pills or transfer it to another pharmacy because he did not want to commit a sin.

Neil Noesen, 30, testifying before a judge at a disciplinary hearing, could face a reprimand or loss of his pharmacist's license for refusing to help Amanda Phiede obtain her pills.

"I could have trouble sleeping at night. I could be suffering the worst kind of pain. Spiritual pain," Noesen told an administrative law judge.

The state Department of Regulation and Licensing accuses Noesen of unprofessional conduct for not transferring Phiede's prescription.

"The additional risk of pregnancy should not have been imposed on her by someone else," said John Zwieg, a lawyer for the department.

Noesen's attorney, Krystal Williams-Oby, said Noesen broke no laws. She described him as a devout Roman Catholic and said any punishment would violate his constitutional right to religious expression.

According to the complaint, Noesen was an independent pharmacist filling in at a Kmart pharmacy in Menomonie in July 2002 when Phiede, then a student at the University of Wisconsin-Stout, asked to renew her birth control prescription.

Noesen, the only pharmacist on duty at the store at the time, asked if the prescription would be used for contraception, then refused to refill it when she said it would. "I just wanted to get my pills and go home," Phiede said.

Noesen also refused a Wal-Mart pharmacist's request to transfer the prescription, she said.

Phiede returned to Kmart the next day with police, she said, and the store manager called Ken Jordanby, the pharmacy director who was out of town. Jordanby filled her prescription when he returned the following day.

In his testimony, Noesen talked about God's law and accused Zwieg of harassing him.

"It's good for a person to be persecuted," he said when asked by his lawyer how the proceedings have affected him. "Really, it helps you grow in your faith."

The hearing was expected to conclude Tuesday. The judge will make a recommendation to the examining board on what punishment, if any, Noesen should receive.

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[Roxicet]

I'd really like to weed these psychos out of the profession!

What really irritates me is the hiprocisy of it all. Nobody is forcing them to make $100k/year, but they run screaming that they've been FORCED to dispense medicine that may "harm" a living being. My point is why do these religious, self-righteous drama queens even become pharmacists?

Why stop at birth control? Why dispense any medication at all if sickness and death is god's will? How dare they interfere with the "reasons" behind why someone has been inflicted with AIDS, cancer, diabetes!!! (/sarcasm) Are not all drugs poisons? Are not all drugs stopping a natural disease process? And why not leave the judgement to God? Why do these crazies feel so IMPORTANT? Why not assume that the person *asking* for the medication is the one who should bear the burden of the punishment? God doesn't give a flying....squirrel!!!! Would these same pharmacists deny their own children a medication that would cure a fatal condition and assume that God wants them to die?!?!? I doubt it.

As you can tell, I have a huge problem with these cases...not a problem with differing religious beliefs, but with one's religious beliefs being forced upon others who have entrusted you to have a non-biased, sincere interest in protecting the patient's health, not saving your own "donkey" from the fire. Why don't they just take a paycut and go teach sunday school? Isnt greed one of the deadly sins!

/rant

 

[ultracet]

Ok I'm going to thow this out.. I attend a religious school. When plan B was not dispensed last year by a pharmacist in Texas we had a huge discussion about it in our OTC class and the instructor told us to figure out how we felt about the issue. The instructor told us to make sure we included a "conscience" clause. This would give us the right to refuse based on our beliefs... Now i have a problem with people who want to make a political issue out of everything. All you have to say is sorry we don't have that here's your Rx back.

Ok anyway... the thing that struck me about plan B is if you refuse to dispense that why not refuse to do the same with BC? People seem oblivious to that fact though.

This guy is completely out of line in my opinion... If i were the girl and got pregnant then i would probably sue him for child support for the rest of the child's life. no i wouldn't i'm completely against litigation but i would think about it!!!

 

[Roxicet]

... Now i have a problem with people who want to make a political issue out of everything. All you have to say is sorry we don't have that here's your Rx back.

Everytime this issue comes up, someone always suggests LYING as the solution to a moral problem. I have to admit that I'm not a very religious person, I'm agnostic, but even I would never lie to a patient to avoid a political issue. If you have moral convictions, then stand behind them and lose your job, but for heaven's sake (no pun intended ) don't LIE! Lying is a silent admission that they know that what they're doing (not dispensing) is wrong.

 

[ultracet]

At a WalMart I rotated at...
Every lortab rx that came in we were instructed to say "all we have is generic is that okay?"
now... of course we had "the ones with the speckles" but if they said " you don't have brand name?" we said no and they would leave.

it was a very interesting practice i must admit but i guess it avioded drug dealers?

i think every pharmacy has something they lie about...
like needles are Rx only... prilosec OTC has to be kept in the pharmacy... we'll have to order that for you and it will take several days...

if i don't want to fill something i'm not going to make such a stink that i am going to lose my liscense over it. i just wont fill it.

 

[Tuck]

A major point that people like this overlook is that they are violating their oath as a professional. I find it funny that the lawyer defending him makes the case to deny punishment based on freedom of religious expression, when clearly he is not according the patient the same rights. You don't have to check your beliefs at the door, but you do have to be professional enough not to interfere with others lives.

 

[futoi]

why is it that a physician can refuse to write an rx for birth control, ecp, whatever. but when it comes to a pharmacist refusing to fill said prescription, the public gets all bent out of shape?

physians can refuse to prescribe these medicines based on their moral beliefs. why is there the double standard?

 

[jdpharmd?]

"A former pharmacist said Monday...."
Sounds about right to me.

 

[Caverject]

"A former pharmacist said Monday...."
Sounds about right to me.

damn straight

I especially love this new organization called "Pharmacists for Life". They are the biggest group of *****s I have ever seen in my life. They feel that birth control is a moral sin and they should rise up and spread the message of Jesus Christ.

What I love, as mentioned by Roxi, the pharmacists that WILL NOT dispense plan B or Preven, but have no problem dispensing birth control. What a bunch of total crap. I lose all respect for my fellow pharmacists that make the arguement about how plan b is an abortificant. IT IS NOT!!!! IT WILL NOT KILL YOUR BABY!!! If the egg is inplanted, plan B will not do jack. All it does is make the uterine lining hostile to the egg and thus no implantation.

My favorite case is the jacka** from Texas that would not fill a girls plan b prescription because of his faith, nevermind this woman was raped. There is nothing like the good ol right wing rhetoric when it comes to that issue! "If you were raped, thats tough luck. Have fun living the rest of your life with your new bastard child!" What kind of message does that send to people? In other words, you get to be reminded EVERY DAY FOR THE REST OF YOUR LIFE you were raped by the mere fact of raising your rapists child. It's disgusting and pharmacists that activly partake in this activity ought to be ashamed of themselves. [/rant]

 

[off2skl]

why is it that a physician can refuse to write an rx for birth control, ecp, whatever. but when it comes to a pharmacist refusing to fill said prescription, the public gets all bent out of shape?

physians can refuse to prescribe these medicines based on their moral beliefs. why is there the double standard?

Then you find a doctor who will write your prescription (within reason). Likewise if I went to a pharmacy and they refused to fill my legitimate prescription, then I'd take my business elsewhere. However, the problem with the aforementioned case was not solely that the pharmacist wouldn't fill the prescription, but he also wouldn't transfer it, thereby denying the woman the right to get the prescription filled at all.

This brings to mind a quote, "I do not believe a word you say, but I will defend 'till the death your right to say it." As a professional, you may not agree with it morally, but the woman still has the right to fill the prescription. Take away that right, and what goes next?

 

[bananaface]

Ok anyway... the thing that struck me about plan B is if you refuse to dispense that why not refuse to do the same with BC? People seem oblivious to that fact though.

The major reason for the differentiation is that many pharmacists do not understand that the MOA is the same. They mistakenly believe that Plan B is an abortifacient. Why? The MOA used to be "unknown" and they assumed the worst.

I had a respectful conversation with a very religious pharmacist in April about the MOA. To my surprise, he was actually open to reconsidering his view on Plan B based on the "new" information I gave him on the MOA. (But, he did insist on looking it up himself.) I don't expect this to be the case for everyone. But, alot of times how we present this information to our peers has as much to do with changing their minds as the actual information. It's just something to keep in mind.

I see refusing to dispense Plan B as more serious than refusing to sell BC pills. Plan B is post coital contraception. If someone doesn't get their BC they can refrain from sex. So, damages for denial of service would be harder to make stick. It would be interesting though, to know if this man refuses to sell condoms.

I have mentioned this before, but Wal-Mart does not stock Plan B, as a company policy.

 

[GravyRPH]

Everytime this issue comes up, someone always suggests LYING as the solution to a moral problem. I have to admit that I'm not a very religious person, I'm agnostic, but even I would never lie to a patient to avoid a political issue. If you have moral convictions, then stand behind them and lose your job, but for heaven's sake (no pun intended ) don't LIE! Lying is a silent admission that they know that what they're doing (not dispensing) is wrong.

I have said this before. I too find it odd to avoid a moral confrontation by lying. As for BB saying all pharmacies lies a little, I can't think of a time I've ever had the need to lie to a patient. Honesty has always worked well for me (except perhaps if my wife asks me how dinner was).

 

[aphistis]

I lose all respect for my fellow pharmacists that make the arguement about how plan b is an abortificant. IT IS NOT!!!! IT WILL NOT KILL YOUR BABY!!! If the egg is inplanted, plan B will not do jack. All it does is make the uterine lining hostile to the egg and thus no implantation.[/rant]

Implantation? You must mean the implantation that takes place after fertilization. No small number of people out there contend that life begins when the new organism is actually created, not a week or so later when it finally moseys down to the uterus and starts feeding off mom. To anyone who holds the position that life begins at conception (myself included), preventing a fertilized egg from implanting is a disruption to the pregnancy leading to the offspring's death, which falls solidly within the scope of abortion.

 

[bananaface]

Implantation? You must mean the implantation that takes place after fertilization. No small number of people out there contend that life begins when the new organism is actually created, not a week or so later when it finally moseys down to the uterus and starts feeding off mom. To anyone who holds the position that life begins at conception (myself included), preventing a fertilized egg from implanting is a disruption to the pregnancy leading to the offspring's death, which falls solidly within the scope of abortion.

Just to clarify, we are using "abortion" in the medical sense. Under the medical definitions, "contraception" is anything that prevents fertilization OR implantation. "Abortion" is anything that dislodges a fertilized egg post implanation. There is no reason to argue over semantics. As medical personnel, we use medical definitions. If you have moral belief that life begins at fertilization, that is fine. But, that does not change the medical definition of abortion or contraception. Instead, you need to accept that we differ, and explain your moral arguments in terms of your own beliefs, while keeping in mind that those you are debating with are speaking in medical terms.

I am not sure why exactly some people in medical professions are tempted to shift to non-medical definitions for abortion. Is there something that rings more powerful about that word than just saying "I believe that a fertilized egg is a live and therefore prevention of implantation leads to death"?

And, do you feel that people who promote prevention of implantation are essentially accessories to murder? And extrapolating from that, is a woman supposed to be super careful to make her body hostitable to implantation to prevent a "loss of life"? And, how is the "death" of a fertilized egg different than the "death" of other tissues (say, the cells that die in a dental extraction)? I am really interested in where you stand on these issues. We don't have access to many people who are in a position or willing to make these deliniations. Those of us who are on the medical definiton side of the controversy tend to speak to each other and not to seek out viewpoints from those who believe that life begins at conception.

And, everybody please be civil or this is all going to end up with us beating our own drums and backing into our own little corners. Thanks.

 

[delchrys]

And, do you feel that people who promote prevention of implantation are essentially accessories to murder? And extrapolating from that, is a woman supposed to be super careful to make her body hostitable to implantation to prevent a "loss of life"? And, how is the "death" of a fertilized egg different than the "death" of other tissues (say, the cells that die in a dental extraction)? I am really interested in where you stand on these issues. We don't have access to many people who are in a position or willing to make these deliniations. Those of us who are on the medical definiton side of the controversy tend to speak to each other and not to seek out viewpoints from those who believe that life begins at conception.

my 2 cents worth of nonsense...incoming:

the death of a fertilized egg is different from the death of other tissues, like cells that die in a dental extraction, because only a fertilized egg has the potential of developing into a human being if left unharmed.

i don't necessarily believe that life begins at conception, but i do tend to believe that life begins when the first electrical impulses travel through, what, the neural tube (?). My reasoning is relatively straightforward.

death and life are mutually exclusive conditions, and every organism is either in one of those two states or the other. if dead, one cannot be alive at the same time; and if alive, one cannot be dead simultaneously. so, when does the transition from "alive" to "dead" officially take place for a human being? every definition for death (of people) i could find (particularly in legal and medical dictionaries) was "an isolectric electroencephalogram for 30 minutes." in other words, the absence of electrical activity in the brain for 30 minutes makes you legally and medically dead. since dead and alive are mutually exclusive, and every organism must necessarily be in ONE of these two stats, the definition for "death" can serve as a basis for the definition for life. particularly, the absence of the conditions that define "death" is what gives rise to the condition of "life." thus, "a nonisolectric electroencephalogram for at least 30 minutes" qualifies a person as "alive." for this reason, i hold that a conceptus is alive once it has had electric activity in its neural tube (or whatever it's called at the point where electrical activity starts) for 30 minutes.

i say nothing about the morality of destroying such an organism, merely that to do so is inconsistent with the rest of our social values, laws, and morality with regards to killing. the last thing i'll ever do is judge some woman who gets an abortion. but it seems pretty clear that destroying a conceptus once it has nerve or brain activity for half an hour is technically the destruction of a living thing, and since human beings don't metamorphose into moose or rabbits or any other species throughout their lives, and the conceptus normally doesn't stop living and then restart at birth, such destruction of the conceptus at this stage would constitute, not just the destruction of "a living thing," but the killing of a living human being.

 

[bananaface]

i don't necessarily believe that life begins at conception, but i do tend to believe that life begins when the first electrical impulses travel through, what, the neural tube (?). My reasoning is relatively straightforward.

I know we are speaking in terms of human life above. But, having done craploads of undergraduate work on invertebrates, I have a hard time accepting the beginning of life as activity in a neural tube. In other words, it would seem to me that a functional neural tube is not a prerequisite to life.

death and life are mutually exclusive conditions, and every organism is either in one of those two states or the other. if dead, one cannot be alive at the same time; and if alive, one cannot be dead simultaneously. so, when does the transition from "alive" to "dead" officially take place for a human being?

I don't necessarily buy that they are mutually exclusive. Why do we have words/phrases like "dying", "slow death", "quick death", etc? We are obviously describing a process.

And, say someone believes that life begins at conception... even that process can be broken down into multiple steps. So, when exactly in the fertilization process does "conception" occur? "Conception" is not exactly a point in time either.

 

[delchrys]

I know we are speaking in terms of human life above. But, having done craploads of undergraduate work on invertebrates, I have a hard time accepting the beginning of life as activity in a neural tube. In other words, it would seem to me that a functional neural tube is not a prerequisite to life.

you disagree that life and death are mutually exclusive conditions? we have words like "slow death" and "dying" because we are defining the process of moving from one state (life) to another (death). if you shoot a person who is dying, you are just as much a murderer under the law as if you shot a 1 year-old child. please provide one example outside the present subject of the conceptus of an organism that is both alive and dead, or that is neither alive nor dead. it is not possible, because these conditions are mutually exlusive, as i stated.

i am not debating what a person thinks who thinks that life begins at conception. i do not believe that life begins at conception. there is a valid argument that can be made regarding the moral, legal, etc consistency/inconsistency of destroying a fertilized egg prior to neural tube activity, but it is outside the scope of the argument i'm making at this time.

so i ask this in response: what is the definition or what are the criteria that must be met for a person to be "alive"?

further, do you dispute that a person with an isolectric EEG for 30 minutes is legally and medically dead? if so, please explain. if not, then...

do you instead argue with the proposition that a thing must be either dead or alive, but cannot be both at the same time? if so, please explain. if not, then...

do you disagree with the logical proof below this line of text?
if an isolectric EEG (for > 30 mins), then dead, then
if a nonesolectric EEG (for > 30 mins), then not dead
if not dead, then alive
thus, if a nonisolectric EEG (for > 30 mins), then alive
in other words, if electrical activity coming from the CNS (for > 30 mins), then alive.
if you disagree with this proof, please demonstrate where the logic is flawed.

i don't mean to sound clipped, but if you don't disagree with either of the premises, and my proof is correct (which i am pretty certain it is rock-solid), then the only room for disagreement is with logic itself, which is an argument i'm not equipped to have, lol. i understand that you disagree with the statement about life/death and being mutually exclusive, but i have never heard of or seen a single example that disputes that statement, and unless you can provide such an example, or at least propose a situation that would satisfy both the conditions of life and the conditions of death simultaneously for the same organism, then i'm afraid i will have to continue to hold that premise as valid and true.

i understand that you disagree with the conclusion, but that is insufficient to refute the argument i've made. my question is this: with what part of my argument do you disagree?

respectfully,

jason

 

[bananaface]

we have words like "slow death" and "dying" because we are defining the process of moving from one state (life) to another (death). .... it is not possible, because these conditions are mutually exlusive, as i stated.

If there is a transition between life and death, how can they be mutually exclusive? Wouldn't the transition be a gray area between the two (for lack of a better descriptor)?

please provide one example outside the present subject of the conceptus of an organism that is both alive and dead, or that is neither alive nor dead.

a sponge, Phylum Porifera

further, do you dispute that a person with an isolectric EEG for 30 minutes is legally and medically dead? if so, please explain. if not, then...

No, I do not dispute this. Mostly, because if they aren't dead, I figure that they might as well be. Legal and medical definitions can be changed. There is nothing intrinsically correct about them. They are just products of our moral reasoning and legislative processes. I would rather think for myself.

BTW in that "proof" you wrote out, EXACTLY 30 minutes is missing. I'm going to call the medical definition what it is: arbitrary crap. You know as well as I do that there is no significant difference between just under and just over 30 seconds.

so i ask this in response: what is the definition or what are the criteria that must be met for a person to be "alive"?

Your question assumes the existance of an absolute answer. I don't know that there is one. I accept the premise that each person's philosophy and belief must stand up under its own premises and fit with observable facts. When I point things out, ask questions, etc., it is not to tear you down, but to force you to rework your own reasoning and shift it so that it at least stands up to a few more challenges.

 

[delchrys]

If there is a transition between life and death, how can they be mutually exclusive? Wouldn't the transition be a gray area between the two (for lack of a better descriptor)?

No, the "transition" is merely the period of time during which observers are able to recognize that death will soon be the the condition of the subject. Until such time, the subject is "alive." we simply call the signs of the impending switch from alive to dead "transition" because it works as a form of verbal shorthand.

a sponge, Phylum Porifera

would you care to add any explanation to this that supports your point? more than anything, i would like it if you would answer one of the earlier questions/challenges i put forth: to list the criteria that, if wholly satisfied by an organism, would mean that the organism is alive, and for which no dead (nonliving) organsim would qualify. alternatively, provide a defintion for life
that excludes all that which is not alive and includes all that which is alive.

No, I do not dispute this. Mostly, because if they aren't dead, I figure that they might as well be. Legal and medical definitions can be changed. There is nothing intrinsically correct about them. They are just products of our moral reasoning and legislative processes. I would rather think for myself.

yes, legal and medical definitions can be changed, and they are "just" products of our moral reasoning. still, my point is that destruction of a conceptus after 30 minutes of electrical activity in the neural tube is the killing of a human being under our moral, medical, and legal definitions as applied here, with the notable exception that the law and medical ethics has carved out an exception for the conceptus specifically. so my point remains what it has been all along--that the act of killing a post-neural-tube-activity conceptus is morally, legally, and socially inconsistent with other laws that relate to murder and killing of human beings. you talk of thinking for yourself, but all you've demonstrated thus far (again, no offense intended here!) is that you are capable of deciding what definitions you DON'T like. so provide the one you use.

BTW in that "proof" you wrote out, EXACTLY 30 minutes is missing. I'm going to call the medical definition what it is: arbitrary crap. You know as well as I do that there is no significant difference between just under and just over 30 seconds.

i actually have no qualms about using the first instant of neural tube activity as the starting point. and ANY definition will be "arbitrary crap"; unless the whole of existence declares itself sentient and announces that death is such-and-such and life is such-and-so, there is no such thing as an objective, "true" standard that we can be aware of. so, objective crap or not, the only way to go is to construct a definition or to just pretend there is no definition, in which case i question how one draws the line between crime and non-crime, life and non-life.

Your question assumes the existance of an absolute answer. I don't know that there is one. I accept the premise that each person's philosophy and belief must stand up under its own premises and fit with observable facts. When I point things out, ask questions, etc., it is not to tear you down, but to force you to rework your own reasoning and shift it so that it at least stands up to a few more challenges.

i don't take it as a tearing down, and i think it's safe to say that we can both drop our disclaimers to each other that we mean no offense in our discussion.

 

[delchrys]

holy crap, you're the OP of the contemplating divorce thread?! i have stayed away from that one since it got full of people ready and willing to fling judgment at you when they don't even know you, lol.

it seems like you made the right decision, and i hope their posts didn't make you feel badly--only you know yourself. the fact that you feel good about your decision is the clearest indicator that your decision was right.

 

[ultracet]

Ok I read all of the discussion on here and I must point out one thing....
For those of you out there who believe "life" begins at fertalization consider this.....
Any pill with progesterone will prevent implantation. Ortho is a combi pill using both estrogen and progesterone. If the estrogen doesn't work the progesterone is there for a back up.
DONT TAKE IT.... you are "aborting" your baby!
hate to break it to you but if you are "pregnant" (fetus is implanted) then all plan b is going to do is help you to stay pregnant. the body releases progesterone inorder to insure a miscarriage does not happen at this point and by taking plan b you would be doing the same thing.

argue over semantics all you want to be please be consistent.

 

[delchrys]

Ok I read all of the discussion on here and I must point out one thing....
For those of you out there who believe "life" begins at fertalization consider this.....
Any pill with progesterone will prevent implantation. Ortho is a combi pill using both estrogen and progesterone. If the estrogen doesn't work the progesterone is there for a back up.
DONT TAKE IT.... you are "aborting" your baby!
hate to break it to you but if you are "pregnant" (fetus is implanted) then all plan b is going to do is help you to stay pregnant. the body releases progesterone inorder to insure a miscarriage does not happen at this point and by taking plan b you would be doing the same thing.

argue over semantics all you want to be please be consistent.

so, for clarity, you have an issue with aphistis, but not with me on this particular point, since i have not once expressed that i believe that life begins at fertilization. i'm just confused because aphistis doesn't seem to be waging a war of semantics, and while i am fine with you having an issue with my position, i want you to at least have an issue with the position i actually HAVE as opposed to associating me with some random point of view.

 

[bananaface]

would you care to add any explanation to this that supports your point?

See the bottom section on regeneration. When you dissolve a sponge, it is basically a bunch of cells and acellular junk sitting in a tray. You can take 1 sponge, dissolve it's skeleton, and regenerate it into several smaller sponges. You cand take 2 small sponges (of the same species), dissolve them, and end up with one larger sponge. When it is dissolves in the tray, it loses its organization/form and the case could be made that it is effectively dead. As I remember you have only a few minutes after dissolution during which the sponge matrix will effectively reorganize itself into a sponge. Glass sponges are not able to do this as their spiclues (ie: skeleton) will not dissolve in this manner.

Cell types
Sponge body

When the sponge is dissolved but reconstituteable, it isn't really dead yet. But, it isn't really a discrete organism anymore either. The individual cells are differentiated into several types which are no longer able to work together and are therefore NOT capable of surviving in this state (ie: no organismal function in this state), so I would not consider that mass to be alive either.

more than anything, i would like it if you would answer one of the earlier questions/challenges i put forth: to list the criteria that, if wholly satisfied by an organism, would mean that the organism is alive, and for which no dead (nonliving) organsim would qualify. alternatively, provide a defintion for life that excludes all that which is not alive and includes all that which is alive.

If you look at the state of science, you will notice that there is no real concensus as to where to draw the line between life and non-life. For example, some argue that the definition of life should be designed to include viruses, while others advocate against it.

still, my point is that destruction of a conceptus after 30 minutes of electrical activity in the neural tube is the killing of a human being under our moral, medical, and legal definitions as applied here, with the notable exception that the law and medical ethics has carved out an exception for the conceptus specifically. so my point remains what it has been all along--that the act of killing a post-neur al-tube-activity conceptus is morally, legally, and socially inconsistent with other laws that relate to murder and killing of human beings.

Why declare "time of death" at 30 minutes? Why not declare it over after the last instance of neural activity, but confirmed by a 30 minute absence of activity? How is 10 minutes after the last activity so different than 45, aside from the fact that 30 falls between 10 and 45?

you talk of thinking for yourself, but all you've demonstrated thus far (again, no offense intended here!) is that you are capable of deciding what definitions you DON'T like. so provide the one you use.

And, as a scientist, my viewpoint is consistent with its own assumptions.

the only way to go is to construct a definition or to just pretend there is no definition, in which case i question how one draws the line between crime and non-crime, life and non-life.

Crime is a socially defined problem. So, I have no issues with a social definition of crime.

 

[MNnaloxone]

Short answer:

Many states are enacting laws that insulate pharmacists from fallout following a refused script based on morality (whatever that is). However, don't expect to keep your job if you refuse a script-many pharmacies have this type of clause written into the code of conduct. That's the big book you sign on your first day on the job. Refuse a script, violate code of conduct, post resume on Monster.com. You had your chance to say no then. I'll shake my head whenever a RPh refuses a script, but that's their morality. Cause a problem to the patient, and that should have everyone outraged.

My $0.02. Slow in clinic today.

 

[ultracet]

so, for clarity, you have an issue with aphistis, but not with me on this particular point, since i have not once expressed that i believe that life begins at fertilization. i'm just confused because aphistis doesn't seem to be waging a war of semantics, and while i am fine with you having an issue with my position, i want you to at least have an issue with the position i actually HAVE as opposed to associating me with some random point of view.

i don't really have an issue with anyone. your or aphistis.
all i am saying is be consistent. EVERYONE should be consistent. me, you, and whom ever else wants to take a position on this issue.
i don't care what anyone believes that's not my business and i don't take issue. but i would like for those who refuse to dispense plan b to also refuse anything with progesterone in it as i feel that would be consistent with the beliefs they proclaim they have.

 

[Tuck]

The main thing (I think) is the fact that people are allowing their own personal judgements to affect their practice. Even in a non-practice setting I think it is incredibly selfish to try and force your beliefs on someone else. I am amenable to changing my mind on many issues and I often have. However, even if I feel very strongly about something I recognize the fact that others may not feel the same way. If everyone did hold the same beliefs it would sure be a boring world. At any rate, this is just one issue that is in dispute among many others. Inflexibility in one area often carries over to other areas and that can be potentially dangerous. I think that acting as a professional should be a way of life, and not just for the pharmacist. Of course, this is only my opinion.

 

[phar]

Simple 101...
You have the right to refuse dispensing any medication if you feel it is wrong or against your customs/beliefs. Scenario... It against your belief that "abortion pill" is wrong but the company says you "must" dispense irrespective of your state of mind. So, you dispense and obeyed their rule. Who ends loosing here? off course, you and the company. In pharmacy, there are tons of jobs if you get fired. How do you loose? GUILT and self-dignity. This is my opinion.

 

[WillowRose]

My sister just encountered a similar situation a few weeks ago. The doctor who has treated her for severe endometriosis for nearly 10 years suddenly decided that he would no longer prescribe birth control for her. He no longer will prescribe for any unmarried woman. While I realize that BC and abortion fall into a gray area, I fail to see how the refusal to write (or fill) a script is anything less than negligent.

Let's leave abortion out of this for a minute. You have a patient who needs/requests BC. You don't think she should be having sex. Well, that's your opinion. You can counsel your patient, but you cannot change the behavior. If you just say no, you've done nothing. So now you have a patient who is at risk because of your decision. In my sister's situation, not only is she at risk for pregnancy now, but she's also in pain.

If you don't want to write or fill a script, the *least* you can do is refer the patient to another provider. However, I personally think it's unprofessional to refuse to fill a script for BC (or to refuse to write one). The hallmark of a professional is that he/she is able to set aside their own beliefs in order to do what is best for the patient. Is it in the patient's best interest for you to essentially say "This will teach you to have sex...now you're gonna get pregnant!"?

Why in the world would you become a pharmacist if you're going to refuse to dispense drugs? And for those that seem to support the idea of pharmacists having a conscious clause, would you ask the patient why they were using a medication? (Is that any of the pharmacist's business? I'm asking...not trying to piss off the pharmacists). I'm just curious how a professional who is probably not in a position to know a patient's particular history can justify deciding to not dispense BCP that can be used for a host of reasons other than contraception. Why a man would become an OB/GYN and refuse to write the scripts is a question I'll just have to save for another day....it still astounds me that now she & I have both encountered the same barriers to optimum health care.

Great discussion. And it reminded me of the 102nd reason why I have boycotted Wal-Mart!

Willow

 

[bananaface]

I'll shake my head whenever a RPh refuses a script, but that's their morality. Cause a problem to the patient, and that should have everyone outraged.

Just a general comment... (ie: not directed towards MNnalaxone)

It's interesting how alot of people get upset over refusal to fill BC and ECP, but not pain medications. So many cancer patients get crap about their narcotic prescriptions. It's amazing how some of us tend to treat these people like crap and act paternalistic about it. *sigh*

 

[Roxicet]

Why in the world would you become a pharmacist if you're going to refuse to dispense drugs?

My point exactly! Which is why aphistis has the right idea....pick a profession where you will never be put in a situation where you may be asked to compromise your morals. A sincere Thank you, aphistis, for choosing dentisty. two thumbs up for you!

And for those that seem to support the idea of pharmacists having a conscious clause, would you ask the patient why they were using a medication? (Is that any of the pharmacist's business? I'm asking...not trying to piss off the pharmacists). I'm just curious how a professional who is probably not in a position to know a patient's particular history can justify deciding to not dispense BCP that can be used for a host of reasons other than contraception.

Willow

Yes, it is our job to ask the patient why they are taking the medicine. We need this info in our vigilance to prevent Adverse drug events/reactions, and the progressive definition of "pharmacist care" is to "provide an expanded level of patient care that focuses on disease prevention and wellness programs including monitoring, evaluating, counseling, intervening, and directing medication-related therapies to enhance patient care and improve health outcomes." No it is not our business to place our own personal moral judgement on the medicine's use. Note that I believe there is a clear distinction between the rights of a pharmacist to refuse to dispense a prescription based on a legitimate reason to fear that the patient will be physically harmed by the dosage prescribed or by drug interactions, and the rights of a pharmacist to refuse to dispense based on moral judgments. The latter, in my opinion, is not a right at all, but a breach of contract that the pharmacist has unofficially signed with the patients when the pharmacist took the oath to ?maintain the highest principles of moral, ethical, and legal conduct.? Also my opinion, is that moral, ethical, and legal are concepts that are not mutually exclusive, and you cannot have one without the other. The pharmacist that follows his morals without considering that the patient is presenting a legal prescription to be filled, is neither upholding the oath nor maintaining the professional relationship with the patient. I will never be a pharmacist who places my own beliefs above the professional relationship with, and responsibility to my patients.

 

[hysteriaweb]

I'd really like to weed these psychos out of the profession!

What really irritates me is the hiprocisy of it all. Nobody is forcing them to make $100k/year, but they run screaming that they've been FORCED to dispense medicine that may "harm" a living being. My point is why do these religious, self-righteous drama queens even become pharmacists?

Why stop at birth control? Why dispense any medication at all if sickness and death is god's will? How dare they interfere with the "reasons" behind why someone has been inflicted with AIDS, cancer, diabetes!!! (/sarcasm) Are not all drugs poisons? Are not all drugs stopping a natural disease process? And why not leave the judgement to God? Why do these crazies feel so IMPORTANT? Why not assume that the person *asking* for the medication is the one who should bear the burden of the punishment? God doesn't give a flying....squirrel!!!! Would these same pharmacists deny their own children a medication that would cure a fatal condition and assume that God wants them to die?!?!? I doubt it.

As you can tell, I have a huge problem with these cases...not a problem with differing religious beliefs, but with one's religious beliefs being forced upon others who have entrusted you to have a non-biased, sincere interest in protecting the patient's health, not saving your own "donkey" from the fire. Why don't they just take a paycut and go teach sunday school? Isnt greed one of the deadly sins!

/rant

Something needs to be done to get them out.

 

[ultracet]

And for those that seem to support the idea of pharmacists having a conscious clause, would you ask the patient why they were using a medication? (Is that any of the pharmacist's business? I'm asking...not trying to piss off the pharmacists).

The appropriate question to ask every new fill rx is "What did the doctor tell you this was for?"

This insures 2 things... 1. The doctor didn't make a mistake
2. You didn't misfill the rx.

 

[WillowRose]

The appropriate question to ask every new fill rx is "What did the doctor tell you this was for?"

This insures 2 things... 1. The doctor didn't make a mistake
2. You didn't misfill the rx.

I totally understand (and agree) with this. I realize that pharmacists are charged with looking out for adverse reactions, etc. But it is seriously overboard to ask whether BCP are being used for birth control. At least it is in my opinion.

In some cases, I guess there's a fine line between professional responsibility and downright nosy.

Thank you all for your input. It's been very enlightening!

Willow

 

[ultracet]

I totally understand (and agree) with this. I realize that pharmacists are charged with looking out for adverse reactions, etc. But it is seriously overboard to ask whether BCP are being used for birth control. At least it is in my opinion.

In some cases, I guess there's a fine line between professional responsibility and downright nosy.

Thank you all for your input. It's been very enlightening!

Willow

really it is going to depend.... i mean like you said i know someone who uses it for endometriosis and there may be other things you need to look at with that condition you don't have to consider with a healthy woman who doesn't want to be pregnant.

I have encountered in having rxs filled... I'll only have 1 Rx at the pharmacy and i'll say i need a refill on my Rx and they pull up my profile and see 1 drug and they ask what the refill is for. its a check to make sure they have the Rx and that's what i want.
i have had Rxs not filled until i picked them up because they were unusually expensive. i was asked if i knew how much they cost (it was a refill) and when i said yes they then filled it.

i don't usually assume when people ask me questions they are doing it b/c they're nosy but perhaps that comes with actually having to ask the people the questions myself.

 

[Tuck]

Actually, I think you have an obligation to find out as much as possible. As a professional you have a covenental relationship with your patients so this information is not available to anyone but the two of you. However, your patients have to be able to trust that you will be impartial and non-judgemental or they will not open up to you. If a patient is not able to trust in their pharmacist (legitimately), then clearly the pharmacist is not doing an adequate job.