Ethics & Law (again)

[baggywrinkle]

Pharmacists' objections to contraception spills into state legislatures
The ongoing controversy over whether pharmacists are allowed to deny consumers contraception based on moral beliefs may be decided on a state level in several instances. Legislation has been proposed in more than a dozen states that protects a pharmacist's right to refuse to fill a prescription, pitting groups such as Pharmacists for Life International against Planned Parenthood Federation of America. USA TODAY (11/9)

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[GravyRPH]

This is such a grey area that this is going to be happening again and again. There are strong stances on both sides as even the debates here have shown. I see a trend towards states allowing pharmacists to refuse to fill a prescription based on moral grounds, but then who protects the patient's rights? Someone's rights are going to be trampled. The right to life pharmacists position may not be mine, but can you just dismiss their beliefs? Should they have chosen another profession? A doctor is not forced to perform an abortion, why should a pharmacist? All valid questions, with no right answers for any one side.

 

[baggywrinkle]

This is such a grey area that this is going to be happening again and again. There are strong stances on both sides as even the debates here have shown. I see a trend towards states allowing pharmacists to refuse to fill a prescription based on moral grounds, but then who protects the patient's rights? Someone's rights are going to be trampled. The right to life pharmacists position may not be mine, but can you just dismiss their beliefs? Should they have chosen another profession? A doctor is not forced to perform an abortion, why should a pharmacist? All valid questions, with no right answers for any one side.

I have dispensed Preven & Plan B without batting an eye, however NO ONE
will ever force me to dispense ANYTHING that I am uncomfortable with. Even if this means walking away from the counter for good.

Without the right to refuse to dispense you might as well be a dispensing machine

 

[ultracet]

I have dispensed Preven & Plan B without batting an eye, however NO ONE
will ever force me to dispense ANYTHING that I am uncomfortable with. Even if this means walking away from the counter for good.

Without the right to refuse to dispense you might as well be a dispensing machine

i completely agree with this.
i really think it will be a huge slap in the face if states decide pharmacists can't refuse to dispense something. i mean that would have a HUGE impact on the practice of pharmacy....

 

[bananaface]

There isn't a legal obligation to fill here in WA. But, no matter whether there is an obligation to fill or not, a denial of service would open the possibility of a civil suit, if damages were sustained.

Personally, I would love to see professionals refrain from imposing their personal views on reproduction and sexuality on others. But, how could we reconcile mandated prescription filling with retaining the discretion that comes with being a professional?

I can see how one could argue that pharmacist refusing to fill a methergine and misoprostol together on moral grounds is not alot different than a physician refusing to write for that same combination. We don't question the physician. Should we? Or, should we not question either?

BTW, if a surgical abortion has already been performed, how could it be morally implicit to refuse to fill a methergine and doxycycline combination? The deed has already been done at that point.

 

[baggywrinkle]

There isn't a legal obligation to fill here in WA. But, no matter whether there is an obligation to fill or not, a denial of service would open the possibility of a civil suit, if damages were sustained.
.

Damages, real or imagined. Not to mention the possibility of an investigation
by the BOP. Any complaint must be followed up on, no matter how trivial. My pharmacy just successfully defended against a BOP complaint which was initiated by a disgruntled patron who claimed she wwas shorted two Tylenol #3 out of twelve. Our policy is to double count and circle all narcotics so she did not have a leg to stand on.

More recently, a fellow complained to my district office because I was on lunch break and my technicians were covering for me telling incoming customers it would be an hour before new prescriptions were ready, the pharmacist was at lunch. He was inconvenienced and stated there was no pharmacist on the premises - clearly a violation of statute - when in fact I was sitting in back enjoying the breaks mandated by labor laws and nothing new was being dispensed. Had he called the BOP there would have been an investigation. Henceforth, I will not feel badly about sitting at the counter and ignoring them in plain sight!

 

[bananaface]

I'm glad that the board can only pursue a complaint by a patient if the complainant is willing to put their name on it. That shuts down alot of people who are just out there to throw their weight around.

I always figured if you were getting paid you were open and working, whereas if you were off the clock you are no longer supervising and need to shut it down. I used to work with a pharmacist who would go on the floor for a few minutes on the clock. She would say, "If the board shows up while I am gone, tell them I have diarrhea."

 

[Leah27]

The right to life pharmacists position may not be mine, but can you just dismiss their beliefs? .

Yes. You can dismiss thier beliefs because so long as it is a legal drug, written legally, on a legal RX blank, you must serve them within the bounds of the law. Can a racist who works at MCDonalds not serve a black person a hamburger because it is against their beliefs? NO!

 

[GravyRPH]

But what about that same person not serving a Catholic? Right to free religious expression is also protected, and since some states have protected the right of the pharmacist to refuse to dispense they do consider it still in line with the law.
My question was intended to be rhetorical. I know that there are people who will vehemently argue both sides of it, it will be interesting to see where the state laws and BOP's fall.

 

[bananaface]

Yes. You can dismiss thier beliefs because so long as it is a legal drug, written legally, on a legal RX blank, you must serve them within the bounds of the law.

A couple of weeks ago, I had a patient who asked me to dispense Vicodin to her despite a history of anaphylactic reaction to hydrocodone, because she cared more about relieving her pain and being able to sleep than her ability to breathe. In this scenario, I was not compelled to dispense it to the patient, just because it was "a legal drug, written legally, on a legal RX blank." In fact, I was legally compelled not to dispense. My point is that just because someone hands me a prescription does not mean that I have to fill it.

I don't know exactly where to fall on the contraception issue. I definitely want women to have access to these services, but making a prescription into a mandate has other consequences that I am not willing to accept.

 

[Leah27]

I'm sorry if I sounded harsh. It is just such a hot topic right now, especially considering the political climate. OF course if the person is allergic to it, or has a certain condition that may cause them to react negativly to the drug , you can politely decline to fill it, while making other suggestions to the patient. As far as birthcontrol goes, I am personally astounded that professionals would let their personal beliefs prevent them from performing a legal service of dispensing a drug tht is less harmful than apap or asprin! When i was in a school interview, the interviewer asked me "what would you do if a teenager came in with a birth control RX"...... I momentarily drew a blank.. i didn't see an issue here, and had to stop and think of one. IT makes me sad to think that medical professionals would let their personal beliefs affect someone else's health, life , and welfare over an issue that is so passive as dispensing a pack of pills.

 

[bananaface]

The patient who asked me to dispense the Vicodin to her subsequently asked for her prescription back. In this case I declined to return it, had a talk with her, and sent her to the ER for an alternative. It was a situation in which I knew what the right thing to do was, and wouldn't have cared if the law obligated me to do otherwise. I would imagine that people with religious/moral convictions against contraception/abortion feel the same way when asked to dispense something that they feel is not right. That said, anyone who took a prescription for birth control, emergency contraception, or abortion meds away from a patient and refused to give them back would get in deep doo-doo.

Another issue is that many people feel that dispensing certain medications would facilitate acts that they viewed as immoral, and thereby make them a participant. Abortion meds are an example. But, perhaps one that will strike more people is assisted suicide. In Oregon, the "Death With Dignity Act" specifically allows providers to choose whether or not they are willing to participate in the process. Many of us who would be willing to dispense abortion meds would be unwilling to dispense for the purposes of assisted suicide.

I guess we have to respect the judgement of our peers even though we may not agree with it. Now, an employer isn't under the same obligation to be so respectful. They can and do terminate employees for refusing to dispense when company policy has set standards. Sadly, I have seen pharmacists at Walgreens who are actually afraid to refuse narcotic prescriptions and early refills for cash because of corporate influence. the background on that is that a couple of years ago a pharmacist refused to fill a cancer patient's pain medications and a big stink was made on the local news. In this case, I view the corporation as infringing on the pharmacist's ability to provide good care.

 

[baggywrinkle]

Sadly, I have seen pharmacists at Walgreens who are actually afraid to refuse narcotic prescriptions and early refills for cash because of corporate influence. the background on that is that a couple of years ago a pharmacist refused to fill a cancer patient's pain medications and a big stink was made on the local news. In this case, I view the corporation as infringing on the pharmacist's ability to provide good care.

Anna, if you have access to those pharmacists you might let it be known that the pharmacy manager at Walgreens in Coco Florida is defending his continued licensure before the BOP for cashing out controls early. One of his patrons was caught selling Oxycontin on the street triggering an investigation.
Walgreens of course fully cooperated by printing out every narcotic this guy ever filled and he is now obliged to defend each early refill on the list before the board. This man is a good pharmacist who will do anything to avoid confrontation.

You can replace a job, but not a license. STAND YOUR GROUND!

 

[aphistis]

The patient who asked me to dispense the Vicodin to her subsequently asked for her prescription back. In this case I declined to return it, had a talk with her, and sent her to the ER for an alternative. It was a situation in which I knew what the right thing to do was, and wouldn't have cared if the law obligated me to do otherwise. I would imagine that people with religious/moral convictions against contraception/abortion feel the same way when asked to dispense something that they feel is not right. That said, anyone who took a prescription for birth control, emergency contraception, or abortion meds away from a patient and refused to give them back would get in deep doo-doo.

Another issue is that many people feel that dispensing certain medications would facilitate acts that they viewed as immoral, and thereby make them a participant. Abortion meds are an example. But, perhaps one that will strike more people is assisted suicide. In Oregon, the "Death With Dignity Act" specifically allows providers to choose whether or not they are willing to participate in the process. Many of us who would be willing to dispense abortion meds would be unwilling to dispense for the purposes of assisted suicide.

I guess we have to respect the judgement of our peers even though we may not agree with it. Now, an employer isn't under the same obligation to be so respectful. They can and do terminate employees for refusing to dispense when company policy has set standards. Sadly, I have seen pharmacists at Walgreens who are actually afraid to refuse narcotic prescriptions and early refills for cash because of corporate influence. the background on that is that a couple of years ago a pharmacist refused to fill a cancer patient's pain medications and a big stink was made on the local news. In this case, I view the corporation as infringing on the pharmacist's ability to provide good care.

You're allowed to keep a patient's prescription?

 

[Glycerin]

You're allowed to keep a patient's prescription?

Yes, in certain instances.

 

[bananaface]

Anna, if you have access to those pharmacists you might let it be known that the pharmacy manager at Walgreens in Coco Florida is defending his continued licensure before the BOP for cashing out controls early. One of his patrons was caught selling Oxycontin on the street triggering an investigation.
Walgreens of course fully cooperated by printing out every narcotic this guy ever filled and he is now obliged to defend each early refill on the list before the board. This man is a good pharmacist who will do anything to avoid confrontation.

You can replace a job, but not a license. STAND YOUR GROUND!

I replaced my job at Wags.

The pharmacists I worked with there knew what they were doing was wrong. They don't need my warning. Plus, people who don't give a rip about their patients tick me off.

 

[bananaface]

You're allowed to keep a patient's prescription?

If she is going to kill herself with it, I don't see how I could legally return it to her, at least without writing her allergy information right across the face so that nobody else would fill it. But, writing on it and handing it back to her would be kind of like saying "I'm not helping you and neither is any other pharmacist, now that you let me touch your prescription." It's just the wrong thing to do on so many levels. She needed to be sent to the ER for care, not handed a piece of paper and turned loose.

 

[Leah27]

AS far as filling controls early, I know in NYS this can't legally be done even if the patient is paying cash ( of course they could just go somewhere eles) However, without a doctors note of dosage change or some similar documentation there are no early refills on controls.... and i'm still mad that pharmacists think it is ok not to dispense birth control on moral grounds; and i'm ravenous for some intelligent argument for refusing to fill that I can respect!!

 

[baggywrinkle]

...and i'm still mad that pharmacists think it is ok not to dispense birth control on moral grounds; and i'm ravenous for some intelligent argument for refusing to fill that I can respect!!

Sorry Leah, I think you will just have to be mad. It is difficult to offer logic
to justify an emotional issue. While I personally have no problem with dispensing BC I will defend a colleagues right to be uncomfortable and abstain
because it doesn't feel right, just as I will defend your right to be angry with them for feeling that way. What I would expect on a professional level from the pharmacist who refuses to dispense is that they refer their patient to you or I. Failure to do so is a breech of the standard of care.

As far as seeing eye to eye, perhaps the best you can hope for is to agree
to disagree.

 

[OSURxgirl]

Since when did pharmacy stop being about helping the patients, and start being about imposing right wing "moral" values on the patients? We need to do what's best for the patient. A patient will not magically become abstinent just because the pharmacist won't fill the Rx. This kind of "holier than thou" attitude can turn people off from health professionals all together. And when we have patients who don't trust pharmacists and health care professionals, we have trouble. I just wonder why these people chose pharmacy anyway. If you are anti-science, anti-stem cell, anti-abortion, in my opinion, you are anti-pharmacy. Why don't we just eliminate drugs all together and let "God's will" be done????

 

[Glycerin]

Why don't we just eliminate drugs all together and let "God's will" be done????

Welcome to Christian Science.

 

[bananaface]

Since when did pharmacy stop being about helping the patients, and start being about imposing right wing "moral" values on the patients? We need to do what's best for the patient. A patient will not magically become abstinent just because the pharmacist won't fill the Rx. This kind of "holier than thou" attitude can turn people off from health professionals all together. And when we have patients who don't trust pharmacists and health care professionals, we have trouble. I just wonder why these people chose pharmacy anyway. If you are anti-science, anti-stem cell, anti-abortion, in my opinion, you are anti-pharmacy. Why don't we just eliminate drugs all together and let "God's will" be done????

To their credit, most people who will not dispense the medications in question on moral grounds are not telling people with other points of view that they cannot make their own decisions. Just it would be unfair if they were to force you to refrain from dispensing what you feel is right, it is unfair for you to expect that they will dispense as you see fit. I'm not trying to judge you in any way. I'm just trying to offer you a way to see why the other point of view cannot be willed away.

 

[ultracet]

On this note...
I read that in Tx they just passed legislation that says in sex ed they are ONLY teaching abstenance.....
talk about imposing morals on someone....

 

[Caverject]

Since when did pharmacy stop being about helping the patients, and start being about imposing right wing "moral" values on the patients? We need to do what's best for the patient. A patient will not magically become abstinent just because the pharmacist won't fill the Rx. This kind of "holier than thou" attitude can turn people off from health professionals all together. And when we have patients who don't trust pharmacists and health care professionals, we have trouble. I just wonder why these people chose pharmacy anyway. If you are anti-science, anti-stem cell, anti-abortion, in my opinion, you are anti-pharmacy. Why don't we just eliminate drugs all together and let "God's will" be done????

Because then the Right Wing would not be able to support the drug industry. Don't forget, the "majority" of Americans who got the chance to vote, voted for the return of American "Values".

So to answer your question OSUgirl, about four years ago

 

[Caverject]

On this note...
I read that in Tx they just passed legislation that says in sex ed they are ONLY teaching abstenance.....
talk about imposing morals on someone....

Yeah, if you don't know about it, your not going to do it right?? In fact, Texas is doing such a great job they have one of the highest rate of abortions and child births of any state in the union. Good job Texas!