Retrospectacle: A Neuroscience Blog

Consider this scenario.
A woman walks into a bank, and up to the teller’s window. You are the teller. She pulls out a check from her purse, made out to her in the amount of $5,000. She slips it under the teller window, to you, and asks you to cash it for her. You look at the check–its from a casino. Uh oh. You are against gambling in any form whatsoever. You think its immoral and wrong, a sin!! Its against your religion and beliefs to condone such a practice, therefore you refuse to cash the check. Its against your beliefs, so why should you be made complicit in the rampant, sinful gambling of others, right? Right???

Abel Pharmboy has a very thoughtful discussion on whether pharmacists have the right (or even obligation) to refuse to fill a prescription that might conflict with their personal beliefs. This is a serious issue, and has already been tested in the public sphere.

(More below the fold)

I think pharmacists are given too much credit, and too much autonomy, due to the fact that they must now fulfill a 6-year degree and are paid well. To me, they are a cog in the machine of getting patients their meds. Now, I’m not slighting the intelligence of anyone who pursues this field, or that it is less than challenging. But their role is to fill the prescriptions that are written by doctors, period. They, themselves, are NOT doctors. They have neither the authority or training to interfere, change, deny, or substitute in any way the mandate of the personal physician of a patient. This patient has a relationship with the doctor that a pharmacist, no matter how friendly and helpful, will ever have. The doctor has the knowledge and the training to give sound medical advice, which the pharmacist should be legally bound to follow to the “t.”

This does not mean that pharmacists should turn a blind eye to drug abuse or malpractice, of course. And I see one of the primary reasons that pharmacists are becoming a more “important” cog in the machine is because of the war on drugs and in escalation of prescription drug abuse. Pharmacists are vital in reducing this abuse.

But part of any job is checking your personal beliefs at the door, or checking out. No one is forcing you to be in a certain position, therefore if pharmacists (or bank tellers) have a problem filling an order from a higher authority, well, don’t let the door hit you on the way out.

Comments

  1. #1 Brandon
    June 30, 2006

    I was a pharma rep for 3 years beforing seeing the light and returning to a grad school. I used to call on pharmacists, and have watched physician offices convert to electronic medical records. Pharmacists will be outdated as soon as the FDA allows Drs to electronically transfer a script to a dispensing machine. Pharmacists are the most trusted profession in the country, and they have less than half the education of an MD, which the payoff practices of pharma are partly to blame for. Either way, I doubt ethical questions about the morning after pill will be a big deal for long, once that annoying human factor is replaced by a cold metal machine (that happens to spew happy pills)!

  2. #2 Jake Young
    June 30, 2006

    In one of the ethics classes you take in medical school we discussed this very issue. It is based on a real case that happened in North Dakota. One of the problems was that in the real case there were no other pharmacists in that town, so there was a real issue of access.

    We ended up talking about it a great deal both with respect to the doctor who prescribed it — whether he or she could say no — and the pharmacist.

    I think in the end we sort of agreed that both the physician and the pharmacist are facilitators of medical choices. Our role is to inform the patients of the variety of options that exist and provide as they are deemed necessary (within the ethical boundary that we cannot willfully harm a patient even if that is what they want). In cases where we know there is other access for a patient, we could refuse on ethical grounds to provide a procedure. But if there is no other choices then you have to bite the bullet.

  3. #3 impatientpatient
    July 1, 2006

    Here the pharmacists just gianed prescribing rights- the DAY I let a pharmacist tell me what to do for diabetes care, heart disease etc is the day I will know I have been assimilated by the Borg.

    I love SOME pharmacists and find them knowledgeable and current. But many are pill counters and nothing else. The ones at the store I go to have an English as a Second Language problem which compounded by a rising volume as they try to MAKE themselves understood make it so that I am sure they are in breach of every privacy law known to man. This is problematic as I do not trust them to be discrete and intelligent.

    I am frustrated with this whole idea of medical professionals being allowed to do waht they think is best. As an educator I do not get to pick how I respond to those who parent badly or children who are not as competent in certain areas, nor do I have th option to discriminate on religious grounds.

    This is ludicrous.

  4. #4 Bob Koepp
    July 1, 2006

    I can’t defend the choice made by pharmacists who refuse to dispense contraceptives, emergency or not. But I do defend their right to make that choice, and I do think it’s in the broad interest of society to make any reasonable accommodations we can to repsect freedom of conscience.

    I also think we need to view this in the context of the tradition of providing for conscientious objections by professionals. If physicians can “opt out” of providing certain services, especially those that are not medically indicated, why shouldn’t pharmacists have the same privilege?

    The more basic issue here, I think, is why the FDA has not granted over-the-counter status to Plan B (not to mention various other contraceptives). If a drug can be safely and effectively self-administered, why isn’t it available without a prescription? If Plan B (etc.) gained OTC status, it would quickly become available in all sorts of venues, not just pharmacies. It would follow a trajectory similar to what happened when access to condoms was removed from the control of healthcare professionals.

  5. #5 Abel Pharmboy
    July 2, 2006

    Bob, I wholeheartedly agree that Plan B should be OTC, even for teenage girls. I had the chance to see a talk recently from Dr Susan Wood, the former FDA director of women’s health who resigned after the continued delays of Plan B review. She is now supported by the Reproductive Health Technologies Project where you can get more information on how to support free access to emergency contraception.

  6. #6 E in MD
    July 9, 2006

    Pharmacists are there to give out the medicine that doctors see fit to perscribe, check for possible interactions with other medicines and prevent fraud or drug abuse. That is the end of their moral obligation. Not to denegrate them, they perform a valuable service. But you do not go through the schooling to become a pharmacist without realizing that there will be some drugs you will not agree with. It is NOT your place to make moral judgements for other people. So if you can’t bring yourself to fill a perscription you do not deserve to have the job in the first place.

    If you feel a need to object to any specific drug then you should object to ALL drugs. Because if god didn’t want the patient to have asthma or an ear infection then he wouldn’t give them to the patient in the first place – so who are you to counteract his will?

    This is a blatant for of proselytizing to a captive audience and nothing more. Yet another way for the right wing, holier than thou, Christian types out there to try to FORCE their own morality on everyone else whether they agree with it or not.