So reads the title of an excellent essay Medscape has reprinted from a recent issue of the American Journal of Health-Systems Pharmacists by Emily Evans (free reg req’d). Evans is a Pharm.D. faculty member at the College of Pharmacy of the University of Louisiana at Monroe. She writes:
In Texas, three pharmacists are fired for refusing to fill a rape victim’s prescription for emergency contraception because it “violated [their] morals.” A Wisconsin pharmacist refuses to fill, or transfer out, a similar prescription and is put on trial for violating the state’s regulation and licensing department’s standards of care. He stated that he “did not want to commit a sin.” A group of Illinois pharmacists sue their employer for religious discrimination after they were each disciplined for refusing to fill prescriptions for emergency contraception.
I wrote back in June on my professional objections to any pharmacist having the right to refuse filling any prescription based on religious or moral grounds.
But what shocked me about Evans’ article was that the professional organization that publishes the journal has recognized the right of pharmacists to object to fill prescriptions:
In an effort to present a compromise acceptable to all parties, the American Society of Health- System Pharmacists (ASHP) and other professional pharmacy organizations have developed policies addressing the topic and have shared these policies with legislative bodies. ASHP recognizes a pharmacist’s right to decline to participate in therapies that he or she finds morally, religiously, or ethically troubling and supports the establishment of systems that protect the patient’s right to obtain legally prescribed and medically indicated treatments while reasonably accommodating in a nonpunitive manner the pharmacist’s right of conscience.
To me, this is abhorrent and runs counter to any standards of professional behavior. As I wrote in June:
Pharmacists are sometimes viewed by the public as the folks behind the counter who just pour, count, lick, and stick. But the movement of pharmacy in the late 80s to a 6-year doctoral degree was motivated by the proposition that pharmacy be considered a profession like medicine or nursing, rather than a simple service. To be considered a health professional, however, requires putting the needs of patients ahead of your own. If a pharmacist chooses to object to filling any valid prescription, I object to their licensure by my state.
Making an exception for a scientifically invalid moral stance opens the door to all kinds of abuses that ultimately compromise the pact between a profession and the public.
This isn’t just about emergency contraception, where some states have passed legislation “respecting” the right of a pharmacist to refuse to fill certain prescriptions on moral or religious grounds. A pharmacist now has the support of professional societies to pick and choose what part of their profession they choose to practice.
So, for example, if you’re a cancer patient who has become so tolerant of the opioid pain medication that gives you relief such that you require very high doses, a pharmacist has the right to deny your prescription if they think you are selling your extra drugs on the side.
You can come up with your own examples of how such allowances can be abused.
In considering both sides of the issue, Evans states,
Some would argue that if a pharmacist is not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with his or her values, then he or she has chosen the wrong profession.