Back in February 2007, we had a lively discussion on a post about pharmacist objection to filling prescriptions for drugs they felt went again their personal moral stance: from morning-after pills to garden-variety oral contraceptives. I held that since pharmacists are licensed by the state to provide a service to the citizenry (and they make about as much money as a full professor at a US research university), they should be required to fill prescriptions. Some commenters argued that ethical practice of one’s profession dictate that one apply moral standards. I disagree. As an agent of the state, one is required to execute the responsibilities of one’s license.
Back then, we discussed where a pharmacist could then draw the line if allowed to be a “conscientious objector.” Could a pharmacist refuse a legitimate narcotics prescription, outside of clear fraud? Could they refuse to fill for an HIV medication or drug to treat a sexually-transmitted disease?
Well, this comment came in from attorney and cancer patient, Sharon Red Deer, former faculty member at the College of Law at the University of South Dakota in Vermillion (MS Contin is an oral, controlled release form of morphine sulfate):
What an interesting discussion. I came across this website researching a law review article I am writing about the hysteria of opioids from the medical community due to my disciplines “war on drugs”. My interest is both professional and personal.
A pharmacist at Walgreens (where I have been customer for several years) refused, on Sunday, to fill a prescription for MS Contin (obviously from my doctor) because he “that I should find some alternative pain relief”. Of course, he doesn’t know that I am terminal or anything else about me. I have had a prescription for MS Contin since I was diagnosed 2 years ago; every month I have it filled there. This was pharmacist I have not seen before. When I asked what I should do, he shrugged. How do these people sleep at night? In my discipline and all PROFESSIONAL disciplines that I am familiar with; your own personal views cannot be allowed to interfere with your obligation to you client (or patient).
In fact, if you are a court appointed attorney, you are obligated to represent that person to the very best of your skill and due diligence unless the person is so repugnant to you as to impede your defense of him / her. No mention of how we may feel about it. Only if the client would be affected. All personal moral and ethical issues are negated. Only the best interest of the client is relevant. It isn’t about the lawyer; it is ALL about the client. I thought that was the standard for all true professionals.
I can’t argue with the counselor’s view of professional responsibilities. I’d personally file a complaint with management of that Walgreen’s store and the regional and national offices. Walgreen’s is one of the better pharmacy chains whose management line is often populated by former pharmacists.
We’ve also noted that people in sparsely-populated areas often don’t have a choice of another pharmacist for literally tens of miles away:
In addition, I just now returned from my doctor, had my unfilled script in hand (now this is Tuesday) and asked her I should do. No answer. Then she suggested I select a new pharmacy. The next one is 30 further miles away. And the kicker: she sided with the pharmacist. Yep. I said to her that this man doesn’t know my history; doesn’t know whether I am terminal or in severe pain from anything.
Her response: (Laughs) and says “he probably gets more drug seekers than terminal patients”. What a ridiculous statement, I don’t know how he would think I was an “illegal” drug seeker when I had a history there for the same drug and the “script” was in hand. It really is enough to shuck it all, and just suffer. The indignity is unspeakable. It is similar like drowning and begging passersby to help you; and instead they ridicule you and say “swim!”.
So we have a cancer patient in pain, in a rural area, unable to obtain opioid analgesics.
I am very sensitive to the fatigue of my pharmacist and physician colleagues with all the tricks used by professional narc seekers. This attorney does not seem to be one of them.
Should this pharmacist have had the right to refuse the prescription?
How do you in practice differentiate between legitimate narcotic use and illicit seekers whose pills keep falling down the toilet?