Thursday, April 13, 2006

Vitamins trouble pharmacist's conscience

Apparently some pharmacists in Seattle have moral issues with antibiotics and vitamins:

According to the complaint, someone at the Swedish pharmacy said she was "morally unable" to fill a Cedar River patient's prescription for abortion-related antibiotics.


The complaint also includes an incident from November 2005 in Yakima, in which a pharmacist at a Safeway reportedly refused to fill a Cedar River patient's prescription for pregnancy-related vitamins. The pharmacist reportedly asked the customer why she had gone to Cedar River Clinics and then told the patient she "didn't need them if she wasn't pregnant."

As the same subject is debated here in Minnesota -- thanks to a bill sponsored by the ubiquitous Tom Emmer -- how far are we willing to go in allowing pharmacists to let their conscience be their guide?

With a few narrow exceptions, I don't think we should pass a law compelling all pharmacists to dispense every single medication customers demand. By the same token, I don't think pharmacists should have special legal protection for refusing to do so. They're free to refuse, and their employer is free to fire them.

The exception I see is those rare cases where, for instance, it's a small town with only one pharmacy and no competition for fifty miles. Even then, mail-order prescriptions would solve most of the problem. But there will be times when a patient needs medication right now, and they should be able to get it. If it comes down to a choice, a pharmacist's conscience does not trump a patient's health or well-being.

A hat tip to Moderate Left for the initial link.

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Anonymous Marc Schneider said...

I think a pharmacist has a professional responsibility to fill legal prescriptions regardless of his or her personal beliefs. What if the pharmacist failed to fill a prescription for antibiotics because he thought doctors were prescribing too many? If the pharmacist fails to do so, IMO, he or she should lose their license. I'm fed up to here with these right-wing lunatics who think it's their place to decide what gets dispensed. If they don't want to do it, get a new profession.

So, yes, I do think they should be required by law to fill all prescriptions. No one kidnapped them and made them become pharmacists. At the very least, they should be fired, but, of course, the pharmacy would be afraid of angering the right-wing lunatic fringe.

4/14/2006 8:38 AM  
Blogger Sean Aqui said...

I respect that line of argument, and agree that if it comes down to a choice, the pharmacist's conscience loses.

But really, I trust the free market to solve this one. If there's another pharmacy down the street that will fill the prescription, all that happens is the first pharmacy loses business.

And other than a bit of embarassment and inconvenience the first time they try to fill the prescription at the first pharmacy, what harm has befallen the patient?

There is a risk that certain medications will suffer a fate similar to abortion services in some states, such as South Dakota, where abortion is technically legal but there's only one clinic in the entire state -- thanks to protests discouraging or frightening doctors from performing abortions. That's a political distortion of the free market, and shouldn't be accepted.

But if and when that comes to pass, that would be the appropriate time to pass a law compelling pharmacists to provide certain medications. Until then, we should try to allow room for both conscience and service.

4/14/2006 10:36 AM  
Anonymous Marc Schneider said...


I have to disagree with you here. Since a pharmacist is essentially a medical professional licensed by the state, I think his or her professional obligations transcend the operation of the market. This isn't like a clerk being a jerk to a customer. This is a licensed professional refusing to fill out a lawfully obtained prescription. To me, it almost a violation of the customer's civil rights. Doctors have an obligation to treat anyone, even criminals. Pharmacists should have no right to decide what prescriptions should be filled.

By the way, on another topic, I have just started reading your blog and I enjoy your take on the issues. And I respect your service to the country.

4/14/2006 3:51 PM  
Blogger Sean Aqui said...

Pharmacists should have no right to decide what prescriptions should be filled.

If I were a pharmacist, that would be my approach, and I think it should be the endorsed approach. But I think there's more gray area there than you're allowing room for -- enough that we should be careful about forcing people to do it.

Should the pharmacy at a pro-life health clinic that exists solely to assist pregnant women be required to stock and dispense birth-control bills and RU-486? If they choose to close up shop instead, society isn't really better off.

Does the pharmacist get any say over which medications s/he will stock, since they can't possibly stock all of them? Or shall the government specify that?

That last question actually suggests a way to resolve the problem. Both the Seattle case and the pro-life clinic case could be resolved with a rule that says if you carry a drug you have to dispense it to anyone with a legal prescription for it. That prevents arbitrary discrimination at the point of sale, while still allowing store owners to decide whether they will carry particular drugs.

In the case where a pharmacist is an employee, it would be up to the chain to decide how to handle the law -- either by requiring their employees to dispense it, or by ensuring there is another staffer on hand who will dispense it.

I have just started reading your blog and I enjoy your take on the issues. And I respect your service to the country.

Thanks! I enjoy the discussion, too, especially when I learn something new. I'll kick issues around with you anytime you like.

4/14/2006 4:31 PM  
Anonymous Anonymous said...

I disagree that a being a pharmacist rescinds all right to make moral choices. You might consider your own profession and what you might be required to do before imposing on another. I am a physician, and the ethical codes for MD's might be a useful guide.

Physicians are not required to prescribe medications they are morally oppossed to. They are not required to perform medical procedures they find objectionable. The general ethical rule is that I cannot make you do anything, and you can't make me do anything.

Abortion as an example. I am not required to perform one. If you asked me information, I am merely required to provide you honest information, and direct you to the means to find an MD who provides these services. Contraception is the same way. I can't lie to you, but other than that I have no other obligation.

Another example was the lady with an eating disorder and rich psych history who I refused to clear medically for a cosmetic surgery procedure. I morally could not be part of facilitating her mental illness. She fired me, and found someone else.

Another MD in my group would not provide contraception rx to unmarried individuals. He refered them to other doctors in our group of our partners.

The current ethical standard for pharmacists is the same. The must either provide the medication or direct you to someone who can. If no other source of the medication is available, they must prescribe it. The stories of pharmacists seizing the rx so it couldn't be filled, or refusing to provide information are violations of current pharamcists ethical standards.

In short, there are many ways in which the needs of patients can be accomadated without forcing individuals to compromise their own moral codes.

(before I'm called a right wing looney, I'm pro-choice, pro-contraception)

4/15/2006 11:36 PM  
Blogger Sean Aqui said...

Thanks for the view from the trenches.

One thing I failed to make clear is that while I oppose a law that forces pharmacists to dispense all medications, I'm perfectly fine with medical organizations establishing standards of behavior as they see fit.

4/16/2006 8:54 AM  

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