More Pharmacy Wars (ethics)

[abstroint]

Trevor

Thank you for the observation. The sentence could definitely be reworked for clarity. They are required to have a Bachelors degree. I think this is better: They are not given the power to write them, so, they do not qualify as having the medical knowledge to deny them.

Here is how I understand the legality. If a pharmacist has record of your other prescriptions and an adverse reaction could occur they can choose to inform you. The “duty to warn” seems to be on the pharmaceutical company to warn the doctor of these reactions. All the pharmacies I’ve been to lately are automated, they punch the script into the computer which is programmed to assist in reducing errors in mixing meds. Legally they do not have to hold the prescription. In all the law suits I was able to find regarding such errors the pharmacist won, so, legally it doesn’t seem they even have to tell a customer about adverse reactions. The way I understand this is that the advent of automated systems freed up some of a pharmacist time, causing many pharmacies to have friendly policies in place to inform customers of possible reactions to meds, and they do call physicians to alert them to problems with other medications or patient allergies. Some pharmacies require a signature from the customer stating they were informed of the reactions of the meds with their other meds before they will fill the prescription. However, I haven’t been able to find anything that forces liability on the pharmacist. This was a good article on the subject:

http://www.uspharmacist.com/index.asp?s ... 8_1306.htm

Personally I don’t leave a pharmacy before I’m sure I have the pharmaceutical companies write up on the medication in my bag. I don’t take the medication before I’ve read it. Medical professionals are human and do error, so, checks and balances are a damn good idea but don’t seem to be a legal obligation.


I was in my last post expressing my opinion on whether someone’s beliefs should interfere with others prescriptions. It seems last year an amendment was signed into law. The Welton amendment, which allows refusal of services based on religious belief. That’s why we’ve seen pharmacists refusing to fill prescriptions lately. It is legal. So, they can refuse on belief alone. Should they be allowed to? No. It is an infringement on others beliefs, and the people who are infringed upon did not force the pharmacist to push pills into jars. I hope after their education pharmacists knew about contraceptives and that many women would be coming to fill prescriptions for contraception. They know what the job entails and yet they choose to be pharmacists. One case I read a pharmacist refused to fill a prescription for Ritalin, based on religious belief. Belief leaves too much to chance. Were the first people to use medications witch doctors or medical doctors? If we were to get real technical on religious grounds pharmacists shouldn’t distribute any medications. Isn’t God supposed to decide when we go? Before science, what better way was there to ease survivors suffering the death of a loved one, than to tell them they’ve gone to a better place, and God wanted the person to join him in heaven to be an angel?

I don’t see how a pharmacist is religiously responsible anyway. They are not performing the abortion as a doctor would (I don’t think doctors should be forced to perform abortions if they view abortion as murder) or forcing the customers to take the pills. They are not themselves committing the act. Therefore, a pharmacist refusing to supply a pill is simply forcing religion on others, infringing upon their right to religious freedom, not the other way around, as recent refusals to fill prescriptions would like us all to believe.

[abcrystcats]

Don't know, Trevor ...

This is what I think: Your argument that pharmacists shouldn't be pharmacists unless they're willing to fill every prescription legally available is kind of like saying that gynecologists shouldn't be gynecologists unless they're willing to perform abortions.

I make the distinction between the pharmacist -- who is an employee and the owner of the pharmacy, who has hired him or her. The owner of a business has the right to decide what business they will do. They give their employees the instructions, and that's where it ought to stop. If you disobey your employer, you're insubordinate and you should get fired.

********************

Abstroint (Cynthia?) you bring up a good point that I hadn't thought of. The pharmacist's job is dispensing, not diagnosing. That is very true, and I had a personal confrontation once, involving birth control pills, where the lady behind the counter was preventing their dispensation. The reason they were prescribed had to do with heavy menstrual bleeding, not birth control. The pharmacist is interfering with the doctor-patient relationship and with the whole medical process.

Yes, the pharmacist has the right to withhold a drug is he sees a potential medical risk to the patient. Does that give him the right to second-guess the doctor's reasons for prescribing it, assume that the reason runs counter to his/her own moral principles and therefore refuse to dispense the drug?

You're right, Abstroint. You've convinced me. Just by jumping to conclusions about the use of a drug, the pharmacist has gotten way beyond the boundaries of his job description.

That answers the whole question for me. Thanks.

[e_dog]

the basic dispute b/t ab-cat and trevor is over the private-public nature of the pharmacy. abcrystcat seems to think that 'tis all 'bout business, whereas trevor (for once) rightly sees that the issue is one of public trust: the pharmacist is serving a social function as licensed dispenser of medication, a component of the system of public health, which should not be up to the whim of private interests, regardless of one's faith in the sanctity of the market.

[Trevor]

Hi LR,

"Trevor, I love the way your mind works. You push an idea to its limits. (also very funny)"

Thanks LR, but its the idea that pushes me to my limits, not vice versa...I'm somewhat compulsive about expressing my opinions, sometimes its a good thing and sometimes its bad....Also, I'm cursed not to be smart enough to grasp concepts immediately therefore I must drag ideas out into the public square and stone them to death.

Hi Cynthia,

Great job with the research! That's really a messed up law that protects the pharmacist but not the customer. I just did a bit of research too on the laws pertaining to ethical conduct by pharmacists here in Ontario Canada. The gist I'm getting, though I haven't dug too deeply, is the right to dispense drugs is issued by the Ontario College of Pharmacists and both individuals and corporations need to apply for licensing through them. In turn, they're regulated by a Council, which is regulated by government legislation, which in turn, is based upon standards recommended by the Council. The government legislation seems to deal heavily with what constitutes an effective Council, the consequences of not living up to the standards set force by the Council/College and also payment and what fees a pharmacy can charge for both dispensing and the drug itself. Here's a brief outline of some of it:

http://www.canlii.org/on/laws/sta/1991c ... whole.html


Whereas the Council sets forth the regulations for dispensing, conduct and so on. With that said, here is a quote from the Colleges Code of Ethics Standard:

http://www.ocpinfo.com/client/ocp/OCPHo ... enDocument

"Principle Two
The pharmacist actively promotes the well-being of every patient in a caring, compassionate manner. The patient's well-being is at the centre of the pharmacist's professional and business practices. This principle ensures that no patient shall be deprived of pharmaceutical services because of the personal convictions or religious beliefs of a pharmacist. Where such circumstances occur, the pharmacist refers the patient to another pharmacist who can meet the patient's needs. The pharmacist exercises his or her professional judgement to ensure that patients' needs are met in situations where emergency services or care may be required."

"Principle Four
The pharmacist respects the autonomy, individuality and dignity of each patient. Pharmacists acknowledge the right to self-determination and recognize individual self-worth by encouraging patients to participate in decisions about their health. Pharmacists respect personal and cultural differences, and do not discriminate against any patient for reasons of race, ancestry, place of origin, colour, ethnic origin, citizenship, creed, sex, sexual orientation, age, marital status, family status or handicap."

Now for me, Principle Two and Principle Four kinda contradict one another, and in some cases, Principle two may even contridict itself (if the only pharmacy in town etc.). P2 says that no patient shall be deprived of pharmaceutical needs based on religious beliefs, but then says if such an occurance happens it is the duty of the pharmacist to inform the patient of where they may obtain this prescription. However, a huge problem with that is what if every pharmacy a person went to, refused to fill the prescription and just recommended another pharmacy? And Principle Four seems to respect the individuality of the patient without discrimination except for religion. So if you meld Principle 2 and 4 together, basically it says regardless or religion, race, gender, etc. the patient shall not be discriminated against, unless of course the pharmacist decides to discriminate based on his/her religious beliefs, not theirs, then he is obligated to send them to someone else who maybe will help them unless they feel the same way as the previous pharmacist. Now to me, that's just fucked because it opens the doors to deny someone medicine through religious whims.

I too haven't been able to find anything that forces liability on a pharmacy. I guess because pharmacies aren't set up on some sort of common data bank, there isn't always a way ensure medications aren't being poorly mixed, not to mention they are a dispensery and not physicians themselves. I guess perhaps the only legal liability they have is to correctly fill out the prescription.

On an interesting side note, last night I was discussing this topic with someone else and they had mentioned of hearing that here in Ontario they will now be selling the "morning after" pill without a prescription. Personally I feel that a few people will misuse this as birth control, but on whole I think its a step in the right direction giving more personal freedom and control over one's own body. Mistakes will ultimately happen, however it does not mean as a society we shouldn't provide safe alternatives to lessen consequences of bad decisions or accidental conception. Not to mention if a woman is raped and doesn't wish to wait a month to see if she has been impregnated by this horrible deed, she can, without risking moral scrutiny and further distress from a zealous religious fanatic at a pharmacy or abortion clinic, take action to ensure she will not be pregnant.


Hi Aabcrystcats,


"This is what I think: Your argument that pharmacists shouldn't be pharmacists unless they're willing to fill every prescription legally available is kind of like saying that gynecologists shouldn't be gynecologists unless they're willing to perform abortions"

Not really, what I'm saying is more in line with; a doctor shouldn't be working at an abortion clinic if whimsically he decides who he will give treatment to based on his own religious convictions. An abortionist shouldn't be an abortionist if they are not willing to perform legal abortions, just as a pharmacist, should not be a pharmacist if they will not fill legal prescriptions. I say this because there is a big difference between an abortionist and a gynocologist....Whereas a pharmacist really has only one main job, that is to dispense medicine prescribed by doctors....and if that breaks down, what's the use of having pharmacists?

"I make the distinction between the pharmacist -- who is an employee and the owner of the pharmacy, who has hired him or her."

What if they are one in the same? What if the pharmacist owns the pharmacy?

"The owner of a business has the right to decide what business they will do."

Years ago most fire stations in the U.S. were privately owned and operated. Unless you were in contract with a particular fire station, you couldn't get a firefighter to even piss on your house if it was burning down. Society saw the need for everyone to have the benefit of this service. It became a state run institution thereby ensuring that everyone, regardless of race, religion, gender and so forth, would have this benefit because not to do so was detrimental to the health of society. Personally, I feel this should be the way of pharmacies as well. It doesn't have to be State owned and operated, but it should be heavily regulated so that it is a service to society, and not just another business.

Though slightly off topic, one thought I always like to throw out in a discussion about health care and the risks of treating it like a business is this scenario:

A hospital or doctor asking for incredible sums of money to perform life saving procedures or refusing to give the best treatment possible based on the financial position of individuals is about as helpful as a police officer asking for payment prior to arresting someone who is about to harm you, or fireman asking for a credit card before they put out your burning home, or as helpful as me asking for money from a doctor, police officer or a fireman before pulling them to safety from a car accident. If a doctor or hospital has the right to deny access to the best possible care they can provide because of money, thereby resulting in a preventible death, don't I have the same right as they do? Can I not say to someone in need, "I will help pull you to safety but its going to cost you $100 000, upfront, for me to save your life." Imagine saying that to a doctor as he hangs from a limb over a cliff, he would be flabbergasted, yet in many cases they have no qualms about saying that to a patient. Now legally, because of the Good Samaritan laws in most places, I do not have that legal right to play god. I am bound legally to at least seek out help for a person in distress, if not help them myself. So I guess I wonder why the average citizen is not allowed to profit financially before helping other citizens in dire need, yet in many cases, we allow this from doctors or hospitals? If they force people to pay them ridiculous sums of money before saving their life, why can't I do the same? Fortunately I live in Canada where most have reasonable access to good health care, but it saddens me to hear that in a country like America, people have to take out a second mortgage, sell their house and cars, take out huge loans they may never be able to pay back, go bankrupt, or even not be able to pay for an operation that could save their life.

Another thing I find really ironic is -- a hospital or doctor in many places, can deny you the access to life saving treatment if you are unable to pay for them -- often by only performing lesser treatments that have little chance of success, like in many cancer treatments -- thereby pretty much condemning you to death. Yet, euthenausia (sp?) is illegal in these same places. So a doctor or hospital can legally not perform their best work to save your life, thereby intentionally decreasing your chances of survival -- sometimes to the point where they consciously know the treatment they are providing has very little chance of saving your life, which to me is the same as letting you die....however legally they can not help expire a terminally ill patient. So basically they can legally not help someone who has a chance to live, but legally they can not help someone pass on, who has no chance to live. Does that seem absurd to anyone else?

"They give their employees the instructions, and that's where it ought to stop. If you disobey your employer, you're insubordinate and you should get fired. "

Yeah but the only problem is once you start condoning discrimination based upon religious beliefs. ie. not filling prescriptions because of your religion....you are now protecting them from termination because of this. You can't say you are legally allowed to refuse to do something in the workplace because of your religion and not protect them from unlawful termination because of this decision. It is illegal to fire someone for their religious beliefs and if you allow someone to shield themself behind this, it becomes illegal to fire someone for their religious beliefs even if those beliefs not only become detrimental to your business but also to the well being of society itself, like in the case of not filling legal prescriptions. You can't say legally you are allowed to abstain from filling prescriptions because of religious beliefs, however you will be legally persecuted for them (such as legal termination).

Hi Edog,

"whereas trevor (for once) rightly sees that the issue is one of public trust:"

Hey now, leave the barbs at home unless you are planning on fishing...lol....don't confuse you finally being wise enough to agree with me as this being my first time being correct about something ..anyways, all kidding aside, I couldn't agree with you more; "the pharmacist is serving a social function as licensed dispenser of medication, a component of the system of public health, which should not be up to the whim of private interests, regardless of one's faith in the sanctity of the market." ...very well said. Funny enough it took me nine hours and forty pages to say exactly what you did in one sentence....but I'm just going to chaulk it up to you being lazy and not you being smart...lol jk.