quote:

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The best defense against this grassroots movement, Cullins notes, is another one--in opposition.

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quote:

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Pharmacists and doctors should be up front about their policies on this, though.

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I agree with. It annoyed me that some people working together didn't know what drugs the other person would/would not dispense. The right hand should know what the left is doing, basic business and all.
 

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Posted by Space Opera (Member # 6504) on :
 


I think this is ridiculous - and I don't like the idea of a pharmacist making moral judgements on medications. What's next? Are we going to have cashiers refusing to ring up cigarettes because they cause lung cancer?

space opera
 

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Posted by UofUlawguy (Member # 5492) on :
 
If the cashier actually owns the store, then yes, that would be acceptable. If he's an employee, then he can try it, but he'll get fired.
 

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Posted by TMedina (Member # 6649) on :
 
Probably.

But then you might need to find another job if your employer doesn't agree with your moral decisions.

A pharmacist is not obligated to sell any and all drugs if he or she so chooses. And there is no law that dictates otherwise.

Doctors are more strongly regulated, but to what extent I don't know.

-Trevor
 

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Posted by beverly (Member # 6246) on :
 
Yeah, that would be a problem. If the store owner doesn't believe in selling cigarettes and chooses not to sell them at all, I have no problem with that. Especially if they have a large sign informing customers that they don't sell that particular product. But if a single employee of that business refuses to ring something up that the store sells--that is another matter entirely.
 

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Posted by Dagonee (Member # 5818) on :
 

quote:

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Are we going to have cashiers refusing to ring up cigarettes because they cause lung cancer?

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I know there are stores that refuse to cell cigarettes for that reason. If only more would do so.

Dagonee
 

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Posted by pooka (Member # 5003) on :
 
So what is this in response to? The extremism of the partial birth abortion thing, or the MAP thing where the Obstetrical journal said most pharmacists support OTC MAP?
 

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Posted by Space Opera (Member # 6504) on :
 
I don't know; I guess it just irks me. There are all kinds of foods that are bad for people - let's just hope we don't find stores like Wal-Mart refusing to carry twinkies.

space opera
 

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Posted by TMedina (Member # 6649) on :
 
Eh. You can make a similar case for a lot of things.

You have the right to shop elsewhere. And let's face it, contrary to the belief of college students everywhere, twinkies are not a necessity.

-Trevor
 

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Posted by ludosti (Member # 1772) on :
 
I agree that a company owner can decide what things they will and won't sell and that people should use their buying power accordingly. If a doctor or pharmacy is not going to offer something as ubiquitous as birth control pills, I think there should be better notification (but also women shouldn't wait until the last possible moment to renew a prescription ).

I'm surprised, however, that a pharmacist (one employee in one of a chain of stores) would be allowed to refuse to dispense prescriptions to which they are personally opposed.
 

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Posted by Speed (Member # 5162) on :
 
Silly, that's all. The train of thought is nothing new, though. I know pharmacists who won't sell insulin syringes to people that they don't personally know to be diabetic. My point of view has always been that, even though I don't abuse heroin, it's not my business to stop others from doing it. I constantly sell syringes to people that I know for a fact are using them to abuse IV drugs. In fact, if someone came into my pharmacy with a vial and asked me to give them the best tool to use to put the contents of that vial into their veins, I would treat them the exact same way as I'd treat a diabetic. I might even throw in the spoon. It's only their lives that they're ruining. The only impact it's making on me is decreasing the prevalence of hepatitis and HIV in my community, and increasing the profits of the company that employs me (which will hopefully be reflected in my bonus).

Of course, that's just my social libertarianism talking, so I can't speak for others' moral decisions, other than saying that I think they're silly.
 

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Posted by TMedina (Member # 6649) on :
 
If the pharmacist doesn't own his store, his ability to exercise his moral choices are fairly limited.

He does, of course, have the right to go find a job elsewhere where his moral sensibilities will be more respected.

-Trevor
 

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Posted by PSI Teleport (Member # 5545) on :
 

quote:

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Lacey, an elementary school teacher, was shocked. "The pharmacist had no idea why I was even taking the Pill. I might have needed it for a medical condition."

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This is true. Alot of women take the pill for reasons that have nothing to do with preventing pregnancy.

And before someone says it, alot of them aren't even having sex.
 

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Posted by fil (Member # 5079) on :
 
Now guys will have to be "pill worthy" in addition to "sponge worthy." We never get a break.



fil
 

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Posted by PSI Teleport (Member # 5545) on :
 

 

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Posted by romanylass (Member # 6306) on :
 
Since he worked for a major chain, he should fill all prescriptions. Maybe he needs a job in a different pharmacy, but I think that is out of line.

OTOH, one reason I would consider cashier at most places a last ditch job is I would not work anywhere I was required to ring up tobacco products, (unless my family was starving).
 

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Posted by Boon (Member # 4646) on :
 
Hey, I forgot to take my pill this afternoon. Thanks for reminding me.
 

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Posted by Space Opera (Member # 6504) on :
 
I just thought of this. I wonder what these pharmacists and drs. think of IUDs? I had one put in about 6 years ago (don't have it now) and my dr. made sure to inform me that if a pregnancy occurred, there could be major problems, among them a miscarriage. I ask this question b/c in the article someone makes a statement "we shouldn't have to dispense medication that we think takes lives." Anyway, I thought it would be interesting to find out how these same drs. viewed an IUD.

space opera
 

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Posted by PSI Teleport (Member # 5545) on :
 

quote:

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Since he worked for a major chain, he should fill all prescriptions. Maybe he needs a job in a different pharmacy, but I think that is out of line.

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I would try to have them fired if they tried to impose their morality on me or my wife, providing that was an option in my state.

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I pay a doctor to examine me, so he can tell me what I need to do to keep/improve my heath and well being. The pharmacists in these cases are usurping both the privileges and rights or doctors, which isn't what I am paying for, or what they got licensed to do. They are also usurping the rights and privileges of the USDA by refusing to prescribe a legal medication that is approved for treatment of patients.

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That may have been the way things were a while ago, but pharmacists actually have a lot more responsibility than that. A patient's drug regimen is a collaborative effort between the doctor and the pharmacist. A pharmacist is required to catalogue and monitor a patient's drug therapy. Using professional judgement in refusing to dispense an improper medication isn't just a right, it's a responsibility; if a drug causes a patient harm the pharmacist will get sued right along with the doctor, even if they were filling a prescription exactly the way the doctor wrote it. Despite what Seinfeld says, we're not just the people who take pills from the big bottle and put it into the little bottle. I kind of wish we were sometimes, but we don't get off that easily. I'm not commenting on this particular issue, but your global statement is somewhat flawed.

Furthermore, I don't see how the pharmacist's action in this case usurped the rights and priveliges of the United States Department of Agriculture.
 

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Posted by Dagonee (Member # 5818) on :
 
This liability exists even if it's the manufacturer's or doctor's fault the harm occurred. Not necessarily fair, but strict product liability seldom is.

Dagonee
 

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Posted by Kwea (Member # 2199) on :
 
I wasn't saying that that is all pharmacists do; I was distinguishing between doctors and pharmacists. I have the right to take medication that is prescribed, without being accused of violating their morality. I don't really care about their morality regarding my medications or lack thereof.

I never said they should be arrested, just that I would do my best to make sure I never patronized their establishment again, and to notify everyone I know what their practices are, and how that affects us.

BTW, I am male, so I will never take the pill. I just think that as the pharmacists should stick to what they know best...looking for allergies, drug interactions, and whatnot. The doctor knows why I need the meds, where the pharmacists might not.

Leave the doctoring to the doctors.....why is that so hard to understand?
 

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Posted by Dagonee (Member # 5818) on :
 
Why is it so hard to understand that someone might not want to sell something they consider to be an instrument of murder?
 

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Posted by Speed (Member # 5162) on :
 
So you have no problem with the doctor who won't prescribe the pill, as long as the pharmacist dispenses it? That's sort of what I'm picking up.
 

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Posted by Mrs.M (Member # 2943) on :
 
First of all, if you work for a company, you agree to abide by their policies (as long as they are within the law). If you feel that their policies are immoral, then you are free to seek employment elsewhere. For example, if you are Hindu, you shouldn't work at a steakhouse. It's wrong to work there and refuse to serve someone a steak because you think it's immoral to eat beef.

Second, women's health professionals have an obligation to inform patients if they do not prescribe oral contraceptives (like one of the doctors in the article). They should also do so before they see the patient, so that she does not have to waste her time and money. I believe that pharmacies also have an obligation to inform customers if they do not fill prescriptions for oral contraceptives if that is the store policy.

I wouldn't think much of a doctor who refused to prescribe the pill for me. I have PCOS (polycystic ovarian syndrome) and therefore have an increased risk of endometrial hyperplasia and endometrial cancer. Oral contraceptives can reduce these risks. Additionally, they can regulate menstruation and increase sex-hormone binding globulin (SHBG) and thereby reduce circulating androgens. And, since one of the symptoms of PCOS that I have is infertility, there is no way I could be pregnant. Denying me the pill can only exacerbate my condition, which is exactly what doctors and pharmacists should not do.
 

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Posted by Shigosei (Member # 3831) on :
 

quote:

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This is true. Alot of women take the pill for reasons that have nothing to do with preventing pregnancy.

And before someone says it, alot of them aren't even having sex.

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quote:

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Why is it so hard to understand that someone might not want to sell something they consider to be an instrument of murder?

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What practicality would there be of a PETA anti-hunting activist working for a gun shop? There is nothing illegal in them working there, but if they are so morally opposed, why work for them in the first place?

Yes, it is the same kind of deal. It is using the same logic placed in a different set of circumstances. While I may not agree with the extreme anti-hunting PETA crowd, they view game hunting as just as murderous as pro-lifers view abortion.

The problem isn't one of should these pharmacists fill the prescriptions if they do not want to, it is that they should not place themselves in the unethical situation of working for a company that fills such prescriptions and then break company policy while making a moral statement. As for the doctors not prescribing, they are creating an unethical situation where patients are not being made aware that certain treatments will be denied them if they patronize that doctor. If they are up-front about their refusal to prescribe, then they are behaving ethically.

It isn't about morals or legality, it's about ethics. These people are pretending to take a moral high ground by taking part in ethically dubious behavior. That sets a bad precedent for their cause, and will eventually make their cause (pro life) look even worse in the long run.
 

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Posted by Kwea (Member # 2199) on :
 
No, maybe I am not saying this correctly. I would have a problem with a doctor who preached morality to me or my wife. I didn't go to him for a lecture. If there is a good medical reason he isn't comfortable prescribing it then that is fine. However, if he has an ethical proscription to the pill then he should post it, and we won't go there. And we will make sure all our friends know why, and advise them to avoid him as well.

I have an even bigger problem with a pharmacist doing this though, because they aren't doctors, so IMO they should leave their ethical opinions at the door when they go to work. If it isn't illegal for me or my wife to have it, and we have a prescription and the means to pay, then I expect to get the damn script filled.

BTW, I spoke to Jenni, who works part-time at a pharmacy, and she agreed with me. She said that things similar to this have come up, too.

Kwea

[ July 08, 2004, 11:09 PM: Message edited by: Kwea ]
 

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Posted by Mabus (Member # 6320) on :
 
Justa, it seems to me there's a difference between working at a gun shop and working at a pharmacy. The only practical use of guns is to kill stuff with, but pharmacists have all kinds of medicines to treat all kinds of conditions. Maybe someone wants to help save lives, not take them, you know?

As for the ethics or lack of it...I'm beginning to think the pro-life cause is lost anyway. The only way left to make any progress is to do end-runs around whichever authority (doctors, the Supreme Court, Planned Parenthood) is sniping at us today, and we end up looking bad all the time.

Kwea, trust me--you do not want doctors, pharmacists, or anyone else leaving their ethics at the door (*nudge*Enron*nudge*). What you want is for them to leave one specific "ethic" at the door because you don't like it--but it doesn't work that way. Having a spine is a package deal.
 

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Posted by Kwea (Member # 2199) on :
 
I feel that it is an ethical decision....and I don't like someone shoving their ethics down my throat.

If you work at a chain drug store, or for someone who feels the same that you do, then fine. But for you to refuse to dispense a legally obtained persciption that is doing no harm to the patient, and possibly enhancing their longevity....well, that is immoral and unethical.

Do no further harm applies to the woman taking the drug, not just to some "potential" life that may or may not be the reason for taking the pill in the first place.

I wouldn't expect a church-run hospital to dispense them, but I wouldn't want to treated at one in part because of that. I want what my family and my doctor have decided on as the best course of action, not what someone who is underqualified and uninvolved in our decision process decides what is moral enough for us to do.

I don't expect everyone to agree with me on this, but you should be able to understand where I am coming from on this ..

I just don't want to have others choices forced down my throat. Last i checked, the pill was still legal, right? What happens if someone refuses to issue it, and the woman dies in childbirth? I had a friend who couldn't have children at all, as it would kill her.

Why not let your parents make all the decisions for you for your whole life? Because you have both the prividledge and the responsibility to make your own choices, right?

So why wouldn't you get upset when someone you barely know uses faulty science and morals you don't share to remove choices from you?

If the chain carries the pill, who are they to refuse it to you?

[ July 09, 2004, 02:05 AM: Message edited by: Kwea ]
 

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Posted by Mabus (Member # 6320) on :
 
Maybe I do, Kwea...it's late, and I'm not fully awake, so I'm not sure. What I'm saying is that people can't check their ethics at the door of their business, not and be anyone you want to do business with. The ethical motive that tells the pharmacist not to give out birth control pills is the same motive that tells him not to cut the dose so the pharmacy can make more money or slip you something addictive so you keep coming back or....you get the picture. They aren't separable.
 

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Posted by Kwea (Member # 2199) on :
 
I disagree....one is not appropreate to any business transaction.

Or are you saying that anyone who wants to make their own moral decisions rather that having them imposed on them is dishonest.

I just don't think they have the right to do this, and I would be very upset if it happened to us.

I may not be able to stop them, but I can use any and all legal sanctions on them...including protests if i so desired.

I would be happy to see them fold...and if they are at a chain, they should be fired. IMO.

[ July 09, 2004, 02:08 AM: Message edited by: Kwea ]
 

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Posted by rivka (Member # 4859) on :
 
My cousin (an accountant) felt that he was being asked to do things that might be legal, but violated his ethics.

So he quit.
 

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Posted by Kwea (Member # 2199) on :
 
I can respect that.

But it wouldn't affect me the same way that refusing to fill a perscription would....

Kwea
 

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Posted by Mabus (Member # 6320) on :
 
I'm saying that you have ethical decisions imposed on you every day. By the government, by the police, by everyone you work with. You can't avoid it. Naturally, you agree with some of them and disagree with others. You impose yours on other people too--you're imposing one when you say you wouldn't go back to that store. And, to tell the truth, I have no problem with that. Everyone constantly imposes their ethics and morals on everyone else. (The left will gain a lot more credibility in my eyes when they realize that.)
 

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Posted by rivka (Member # 4859) on :
 
I think I didn't make my point clear. IMO, if your job requires you to do things that violate your ethics/beliefs/whatever you can't generally just refuse to do them, yet keep your job. You quit.

Why should pharmacists (or doctors) be different?

I'm not saying don't BE a doctor or pharmacist. (My cousin, for example, is still an accountant -- he just doesn't work at that firm.) But choosing to work at a company that made the choice to offer those products should not include you refusing to do your job -- and yet expecting to keep it.
 

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Posted by Kwea (Member # 2199) on :
 
Sorry, you did communicate that pretty well, it was very late when I wrote my reply. That is why I said that I respected his choice.

I don't believe that I should have to worry about having a pharmisists moral decisions impinge on my choices for medical treatment.

Ever. Unless I am about to do something illegal.
 

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Posted by Dagonee (Member # 5818) on :
 

quote:

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What practicality would there be of a PETA anti-hunting activist working for a gun shop? There is nothing illegal in them working there, but if they are so morally opposed, why work for them in the first place?

Yes, it is the same kind of deal. It is using the same logic placed in a different set of circumstances. While I may not agree with the extreme anti-hunting PETA crowd, they view game hunting as just as murderous as pro-lifers view abortion.

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quote:

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The problem isn't one of should these pharmacists fill the prescriptions if they do not want to, it is that they should not place themselves in the unethical situation of working for a company that fills such prescriptions and then break company policy while making a moral statement. As for the doctors not prescribing, they are creating an unethical situation where patients are not being made aware that certain treatments will be denied them if they patronize that doctor. If they are up-front about their refusal to prescribe, then they are behaving ethically.

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quote:

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It isn't about morals or legality, it's about ethics. These people are pretending to take a moral high ground by taking part in ethically dubious behavior. That sets a bad precedent for their cause, and will eventually make their cause (pro life) look even worse in the long run.

---

quote:

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I have an even bigger problem with a pharmacist doing this though, because they aren't doctors, so IMO they should leave their ethical opinions at the door when they go to work.

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quote:

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I feel that it is an ethical decision....and I don't like someone shoving their ethics down my throat.

If you work at a chain drug store, or for someone who feels the same that you do, then fine. But for you to refuse to dispense a legally obtained persciption that is doing no harm to the patient, and possibly enhancing their longevity....well, that is immoral and unethical.

---

quote:

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Why not let your parents make all the decisions for you for your whole life? Because you have both the prividledge and the responsibility to make your own choices, right?

So why wouldn't you get upset when someone you barely know uses faulty science and morals you don't share to remove choices from you?

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quote:

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Or are you saying that anyone who wants to make their own moral decisions rather that having them imposed on them is dishonest.

I just don't think they have the right to do this, and I would be very upset if it happened to us.

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quote:

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I think I didn't make my point clear. IMO, if your job requires you to do things that violate your ethics/beliefs/whatever you can't generally just refuse to do them, yet keep your job. You quit.

Why should pharmacists (or doctors) be different?

I'm not saying don't BE a doctor or pharmacist. (My cousin, for example, is still an accountant -- he just doesn't work at that firm.) But choosing to work at a company that made the choice to offer those products should not include you refusing to do your job -- and yet expecting to keep it.

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quote:

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they should leave their ethical opinions at the door

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quote:

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But Kwea has said that a pharmacist doesn't have that right to work in the profession in accordance with his own ethical and moral beliefs. It's "shoving morals down" his throat.

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quote:

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I disagree....one is not appropreate to any business transaction.

Or are you saying that anyone who wants to make their own moral decisions rather that having them imposed on them is dishonest.

I just don't think they have the right to do this, and I would be very upset if it happened to us.

I may not be able to stop them, but I can use any and all legal sanctions on them...including protests if i so desired.

I would be happy to see them fold...and if they are at a chain, they should be fired. IMO.

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quote:

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I disagree. The people making the choice not to use birth control have every right to act on even a possibility of doubt, no argument there. But for the original marketers to make the claim that the probability of implantation was reduced with absolutely no evidence is faulty science. In fact the quote from Dr. DeCook – “speculation that became truth by repetition” is practically the definition of (one form of) faulty science.

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I never said that they had to leave all their ethics at the door, I said they
quote:
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they should leave their ethical opinions at the door
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,, meaning that they don't have the right to preach religion/ethics to me...they can feel/believe whatever they want, but they don't have the right to preach morality at me.

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That is what I feel they are doing here, using the workplace as a soapbox, and trying to enforce a morality on me that I don't agree with.

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I feel that I have the right to the meds my doctors prescribe.

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I also know that most of the chains don't allow this type of behavior because it is bad for business. I don't go to a pharmacy for moral judgments, nor do I care about the pharmacists feelings on birth control.

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I don't have to prove that they don't cause abortions. As a lawyer, you should know the futility of trying to prove a negative. It is up to the doctors who believe this to prove it, using the scientific method.

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No one has been able to do so yet, and until then the "scientific" claims are merely a smokescreen for moral posturing in the workplace.

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If they can do this, and it is clear that in some cases they do, then I have a right to protest against it too, right? Or are they the only one with rights again?

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Re: “faulty science” – the article linked to in the first post alludes to it, and if you follow the “post fertilization effect?” link in the article you find that there never has been a study that shows birth control pills make it less likely for a fertilized egg to implant. The claim was part of the original marketing of the pill, claiming a “three fold defense” against pregnancy, but the only part of that which was scientifically documented was the fact that it suppresses ovulation. There’s even a quote from the vice president of the American Association of Pro-Life Obstetricians and Gynecologists saying that “the post-fertilization effect was purely a speculation that became truth by repetition."

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quote:

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You're saying he doesn't have the right to not commit murder. That because of one very small class of pills, he has to forgo a profession that allows him to help people.

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How is he helping me, Dagonee? I need the pill for a number of valid health reasons, as do many other women who suffer from PCOS. And there's no way that I could possibly be pregnant. What if I get endometrial cancer because he wouldn't sell me the pill? What kind of morality is that?

Tullaan, can you give some more information on the law that allows pharmacists to refuse to fill prescriptions (maybe a link)? If it was made to prevent potentially fatal mistakes, then isn't it violating the spirit of the law to refuse to fill on moral grounds? Where does it end? I think that behavior-modifying drugs are overprescribed for children, does that give mean I can refuse to fill ritalin prescriptions?
 

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Posted by PSI Teleport (Member # 5545) on :
 
Kwea....ergh. What you are doing is asking the professional to go against their beliefs to make you happy. What good is it for a person to have an ethical opinion if it doesn't effect how they live their life?

You might as well tell someone, "I don't care if you are against murder. Don't preach that to me, just kill this person like I asked you to."

It's one thing to suggest that if they don't want to give you the pill, they are in the wrong line of work. (Or working for the wrong company.) But truly, you can't expect someone to give up their beliefs to give you what you want. It's not about you, it's about the fact that THEY have to sleep at night.

[ July 09, 2004, 10:13 AM: Message edited by: PSI Teleport ]
 

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Posted by PSI Teleport (Member # 5545) on :
 
And regarding the post-fertilization effect:

The only studies I can find are from extremely conservative or liberal sites, and argue both sides, so I am loathe to post them. But it stands to reason that it would occur, because that's how progestin WORKS. They know that it keeps the uterine lining from developing properly, (also causing periods to stop when taken continuously) so it stands to reason that the embryo won't implant. (Since the lining forms to give the embryo something to attach to in the first place.)

Does there need to be a study to prove this? We have proof that progestin works the way it does, and no one disputes that. The only dispute is over whether the lack of lining affects implantation. It seems like the answer to that would be "duh", since many women suffer from the inability to get pregnant precisely because their uterus doesn't form a sufficient lining.
 

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Posted by Kwea (Member # 2199) on :
 
Except that killing is illegal, and immoral. Most of the time.

I don't think they should have the right to block my access to legally prescribed drugs.

Unless there is a drug interaction, or allergy, or an obvious mistake on dosage; that is why the law was put in place.

Not so they can go all pro-life on me.

Funny part of this whole argument is that I have pro-life belief myself, it's one of the things I made sure I discussed with my wife before we were married. I wanted to make sure that we were on the same page as it could affect our future; fortunately we were .

I just don't like how people use these types of false arguments trying to give themselves the right to impose their moral judgments on others. I will never protest at an abortion clinic, and I wouldn't do it outside the pharmacy that did this either....but I have the right to do so if I so choose.

Doctors prescribe, and pharmacists double check then fill. Anything else isn't a good thing for the medical field, IMO. That is their job, and if they can't in good conscience do it, then why work there. That is like saying "I work at McDonald's, but he is too fat for a big mac...I'll only sell him a salad!".

Not a perfect analogy, of course, but you get the point. Fetuses don't have personhood.....so the do no further harm doesn't apply to them.

Do no further harm, people. It's not rocket science. Refusing to fill this is wrong...they are refusing to fulfill their duties as a pharmacist.

All this id IMO, of course.

Fortunately, most employers feel the same way; or I think they do, anyway. Hopefully I never find out.

[ July 09, 2004, 10:36 AM: Message edited by: Kwea ]
 

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Posted by Kwea (Member # 2199) on :
 
And some woman have tubal pregnancies, where not only is there no lining, it's not even in the uterus!

Common sense isn't good science.
 

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Posted by PSI Teleport (Member # 5545) on :
 
What's "not rocket science" is that no one should be forced to do something that goes against their beliefs, whether or not it's illegal. IT'S NOT ABOUT YOU.

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Okay, Kwea, why don't you go ahead and explain the science on how an embryo can implant in the fallopian tube? (Which is not only extremely rare, by the way, but doesn't result in a viable baby.)

[ July 09, 2004, 10:35 AM: Message edited by: PSI Teleport ]
 

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Posted by Kwea (Member # 2199) on :
 
I don't have to....it occurs, so it can be proven. Therefore, the lining isn't alway necessary for an embryo to attach.

When I go to get something filled, it is all about me, or whomever it is for; that is why they are there, to serve the customer. In refusing to do so, they are imposing their beliefs on me. That is not why the law was enacted, and to use it as such is immoral, and unethical.IMO.
 

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Posted by Mrs.M (Member # 2943) on :
 
PSI, I have to disagree with you here. The pharmacist is not being forced to do something that goes against his or her beliefs. He or she is is free to choose another profession.

Frankly, someone who believes that filling prescriptions of oral contraceptives is murder should probably not be a pharmacist. Oral contraceptives are widely prescribed and a pharmacist has to know that he will be put in that position again and again.

Also, it is about me, and my health. My mother had endometrial cancer, which could have been prevented by oral contraceptives. As someone with PCOS and a family history of endometrial cancer, I am greatly at risk. I think it's immoral for anyone to deny me the drugs that can prevent me from getting endometrial cancer.

Let me give you an extreme example. What if every pharmacist in my town thinks that prescribing the pill is murder and I die from endometrial cancer because I was denied access to a preventative? Isn't that murder, too?
 

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Posted by PSI Teleport (Member # 5545) on :
 
Mrs. M: I've already stated several times that the pharmacist should choose another profession (or company) if they don't like doing something vital to their job. My argument is against the idea that when a person makes a personal decision for themselves, and someone nearby is affected, that they are trying to preach or espouse their ideas onto another person and should be stopped.
 

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Posted by Dagonee (Member # 5818) on :
 

quote:

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How is he helping me, Dagonee? I need the pill for a number of valid health reasons, as do many other women who suffer from PCOS. And there's no way that I could possibly be pregnant. What if I get endometrial cancer because he wouldn't sell me the pill? What kind of morality is that?

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quote:

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Tullaan, can you give some more information on the law that allows pharmacists to refuse to fill prescriptions (maybe a link)? If it was made to prevent potentially fatal mistakes, then isn't it violating the spirit of the law to refuse to fill on moral grounds? Where does it end? I think that behavior-modifying drugs are overprescribed for children, does that give mean I can refuse to fill ritalin prescriptions?

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quote:

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I'm not looking to be offended, I would just want to know why...as in are they out, or should I switch pharmacies. Duh. I have said 20 time that i don't care what their moral opinion on this issue is, I just want the damn pills.

Stop trying to twist my words.

How else would I know if they would be carrying them later on in the week unless I would ask? Am I telepathic?

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You are the one being argumentative. I would not want to buy anything from a store that would allow their employees to do that. And I would inform my friends and family why I refused to go there again. And I would write the company and tell them how I felt about it.

I am not saying that they would be terrible people, or that they shouldn't be pharmacists; just that I don't want others to impose their morality on me in this type of instance.

Last I checked I was still allowed to do those things here in America.

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In refusing to do so, they are imposing their beliefs on me. That is not why the law was enacted, and to use it as such is immoral, and unethical.

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They are not doctors!

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How is any of the courses of action forcing my morals on anyone?

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I just refuse to allow their decisions to limit my choices.

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Except that his not selling it to you won't be what gives you cancer. Your not getting it from another source would be. If there were no other sources available, then a pharmacist with these beliefs would have to ask why the pill's being used, which would be intrusive. Given that other sources ARE available, the least intrusive thing to do is simply not carry it for any reason, given that the majority of users don't have your specific circumstances.

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Considering the state of this country, I'd think people would welcome someone sacrificing financial gain on moral principles. Even if you don't agree with the instant principle, isn't it better that people have principles and are willing to sacrifice for them?

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A pharmacist is required to catalogue and monitor a patient's drug therapy. Using professional judgement in refusing to dispense an improper medication isn't just a right, it's a responsibility; if a drug causes a patient harm the pharmacist will get sued right along with the doctor, even if they were filling a prescription exactly the way the doctor wrote it.

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I even talked to some pharmacists I know, and they agree with me. It isn't their place to make moral choices for their customers. The law is to prevent medication from being dispensed incorrectly, to do no further harm ...if you are wondering why I keep repeating that phrase, it is part (the most important part) of the Hippocratic Oath. I know, I took it as an EMT.
 

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Posted by Bob the Lawyer (Member # 3278) on :
 
Because nothing gives them the right to strip the patient of their right to autonomy (assuming the patient is of sound mind). That right is a fundamental right in North American medicine and overrides individual ethical concerns. The health care worker has the right to educate the decision of the patient, but not the right to influence that decision. It's a tough line to walk and disagreements over safety and effectiveness crop up all the time.

Ethics, however, are another kettle of fish. While I sympathize with the pharmacist in this case, they are there to aid the patient in his or her decisions regarding their care. The fact of the matter is, they are there to aid the patient with the care he or she and their doctor have decided on. They are free to call the doctor if they have safety concerns, they are even free to talk to the patient (although many patients may consider this "crossing the line") but they aren't free to deny the patient their right to care because of the pharmacist's ethical concerns. That is not your fetus and, as it stands in America, the decision of whether or not it is a human life is not yours to make.

If you chose not to stock the drug, fair enough. There isn't room for every drug back there in that little stock room. But you do have to aid the patient in obtaining it. By order, by an address of somewhere that will provide it, or the like. Again, you have a duty to the patient that overrides your own ethical (and there's a world of difference between "ethical" and "medical") concerns. If someone cannot make their peace with that than they should find another profession. There are plenty of professions where you may be ethically opposed to a few small things, Dags. You either make your peace with them or you move on. There is no fundamental right to be a practicing pharmacist
 

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Posted by Dagonee (Member # 5818) on :
 
At this point I bow out, because the divide is too great to cross any more, as evinced by the "small things" remark.

Dagonee
 

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Posted by PSI Teleport (Member # 5545) on :
 
Kwea: The point is only that they have medical responsibility too, and that goes far beyond the "give me the #$%^ pills" role that you want them to fill. You make comments like "They're not doctors" and I don't know why, except that you maybe want to show that they don't have the same responsibility to your health that your doctor has? I could go on about how pharmacists probably know more about the medicine prescribed than the doctor does, but that's kinda irrelevant. I could say that when I have a question about what to give my child or how much medicine she needs, I call the pharmacist. They aren't robots.

I am NOT saying that they have a responsibility to decide if you should have pills or not (based on a moral judgment). You keep missing this. I AGREE with you. But I don't agree that you have the right to destroy their life and profession because they made a PERSONAL decision that they can't in good conscious violate.
 

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Posted by Kwea (Member # 2199) on :
 
Thank you Bob, that is what I was trying to get at. In the medical field things are different that in other professions. There is an overriding concern for the patient (or there is suppose to be) that is fundamentally more important than individual beliefs. That is why the patient always has the last word on his/her treatment, not the doctor.

A doctor is free to refuse to preform abortions, but that is an act he commits. I am not asking the pharmacist to take the pill for me, merely to do his job, which is to dispense meds that have been prescribed.

If a pharmacist doesn't (working for a place that stocks the pill) due to ethical considerations, then he is saying that his personal ethics are more important to him than my healt....he doesn't have the knowledge or experience a doctor has, and shouldn't be impinging on the rights of others to follow a prescribed course of medical treatment.
 

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Posted by Kwea (Member # 2199) on :
 
I never said they were robots. I just don't think they have the same training.

And they know a lot more about the drugs..point accepted. But they know a lot less about pathology, and my medical history, than doctors do.

It is a doctors job to prescribe, and a pharmacists job to correctly fill the prescriptions. Both are necessary, and there is some overlap.

There is a difference between private morality and public morality.

I feel that everyone has the right to think what they want, even if it is the complete opposite from what I believe.

[ July 09, 2004, 10:49 PM: Message edited by: Kwea ]
 

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Posted by Bob the Lawyer (Member # 3278) on :
 
Dags, if you read this thread, I meant "small things" in terms of number of times they crop up, not in terms of severity.
 

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Posted by Dagonee (Member # 5818) on :
 

quote:

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Dags, if you read this thread, I meant "small things" in terms of number of times they crop up, not in terms of severity.

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quote:

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If they don't like the pill, they don't have to take it or recommend it. But to refuse to fill it is overstepping their rights, IMO. I feel that there obligation to me as their customer/patient, and to their employer, is more important than their individual feelings.

If they can't, then it is time to replace them with someone who can.

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I agree with this too. What about a pharmacist with his own business, or one that works for a pharmacy with his same beliefs?
 

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Posted by Bob the Lawyer (Member # 3278) on :
 
No problem. I don't want you to think I'm belittling your position or that I completely don't understand it.

It's too bad you're out, I enjoy discussing things with you. Even if the only we're going to reach this conclusion is in a cage match.

In the event of a cage match, $5 on Dags.
 

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Posted by Dagonee (Member # 5818) on :
 
I liked this discussion (Edit: and the participants), but we're all starting to repeat ourselves, and our starting positions are both fundamental and unlikely to change.

Dagonee
Edit: I'm mean in a cage match. I get my beautiful manager to slip me a T-ball bat and it's all over.

[ July 09, 2004, 11:53 AM: Message edited by: Dagonee ]
 

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Posted by PSI Teleport (Member # 5545) on :
 
Dag, I'm just frustrated because Kwea seems to think I totally disagree with him, but I don't. I'm repeating myself because, although I thought I made my opinions known in the first page, he keeps arguing things that I don't agree with or never said.
 

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Posted by Bob the Lawyer (Member # 3278) on :
 
So the only thing standing in the way of this conversation is that we understand each other too well? Yeah, that's why I waited so long before posting anything.

Something tells me my cage matches would look a lot like Homer's boxing matches. Only more me getting punched in the face and less me standing up afterwards.
 

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Posted by Dagonee (Member # 5818) on :
 
PSI, that wasn't aimed at you. We're all repeating ourselves, which is usually a good signal that it's time to adjourn the discussion for beer.

Dagonee
 

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Posted by Dan_raven (Member # 3383) on :
 
The biggest difference I see in the sides on this discussion is the question of "who is the patient".

The pharmisists who refuse to sell the pills assumes the patient is the fetus, and as such, believes they have a responsibility to it that overrides their responsibility for the convience of the mother. "That pill is a poison. I refuse to sell poison."

Those who are against this pharmisist's decision believe that the patient is the woman buying the pills. His decision not to prescribe the legal requested medication is an attempt to force his beliefs on the mother. "That pill is a sin. Stop sinning."

From the pharmisists point of view, he is saving lives, or at least refusing to be part of taking them.

From the customer's point of view, the pharmisist is preaching. Preaching is bad customer relations unless you are a minister.

My opinion: I agree that the pharmisist has a right to his moral standing. However he fails in two areas. 1) He assumes that the pill is a poison while the science he practices has no proof of this. 2) He assumes a use for the pill--contraceptive--that is not the only use for that pill. As such he may be doing more harm than good. This shows he is making a moral stand without giving that stand the true deep thought it requires. He is playing Don Quixote, more enamoured by his martyrdom and valor than in the realities of his decisions.

My solution, if a pharmisist gave me such a speech about not promoting abortion by selling the pill, I would explain to him his mistakes, not in the poisonous of the pill, but in the other uses that the pill can be put to, and that his decision needs to be further examined.

His reaction to my calm reciting of these facts would determine if I would ever return to this pharmacy, report him to his manager, or remain a good customer.
 

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Posted by Speed (Member # 5162) on :
 
Hey dudes. This thread has gone a long way since I read it last. I'm not going to join the fray because I'm trying to save my posts until I figure out what my landmark is going to be. But I thought I'd use one to clarify a couple of things.

First, Kwea keeps saying that pharmacists are not doctors. The fact is that most of them are. In fact, any pharmacist graduating today is required to get a doctorate of pharmacy. I know it's not an MD, but it is a six year degree, and a fairly intense six years at that, so be careful what you say a pharmacist isn't qualified to do.

Second, pharmacists are required to use professional and moral judgement in filling, or refusing to fill, any prescription. It's not just scanning for interactions. A computer program can do that. There are many legal and valid reasons that a pharmacist can refuse to fill a prescription. Some doctors try to write prescriptions for morphine for themselves, friends or family members. If you've got a friend who's a doctor and you can convince him or her to feed your smack habit, the prescription he or she writes for you would be just as legal as the one they write for oral contraceptives. The only way a doctor can get morphine is through a pharmacy, and if a pharmacist gets the idea that they're diverting or abusing it, we get to refuse to fill it. It still may be a valid legal prescription. We don't even need legally feasable evidence, since we're not prosecuting anyone. To refuse to fill it, we need nothing more than a suspiscion and a moral qualm. It's no less a moral decision than refusing to fill birth control and it's perfectly within a pharmaicst's rights to do it.

I've never had a doctor try to write controlled substances for themselves. But I've seen some try to write prescriptions that weren't in their scope of practice, and I've refused to fill them. And if the patient tells me that one of my colleagues would fill it, I tell them that they can come back when that person is working.

You may say that your health care is between you and your doctor, and whether or not I agree with you, I think we can agree that a chain pharmacist's employment is between him and his employer. It's a free market, and you're free to complain, but every pharmacist, at one time or another, eventually refuses to fill a prescription for some professonal or ethical reason. And if Walgreens wants to keep them on and DOPL won't revoke their license, you can tell them to get another job all you want, but it's probably not going to happen.

As I said earlier, I agree with you on this specific issue, but I think you're misinformed on the duties of a pharmacist in general.

[ July 09, 2004, 02:33 PM: Message edited by: Speed ]
 

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Posted by Alucard... (Member # 4924) on :
 

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I just think that as the pharmacists should stick to what they know best...looking for allergies, drug interactions, and whatnot. The doctor knows why I need the meds, where the pharmacists might not.

Leave the doctoring to the doctors.....why is that so hard to understand?

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Kwea,

I tried to read through most of you posts and made it to where you claim that pharmacists are not doctors. I take your offensive insults personally, since I am pharmacist, and if I had the opportunity to meet you in person, I would slap you in the face for insulting the profession I love. I am not a violent person, but you have severely upset me, and I expect an apology. Until then, consider yourself off my list for poinsettas at Christmas.

I could quote all the other inflammatory crap that you have spewed out, but I would be wasting my time. The fact that your spouse works in a pharmacy should enlighten you to the fact that not all pharmacists are the same. Anyway, there are much more important issues to discuss.

1. A pharmacist can only refuse to not fill a prescription if they believe the patient is at risk to be harmed, or they deem the prescription not appropriate or legitimate. This clause is mainly in response to controlled substance prescriptions, but also applies the the reasons that Tullaan made.

2. The laws that support a pharmacist making a decision based on political, religious, or ethical grounds are very very gray. The one Tullaan has referred to is the same one I refer to as well. There was a Pfo-Life bill that was proposed to the House of Representatives that would enable a pharmacist to refuse to fill abortive medications based on their beliefs, but due to support of more than one kind, did not pass.

3. If you owned your own pharmacy, you are entitled to practice pharmacy in whatever way you choose, as long as you follow laws and regulations. What this means is that if someone like Kwea came into my pharmacy and insulted me to my face and practically brought me to violence, I would still have to fill his medication, as long as it was in good faith as described above. I may not want to fill a prescription because someone is an @$$, but I have to.

As far as I am concerned, no matter my religious beliefs, I am required to fill a prescription as long as I believe it to not be harmful to the patient, in good standing and legitimate, and falling within the other rules and regulations that apply to my profession.

We talked about this at length in another thread: Wafer Nazis: No Jesus for you!

In essence, this is a very difficult dilemma to deal with. I applaud a pharmacist for having such strong faith or belief that they do not want to take another life. That is a noble endeavor in a religious sense. However, I am also saddened in that the pharmacist has severed the doctor-patient-pharmacist relationship and has refused legitimate service to a patient that our laws and regulations require.

There are no easy answers here, and almost always, someone is offended.

Here is the link to the prior discussion:

http://www.hatrack.com/ubb/forum/ultimatebb.php?ubb=get_topic;f=2;t=025499

[ July 09, 2004, 06:48 PM: Message edited by: Alucard... ]
 

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Posted by Jutsa Notha Name (Member # 4485) on :
 
Um, Wal-Mart sells guns, too, but if you are against the sale of guns, would you work there? Would you stand at the counter and refuse to sell guns to people because they kill things? Do you deserve to keep your job at the sports counter if you refuse?

No.
 

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Posted by Dagonee (Member # 5818) on :
 
Please read the whole thread before adding to a 2-page controversial discussion. There's a clear set of distinctions between the two situations, which have been addressed by those on both sides of the issue.

Dagonee
 

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Posted by Jutsa Notha Name (Member # 4485) on :
 
Please don't be rude when I've already read the two pages. I don't agree. It's a conflict of ethics. Refusing treatment without clearly stating that one refuses treatment is unethical. If they laid it out quite clearly that they did not, much like how Jehovah's Witnesses make it quite clear there are medical practices they will not allow, then all is within ethical bounds.

This situtation is not. If you want to be morally superior, behave morally superior. Not underhanded like that.
 

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Posted by Dagonee (Member # 5818) on :
 
It's not a question of agreeing. It's a question of repeating an earlier post without even addressing the reasoning posted in response to it.
 

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Posted by Jutsa Notha Name (Member # 4485) on :
 
Oh, and because you agree with the reasoning, then the discussion is over?

How superior.
 

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Posted by PSI Teleport (Member # 5545) on :
 

 

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Posted by TMedina (Member # 6649) on :
 
No, what Dag is trying to say is:

Someone already posted a point. Someone (Dag, I think) posted a response.

Then someone posted the same point from before without ever addressing the response.

So, unless you want someone (Dag, I think) to re-post his reply...

-Trevor
 

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Posted by Dagonee (Member # 5818) on :
 
Thank you, Trevor.

Dagonee
Edit: The further point is that the responses to those posts were incorporated into the discussion as a whole.

[ July 09, 2004, 07:39 PM: Message edited by: Dagonee ]
 

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Posted by Alucard... (Member # 4924) on :
 
Jutsa,

No offense meant to you at all. Dag is just trying to move forward with the discussion, and your gun sale analogy has been posted and addressed.

One thought I would relay to your analogy is that doctors do not have to declare their intentions or lack of intentions concerning treatment. They have considerable control over the type of therapy they agree and do not agree with administering. You are demanding that pharmacists not make these ethical decisions in an underhanded way. How and WHEN do you expect them to convey their beliefs?

Well, what comes to mind, is exactly after you bring in a prescription that they do not ethically want to fill.

[ July 09, 2004, 07:43 PM: Message edited by: Alucard... ]
 

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Posted by rivka (Member # 4859) on :
 
Back to the issue of whether the Pill causes a fertilized egg to not implant. Not only are there no studies on this issues, how on earth would such a study be conducted? Can you imagine women being willing to ONLY take the Pill in the narrow window between fertilization and implantation? Even if some were, how on earth would this window even be determined?

On this subject, PSI said:

quote:

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Does there need to be a study to prove this? We have proof that progestin works the way it does, and no one disputes that. The only dispute is over whether the lack of lining affects implantation. It seems like the answer to that would be "duh", since many women suffer from the inability to get pregnant precisely because their uterus doesn't form a sufficient lining.

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quote:

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Okay, Kwea, why don't you go ahead and explain the science on how an embryo can implant in the fallopian tube? (Which is not only extremely rare, by the way, but doesn't result in a viable baby.)

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Could be -- but there's not much evidence to support it.

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And Dagonee's and others' excuses aside, it is not ethical to place one's self in a place where you will refuse a service without warning that you will not, even though the place one is working is publically providing such a service.

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And since neither I nor anyone else on this thread advocated doing that, I guess you don't have a problem with us. As you read the whole thread, I'm sure you saw my very first post: "Pharmacists and doctors should be up front about their policies on this, though."

It's a shame that one of the best discussions on a very controversial topic on Hatrack has been lowered by such mischaracterizations of others' positions, not to mention the "obligatory reference to some fascist or totalitarian movement in the past here."

Dagonee

[ July 09, 2004, 10:01 PM: Message edited by: Dagonee ]
 

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Posted by Speed (Member # 5162) on :
 
Alucard:

Hey. I just read your response, and it's something that I've never heard before. I don't want to get any bad intra-Hatrack RPh mojo going on, so don't take this as a challenge or anything, particularly since I have a great deal of respect for you, personally and professionally. But if I'm interpreting your post correctly, what you said is the opposite of what I've always been led to understand.

First off, did any of these pharmacists that you saw get fired have any legal action or censure by the board take place against them, or was it just a firing? I can see a firing occurring, as their choice could be seen as very bad business practice. But honestly, I've never heard of any censuring going on because of a refusal to fill a prescription for any reason.

I just graduated a couple years ago. I remember being in the pharmacy law class and going over the pharmacy practice act and the controlled substance act. The teacher went into some detail about when we were allowed to accept a prescription, when we were not allowed to fill it, and when we were required to to research the difference. One day I actually asked him if there were any circumstance under the law in which we were required to fill a drug in a non-life threatening situation. He said it might not be a good idea, but gave no reference to any part of the law that mandated that we fill a prescription if we don't want to.

Since then I've studied the pharmacy practice act to see for myself if it was in there, and I couldn't find it. Although I've never done it myself, I've known several pharmacists who have, on occasion, refused to fill a prescription for no other reason than a patient's extreme and disruptive bad attitude. They always give back the original or offer to transfer it, but they won't fill it at their pharmacy, and I've never heard of anyone being censured or investigated for it. This very evening I skimmed the Pharmacy Practice Act and Rules and was again unable to find any reference to a mandate to fill a prescription. My wife, who is a technician, just called from work, and I asked the pharmacist she was working with. He said the same thing I did.

Now, with all that said, we do work in different states. I know that we work under different laws. There may be a law in your state that doesn't exist in mine. Or perhaps there is even a law in my state that is obscure enough that neither I nor the pharmacists that I work with are aware of it. I'm willing to admit these possibilities; I'm not all-knowing, and if I'm wrong, it won't be the first time. As I have said, I've never been in a situation where I've felt it necessary to refuse service based upon any moral reservation I have to do so, nor have I ever turned anyone away for being a jackass, although I have been tempted. But at this point I'm honestly unaware of any law that makes it necessary that I serve a patient when there is no immediate danger of morbidity or mortality from my refusal.

[ July 09, 2004, 10:13 PM: Message edited by: Speed ]
 

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Posted by mr_porteiro_head (Member # 4644) on :
 
Yet again, I wish I were as eloquent as Dagonee.
 

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Posted by Kwea (Member # 2199) on :
 
Alucard, I won't apologies to someone who has said he would hit me. BTW, I hit back, be it verbally or physically.

I don't think I have been inflammatory, not considering some of the things that have been said. In never started out to insult pharmacists, nor do I think I have.

Pharmacists aren't doctors (Md's). Not as in "I go to a doctor when I am sick so he can tell me what is wrong with me."; they may all have doctorate's, but I wouldn't allow any of them to operate on me, or to diagnose anything but minor illnesses. That isn't their area of expertise, and any pharmacist who thinks it is should go apply for a medical license (as in to practice medicine)instead of their harm licence......MD's make better money.

They are the experts on drugs, and the possible interactions between medications, and when I have a question on side affects, or when I don't remember what a particular medication is, I call them. They are an integral part of the medical system that provides care, but they aren't who I consult on treatment. Or for anything other than what they are experts in.....drugs.

I never said that they were robots, or idiots. I never said that their jobs were easy, or that I could do their job. I haven't insulted any of them, except to say that if a pharmacist who works in a chain that sells the pill refused to sell us the pill because of their "moral stand" on it's possible effects, I would complain to the manager of the pharmacy, and if they were not disciplined and/or changed their stand would hope that they would be fired.

I object to his grandstanding, and feel that he would be overstepping his bounds and trying to impose his morality on me and my wife. He would also be neglecting his oath to do no further harm (possibly), placing his personal convictions higher that the welfare of his customer/patient.

If a pharmacy doesn't stock the pill because of their beliefs, why am I wrong to say that I would never go there again, and would hope they would go out of business because of it? Don't I have the right to say how I feel about it, or are they the only one who has the right to opinions....

If a store doesn't carry it, then I go to another store and take as many of my friends as are willing to switch to another, more caring and honest store where I don't have to worry about others attempting to impose their morality on me.

One thing I never did was advocate violence to wards anyone. That is more than you can say.

I guess both of us are glad that you aren't my pharmacist.

Or do you think you should be able to threaten or hit people there and not be punished for it as well?

Kwea
 

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Posted by Jutsa Notha Name (Member # 4485) on :
 

quote:

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As you read the whole thread, I'm sure you saw my very first post: "Pharmacists and doctors should be up front about their policies on this, though."

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quote:

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No, I read it, just as I read as you (and others) went on to defend the behavior anyway.

It's a shame that such a discussion seems to ignore such things like that, when they stand out as glaring inconsistencies with logic to me.

Saying "I don't think it's right, but" is not the same as just saying "I don't think it's right." Nothing you say will make it so.

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quote:

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The only time I discussed the pharmacist telling the customer about the policy AFTER the customer tries to fill the prescription was in response to a hypothetical by Kwea.

It's called context. Learn it. Love it.

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Oh, I'm sorry. Was I just supposed to say "we'll just have to agree to disagree here" and leave it at that?

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quote:

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t's called consistency, or are you going to tell me you weren't defending the act with a "I don't think it's right, but" defense?

Learn it. Love it.

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quote:

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Actually, I'm beginning to not give a damn what you say.

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quote:

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The totalitarian analogy can just as easily swing the other way: "If you don't conform to our ideology on when life begins, you will be denied access to certain professions."

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quote:

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And popping into a thread and restating an analogy what's already been stated, not responding to any discussion on that analogy, and then playing the Hitler/Stalin card hardly makes you a model of clear-headed discussion.

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Ahh, no one is ever allowed to say something once someone else says it here? "Hey, someone else already said that! Get out of here!"

As I already pointed out, I made no connection with Hitler or Stalin. I find it quite amusing that you can freely attribute things I did not say to things I did as if that's what I meant, but when pointing out how your own words have done the same, you balk at the thought of it.

So good. I don't believe you, you don't believe me. Impasse. What can you do about it?
 

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Posted by Kwea (Member # 2199) on :
 
I think that I was more concerned with the rights of the patients, while Dag is more concerned with the rights of the pharmacist.

Big major difference, to be sure, but interesting viewpoints. I even sympathize with him a bit...not much, as I feel their obligations to their patients are greater, but a little bit...

I really am out now, from this thread at least. Too much personal stuff in here...if you know what I mean.

Thanks to all.....well, almost all....

Kwea

[ July 09, 2004, 11:46 PM: Message edited by: Kwea ]
 

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Posted by Jutsa Notha Name (Member # 4485) on :
 

quote:

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I think that I was more concerned with the rights of the patients, while Dag is more concerned with the rights of the pharmisist.

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quote:

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Yes, which is why I mentioned both in my post (fascist and totalitarian). Maybe you should learn to freaking read.

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quote:

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Ahh, no one is ever allowed to say something once someone else says it here? "Hey, someone else already said that! Get out of here!"

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As I already pointed out, I made no connection with Hitler or Stalin. I find it quite amusing that you can freely attribute things I did not say to things I did as if that's what I meant, but when pointing out how your own words have done the same, you balk at the thought of it.

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So good. I don't believe you, you don't believe me. Impasse. What can you do about it?

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Oh, please. You won't convince anyone you didn't mean Hitler and Stalin with the "totalitarian movement in the past" reference. Or that you didn't mean to apply them to me.

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I can reiterate that you are seemingly incapable of discussing what people actually say, either because you can't figure out how to respond to it or you just can't comprehend it.

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It was a rhetorical question. Thanks for insulting my intelligence when all else fails, though. At least I know you're human.

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Why do you remind me of somebody else, I wonder?

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I've read the thread, and was unsatisfied with the direction.

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You give yourself a little too much credit taking it personally. If I want to tell you I don't like you, I won't hide it with silly comparisons or innuendo. Looking for some hidden meaning behind what I say as an excuse to take it personally is counterproductive, and rather hypocritical of your "take me at face value" demand that I do with you.

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You know others who don't believe everything you argue as enlightening and pertinent, no matter how eloquently you put it, mayhap?

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But you find the current Justa vs. Dags trend to be intimately more interesting?

Well, that makes one of you.

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Alucard, I won't apologies to someone who has said he would hit me. BTW, I hit back, be it verbally or physically.

I don't think I have been inflammatory, not considering some of the things that have been said. In never started out to insult pharmacists, nor do I think I have.

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One thought I would relay to your analogy is that doctors do not have to declare their intentions or lack of intentions concerning treatment. They have considerable control over the type of therapy they agree and do not agree with administering. You are demanding that pharmacists not make these ethical decisions in an underhanded way. How and WHEN do you expect them to convey their beliefs?

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First, Kwea keeps saying that pharmacists are not doctors. The fact is that most of them are. In fact, any pharmacist graduating today is required to get a doctorate of pharmacy. I know it's not an MD, but it is a six year degree, and a fairly intense six years at that, so be careful what you say a pharmacist isn't qualified to do.

Second, pharmacists are required to use professional and moral judgement in filling, or refusing to fill, any prescription. It's not just scanning for interactions. A computer program can do that. There are many legal and valid reasons that a pharmacist can refuse to fill a prescription. Some doctors try to write prescriptions for morphine for themselves, friends or family members. If you've got a friend who's a doctor and you can convince him or her to feed your smack habit, the prescription he or she writes for you would be just as legal as the one they write for oral contraceptives. The only way a doctor can get morphine is through a pharmacy, and if a pharmacist gets the idea that they're diverting or abusing it, we get to refuse to fill it. It still may be a valid legal prescription. We don't even need legally feasable evidence, since we're not prosecuting anyone. To refuse to fill it, we need nothing more than a suspiscion and a moral qualm. It's no less a moral decision than refusing to fill birth control and it's perfectly within a pharmaicst's rights to do it.

I've never had a doctor try to write controlled substances for themselves. But I've seen some try to write prescriptions that weren't in their scope of practice, and I've refused to fill them. And if the patient tells me that one of my colleagues would fill it, I tell them that they can come back when that person is working.

You may say that your health care is between you and your doctor, and whether or not I agree with you, I think we can agree that a chain pharmacist's employment is between him and his employer. It's a free market, and you're free to complain, but every pharmacist, at one time or another, eventually refuses to fill a prescription for some professonal or ethical reason. And if Walgreens wants to keep them on and DOPL won't revoke their license, you can tell them to get another job all you want, but it's probably not going to happen.

As I said earlier, I agree with you on this specific issue, but I think you're misinformed on the duties of a pharmacist in general.

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A patient has the right to privacy and the right to the medicine that they need.
These pharmacist have the responsibility to keep their personal beliefs out of their job or to at least do more research on birth control pills instead of banning them.
It's not logical. Especially when many of the women taking the pills are trying to AVOID getting pregant so they don't have to get an abortion. They are doing the responsible thing.
What next, will they refuse to sell condoms and spermacide or something?

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I see both sides of your argument, and hope that we can get back to some of the more pertinent topics at hand. Jutsa, previously, I presented one to you specifically, but it was ignored:

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No, I didn't. I did not just say that pharmacists need to make it clear. I said that both doctors and pharmacists need to make it clear.

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OK I follow your rationale, but wouldn't mandating that professionals state their ethical or religious beliefs in public be an invasion of privacy, or even grounds for discrimination? I doubt your suggestion would make it to policy.

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• giving a blood transfusion to a Jehovah's Witness?
• performing a restricted organ transplant on a Muslim?
• discarding intravenous, catheters, and other fluid holders from the dead body of an orthodox Jew?

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Are you going to say that doctors and pharmacists are allowed to disregard these desires of their patients because they may disagree with their religious or ecumenical beliefs?

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However, what it comes down to is that even the medical profession has no ethical right to impose their own morals on others.

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Sound like a pain in the ass? Well, so is the whole idea of having to find another doctor and/or pharmacy for something as simple as getting an oral contraceptive. At least this way, both sides are equally inconvenienced.

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I never support decisions that are based on equalizing the misery that both parties have to endure. I would much rather see a system in place that makes the process easier for both parties. Good communication between the patient and the health professional would be a start. But I already said this.

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As for the "discrimination" factor... well, not to bring religion into it, but most of the religions who precipitate this type of ideology already foster the notion that "everyone else" is against them. You'll have to forgive me if I have no pity for the persecution complex of a population who makes up over 85% of the United States.

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However, what it comes down to is that even the medical profession has no ethical right to impose their own morals on others.

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Exactly. But...

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Ah, ah, ah. That's one of those caveats I was talking about earlier. Every individual has a right to their beliefs, right up to the point where it infringes on the well-being or freedoms of others to enjoy their beliefs and morals.

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I never support decisions that are based on equalizing the misery that both parties have to endure.

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What I would ask of you is to stop demanding some sort of "up front" disclosure of a heath professional's beliefs or ethics. That sort of information is private and should be left to the discretion of the provider as to whether they want to share that information or not.

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Actually, the decision to participate in a medical treatment that could conflict with a health professional's religious or ethical beliefs is EXACTLY what this thread is about.

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And that's EXACTLY what I'm saying is intentionally missing the point. I'm saying that it's the professional's duty to be up-front so as to be sure to provide the most comprehensive and honest service to begin with. No exceptions.

As a child, my doctor was a Menonite. As a rule, he would opt out of many different prescriptions in favor of other treatments. My parents actually preferred this measure, as I'm sure many would. The reason I bring this up is that, considering the very high number of Pro-Lifers out there, making it public knowledge that a doctor won't prescribe or a pharmacist won't fill an oral contraceptive would be anything but a bad thing for these people. That is why I simply don't buy the poor, little "right to privacy to avoid discrimination" excuse for non-disclosure before engaging in the service.
 

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Posted by Space Opera (Member # 6504) on :
 
Seriously, have you guys ever had a Pap Smear? I'd be mighty ticked if the dr. hadn't informed me beforehand that they would not write a prescription for the pill. I would hope that something would be said over the phone while making the appointment.

space opera
 

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Posted by Theca (Member # 1629) on :
 
This is slightly off the subject, but I know a lot of people at Notre Dame who have insurance through the school. The insurance will NOT pay for any birth control unless the doctor writes a note explaining that the birth control is for a medical illness. I wonder if they cover tubal ligations and hysterectomies in fertile women. Hmm.

(What gets me is when the patient or the patient's mom calls and informs me I need to write this letter and they expect me to lie so they can get the birth control covered.)
 

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Posted by Alucard... (Member # 4924) on :
 
Well Jutsa, I suppose we can only agree that we disagree. I respect your firm opinions on the matter.

However, I will be saddened when there comes a day where I have to openly profess what I believe and what I do not believe in order to practice pharmacy.

Maybe I could run for public office and avoid all the scrutiny?

Anyway, rest assured, I would be very surprised in anyone here at Hatrack has to worry about being denied service at their pharmacy, escecially concerning oral contraceptives that prompted Syn to start this thread. I personally know of no other pharmacist who practices pharmacy this way.

[ July 10, 2004, 03:48 PM: Message edited by: Alucard... ]
 

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Posted by Alucard... (Member # 4924) on :
 
:
Did someone say off subject? Oh, thank you! I was beating a dead horse, but the horse just would not die.

Theca, I have many Catholic patients that fill their birth control at my pharmacy. There was another earlier post that mentioned Catholic hospitals filling BC Rxs, also. These are just a few examples of how commonplace oral contraceptive therapy has become. I was truthfully surprised that Syn or anyone else would be concerned that all of a sudden, pharmacists would collectively become Ethics Supremists and stop dispensing medication...
 

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Posted by Kwea (Member # 2199) on :
 
Alucard, I think that the whole issue you took offense at was merely a lack of clarity in my language, and I accept your apology. I also offer mine to you, for not being clear enough and for offending you. That wasn't what I intended.

When I said doctor, I was referring to a MD. When I stated that the Pharmacist should "just give me the damn pill" I was frustrated with my own inability to articulate my points. So I oversimplified, and the oversimplification led to conflict.

In my own defense, I believe I had said earlier that I respected Pharmacists and that their jobs weren't easy. My point was that they weren't Md's, and a MD is where I go to receive medical advice regarding treatment. Then i go to the pharmacy to have the script filled, providing there isn't a problem with it.

It seem to me that half a dozen new drugs hit the market every week, and while I am better informed than most patients, I have no idea on what most of them do. It seems an impossible task for me to keep track of just my families medications, and I wouldn't be able to do it without the active help of our pharmacists. They are all JenniK's friends and co-workers, so I feel very comfortable asking them any question that occurs to me. Even before I knew her though, that was where my mother went years ago, and the people in the pharmacy were great to her as well.

They make great money, and are worth every penny, if not more.

As I mentioned earlier, when I have a question about medications or side effects, or want a second opinion about meds, I go to them. When I need a good doctor, I ask if they can recommend one (as friends, I'm sure the chain doesn't let them favor one over others). And they have given me heads up about things I never even thought to ask about.

But if one of them tried to block access to a med I knew they stocked, because of their ethical beliefs, I would still be angry. I would still think that they had no right to do so.

I hope I was a bit more clear on my stand this time around. It's not that I don't respect pharmacists, or think that they aren't professional; I get mad because I know I have the right to expect good ethical treatment and i don't feel I am getting it.

I don't think a nurse should be force to perform an abortion. But if a woman is dying, and a MD makes a choice to save the woman at the cost of the baby, then the nurse does not have the right to leave in the middle of it due to her ethical beliefs. Doing so puts the patient at risk, and ignores her oath.

I feel that the pharmacist is doing the same thing by refusing to fill a legal script. If it is a questionable script, fine, don't fill it. If you don't stock the med, fine; help me find it. If there is a mistake (and God knows they catch enough of those!) in dosage or a problem with conflicting meds, then fine.

If your morals endanger me or mine, then there is a problem. I know that not all scripts are life and death like the analogy with the nurse, but it could be, and the pharmacist has no right to ask, or to question my moral choices. They have a right to their beliefs, but they don't have the right to ignore mine, or to impose their ethical beliefs on me.

Thanks again. This has helped me see more than one side of this issue, and even though I haven't changed sides here, I feel like I have learned things in this discussion.

Kwea
 

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Posted by Alucard... (Member # 4924) on :
 
Thanks Kwea, I feel much better now. Keep in mind how busy a community pharmacy can be and how often I have to shoulder the burden of frustrated customers yelling, ranting and raving. I took offense to your comments because they brought back some bad memories.

I used to work in inner-city Chicago. I have been spit on, spit at, have had things thrown at me, had death threats, bomb threats, my car keyed, robbed, and called the police more times than I can remember. I have seen and done it all, and I would not change a thing.

But all things being said, I agree with you on much more than I disagree on, and you seem like a very nice guy, which is what I have come to expect from the good people along the river. Thanks for taking the time to respond.

I do have to say that all day at work, I have viewed things in a new light, and I have taken all the concerns and arguments to heart. I hope they make me a better pharmacist.

What is really strange is that I am working in another store tomorrow, and the pharmacist working there (who is also filling in) found a prescription for Plan B, which is one brand name of the morning after pill. Catchy huh? But more to the point, she asked me if she should order it, because she was unsure as to whether it had been ordered already.

But how I answered her is another story for another time...
 

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Posted by Jutsa Notha Name (Member # 4485) on :
 

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Maybe I could run for public office and avoid all the scrutiny?

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That seems to be the only sure way around it nowadays.
 

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Posted by JenniK (Member # 3939) on :
 
OK I haven't read the entire thread yet, but I have 2 perspectives here to view this from:

1. I am a woman and i take birth control. The main reason is to help prevent the agonizing "super witch cramps from HELL" that come along (in my case) with the whole being a woman thing. The added bonus is that I most likely will not have an unplanned pregnancy. Without the pill, I had days where all I could do was curl up in a ball and cry because it hurt so much. This prevented me from going to school and has in the past prevented me from going to work. As I work in a pharmacy, with women pharmacists, they understood my predicament.

2. I am a pharmacy technician for a pharmacy chain. I enjoy my job because I enjoy being able to help people to feel better when they are sick or in pain. Luckily the women I work with are great ladies who are very good at what they do. They are also very sympathetic to their patients' needs. Deb, the Pharmacy Manager has always taken time out to hear out people s problems and understand why they were given prescriptions for things. If she has a problem with the way a script was written,she calls the Dr. for verification or clarification. Yes, some Dr.s have been jerks and said things like "just fill it!" I have been there to hear her tell one Dr. "the dosage you prescribed is potentially lethal, do you still want me to fill it as written? " I have also heard things like this: " the drug you prescribed is no longer on the market, is there something else that you would prescribe?" Liz, another pharmacist, has problems with what she calls "sketchy" scripts. She always checks with the Dr when she has a question... and has caught a person who stole a narcotics script pad and was writing himself scripts for Oxycontin ( a med for severe pain usually associated with terminal cancer patients, etc. , that has become worse than cocaine and heroine when used improperly). Just last night we had a problem with a patient who was taking more than twice the prescribed dosage of a med. Liz refused to fill it and told the patient that it may actually be making the patient feel worse and that she should contact her doctor to tell the doctor the reason it wasn't filled, if the doctor had a problem they could call and talk to Liz. This is the way pharmacies s are supposed to work...to do what is in the best interest of the patient's health by working with the doctor and the patient.

When a privately owned pharmacy has a problem with filling a particular med they can simply not order it so that it is not in stock, however ethically, in my mind, they should refer the patient to a pharmacy where the product can be obtained. As should any doctor who refuses to fill a legal script especially when it is something the person has been taking previous to the renewal request. If they feel it is immoral , they should refer the patient to another doctor, especially if they know that the patient is taking it for medical reasons and not for birth control.

As for ludosti's comment about not waiting to refill a script, some insurance companies will not allow refills until one or two days before the refill is due (usually a 28 day supply with birth control). Most insurance companies will not cover a refill until 26 or 27 days have gone by since it was last filled, so you would have to pay full price instead of a co-pay. God forbid u go on vacation and run out of a med... you can't fill it before you leave.. you have to take it with you to another pharmacy and have it transfered... then transfered back when you go home.... unless of course you are leaving the country then you can get an override, but usually at a higher cost than what your normal co-pay is! (military personnel it's even worse...you don't want to know the red tape to get a script filled early if you are activated and sent overseas!)
I have a problem with people who want to decide what is best for me for me. I believe that my doctor should (if they are any good) explain to me all the risks involved with medication...such as why you should not take Ortho tri-cyclen (or similar birth control pills) if you have a history of migraine headaches as the higher hormone levels can cause migraine. Then, together, WE decide the best course of treatment.

Those are my rambling thoughts on this particular topic any questions?
 

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Posted by Jutsa Notha Name (Member # 4485) on :
 

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OK I haven't read the entire thread yet...

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Careful, you could get flamed for that.
 

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Posted by JenniK (Member # 3939) on :
 
Just a few comment s upon reading further....

Speed..where did you get the idea that all pharmacy students who graduate have to be a Dr of Pharmacy?? Yes it is a 6 year course, but, in Massachusetts and Connecticut, you then have 5 weeks before you are allowed to take the State boards (to verify that you did indeed graduate and pass required courses). Then you get a nice Registered Pharmacist title (RPH) That is the 6 year degree. It is yet more schooling to get your "Pharm D" or Dr of pharmacy degree. I work with someone who has just graduated from pharmacy school and is soon to take the boards, and I have also worked with a Pharm D (an overachiever who is also a nationally registered EMT and an Registered nurse practitioner...so he can write the scripts that he then fills for patients!)
I think Kwea has been trying to explain his thoughts and somewhere along the line they were misinterpreted. I agree with Allucard..there have been people who rant and rave and act like fools (for lack of a worse adjective), but we do still fill their scripts if they are written properly and do not conflict with other meds or present a possible allergic reaction. We grumble behind the counter and fill the stupid thing just so they will stop staring at us and go away, but we do fill them.

You have to love this "fun with pharmaceuticals" topic don't ya?

.....oh yeah...at the chain that I work for, if a pharmacist refused to fill a legal script for ethical/moral reasons, and a customer complained (which I would do if it were me), they would be written up and told that they will fill such legal scripts in the future if they did not pose a threat to the life of the patient... (the patient is considered to be the person whose name appears on the script.. therefore the pharmacist should not assume that the patient is the fetus). If they did not comply, they would be asked to seek employment opportunities elsewhere.

[ July 10, 2004, 08:39 PM: Message edited by: JenniK ]
 

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Posted by Speed (Member # 5162) on :
 
The R.Ph. is the name of the license. The Pharm. D. is the name of the degree you get from the school. Up until a year or two ago, some schools allowed you a choice between a B.S. in Pharmacy and a Pharm. D, although many schools were only offering a Pharm. D. Now as far as I know they're all mandated to offer only the Pharm. D, although if you know a school that is still offering a B.S., post a link and I'll retract my statement. Anyway, you can have a degree without having a license, although it would be kind of pointless, but you can't have a license without having one of those two degrees. Either degree gives the exact same license, but some jobs will consider a Pharm D more qualified than a BS. I don't know of any retail setting in which it makes any difference. Most younger pharmacists now do have Pharm Ds and the proportion will obviously increase until it reaches 100% several decades from now.

Back to my stand... I wasn't saying that certain chains might not legitimately fire a person for doing what was mentioned at the beginning of this thread. I never said I would refuse to fill such a prescription. I never said that I wouldn't consider a person that did it a complete and utter bastard. All I said was that pharmacists have, at this point, a legal right to exercise their moral principles (as long as doing so isn't an immediate threat to a patient's life), and there is no purely legal mandate for a pharmacist to fill any non-life-threatening prescription if they don't feel like it. Of course, there are plenty of things that people are legally entitled to do that they still shouldn't do, and you won't hear me saying that this isn't one of them. It's a limited statement that I made... don't read anything into it that isn't there.

[edit: although I don't support the idea of a pharmacist doing something like this, I do support the fact that the law gives a pharmacist discretion. Pharmacists have more training, responsibility, and subequent liability, than most people realize. There's no way to deal with this responsibility without being able to selectively refuse or delay to fill a prescription if they honestly believe it is a mistake. I hope pharmacists don't misuse their discretion in this way, and I honestly don't think any more than a negligable few ever will, but I don't believe we can take away their right to use discretion for fear that they might.]

Dangit, I used another post. This landmark is coming up way too fast. Kirk out.

[ July 11, 2004, 01:11 AM: Message edited by: Speed ]
 

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Posted by Kwea (Member # 2199) on :
 
My understanding of the law was that they are allowed to refuse any script that could cause damage to the patient, or complications due to drug interactions. Also one that the dosage is off, or one where they think there might have been an error, or that they can't read, or even one that isn't filled out correctly.

Also, the have the right to refuse to fill any script that they feel is fraudulent, or might have been altered.

I might be wrong, though. I haven't looked up the laws. I think I will mention this conversations to my pharmacists and get their impressions again. Maybe talk to more than one at a time. Should be very interesting.

I did mention some of the arguments to them in passing, but they were busy so I didn't go in depth...

Jenni works with several people who have just graduated from pharm school, and none of them have a pharm D. According to the one person she knows has it, it involves more schooling, and different courses on top of the regular pharm lic.

Could be wrong, or she might have misinterpreted, but they talked about it in depth a while ago, when she had to pass her test/certification as a pharm tech.

Kwea
 

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Posted by Mabus (Member # 6320) on :
 

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I agree with Mabus that incidents like this are what will make the Pro-Life position a lost cause, for possibly similar reasons (or not). Claiming to fight for (a) life at the expense of another's (well-being or life in general) is not really fighting a just battle to begin with, and doomed to failure or self-destruction. That's pretty much the nit and the grit of why this "grass roots movement" is utterly full of horse manure.

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Science supports that fact that all races are human. It doesn't support ANY theory on when life begins. There is a huge difference between the two, and I am sick of pro-lifers trying to equate themselves with the civil rights movement when the parallels aren't really that close.

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It goes back to my opinion on public morality vs private morality. I have the right to think whatever I want, but when it comes to pushing those morals onto others, I am very hesitant to do so. I don't have that right, IMO, unless it directly affects me. If it was my child, then i can say whatever I want. Otherwise......

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That's exactly what slaveholders used to say. If you don't like slavery, don't own slaves. Let us live according to our morality. Sometimes you can't let others live according to their morality and be a moral person yourself. Very few people committing systematic evil think they are being immoral. Most think they are living according to their private morality.

Dagonee

[ July 11, 2004, 08:50 AM: Message edited by: Dagonee ]
 

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Posted by Kwea (Member # 2199) on :
 
9 months later you can arrest me if you like. If you stop the mothers heart, no baby. They aren't separate or discrete entities until they leave the womb.

Thank you for pointing that out.
It's more that a process has begun that will result in a human being born.

Unless slaves were living in symbiosis and I am unaware of it, it isn't the same thing at all.

Not that there aren't parallels, but there is a difference between owning an individual person and and forcing a woman to sacrifice her health and wellbeing.

Also, science did prove that other races were people, as common sense had shown people for years. Science has proven no such thing in regard to unborn children, nor does it look to do so any time in the near future.

It comes down to choices. In most cases, not just abortion, I believe that individuals should have the right to decide for themselves what is the proper course of action. What is right for me may not be the same for you; but that doesn't give you the right to force me to do what you want me to, usually.

And yes, I know we live in a society with rules, and compromise all the time. That "argument" gets as old as the slavery allusions, only faster. I'm talking about the right to choose, without intimidation tactics being used, about having a right to have your own morals and ethics. We have no clear consensus abut these issues, unlike murder or rape. That is why it is a personal decision.

Kwea

[ July 11, 2004, 09:04 AM: Message edited by: Kwea ]
 

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Posted by Dagonee (Member # 5818) on :
 
We had no clear consensus on slavery or the Civil Rights movement, either.
 

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Posted by Kwea (Member # 2199) on :
 
Big differences though Dag.

People that can live on their own,breathe on their own.

Vs single cell live that isn't viable without a host.

I'll get you a microscope so you can see the difference...

Wait, you don't need one...

Kwea
 

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Posted by Dagonee (Member # 5818) on :
 
A newborn can't live without having EVERYTHING provided for it by someone else. The only difference is that more than one person can do the providing.

Dagonee
 

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Posted by Kwea (Member # 2199) on :
 
And that someone other than the mother can do it.

It has it's own lung power, it's own circulatory system active at that point. It lives on it's own, so we are obligated to allow it to continue to live.

Once again, pointing out the differences.

Enough of this, I guess... we are repeating ourselves again..

Kwea

[ July 11, 2004, 09:59 AM: Message edited by: Kwea ]
 

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Posted by Dagonee (Member # 5818) on :
 

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It has it's own lung power, it's own circulatory system active at that point. It lives on it's own, so we are obligated to allow it to continue to live.

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In your world there would be none for the 10 months before birth, merely because you think a embryo should have greater rights than the mother.

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Jutsa...can you explain? I honestly don't comprehend why someone would think this. I see the end coming, but I can't figure out what it is that makes us so despicable in the eyes of pro-choicers. No one except a few racists looks at the civil rights movement this way, and all we've done are the same things they did. How are we saying anything should be done at the expense of someone's life?

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Well, as a general and non-specific movement, your general "we" are not. However, in ways that specific movements, much like this "grass roots" movement by pharmacists and doctors (a few hundred total at this point, according to the article?), are very much insisting it be done at the expense of someone's quality of life, at the very least.

Of course, to those who are ardently pro-life, that just seems a small price to pay for these poor babies who never had a chance.

However, that's really the point of using the "racists" accusation to begin with, right? Funny, someone else got all ingignant and insulted when they believed I was making such an accusation (even though I wasn't). I won't bother pointing out the hypocrisy of it. Instead, I'll reply by pointing out that militant fundementalist groups also believe that they are fighting for the greater good.

See? We can always demonize those things we disagree with to make ourselves feel better. It makes us believe we are truly more righteous to begin with. And before you (or someone else ) decides to claim I did it first, I'll be happy to inform you that all I mentioned were ideological extremes, of which such demonizing is a perfect example of, and which you have so perfectly demonstrated.

That's the problem with extremes, and that's the problem with both extremes on issues like abortion to begin with. The Pro-Life camp is, to date, far more extreme with its position in organizational form, even if not in general form. That constant propensity towards extremes is, ultimately, why the Pro-Life movement is doomed to obsolescence, whether abortion is right or not.
 

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Posted by Dagonee (Member # 5818) on :
 
*wants everyone to notice how much I'm behaving myself*
 

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Posted by JenniK (Member # 3939) on :
 
just to make a small point about the difference between fetus vs. slavery and how they are different..... the slaves were already born, living, breathing, moving, working, speaking,individuals and therefore, considered, by some (primarily in the north) to be human "endowed by God with certain inalienable rights".

Not to say that I personally could ever have an abortion, but that is my decision, my personal beliefs and values have made it impossible for me to consider such a course of action. My cousin, however, was 13 when she was kidnapped, drugged, beaten, and raped repeatedly before being left for dead in the woods. Luckily an off duty police officer found her while hiking and saved her life. She went through every test imaginable, and is now terrified of Dr's, but was more terrified of having the child of a murderer. (he had a newspaper clipping in his wallet [when found] of a girl from Wisconsin matching my cousin's description with the same M.O., found dead in the woods, and is now serving a 120 year sentence without the possibility of parole because my then 14 year old cousin testified against him) It took years for her to heal enough emotionally to consider marriage,let alone consider having children, so a Dr. or Pharmacist that won't write or fill a script for birth control could potentially cause her severe emotional/mental harm. Would that be in the best interest of the patient?

Just a new twist to throw in. For a sense of perspective my cousin is 3 months younger than I am and I was not allowed to know the details of what had happened until after she testified in Massachusetts and Wisconsin. She still, at the age of 29, cries for days before she has a Dr. or dentist appointment and has to be given a mild sedative before each appointment.

[ July 12, 2004, 12:34 AM: Message edited by: JenniK ]
 

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Posted by Kwea (Member # 2199) on :
 
I can't post now!
 

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Posted by Kwea (Member # 2199) on :
 
Dag, my point was that the same thing you said. Only the mother has the ability to care for the child, because the process of becoming a complete, self-sustaining human being hasn't occurred yet.

A child needs care for years, but they are much further along the path toward the end....and the line has to be drawn somewhere.

Right now, the best compromise we have been able to come up with is that a child is human when it is born...out of the womb for good, even if it is very early.

Until then they are potential individuals, locked in a symbiotic relationship with the mother.

At least that is what the arguments for pro-life are. I am not really sure what to believe, but I know that forcing others to give birth to babies they don't want or can't raise is not a viable option. Forcing a woman to abide by my beliefs, even when I am not sure when life begins, is wrong, and violates everything I believe in about individual freedoms and rights.

Well, I know there have been many threads about abortion here on Hatrack, and if you were to look through every one you would never, ever find my name on a post in one of them. I avoid them because they are so polarized that most people in them become angry, and an opinion is rarely changed. I don't really want to participate any further in this conversation now that it has morphed into yet another abortion thread.

However I do appreciate the tone since we "changed" topics...no one has gotten flamed, at least about this part of it...lol.

Tullan, you were closer to on-topic than we have been lately! Thanks for the info, but that isn't what the pharmacists told JenniK when she asked about it. Maybe it is different here in MA< or perhaps this represents changes in curriculum that they were unaware of at the time of her conversation.

My points, a few pages back, I think:D, were more about the differences between Md's and Pharmacists, particularly in the differences from a patient perspective. I know that there are specialties in pharmacy as there are in other branches of the medical field, and i respect the job they do. However, it is a different job than a MD has, even if there is quite a bit of overlap in practice.

Hell, I have trouble remembering to take a vitamin every night...

Kwea
 

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Posted by Kwea (Member # 2199) on :
 
That was weird, I couldn't post that for a while...had to remove a set of parenthcies...lol...
 

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Posted by Mabus (Member # 6320) on :
 
Jutsa, thank you for your thoughts. It seems to me that a lot of the extremism among pro-lifers is more desperation than anything else, but what can I say? I'm not all that involved.

Kwea, earlier I was too annoyed to notice that you kept repeating that "the mother is the patient, not the child". Can you explain why the distinction is necessary? Don't people have obligations to each other aside from their professional relationships? I barely know you, but I hope I'd try to save your life if you needed it.

And I apologize if I have angered or annoyed you. I have strong feelings about this, and I know you do too. I just don't understand a moral universe where killing babies, born or not, is morally acceptable and preventing it isn't.
 

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Posted by ssywak (Member # 807) on :
 
This discussion has gone so far afield, I just want to make sure that I haven't missed something...

The article that started this whole thread was not about abortion, not even about the controversial Morning After Pill ("MAP"). It was about birth control pills. As far as I know, birth control pills are not abotifacients; they prevent fertilization--they do not stop it after it has happened.

I just don't get why this should even be a controversial topic. It's just birth control, plain and simple (not as plain and simple as other methods, but it is a pre-conception control). Is the pharmacist going to stop selling condoms next?

I have always felt that if one is going to "make a case" to fight post-conception birth control (abortions, the Morning After Pill, and similar abortifacient medications), then one had damn well better support pre-conception birth control, where nobody gets "hurt" (and yes, I understand that the Pill is not without its medical dangers).

Unless its just some masked desire to force more babies into this world...in particular, more babies of certain religions.
 

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Posted by WasabiTurtle (Member # 6691) on :
 
Whoo boy...my first post and it's in a doozy of a thread. Let's see if I do this correctly...

I don't think it's been touched on in this particular thread, but I'd like to bring up the FDA Plan B approval debates. In short, the drug, aka the morning after pill, was prevented from being sold OTC because there wasn't enough research, in the minds of some doctors, done on how this drug effects children of 12-14. Once this research was done, implied the FDA, Plan B would be a-okay.

The problem, if anyone followed the debates, was that the FDA advisory boards decided that Plan B was safe enough to be sold OTC. The squall about preteens and young teenagers was manufactured to cover an ultimately political move by the FDA: Bush is against abortion and the FDA is, for all intents and purposes, following his wishes against that of its own advisory committees. I remember reading that this was one of the first, if not the first, time that the FDA had gone so blatantly against its own review.

We now have an uncomfortable precedent in the government. When the administration doesn't like the science, the scientists are replaced, occasionally with political pundits. (Witness the replacing of a respected and well-published cell biologist with a political science professor on a stem cell committee).

If the precedent is set at the highest level that science can take a back seat to personal preference, is it any suprise that vigilante medicine is beginning to come to bear?
 

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Posted by zgator (Member # 3833) on :
 
Since there's not much more I could add to the main topic at this point, I wondered if anyone else noticed this part of the article.

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As for Williams, she got her prescription that day. Desperate--new to her job, she couldn't afford to take off another day without pay--she asked for help from an employee in Jones-Nosacek's office, who told her there was an OB/GYN in the same building. Williams went there directly and asked one of the doctor's assistants to relay her story to the gynecologist. This new doctor wrote her a prescription, no questions asked.

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The article that started this whole thread was not about abortion, not even about the controversial Morning After Pill ("MAP"). It was about birth control pills. As far as I know, birth control pills are not abotifacients; they prevent fertilization--they do not stop it after it has happened.

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The article that started this whole thread was not about abortion, not even about the controversial Morning After Pill ("MAP"). It was about birth control pills. As far as I know, birth control pills are not abotifacients; they prevent fertilization--they do not stop it after it has happened.

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It was the manufacturer of the Pill that brought up prevention of implantation of a fertilized embryo as benefit of the Pill.

The pharmacists who choose not to dispense do so because the possibility is too great in their mind. I've just been arguing that freedom of conscience in general is a good thing.

Were I a pharmacist, I'd have a much better handle on current science of the pill preventing implantation. But I have no need to reach a decision on this. I don't want the Pill banned, I know enough about it to support the decisions made about it for our marriage

Even if it did sometimes prevent implantation, I'd still have to consider whether it stops implantation or generally makes the uterus more hostile to implantation to decide if it was the agent that caused the failure.

All I've been arguing for, given the doubt that seems to exist right now, is for the right of individuals to decide whether they will be part of the dispensing of this medicine.

If physician-assisted suicide were legalized, would you support a pharmacist's right to not dispense medication for ending a life?

Dagonee
 

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Posted by Beaver Dick Leigh (Member # 2174) on :
 
My women ain't takin' no pills. Gotta breed 'em fast and strong iff'n they're gonna survive out here. An' if there's a runty one, all ya gotta do is leave it out for the mountain cats.

'Course my Jenny wouldn't let me do that, and now we got a bunch o' scrawny brats runnin' round the cabin. So's I take my time runnin' the traps. An' let Jenny take care o' her runts by herself.
 

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Posted by Kwea (Member # 2199) on :
 
Mabus, I kept saying that because in some ways, to some people, that is what the whole issue is about.

Some pharmacists would use the argument that the fetus is a patient as well, and that their oath to do no further harm applies to the fetus as well as the mother.

By all legal standards I am aware of, this is false. I also feel it is a cop out.

I feel that we do have responsibilities to each other, far beyond that of legal responsibilities, but I know that defining those responsibilities would result in many different opinions as to what they were...so I'll pass, if you don't mind. I am in enough trouble as it is here...

Most of my argument has been based on the ethical teachings I received as an EMT when i was in the Army. I was taught that the standard towards care of a patient is the largest ethical consideration a medical care provider has to consider. I was taught that it was the patients right and responsibility to determine their own care, and that while I may not agree with their choice I, as a care provider, must honor their choices, providing what they request is legal.

Abortion was provided as the example in this instance, but it carries over to all aspects of the medical profession, not just in that case.

And I was told, repeatedly and by many different instructors, that in a case where there is a conflict between my morals and theirs, their opinion/choice was always the one that was more important...once again providing what they wanted was legal.

It is the same thing as DNR's (Do Not Resuscitate orders); the medical team is responsible for obeying them because the patient has the supreme responsibility for determining what care will be provided, even if the doctor/staff feel they know better.

If your ethics prevent/interfere with a patients right to choose treatment plans, then you need a new field.

I believe that their obligation to their patients should be the foremost o their minds, and if they refused to fill the script it wouldn't be. They would be more concerned with their morals than in assisting their patients, which would be a very dangerous precedent.

In practice, Dag and I have almost the same view on the practicality of these pills, and probably on abortion as well...at least in our own lives. I feel that since the companies made claims that they can't prove they have made themselves targets on this issue, and feel it is fair to discuss this now.

WasabiTurtle: Decent first post. Looks like you read the thread, and didn't just jump in and start blabbing like some newbies(no poke at anyone specific intended here)....great to meet you!
You're braver than I was, that's for sure!
See ya around!

Kwea

[ July 12, 2004, 11:32 PM: Message edited by: Kwea ]
 

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Posted by Mabus (Member # 6320) on :
 
I guess from that perspective your position makes sense, Kwea. OTOH, that now means I have issues with the whole medical profession. I guess it's a good thing I didn't go into med school after all.

I don't so much see a doctor (or other health care professional) as even having specific patients, or a quid pro quo relationship for treatment. A doctor gets paid (to me) not for a specific service to a specific person, but so that he can stay alive to heal people in general. By being a doctor, he's just fulfilling his general obligation to help people in the way best suited to his talents.

So since there's no specific patient, he has only the moral obligation to help those he sees need help--including a patient's fetus or embryo, if he knows it exists. I suppose this would put me at odds with most of the profession, so I guess that's a bullet dodged.

Anyway, I suppose I should say that I changed my mind about the specific pharmacist in question. Unless and until it were proven that the pill really does act as an abortifacent, this kind of scenario falls under the "disputable matters" Paul mentions in Corinthians (or maybe Romans) as something you're not supposed to impose on others.
 

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Posted by Jutsa Notha Name (Member # 4485) on :
 

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Jutsa, thank you for your thoughts. It seems to me that a lot of the extremism among pro-lifers is more desperation than anything else, but what can I say? I'm not all that involved.

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I understand. As someone who has no sexual life to speak of currently and not planning to go out and get one, I can say I don't have that much involvement on the personal level as well.

I agree about some of the extreme behaviors. On both sides. I'm also glad you didn't immediately assume I was insulting you with my example, because I wasn't. It makes for very pleasant discourse this way.

With regard to the issue discussed in the article, the question about contraceptive being a useful abortive is why I am mostly appalled at these otherwise educated people behaving this way. I could understand if there were more to go on with their assumptions, but there isn't. Which makes this behavior highly extreme on their part, and ethical issues aside, it does little to help the Pro-Life stand anyway. As for the issue on Pro-Life versus Pro-Choice, I think that I can accept our different views as something that each of us is pretty much resolute in, and I promise not to make you have an abortion if you promise to not take away my condoms (bad analogy, I know).
 

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Posted by Kwea (Member # 2199) on :
 

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I promise not to make you have an abortion if you promise to not take away my condoms (bad analogy, I know).

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If your ethics prevent/interfere with a patients right to choose treatment plans, then you need a new field.

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She's not crazy, she's manipulative. She doesn't want to deal with life, so she gets high on legal drugs. She enjoys the manic part and dopes up during the downs.

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I promise not to make you have an abortion if you promise to not take away my condoms (bad analogy, I know).

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It was the manufacturer of the Pill that brought up prevention of implantation of a fertilized embryo as benefit of the Pill.

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Fertilized embryo? Well, I guess. I would have called it an cellularly-undifferentiated blastocyst. If that.

Next step: masturbation and periods become illegal.

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ssywak, even if you don't agree with the distinction being made, please don't pretend it's not self-consistent. There are clear, logical reasons for choosing conception as the point where life begins, and there's a clear distinction between a zygote and a gamete.

Dagonee

[ July 13, 2004, 02:24 PM: Message edited by: Dagonee ]
 

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Posted by Katarain (Member # 6659) on :
 
Wow, what a long thread! I wanted to read the whole thing so I would be sure not to repeat anything already said. (It's clear from reading the posts that I made the right decision. )

After reading that article, I was in shock. My taking birth control pills can be compared to having an abortion?? After reading several of the posts here, I see that it's not all that cut and dried. Maybe they do, maybe they don't.

The issue, though, is an important one to me, and I would have appreciated it if my doctor had mentioned the possibility to me. I'm very pro-life for myself personally--although I do believe in pro-choice in many instances--more on that later.

When I got the prescription, I wasn't sexually active, but since then, I've gotten married. I got the prescription for PCOS symptoms. I would have been mortified if my pharmacist had refused to fill the prescription. There I was a virgin, standing in a brightly lit drugstore, completely red-faced because I didn't want anyone to think I was sexually active. (And I was 25 at the time!) Don't get me wrong, I was proud of my decision to wait for sex until marriage, but it isn't something I wanted to discuss with my pharmacist in a not-very-private setting. I don't care if we live in a world where sex is no big deal.

But even that isn't the issue I take with pharmacists refusing to fill the prescription. I think several people (MrsM, especially) have made excellent points about when it is unethical NOT to fill a prescription. I am not in that situation. I could easily go down the road to another pharmacy. My issue is with the groups who want to make it illegal for Birth Control Pills to be prescribed at all! I realize that is a very small group, but obviously it is catching on with enough doctors and pharmacists to begin having an effect on the real world. I agree that illegalization is not very likely at all, but that doesn't mean we should just sit idly by while it happens a little at a time.

As for abortion, personally, I'm against it. The thought that taking birth control pills for the last 8 months that I've been married could have caused an abortion in me is sickening. I have dreams sometimes about having my own children--and the thought that I could have lost one or more makes me very sad. Having said that, though, I'm not willing to stop taking the pills because the chance is so very slim. Taking them now, according to my doctor, could very well increase the likelihood that I would even be ABLE to get pregnant later.

I am against a flat-out abortion ban, however. There are many medical and ethical reasons to allow abortions. While I would hope that all abortions are completely necessary, I don't believe it is right for the law to take much of a role in that decision. That's a behind-closed-doors doctor/patient thing--I just hope, again with the hoping!, that the patient is well-informed of their options and the effects of their choice.

Partial-Birth Abortion, however, is blatantly evil! Disagree if you want, but I think it's ridiculous to make a distinction of life for a few inches. Oh, the head is still in the mother's body, if we just inject something here, or suck something here, it's an abortion and not murder. Give me a break! That baby could live and function just like a normal baby outside of the womb. I wasn't aware that Bush had signed a ban on partial-birth abortion, but if he really did, then I'm very pleased.

So, my response to the article:

1. My doctor should have brought up the issue of the possibility of some sort of abortion, and the science behind it either way.

2. I would have been mortified to have my pharmacist refuse to fill the prescription in a public place. (Those mini-walls aren't enough for privacy--you can hear everything just being a few feet away waiting for your own prescription.)

3. We have to be careful that this doesn't turn into an illegalization of BCP, a very unlikely, but seemingly wanted result from Anti-BCP activists.

The abortion rant is just my response to the thread here.

Is that enough new comment??

[ July 13, 2004, 04:50 PM: Message edited by: Katarain ]
 

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Posted by Katarain (Member # 6659) on :
 
Just found this article... most of this (if not all) was already said, but it's nice to have it in "official" article form... (After all, if it's in print, it MUST be true... )
The Post-Fertilization Effect: Fact or Fiction

[ July 13, 2004, 05:12 PM: Message edited by: Katarain ]
 

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Posted by Suneun (Member # 3247) on :
 
Dagonee: Embryo is... "In humans, the prefetal product of conception from implantation through the eighth week of development." Dictionary.com

There exists a broader definition of embryo, but that's like calling a plum a vegetable. Embryo is used medically and should be used in this conversation as its medical term. That means from implantation to 8 weeks, roughly from week 1 to week 8 not week 0 to week 8.
 

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Posted by Suneun (Member # 3247) on :
 
not to confuse anyone, but when I wrote "week 1" I meant starting day 7'ish, so after one week. Counting all funny, you see.
 

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Posted by Dagonee (Member # 5818) on :
 
Good to know. I guess I mean zygote. It changes the argument not at all. Although I note there are other definitions in the same dictionary that meet the specifics of my usage.

Dagonee
 

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Posted by ssywak (Member # 807) on :
 
Thanks, Katarain.

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[even in women not taking "The Pill"] fertilized eggs fail to implant 40 to 60 percent of the time

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Consensus comes from a surprising source. "The post-fertilization effect was purely a speculation that became truth by repetition," says Joe DeCook, MD, a retired OB/GYN and vice president of the American Association of Pro-Life Obstetricians and Gynecologists. "In our group the feelings are split. We say it should be each doctor's own decision, because there is no proof."

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Further, if I own a store which sells items A-Z, and person 1 says he is morally opposed to item J, don't I have the right to hire him with the understanding he won't be asked to sell item J? (emphasis mine)

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Aye, but there's the rub.

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In practice, the store would not be selling that item during those times, as the only person allowed to sell them by would be the person who is objecting.

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The most authoritative guidance for pharmacists in meeting their responsibilities for dispensing controlled substances is provided by the federal Drug Enforcement Administration (DEA). In a DEA regulation often referred to as the "Corresponding Responsibility Rule," the agency instructs pharmacists as to their expected conduct. The DEA distinguishes clearly between a prescription and a purported prescription. A prescription is an order for medication that has been issued for a legitimate medical purpose by an authorized prescriber who is acting in the usual course of professional practice. Thus, a prescription must be issued for therapeutic reasons: to diagnose, cure, ameliorate, treat, or prevent disease. Orders issued for other reasons, such as the support of addictive habits, are not prescriptions-they are purported prescriptions. The most important aspect of this regulation makes it unlawful for a pharmacist to knowingly fill a purported prescription. An innocent filling of a purported prescription by a pharmacist who could not know that the order is not legitimate does not violate the regulation.

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Patients who bring legally valid and therapeutically appropriate prescriptions to their pharmacy expect to have them filled. They do not expect to be left to the whim of a pharmacist who decides on an ad hoc basis whether to fill their prescriptions. The pharmacist who decided to refuse filling of a legally valid and therapeutically appropriate prescription would be held liable for harm to the patient under a patient expectation model of professional standards.

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Pharmacists have many difficult responsibilities in their professional capacity as gatekeeper over the nation's drug supply. They must ensure that prescriptions are legally valid and that they are therapeutically appropriate. In addition, they must ensure that patients receive medications they have a right to receive. Pharmacists who fail in any of these responsibilities may discover that there are legal consequences for that failure.

Dr. Brushwood is Professor of Pharmacy Health Care Administration at the University of Florida, Gainesville, Florida.

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Does a pharmacist, when presented with a valid prescription for a drug that is to be used in a treatment that is in conflict with personal beliefs, have the right to refuse to dispense the drug? What duty does the pharmacist have to the patient in this situation?

Pharmacies are privy to extremely sensitive information that, many times, is accessible only to other members of the healthcare team. Sharing this type of information puts the patient in a vulnerable position and it is the duty of the pharmacist and other healthcare team members, to only use this information for the benefit of the patient. The patient must trust in the pharmacist's belief of nonmaleficence so that they feel comfortable sharing such personal information. Patients trust in pharmacists to be the drug experts of the healthcare team, to provide information that they, as laypersons, do not know. They trust that the pharmacist will justly distribute this information to them as part of their healthcare, understanding that the pharmacist's vast knowledge is intended to be used to improve health. Patients trust that pharmacists will ensure that the pharmaceutical care that is provided to them will not harm them unnecessarily. A pharmacist has a duty to refuse to fill a prescription if, in the pharmacist's professional judgement, filling it as written will cause unnecessary harm to the patient. This includes if the physician made an error in the strength or dosage, if a drug interaction is possible, or if it seems, in the pharmacist's judgement, that the prescription was obtained illegally. However, more is expected of the pharmacist than just to monitor and correct technical errors of prescriptions. Patients expect pharmacists to use professional judgement to make sound, objective, and factual decisions that affect healthcare outcomes and to provide that care without personal judgement of the patient. The trust that patients put in pharmacists is similar to the trust they have in family and close friends. It is given with the expectation that the pharmacist knows that the patient is capable of understanding what healthcare options are available, what information is revealed to the pharmacist, and deciding with whom the information is entrusted. A patient need not divulge everything, but for competent health care, more information is better, and one way to get the necessary information is to develop a trusting relationship. For that trust, the patient expects a degree of loyalty from the pharmacist.

With the access that the pharmacist has to the information regarding the patient, and to preserve the trusting relationship between the patient and the pharmacist, comes the responsibility to fill valid prescriptions. Moral dilemma arises when a pharmacist is presented with a prescription that if filled, will cause harm to the patient. Depending on the situation this apparent moral dilemma may be resolved by the pharmacist gathering more information and developing a more clear understanding of the patient's situation. A genuine moral dilemma exists when the issue cannot be resolved with more information or discussion and the pharmacist feels morally unable to fill the prescription. If the pharmacist fills the prescription, the ethical principle of nonmaleficence is compromised; the pharmacist is knowingly contributing to harming the patient. If the prescription is not filled, it may appear to the pharmacist that the principle of beneficence is being fulfilled, but this may be at the expense of the patient's autonomy. By not filling the prescription using the reason that the pharmacist is preventing harm, the pharmacist assumes the paternalistic role of ``knowing what is best" for the patient. The pharmacist must recall that the trust developed between patient and pharmacist includes the understanding that the patient is capable of making informed decisions regarding health care. The trend in health care is toward empowerment of patients to control their own health care. Autonomy - self-determination - is expressed by freedom of choice based on informed decision-making. Adult human beings are entitled to make choices that affect their lives, even though others may not agree with those choices. Informed consent, the right a patient has to information, provides that the patient have access to the information necessary to make informed decisions. Pharmacists have the duty to help patients make informed decisions by supplying and interpreting information that the patient does not readily have available. The patient then has the obligation to weigh this information, including the risks and benefits, and make a decision. It is critical that the pharmacist determines that the patient has full understanding of the implications of the course of treatment, and once that has been accomplished, there is the expectation that the pharmacist will provide access to the prescribed drug. The pharmacist must have respect for the patient's autonomy. This is not to say that a pharmacist does not have the right to personal beliefs, but provisions must be made to accommodate both the patient's needs and the pharmacist beliefs, without destroying the patient-pharmacist relationship or infringing on the patient's right to treatment

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What are the implications to the patient, the employer, co-workers, the profession of pharmacy, and society?

The patient is entitled to continue the treatment that the physician has initiated.

When a pharmacist takes a job, that employee is obligated to comply with the employer's policies and procedures. It is important that the pharmacist in the job market understand the employer's position on issues that have the potential to conflict with personal values.

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This article does recommend that so-called "consience clauses" should be implimented in most states, and that there is no legal requirment in many states for pharmisicts for full perscriptions. It does also state that refusing to fill them does leave the employer and pharmisicts open to lawsuits though, as well as infringes on the patients right to autonomy, which is considered one of the single most important aspects of patient care.

It also says that North Dakota is the only state that has a law on the books that protects pharmisics right to refuse.

So in other words, we were all right, even though we disagree....

It does say as well that if a pharmisist has a moral objection to fulling certin scripts that they need to be clear to both their employers and patients up front, before such treatment is requested.

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When such personal and volatile issues occur without notice in the workplace, people are caught off guard. The tendency is for co-workers to examine the moral beliefs of the pharmacist making the moral decision as well as their own. While this can be enlightening, the time and place is not particularly conducive to open discussion and finding a resolution to the issue.

The effect on the profession could potentially be negative, due to the perception of lack of support by professional organizations. Society has expectations of healthcare workers as professionals, including that there be guidelines by which members of the profession abide.

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This means that if a pharmacist does not morally agree with the course of treatment, there is a need to refer the patient to another pharmacist. There may be pharmacists that feel that the act of referring makes them a participant in a procedure that they are morally against. It would appear that this is where a patient or employer would have the most leverage legally. Pharmacists have a duty to provide access to drugs to people who need them. If there is a technical problem with a prescription, or if the pharmacist must make a professional judgement to refuse to dispense, it is the expectation that the physician be contacted. The same applies when a pharmacist is faced with making a moral decision. If nothing else, the physician should be contacted; preferably, the pharmacist will refer the patient to another pharmacist.

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I didn't see any of us name-calling here, but if you want to bow out go ahead and do so. I did for a while, but came back because this has been a good conversation...IMO.

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Both situations happen, Mabus....they don't cancel out each other.

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In most cases of abortion the fetus isn't viable...I know a lot of the examples here say otherwise, but most abortions done are early-term abortions where the fetus can't survive outside the womb. Not late term, those are much rarer(and a whole different kettle of fish).

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But if both parties can survive, and one is killed for the convenience--or, within limits, even the health--of the other, I can't imagine that being ethical.

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That was what I refering to, where you said that both could survive. In most cases they can't both survive; the fetus can't survive without the mother, as it isn't complete yet...no lungs, insuficient cirulatory system...often times so early that nothing has developed at all, not in any reconizable way.

It's funny how I seem to be arguing for abortion here, when I am not...I have already said that I would never wish for that, unless there was no other alternitive. I feel that it wouldn't even be an option we would consider.

I just don't think it is as clear-cut as people wish it was. I don't believe that I have the right to force another human to carry their pregnancy to term, and there seems to be such confusion in reguards to when life begins that I wouldn't presume to know what is best for others to do.

If life begins at conception, how may "humans" have been thrown in the washer, or flushed down toilets without us even knowing about it. Do we have a moral responsibility to find them when this happens naturaly and surgicaly implant them ourselves?

A two celled organism isn't human, even if it contains human DNA...It will become human, that is what makes it so difficult to deal with. Abortion eliminates the potential for a human to live, and that is a terrible thing in and of itself.

I will let this thread die now. I don't think we really are that far apart in what we personaly believe, Mabus. Where we differ is who has the majority of rights, a human who is mobile and self-aware, or a fetus who may or may not be aware, depending on it's age.

I don't really want to talk about this any more.....see you around, maybe in a nice fluff thread next time....

Kwea
 

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Posted by ak (Member # 90) on :
 
The question here (to put it in LDS terms) is whose stewardship this decision falls under. When the doctor and patient between them have decided the pill is the best option for the patient's needs, does the pharmacist have stewardship over that decision? Or should the pharmacist sustain the doctor and patient in their own stewardships? I obviously think that to do anything else is to violate free agency and attempt to usurp the right to make moral choices for others.
 

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Posted by Kwea (Member # 2199) on :
 
Well put, ak.
 

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Posted by Alucard... (Member # 4924) on :
 
A quick clarification:

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Speed..where did you get the idea that all pharmacy students who graduate have to be a Dr of Pharmacy?? Yes it is a 6 year course, but, in Massachusetts and Connecticut, you then have 5 weeks before you are allowed to take the State boards (to verify that you did indeed graduate and pass required courses). Then you get a nice Registered Pharmacist title (RPH) That is the 6 year degree. It is yet more schooling to get your "Pharm D" or Dr of pharmacy degree.

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quote:

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Back to the issue of whether the Pill causes a fertilized egg to not implant. Not only are there no studies on this issues, how on earth would such a study be conducted? Can you imagine women being willing to ONLY take the Pill in the narrow window between fertilization and implantation? Even if some were, how on earth would this window even be determined?

On this subject, PSI said:

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Does there need to be a study to prove this? We have proof that progestin works the way it does, and no one disputes that. The only dispute is over whether the lack of lining affects implantation. It seems like the answer to that would be "duh", since many women suffer from the inability to get pregnant precisely because their uterus doesn't form a sufficient lining.
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The research I have seen speculates that some women have difficulty getting pregnant because of a too-thin endometrial lining. I don't believe that has ever been proven to be a cause of infertility. In many cases of infertility, no conclusive reason can be found, and speculation -- and speculative treatments -- abound.

So, does the Pill keep implantation from occurring? Could be -- but there's not much evidence to support it.

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