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.
posted
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: 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.
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.
PSI also said:
quote: 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.)
First of all, the two reasons that ectopic pregnancies do not result in viable babies are: inability to tap into, via the uterine wall, the maternal circulatory system (and all the nutrients and oxygen); and insufficient space to grow. Oh, and they're not that rare.
Ectopic pregnancies can occur not only in the (unlined) fallopian tubes, but other spots in the abdomen -- places that lack ANY endometrium. How this happens is not well understood. Hoverer, it mostly seems to be a case of a fertilized egg, ready to attach, being in the wrong place. (Blockages or scarring of the fallopian tubes, or an egg escaping into the abdomen, are believed to make this more likely.)
So, does the Pill keep implantation from occurring? Could be -- but there's not much evidence to support it.
quote:Could be -- but there's not much evidence to support it.
Enough for people to behave like they're morally superior and unethical. 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.
I don't provide solutions for customers who pirate software. However, I make it a point before ever talking about doing work for them that I will not provide support for pirated software. There are others who will overlook such things. I'll even tell people that, and leave the choice up to them.
Those who deny a service without expressly stating they deny that service beforehand are behaving unethically. Is that illegal? Not in many cases, and probably not in this one. Does this mean these people are actually behaving morally? As long as being ethically wanting has no bearing on morality, I guess not.
Insert obligatory reference to some fascist or totalitarian movement in the past here.
Posts: 1170 | Registered: Jan 2003
| IP: Logged |
quote: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.
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."
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.
posted
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?
quote: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."
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.
Posts: 1170 | Registered: Jan 2003
| IP: Logged |
posted
Oh, I'm sorry. Was I just supposed to say "we'll just have to agree to disagree here" and leave it at that?
Posts: 1170 | Registered: Jan 2003
| IP: Logged |
quote: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.
The behavior I've been defending is the right of pharmacists to refuse to dispense medication based on their ethical and moral concerns with that medication. I stated my preferred method for that right up front.
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.
quote: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.
It'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.
Posts: 1170 | Registered: Jan 2003
| IP: Logged |
quote:Oh, I'm sorry. Was I just supposed to say "we'll just have to agree to disagree here" and leave it at that?
Actually, I'm beginning to not give a damn what you say. I care what Kwea says, because he's stated an entire position, defended it vigorously, and responded to what's been said in response, not to something he made up because it's easier to refute.
I care what Alucard, Mrs.M, and Rivka (Edit: and BtL, just to show there's no hard feelings over "small things") say for much the same reason. It's clear we understand each other, even though we radically disagree. In fact, we disagree because we start from a very similar premise of "Live and let live." We just define what that means differently.
Actually, pretty much everyone who's participated in this discussion has contributed to the dialog in a constructive fashion. Pretty much.
posted
I think this has been a very interesting conversation, and I am glad that I took part in it. I am sorry that my posts seem to be misquoted, and my position seem so controversial. I didn't change my mind; as Dag said, we were all beginning to repeat ourselves.
Before the personal insults began, that is.
On that note, I will leave this discussion now, as I seem to have lost my taste for it. It isn't nearly as much fun as it was before.
Not that I wasn't serious about what I was saying. I think I understand where some of those pharmacists might be coming from better than before we began this conversation, but I still believe that they are wrong to act the way they did. (read the link...it explains actual events that happened, a little bit)
But this is just too pathetic to worry about anymore.
And to think that I was really looking forward to coming home to read this thread when I was at work.....
quote:Actually, I'm beginning to not give a damn what you say.
Yeah, I don't think I like you, either.
However, the problem with the discussion as it stands is that it continually devolves into semantics and hypotheticals, instead of addressing the realism of the issue as it truly is. The reality is that this is not a hypothetical, this is not a cut-and-dry case of "this is right, this is wrong." The problem with the issue is that, while trying to come up with all avenues of both deriding and defending the case, what actually is right and/or wrong about the actions themselves has been completely and totally separated from the human element from which it was borne.
The fact that these are people who are doing this, under the pretense that they are acting unethically for the sake of other lives, that is ultimately ignored after all the semanticizing is done. It no longer becomes an issue of someone using the same old "ends/means" justification for their actions. It becomes a matter of what jurisdiction the position of pharmacist holds over the realm of medical treatments, as compared to the jusridictional influence of medical doctors. It becomes the completely hypothetical argument over whether birth control is actually an effective abortive or not—something which is not known by experts who study this as a career. Kwea has been the only one here trying to bring it back to tha actual act being done by people as the issue, and it constantly gets broken down into semantics, over and over.
You know what? That is nowhere near sufficient to me. The reason I made the comment about fascist and totalitarian movement is because using semantics and "ends/means" arguments is a method often used in extreme cases of enforced "morality" (which can be relative at times), which is something both sides of the ideological extremes spectrum (totalitarian <--> fascist) tend to embrace. I didn't call anyone "the devil" or compare them with Hitler, I made it clear that all the semanticizing is good for is leading to one of those extremes. Maybe I need to write out such ideas inside of a full thesis, so those who are looking to be immediately offended at any resistance or opposition don't jump the gun.
Somehow, I doubt it. (go ahead and take that the wrong way, too)
So yes, Dag, your semanticizing is, as far as I have seen, just another "I don't think it's right, but" argument. No, you have never said those exact words. I'm sure that, for you (and many others), that is good enough. I'm saying that, to me, it is not. And as a reply, I get "it's already all been said."
Thanks for the consideration. Just like with all abortion, homosexuality, great-taste/less-filling, and religious discussions, I fully expect this to be an endless loop. I, as I am entitled to, am voicing my contempt. 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.
Posts: 1170 | Registered: Jan 2003
| IP: Logged |
posted
Someone posted an article and asked if "this is right," meaning the actions taken by pharmacists in the article.
I said, it's right under these conditions.
You can accuse me of semanticizing all you want. If you don't want to take what I say at face value, I can't force you to. But I can say that you are 100% wrong in your presentation of my viewpoint.
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."
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.
quote: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."
Yes, which is why I mentioned both in my post (fascist and totalitarian). Maybe you should learn to freaking read.
quote: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.
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?
Posts: 1170 | Registered: Jan 2003
| IP: Logged |
posted
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.
quote:I think that I was more concerned with the rights of the patients, while Dag is more concerned with the rights of the pharmisist.
I understand that, and I still feel that too dehumanizing to the situation. It's already pretty clear that barring outstanding circumstances, it's not illegal.
It's still a sh!tty thing to do to another person, even in protest of sh!tty things being done to others. I hear there are other groups out there doing basically that today... nah, I won't even bother going there.
Posts: 1170 | Registered: Jan 2003
| IP: Logged |
quote:Yes, which is why I mentioned both in my post (fascist and totalitarian). Maybe you should learn to freaking read.
What is that supposed to mean? I wans't comparing two authoritarian forms of government. I was stating that the authoritarian form of government might impose the policy you seem to be advocating.
quote: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!"
Maybe give some indication THAT YOU'VE READ THE REST OF THE THREAD. Which is what I originally suggested. I'm sorry I made the assumption you hadn't read it. I was assuming you weren't rude enough to blithely repeat something that had already been answered without even saying mentioning you'd read it.
quote: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.
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.
quote:So good. I don't believe you, you don't believe me. Impasse. What can you do about it?
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.
posted
I've read the thread, and was unsatisfied with the direction. Even after explaining why, it seems I must be lying (according to you).
quote: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.
You really take it personally, don't you? For your information, I meant it as both the conservative ideal and the liberal ideal, taken to the extreme in either direction. People of opposing ideologies often wind up using the same tactics and rhetoric as each other, even if toward different ends. It's because any ideology, taken to its fullest extreme, will circle back on itself and become its opposite when unchecked. That is why I mentioned them both: because like the idea of Yin and Yang, they are pretty much tied to each other, most expressive in their extremes.
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.
quote: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.
It was a rhetorical question. Thanks for insulting my intelligence when all else fails, though. At least I know you're human.
quote:Why do you remind me of somebody else, I wonder?
You know others who don't believe everything you argue as enlightening and pertinent, no matter how eloquently you put it, mayhap? Make no mistake, you say it well. I just don't feel it has to do with the actual situation, rather than a hypothetical one placed in an intellectual glass jar.
You say it does.
I say it doesn't.
You insult me (again).
I say it still doesn't.
I can feel a song coming on. How about you?
Posts: 1170 | Registered: Jan 2003
| IP: Logged |
quote: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.
It wasn't a hidden meaning. You spent a post calling those whom you claimed I was excusing "ethically wanting" and then added an "obligatory reference" to what was clearly meant to invoke existing totalitarian regimes of the past. Maybe next time you should actually insert your comment rather than talking about it so when people take what you say at face value they can actually be taking what you mean.
quote:You know others who don't believe everything you argue as enlightening and pertinent, no matter how eloquently you put it, mayhap?
Actually, most of the people I like and respect disagree with me on very fundamental, important issues. Especially here. I certainly don't expect anyone to agree with something I said just because I said it. Nor do I expect it to be "enlightening." I do expect people who read my opinion on something to come away with an idea of what my opinion actually is. In fact, I've been known to piss off the people I agree with on an issue more than the people I disagree with.
As for pertinent, it seems the principle participants in the discussion found my contributions pertinent, even when they didn't agree with me. I guess they're not as smart as you are, and couldn't see through my charade.
posted
For what it's worth, I don't think you're acting. I just don't agree with you that your points are pertinent. I also pointed out that I don't think others' points aren't pertinent. However, as of yet, no one else has responded as vocally or vehemently as you.
quote:But you find the current Justa vs. Dags trend to be intimately more interesting?
Well, that makes one of you.
You're right BtL. I've got to stop letting myself get sucked into these things.
There you go: you may now have the last word, Justa.
My silence hereafter should not be taken to mean that I agree with any characterizations you may make of my posts.
If you wish me to answer a question, or respond in any way, let me know. Otherwise I'm done. I think the discussion reached it's logical end when I bowed out the first time; everyone had heard the others' arguments and it was clear there would be no mind-changing. I should have left it alone then.
Right, this thread has gotten entirely too confrontational. This has been brought up a few times but sort of lost in the patients' rights vs. pharmacists' rights argument: what about people who are taking the Pill for completely non-contraceptive reasons? Why deny them medication they need, any more than you'd deny a person pain medication on the grounds that many people abuse it? If the number of women taking the Pill for health reasons is more than the number taking it solely for contraception, would those who take the pharmacists' rights side change their minds? What do you think about, say, an OB-GYN who would prefer that a patient suffer from PCOS rather than take the risk of killing embryos? Or, to make the question more concrete: if my endometriosis is not treated, it increases the risk of infertility and ectopic pregnancy. Kill the babies now, or kill them (and maybe me!) later? There are risks of losing an embryo either way.
On the other hand, in most cases the patient has plenty of other options such as family planning clinics or other pharmacies in town. Sure, it might be insulting, but for most people, the loss will be fifteen minutes of your time waiting in line before the pharmacist tells you that he or she won't be giving you your drugs. So unless the presctiption is confiscated (definitely unethical and immoral, in my opinion) what's the big deal?
My opinion is that the pharmacists are probably overstepping their bounds, but as long as they refer people elsewhere, and preferably make their policies clear, I really don't condemn them for it. However, I would be upset if I were lectured or preached at, especially since I'm not, um...making any embryos at this point. And I think that if there's only one pharmacy in town, it probably should stock the Pill, if only because some women take it for non-contraceptive reasons. And there are plenty of people like that, since 10%-15% of women have endometriosis and 5%-10% have PCOS.
Every month in the female cycle eggs are dropped and discarded.. 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? It's simply not logical anymore than teaching teenagers abstinence only is...
Posts: 9942 | Registered: Mar 2003
| IP: Logged |
posted
I apologize to Hatrack if I too contributed to the derailment of this thread.
However, I need to address Kwea, who I apologize to as well.
quote: 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.
I quote you Kwea that you think you have not offended pharmacists, even though in the previous post, (the one where I was so angered by your repeated, offensive insults, that I threatened to slap you) I quoted you as well as to just ONE of the comments that was very offensive to me personally. Sadly, I deal with this low-brow mentality at work on a daily basis, and never thought in a million years that I would have to deal with it considering the brilliant callibur of minds here at Hatrack. But in all fairness, you probably never expected to be slapped either.
I completely defend your right to your opinion, Kwea, and would hope you can make your points without being as insensitive as you have been in the previous posts of this thread. I do not even know you personally, and I doubt we would dislike each other if we did meet in person, so I offer my hand and again, I apologize for being a jerk. Sorry.
Jutsa and Dag,
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:
quote: 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?
I also thought that everyone who has not re-read this post by Speed should do so again:
quote: 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.
And Speed, in response to your most excellent post on the matter, as far as I am aware, there is no specific legislation or law that makes a pharmacist fill every prescription. As you stated, we can refuse to fill a prescription for a number of reasons: harm to patient, legitimacy, etc. That being said:
Our company has a specific stance on the issue of refusing to fill a prescription based on ethical or religious beliefs, namely the morning after pill. In one case the pharmacist refused to fill a precription and REFUSED service to refer a patient to a pharmacy where they could find the service they requested. That pharmacist was fired. In another case, a pharmacist refused to fill a precription, but did find the med for a patient at another pharmacy, and the patient filled it there. This pharmacist was suspended and most likely is still on probation.
Keep in mind, these decisions were corporately-mandated ones. What many of Hatrack may not understand is that pharmacies are governed over by more than one federal or state body.
So Speed, to answer your question in more detail, I make the distinction that many of Hatrack may not appreciate,(but can respect):
I too am not aware of the Board of Pharmacy or any other state board or Department of Professional Regulation having reprimanded any pharmacist for making a decision not to fill a prescription based on religious or ethical beliefs. Speed, you are so refreshingly gracious, but do not fear. If you disagree with me, I will not slap you.
In defense of my stance that I stated previously, I interpret the profession of Pharmacy to give the Pharmacist, Patient, and Doctor certain rights. I believe that a pharmacist who does not fill a prescription based on religious or ethical reasons to have put their license to practice Pharmacy in jeopardy. I also believe that if legal action were brought against the pharmacist, that the pharmacist would lose in court. What Hatrack should know is that Speed is right. There is no specific law or regulation that states we must robotically fill every prescription, regardless of our beliefs.
And as I've said again and again, this area is very vague, open to much interpretation, and has no easy answers.
Now would someone please address Rivka's excellent question concerning the 3 supposed effects of oral contraceptives?
posted
Syn, it's perfectly logical to teach teenagers abstinence-only. What's not logical is the failure of teenagers to listen. Unfortunately, that illogical failure has to be taken into account eventually, which is why I gave up supporting the abstinence-only position. Eventually one has to accommodate other people's illogic in one's decisions.
Posts: 1114 | Registered: Mar 2004
| IP: Logged |
quote: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?
Syn, the position is logical and self-consistent. It relies on starting premises you don't share, but at worst that makes it wrong, not illogical. And the inability ot prove the starting permises is pretty much accepted by both sides, although both seek to introduce evidence to show one side is more likely than the other.
Neither condoms nor spermacide are thought to have abortificient properties. Shed eggs are not the same as zygotes or embryos from these pharmacist's perspective. I'm not qualified to judge the science involved here about implantation prevention, nor am I in a position in my life where I need to. I'm simply supporting someone's rights to act on their conclusions on this topic - to make their own choice, if you will.
As to the use of the pill for non-contraceptive purposes, I would think that one would defintely be a doctor/patient issue, not pharmacist issue. Otherwise the pharmacist really is intruding on that relationship in an unsustainable manner.
Either the pharmacist needs to not stock it, or the pharmacist needs to dispense it to everyone with a valid prescription. Anything else is really unworkable from a pragmatic standpoint. I suppose he could have a list of doctors he knows only prescribe it for non-contraceptive reasons, but that seems unworkable in practice as well.
quote: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:
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. In fact, doctors who aren't clear are worse than just unethical sonsa-bitches, they're also greedy. They'll charge you for an appointment before they decide to attack you with their ideology at your expense.
I didn't skip over doctors. They are even mentioned waaaay back in my first post in the thread. By the way, the Wal-Mart tack was never addressed, the gun store one was. The difference is that Wal-Mart doesn't sell only guns, not even in the sports section where they are kept.
But don't sweat that question now. If everyone else is self-assured that it has been sufficiently answered, far be it from me to remain unsatisfied.
Posts: 1170 | Registered: Jan 2003
| IP: Logged |
quote: 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.
OK I understand. Now what I was asking specifically was, How exactly do you propose that doctors and pharmacists clearly state their beliefs in relation to their practice? Up Front?
posted
A notice in the respective lobbies are a good start. Also, with doctors, having a statement making that clear when setting an appointment by phone is a step in the right direction (almost all calls ask what an appointment is in reference to).
Posts: 1170 | Registered: Jan 2003
| IP: Logged |
posted
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.
To reverse the scenario, what if the doctor asked your religious affiliation or beliefs before allowing you to be scheduled an appointment?
The point I am trying to make is that if you have any questions about the health professional you are seeking treatment from, then talk to them privately. I give free advice all day long whether someone asks for it or not. I believe in informing my patients the best they can be so they too can make informed decisions. I am sure that if you were seeing a new doctor, and did not like the answer you got in your initial interview, you could get up, walk out, and tell the office manager you should not be billed and why. This sounds much more reasonable to me.
quote: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.
That kind of discrimination is acceptable. Once again, I bring up the tendency of Jehovah's Witnesses to refuse certain medical treatments under even fatal conditions. There are other faiths who do the same, depending on what denomination of the faith you are dealing with. 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? What justification is there for:
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?
Of course, I expect the typical "not the same thing" argument to it, with (as I already spoke of) the usual semanticizing and legalities. However, what it comes down to is that even the medical profession has no ethical right to impose their own morals on others. Not doctors, not pharmacists, no one. The ever-annoying ACLU has even gotten into this mess with doctors and hospitals already, particularly in the matter of rape victims who are given a contraceptive (not an abortive) if it is believed they are at risk. What it comes down to is that no medical professional should be required to do something which they are morally opposed to, but that an alternative provider be made readily available or accessible in such a case.
So, in the case of contraception, a doctor's office who does not prescribe could tell the patient of colleagues who will or may. A pharmacy could have the phone number of another who will or may fill such a prescription.
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.
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.
Posts: 1170 | Registered: Jan 2003
| IP: Logged |
quote: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?
Answer: No.
A patient has a set of rights, just as a doctor or other health professional does. As to the exact rights a health professional has is the centrality of this argument, I do believe.
quote: However, what it comes down to is that even the medical profession has no ethical right to impose their own morals on others.
Exactly. But we do have a right to our own ethics, morals, or religious beliefs. Let that be understood. The extent to which they may affect the decisions we make within our profession is also another big factor in this thread.
quote: 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.
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.
quote: 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.
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.
You simply have to understand that I am not looking for your pity. 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.
posted
There are no exact rights. The prescription of morphine is different from the prescription of contraceptives, is different from someone prescribing what the pharmacist believes is too much.
quote:
quote:However, what it comes down to is that even the medical profession has no ethical right to impose their own morals on others.
Exactly. But...
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.
quote:I never support decisions that are based on equalizing the misery that both parties have to endure.
I never did, either. If you want my personal opinion, the medical professionals deserve the many extra hoops and annoyances they have to deal with. Cost of doing business.
quote: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.
Absolutely not. When a professional places themselves in a position of service, they should be required to be up-front about what services they refuse outside of the generally accepted bounds of said service.
quote: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.
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.
Posts: 1170 | Registered: Jan 2003
| IP: Logged |
posted
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.
posted
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.)
Posts: 1990 | Registered: Feb 2001
| IP: Logged |
posted
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.
posted
: 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...
Posts: 1870 | Registered: Mar 2003
| IP: Logged |
posted
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.
posted
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...
Posts: 1870 | Registered: Mar 2003
| IP: Logged |
posted
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? Posts: 325 | Registered: Aug 2002
| IP: Logged |
Printer-friendly view of this topic
![[Confused]](confused.gif)
![[Hat]](graemlins/hat.gif)
![[Big Grin]](biggrin.gif)
![[Smile]](smile.gif)
![[Wink]](wink.gif)
![[Wall Bash]](graemlins/wallbash.gif)
![[Blushing]](graemlins/blushing.gif)
