posted
So, Kwea, would you support policies that could result in women being forced to abort a baby that she wants? (Yes, this is, I suppose, a "trap")
Posts: 11017 | Registered: Apr 2003
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The patient has the right to decide on her treatment, remember?
No, never...unless...
Unless she was unconscious, and it was her or the baby and the doctor (MD) decided that she had a better chance of living than the baby did...but only if the woman hadn't made it clear that she would rather die.
A doctor could object, but I really can't think of a situation where a woman could be forced to abort....not if she has the final say, which is how it is suppose to be in regards to medical decisions.
quote: If your ethics prevent/interfere with a patients right to choose treatment plans, then you need a new field.
This has nothing to do with abortion, just ethics in general.
An old friend of my mom's who we've known forever is bipolar. She's also poor. So she's been going to a shrink as a pro bono patient for over a decade. She's on about a dozen meds that she gets free, she doesn't take any of them properly, and she's only crazy when she isn't getting her way.
I've watched this woman in action for close to two decades now. She's only crazy when it's the easiest way to get what she wants. Don't want to see the parents but are too chicken to say so? Go crazy. Don't want to go to church but feel guilty about not? Go crazy. Aren't getting enough of hubby's attention? Go crazy.
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.
So the old shrink retired. My ethical question is, would the new shrink be moral obligated to continue perscribing meds to a woman who doesn't need them becuase she really thinks she does? To me, the old shrink was nothing but an enabler and immoral himself. But this is the treatment plan she's chosen for herself. She wants to be high. Does the doctor have the right to deny her more meds for the good of society since you and I pay for them with our tax dollars? Or is that us shoving our morality down her throat?
Posts: 2283 | Registered: Dec 2003
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posted
No, that is a matter for him to decide. A patient has the right to participate in his/her treatment decisions, but they aren't the doctor. If, in his opinion, she is faking, then he is obligated not to perscribe the meds she has been abusing. That is why he is the doctor (MD, or whatnot).
Now, if a pharmisist feels that a patient has been "Dr shopping, they have an obligation to report that, it's the law (I think). That is one of the reasons pharmisists had that law passed, so that if there is abuse they can withold meds.
But overuling a MD's decision on proper treatment sue to personal morals is a different kettle of fish.
It is a completely different issue, not really related.
A patient can't perscribe meds for themselves, they have to go to a doctor(MD) for that. But they have the right to refuse meds, and possibly change meds with the help of their doctor if it isn't working. Providing there are treatment options, the doctor is obligated to share those options with the patient if they ask.
quote: 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.
[derail] I think this is why I can't stand Robin Williams[/derail]
Kwea, I can't recall exactly what I was thinking. I still haven't settled conclusively on when I think "life" begins, but I don't think it is whenever the mother decides it does.
I guess there is no such thing as a compromise that everyone will be happy with. I just think our culture will suffer if we continue to support abortion.
Posts: 11017 | Registered: Apr 2003
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quote: I promise not to make you have an abortion if you promise to not take away my condoms (bad analogy, I know).
???
I don't recall asking that women be forced to have abortions. All I said was that if you're going to take the "moral high ground" and ban abortions, then it is only morally proper to allow the discussion of pre-conception contraceptive use as an alternate. For instance, our wonderful government will not pay for international Aids prevention because the parental planning institutions that typically provide information ands medication in support of the fight against aids do not recommend absitinence, they recommend birth control, and make abortions available (and may, for all I know, recommend abortions).
But if you are going to disallow the discussion of condoms, or fail to prevent them as a viable option to prevent further viability, then I feel you're being manipulative and/or hypocritical.
quote:It was the manufacturer of the Pill that brought up prevention of implantation of a fertilized embryo as benefit of the Pill.
Fertilized embryo? Well, I guess. I would have called it an cellularly-undifferentiated blastocyst. If that.
Next step: masturbation and periods become illegal.
Posts: 1862 | Registered: Mar 2000
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quote:Fertilized embryo? Well, I guess. I would have called it an cellularly-undifferentiated blastocyst. If that.
Next step: masturbation and periods become illegal.
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.
posted
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.
posted
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
posted
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
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
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.
quote:[even in women not taking "The Pill"] fertilized eggs fail to implant 40 to 60 percent of the time
1) "Fertilized eggs." Not "Embryos." Not that it really makes much of a difference.
2) What are we to consider those 40 to 60% of fertilized eggs that do not implant? Has nature aborted these embryos? Has God? Are we to try and do something to make sure that 100% of all fertilized eggs implant successfully? If a drug was created that could guarantee 90% succcessful implantation, would the government have the right (or the obligation) to mandate its use?
How can we allow 40 to 60% of all unborn children to die at conception?! This is worse than the current abortion rate in the United States! This is worse than the Holocaust! This is almost worse that the infanticide rate in China!
Is it fair to say, "How can God allow 40 to 60% of all unborn children to die at conception?"?
From a humanist point of view, it is sad that there is a 40 to 60% failure rate for implantation--especially for couples wrestling with infertility. But, apparently, it's natural; it's the way the human body works. From a larger (global population explosion) point of view, it's not something I would recommend playing around with. You'd, uh, be "Playing God."
Back to that article: The article states, though, that "nobody knows" if that implantation prevention aspect of BC Pills really takes place. The article hints strongly that it does not (my opinion).
quote: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."
Even though there are some very well presented arguments for the "unborn child" status of a foetus at the end of the first trimester, the undifferentiated ball of cells at initial conception--the same ball of cells that nature/God sees fit to kill off up to 60% of the time, the same ball of cells that may or may not be affected by birth control pills (though it appears that what little evidence we have indicates it has no such effect)...I cannot see a misplaced concern for such a ball of cells as rationally leading to opposition to the use of birth control pills.
I'm not currently making a statement on the use of abortifacients, or on abortion itself. Just on Birth Control Pills. That is, after all, what this thread is about, neh?
Posts: 1862 | Registered: Mar 2000
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posted
Well, for a person to have to right to decide things for him/her self, it sort of requires that the other person not have the right to impose their will on that first person, correct?
Your right to swing your arms around ends at the tip of my nose, and all that...
Does the pharmacist have the right to deny legitimately prescribed Birth Control Pills to a patron? What would that pharmacists assumptions be based on? Do I consider them to be valid; and: if not--why not? Do these pills harm the unborn patient?
Posts: 1862 | Registered: Mar 2000
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posted
But clearly the standard of proof should be lower for that than for banning the Pill, right?
You're question can be easily rewritten as, "Does the patient have the right to force the pharmacist to dispense legitimately prescribed Birth Control Pills in a manner contrary to the pharmacist's most deeply held beliefs?"
Now we're talking about the pharmacist's nose. My instinctual bias is to prefer the mandate that preserves free will and voluntary action.
posted
"Lower than that..." Lower than what? I'm all out of context on that sentence, Dag.
"Does the patient have the right to force the pharmacist to dispense legitimately prescribed Birth Control Pills in a manner contrary to the pharmacist's most deeply held beliefs?"
Um...yes. Completely. If a person takes on a job where they are consistently asked to act in a way that directly contradicts their "most deeply held beliefs" then they're in the wrong job. Or they are there to serve as some sort of political activist.
If X and Y and Z are legal, and I go to the XYZ store, I expect to be able to do X or Y or Z. If you think that X or Y or Z should be illegal, then you have ways to make your point. If you get a job in the XYZ store, only to prevent people from doing X or Y or Z, you should expect to be fired.
I won't serve you McDonald's fries, because I think they're bad for you. I won't neuter your cat because I think it's morally wrong. I wont let you borrow certain books from the library, because I disagree with their content. Need I go on?
I join the Young Republicans only so I can yell at Bush when he's in town for a rally. I refuse to sell rope and lighter fluid to a known KKK member.
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There's 4 pages of distinctions on those and discussion of what the limitations should be. If I own an XYZ store, but think that z' is immoral, am I obligated to sell it?
posted
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?
quote: 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)
Aye, but there's the rub.
Posts: 32919 | Registered: Mar 2003
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posted
Except for the fact that most pharmacies only have one pharmacist on for hours at a time, when there is no rush.
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.
It completely violates the MD/Pharmacist?patient link, and does damage to the whole system of care.
Suneun, I am curious what your opinion on this issue is as you are in medical school and probably have more recent experience with the ethical concerns mentioned here, and are more in touch with what the medical establishment has to say on it.
Not that I am asking you to comment on everything mentioned here, as quite a lot of it is very personal and I don't know what you would be willing to share here on-line. I was thinking of the original issue raised here, about pharmacists refusing to dispense medication to patients based on their own ethical beliefs. Surely there are some parallels within the medical field, What do the Md's you work with/ have classes with have to say on these types of issues?
Of course, if you would like to comment on the rest, I would like to hear that as well, even if you disagree with me:D...but I wouldn't want to feel obligated in any sense. i just thought you would have a very different take on this from the rest of us, as it is something that you will have to deal with on a personal level in your chosen profession...
Of course that's the rub. The employer/employee issue is a distraction from the major issue, which is whether a pharmacist is required to dispense any prescription.
quote: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.
This isn't difficult: A pharmacist who doesn't object can fill the prescription when s/he is on. A non-pharmacist can hand it to the customer when the objecting pharmacist working. I get prescriptions from cashiers all the time. I also get told all the time I have to come back for prescriptions.
posted
And the inconvenience (at best ) to the patient?
I don't think the employer issues to be minor. In practice, that is a major concern. At least it is if the pharmacist wants to remain employed.
I will look up this question on a medical ethics site, if I can find one....and not from a pro-life or pro-choice site, either....this is a much larger issue than that, I think. The most basic issue here is who determines the treatment for patients.
Or rather, does a medical care professional have the right to refuse treatments that are legal and prescribed based on their own personal ethics if doing so negates the choices made by the patient themselves; or are they required to provide the treatment based on medical recommendations and the decisions of the patient.
I know what I was taught as a medic/EMT. It is a bedrock of western medicine that the patient has the right to treatment, and that right outweighs other concerns. That is why I could have been prosecuted for not stopping at an accident scene, and why hospitals are required to provide care to patients who will never, ever pay for it. It is why a DNR order MUST be honored even if the Doctor thinks it is not necessary, and why patients are allowed to sign themselves out against medical advice....the right of the patient is the most important issue in medicine.
So if a pharmacist thinks his decision should be based on his own personal ethics at the expense of the patients right to choose, then he should seek other employment, IMO. I'm not saying he should always feel like it is easy, or that conflicts like these should never arise. They are almost guaranteed to happen, which is why I thought it would be interesting to hear from either a MD or a intern.....these issues are somewhat abstract for most of us (not all, though...), but not for them. A doctor (MD) has to deal with situations similar to these, and often times it is a matter of life or death, so these issues are great concern to them.
quote: 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.
quote: 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.
quote: 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.
This is from an article in Pharmacy Times, and it is pretty clear. The article isn't based on the pill, though, it is based on pain management medication. However, the points raised are valid for any prescription.
posted
Kwea -- you're an EMT too? I was for many years - -just gave up my license last year because I didn't really have time to do it anymore, or time to take the recert classes.....
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I passed the NR EMT, but MA is one of the states that doesn't recognize it and requires more training and testing. I passed the NR EMT 12 years ago when I was a medic in the Army, but I never held a job as an EMT in the civilian world, except on a volunteer status.
I still like the field, though....which is why this issue matters so much to me.
What if my "religious" views held that woman were lesser creatures, and not deserving of medical treatment? Would I be allowed to refuse to treat them, even if their lives were in danger?
By my understanding, ethically I would still be held accountable, and my license pulled, with legal action to follow, if I were to do such a thing....but if these laws go into practice, then they can refuse treatment to gays, or Muslims, or whomever they want, because the patient would have no right to treatment, and no legal expectation of proper care.
quote: 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
quote: 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.
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.
quote: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.
and also....
quote: 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.
This is all from one site, but it seemed to address most of the specific concerns raised here. i don't like some of their claims (suprise!), but it seems internaly consistant with a lot of the ethical beliefs I have been taught. And a lot of the other sites were either pro-life or pro-choice, and i didn't want to use such obviously biased reports from either side.
This link has the whole text if anyone is interested. It appears to be a paper written by students, and supported/assisted by their professor.
posted
I've been thinking about this and I can't get it to work out right...
If the current basis of medical ethics requires health care professionals to harm individual B because individual A is the patient, entitled to treatment, and individual B is not, isn't that a serious flaw in that ethical system? Doesn't it need revision?
I've been trying to come up with an analogous case, because I can see how the particular scenario we're discussing would be overlooked. The closest thing I can come up with--suppose that instead of an embryo and mother, one were dealing with conjoined twins (of the sort where both are viable and self-aware). It's hard to imagine it happening, but if a doctor were to treat one of those twins as the patient and ignore the needs of the second, condemning him or her to serious harm, wouldn't it be absurd to say that was ethical? (To make sure it's clear, by "viable" I mean that both twins will be able to live out a relatively normal life--I'm not talking about a case where only one can survive or a "calculated risk" separation scenario.)
posted
The trouble with your analogy is that in that scenario, each individual is equally independently-alive. The same simply cannot be said of an unborn child and its mother -- especially before about 30 weeks gestation. As a matter simply of practicality, the mother MUST be the patient. If she dies or is seriously harmed, the fetus will be as well.
Additionally, there is the simple fact that a doctor or pharmacist is bound -- MUST be bound -- to treat the individual who came to them for treatment. And the fetus is pretty much just along for the ride. Ideally, there should be no conflict between treating the mother and the fetus. But if the mother's life were at risk, there would be no question as to who was the patient, neh?
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posted
Also, there have been situations where twins were joined, but one was dominate , and the other not able to live without the stronger twin. The operation was still done, even though it meant only the stronger of the two would live.
posted
Rivka & Kwea, your arguments seem to be canceling each other out--in the scenario Kwea describes, the dependent twin is (obviously) not independently alive.
If one party is doomed to death regardless, and the other can only survive if that one is separated, that's one thing. 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.
But I've run out of patience with the question, and I'm clearly not getting anywhere. I will bow out, at least for now, rather than end up name-calling.
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posted
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.
Both situations happen, Mabus....they don't cancel out each other.
In my situation, both were alive, but one was much less developed, and the surgery was conducted to improve the quality of life....his life wasn't in immediate jeopardy.
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).
So that is why I felt it was a closer analogy. Not a perfect one, if such a thing exists, but a fair one.
quote: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.
There hasn't been any yet. I am frustrated enough I am afraid I will begin it. It's not your fault--I just get fed up with these arguments because the answers seem so obvious to me.
quote:Both situations happen, Mabus....they don't cancel out each other.
*nods* I think I misunderstood what the two of you were saying.
quote: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).
One last clarification--are you saying "will never be viable" or "just isn't viable yet"? Because I see a tremendous difference between the two.
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posted
Both actually....70% of fertilized eggs never implant and are washed out of the womans uterus...the pill makes sure that the percentage is higher.
I really meant "not viable yet" I guess, as I was speaking of abortions (holy morphed topic, batman!); by definition, none of them would ever be viable if they were aborted, right?
quote: 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.
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....
posted
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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quote: 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.
To be definitive, the last pharmacy class that could have graduated with a Bachelor's Degree in Pharmacy (the older 5-year program) was the 2004 class this year. From hence forth, pharmacy schools will be graduating nothing but Doctor of Pharmacy degree pharmacists or PharmDs who have to go to college and pharmacy school 6 years.
There are 2 things that make this confusing: all graduates will be PharmDs from now on. So yes, they are doctors. However, if a pharmacist is a consultant, lawyer, or professor, they may choose to not register with the state to actually practice pharmacy.
Also, PharmDs have a tendency to specialize, like physicians do, in diabetes mgmt., pediatrics, infectious disease, asthma mgmt, etc... These residencies are also similar to what physicians are REQUIRED to do, but are elective for PharmDs. These PharmD electives may be an additional 1 or 2 years in addition to the 6 year PharmD degree.
I have shadowed medical residents fresh out of medical school, and I have shadowed PharmDs. Make no mistake about it:
PharmDs with a residency under their belt usually dwarf the knowledge-base a resident has concerning pharmacology, and usually equals or surpasses the Attending Physician's knowledge.
What is the achilles heel of pharmacy is that doctors are trained to diagnose and treat, whereas pharmacists are trained in pharmacotherapy and usually have to "work backwards" to try to infer the diagnosis.
So when posts here mention that "I take BC pills for a medical condition" only reinforce why pharmacists have a moral and ethical dilemma if their beliefs prevent them from treating these patients.
I hope to post more later, but work has been preventing me from getting on regularly!
posted
A week ago, in this very thread, I was hoping someone else would tackle the post by rivka addressing the three-fold mechanism of action that oral contraceptives have to prevent pregnancy.
But no one did. And her post bothered me a lot. Not because of what she said, but the information was a bit jarring when weighed against my professional training and academic studies.
quote: 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.
So, does the Pill keep implantation from occurring? Could be -- but there's not much evidence to support it.
This information is as the heart of whether a pharmacist considers the pill to be abortive or not. But let us look at how a birth control pill works:
1. It prevents ovulation, thus preventing fertilization from happening in the first place. 2. It thickens the mucous plug, thus further protecting the woman from sperm being able to reach an egg to fertilize it. 3. It prevents implantation of a fertilized egg within the wall of the uterus.
Now rivka was questioning the third method of contraception, and I was a bit hesitant to answer.
But here is the simple answer: If a woman becomes pregnant (time elapsed assumed to be days or even weeks), and begins to take oral contraceptives, she will very likely cause implantation to fail and eventually abort. For years, doctors have prescribed birth control pills as a "morning after pill" and instruct the patient to take larger loading doses of the pill on the first 4 days of therapy, then to reduce the dosage to one a day until the pack is finished.
Today, we have a few commercially-made morning after pills that streamline this procedure, but they are the same therapy that oral contraceptives provide.
So with this information in hand, there are no ethical studies that could be done, as rivka eluded to, that measure if oral contraceptives block implantation, but they can and they do. The means to prove it scientifically though, are completely beyond the ethics that medicine embraces.
So finally, if all of you questioning a pharmacist's right to choose whether they will dispense birth control pills or not take this information in hand and put yourself in this pharmacist's place, you might understand why they are making the decision not to dispense birth control pills at all. (In their eyes) at best, they are causing the occasional fertilized egg to not implant, and at worst, they are giving a pack of birth control pills to someone who did not have protected intercourse, and who is resorting to using these pills to abort any potential pregnancy.
As I have stated numerous times, I support the right a patient has and I cherish the bond that is shared with a physician as well. I also have no dilemmas in dispensing oral contraceptives for their intended use: to prevent pregnancy. I do however, have a problem with them being used to counteract a potential pregnancy from unprotected intercourse. But, and this is a big but...if the doctor writes "as directed" for the instructions (which they do half the time anyway) I will dispense the medication and be none the wiser. I do not feel any better knowing I might have been bypassed from making my own ethical choices, but I respect the patient/physician privilege that much to allow it to happen.
posted
That is the exact path I would hope all Pharmacists would take, Alucard. I never meant to imply that a pharmacist didn't have a right to question the way a medication works, or that they don't have a right to their own beliefs, but to me (and 4 or 5 of the more impartial sites I went to) one of the most fundamental rights a patient has is the right to autonomy. It was listed as one of the cornerstones of modern medicine at every site I visited, even the ones that were proposing a "Code of Ethics" be established giving the pharmacists the right to say no to certain scripts. All of them said the same thing that you and a few others here have said.....that you either don't stock it, or you fill it.
And if you don't stock it, you need to assist them in finding it somewhere else....respecting their right to autonomy.
Being in the medical field isn't an easy job by any stretch of the mind. Some of the most disturbing ethical questions of our time crop up more often in hospitals than just about anywhere else. I just really hope that the patient stays in charge of their medical treatment (as much as possible), and that others respect the patients right to choose.
If you (meaning anyone) remove one of the choices, what is the purpose of allowing them to choose?
posted
Well said, Kwea. In case anyone is wondering, what pokes holes all through what my previous post elaborates on are women who get pregnant while on birth control.
Why just yesterday I had a twentysomething woman inquiring on the availability of the female condom. I expressed the sad fact that we might never see such a thing, as well as male birth control pills (as if we'd have the decency to take them as a sub-species, anyway).
But back to the point, she became pregnant on Depo-Provera injections and also became pregnant on the Ortho-Evra patch. She is an extreme case, but she is evidence that contraceptives may not prevent implantation of a fertilized egg. These patients constitute less than 1% of the population, however.
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posted
Alucard, I have heard of several ongoing studies that are examining potential male BCP's, adn one of them was showing some promise.
The problem they are having is that most pill/patch based BC is hormonal based, and if you start mucking around with the male hormones it affects a lot of things...if you know what I mean. They haven't found the right mix yet...one that will affect fertility and not adversly affect "performance".
posted
Sorry, Theca you are absolutely correct. At one time we had three different brands for sale in the US. As far as I know, they have all been taken off the market for sale in the US though, but my information is a few years old. There is a good possibility they have been introduced again in the US, which is only a good thing.
Kwea, Good info indeed. Paxil does some amazing things for men, especially for premature ejaculation. Because, anti-depressants in the serotonin specific reuptake inhibitor class (Paxil, Prozac, Zoloft, Celexa, Lexapro) cause some degree of sexual dysfunction, they can be used to combat premature ejaculation. Men who had seconds of pleasure can now have minutes of pleasure!
And who said reading the articles in Playboy are a waste of time?
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posted
Where does a pharmicist's responsibility rest if an obviously pregnant woman comes in with a prescription that the pharmacist knows would be harmful to the fetus?
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posted
I believe that they are required to question the prescription at that point. They call the doctor and discuss it with them.
The law in question here was put in place specifically for that reason....so that a pharmacist could refuse to fill a potentially dangerous script. Pharmacists have been sued for prescribing scripts in that type of situation, and until the law was passed it wasn't clear what their options were. The law allows them some discretion.
My objection was that it seemed that some of the pharmacists in the previous articles were using that law to promote a social agenda at the expense of the patient, severely reducing the quality of care and eliminating patient autonomy.
Autonomy doesn't mean that a patient has the right to any and all medications. It means that, in conjunction with their MD, they have the right to determine what type of care they get.
Meds are very, very tricky; that is why they are controlled substances. In order for a patient to have a right to a treatment, it must be an appropriate treatment for their illness/injury.
So it isn't right to refuse the pill to someone because they might use it for birth control, but it would be right to refuse a script that the pharmacist feels would do further harm to the patient.
posted
Kwea is right. I can refuse to fill any prescription, that in my professional judgement, could harm a person or is not deemed appropriate therapy.
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