Offhand, I approve entirely. It is not a pharmacist's business what the birth control was prescribed for. It can be used for controlling periods, cramps, endimetriosis as well as contraception. That's between the patient and her doctor, and if they have decided that's the best course of medical action, it isn't the pharmacist's job to second guess that or presume for what purposes the birth control is being used (and then render judgment on THAT, either).
How did the bill propose to "protect" these pharmacists?
Posts: 99 | Registered: Mar 2005
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posted
I don't see how anyone can be compelled to sell anything. It's a private business, for heaven's sake. If a grocer doesn't want to have a deli, they don't have to. If a boutique doesn't want to carry size 20, they don't have to. On what authority is the state telling pharmacies what they have to carry? And who does it apply to - any pharmacy in Arizona?
Posts: 285 | Registered: Apr 2005
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I'm sure we won't be the last state to try this, but I am moderately shocked we were the first. This is probably blow back for giving our electoral votes to Bush...
posted
Health care is a bit different than a grocery store. It's concern is providing the best health care possible to people who have the right to have that.
Also, there are standards of care involved with doctors, and I assume this would apply to pharmaceuticals as well.
Anybody have any ideas as to if there's a professional code of ethics for pharmacists and what it says? Or what the laws around pharmaceuticals are?
And that's why I'm curious as to what the protection meant, also. Is it saying that the pills or an alternative means of providing them do not have to be provided at all? Is it saying that companies have the right to fire/not hire those pharmacists who would refuse to fill this prescription? The first post is very vague as to what function this bill would have served.
Posts: 99 | Registered: Mar 2005
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posted
Well, the precedent set by the Wisconsin case discussed in Feyd's article says that it's OK to refuse to fill it if you make sure the prescription gets transferred to another pharmacy. Prescriptions get transferred all the time in my experience - when one pharmacy doesn't keep a certain item in stock.
My little sister has a hormonal disorder and requires monthly shots of a rare drug, and there's only one pharmacy in town that will stock it for us. This is a business decision - it's not like this drug has a high market demand - and not an ethical one, but I would think that would be part of the issue too. Should the governor require everyone else in town stock it, even if they don't believe it will make them any money?
Why then should they require someone to carry a drug they object to on religious grounds? It's not even the daily birth control pill we're discussing here - it's the morning after pill, which leads to the destruction of a fertilized zygote. Do all doctors have to perform abortions?
Posts: 285 | Registered: Apr 2005
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posted
IMO, if every pharmacist who objected to filling these scrips simply transferred them to a pharmacist who would, there would be no issue. None.
The problem is, the vast majority of the incidents (at least the ones that make the news) involve situations where the pharmacist will not only refuse to fill the prescription, but will refuse to transfer it, or give a referral. In at least once case, refused to even return it to the patient.
posted
Would HIPAA come into play if they tried to transfer to another pharmacy?
Personally, I see of no problem if there is another pharmacist on staff immediately available who is willing to fill the prescription.
On the other hand, for something like the morning after pill which has to be given within 72 hours of intercourse, putting someone off can have the consequence of the patient not receiving the treatment at all. Also, in rural areas, assuming that there is another hospital/doctor/pharmacy/pharmacist available is problematic.
Again, anyone have any inside knowledge on the ethics/laws involved here?
Posts: 99 | Registered: Mar 2005
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posted
Prescriptions get transferred to other pharmacies all the time, so whatever needs to be done to have that happen is almost certainly already in place.
I agree, having another on-duty pharmacist at the same location dispense the prescription would be ideal. But that isn't always an option. And what of a pharmacy that is owned and run by a single pharmacist?
We've argued this issue before, and I've been convinced that we do have to make some allowances for pharmacists who cannot/will not dispense BC prescriptions.
Posts: 32919 | Registered: Mar 2003
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posted
Thank you, rivka, I was just going to do that....
I don't think that anyone is FORCING the specific pharmacies to sell anything, Anni, but if a pharmacist works at a pharmacy that does sell it, then they have to dispense it...as it should be, IMO.
Of course, the previous 3 discussions made my opinion on it quite clear.....to be honest, most of us were closer together than we originally though, once the discussion was drawing to a close.
posted
I argue this kind of attitude leads towards a slippery slope. Suddenly a pharmacy can chose which drugs they want to give and which drugs they can't... What happens when you get a christian scientist pharmacist who says that *ALL* drugs are immoral? You open the floodgates for every phramacist to question drugs prescribed by doctors. Pharmacists are now allowed to second guess doctors, without ever examining a paitent. I think this blatently goes against their purpose and their ethics. No matter what their personal opinion about things like Viagra and Birth Control, it should stay out of the pharmacy and it should NOT be forced upon other people.
Posts: 84 | Registered: Apr 2005
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posted
Very true, adam. However, the pharmacist in the last discussion refused to fill BC prescriptions because he did believe that they could potentially cause termination of an unknown pregnancy (or was that the one two threads back? ( ) ).
This is an issue that has become more and more discussed in the last few years -- the notion that the Pill may not merely prevent fertilization, but in some cases prevent implantation of a fertilized egg. To me there is no difference, but to many there is a major distinction.
Posts: 32919 | Registered: Mar 2003
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posted
I'm pro-life and here's what I think, and I believe this is reasonable:
If you are a pharmacist who owns a private pharmacy and you personally don't want to stock and dispense bcps, then you shouldn't have to. However, I agree that any requests should be met with "Sorry, we don't stock them, try ABC pharmacy down the street." Refusing to give a patient back their prescription is inexcusable.
If you are a pharmacist who works for a pharmacy or chain that you do not own, and their policy is to fill and dispense bcps, and you choose not to follow that policy - you should have to suffer the consequences of going against company policy. You are always free to leave and seek employment elsewhere if you don't like the policies.
Why birth control pills are prescribed are none of the pharmacist's business. That's between the woman and the doctor. As has already been mentioned, they can be used for many different medical conditions. There's no way for a pharmacist to know if a woman asking for bcp's is going to use them to prevent conception or to treat endometriosis, so in my opinion, he/she should just fill the darn prescription.
The ECP, or emergency contraception pill, is what I think is at issue here. In my personal opinion, taking ECP is not equivalent to getting an abortion. From the prescribing information or package insert the mechanism of action for ECP is:
quote:Plan B is believed to act as an emergency contraceptive principally by preventing ovulation or fertilization (by altering tubal transport of sperm and/or ova). In addition, it may inhibit implantation by altering the endometrium. Plan B is not effective if a woman is pregnant. Plan B is a contraceptive and cannot terminate an established pregnancy.
From what I've read, ECP usually prevents conception by stopping release of an egg, which makes it virtually no different from regular birth control pills. The secondary method of action is an increase in the thickness of the cervical mucus, which acts as a barrier to prevent sperm from meeting egg. Again, no different from other barrier birth control methods.
It is believed to also alter the uterine wall, so that implantation cannot occur - and this is where the real heart of the matter is. In my opinion, though, I don't see enough of a difference between ECP and regular birth control pills to say that one is okay and the other is not. Regular birth control pills also change the endometrium and may therefore prevent implantation, if the primary action of preventing ovulation fails.
I think ECP has a place in women's health. For one thing, it could be a Godsend for a woman who has been raped. If she could begin taking ECP soon enough after the attack, she can cut way down on the anxiety and worry about a possible pregnancy resulting from the rape.
Posts: 14428 | Registered: Aug 2001
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posted
Belle, I thought your response was great. That's probably why it killed the thread -- after your post, who had anything left to say? Posts: 32919 | Registered: Mar 2003
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posted
That, or a lot of us have hashed this out before you did here, and came to a lot of the same conclusions you did.
Wait, that sounded snarky, and I didn't mean it like that.
What I meant was that this topic has been discussed before, and to be honest it was one of the best conversations I have had here at Hatrack. I am not saying this thread isn't important, or that this is old hat....but I have talked about it so many times now that I don't want to keep repeating my points over and over (and over, and over, and over.... because then I feel like I am being overly preachy.
I agree with most of what you said in your post, Belle, and I think that while not everyone would be willing to go along with those ideas, most people would. If you own the store, then you can sell what you want...and not carry the rest. If you work for someone else and have these sorts of qualms, then you have to let them know before you are hired....and they have the right to not hire you if your beliefs would interfere with the job.
Under no circumstances should they be able to lecture you about these types of choices, or attempt to prevent you from seeking that care elsewhere.
This is a subject that touches on some very important issues, and I will be watching the new developments with concern.
quote:The problem is, the vast majority of the incidents (at least the ones that make the news) involve situations where the pharmacist will not only refuse to fill the prescription, but will refuse to transfer it, or give a referral. In at least once case, refused to even return it to the patient.
Personally, I think the pharmacist should be able to refuse to fill a prescription, or refer a person to a different pharmacist (your doctor should be able to do that). However, refusing to give back the prescription is wrong and should be illegal (if it isn't already).
quote: What happens when you get a Christian scientist pharmacist who says that *ALL* drugs are immoral?
That would be his right...but of course that pharmacist would be out of business rather quickly.
Personally, I don't have a problem with birth control...and don't understand WHY a pharmacist would refuse to prescribe it. However, as a private business owner you should have the right to sell what you want. That being said...if someone works for a chain and refuses to sell birth control, they should expect to be fired by the owner of the chain. When you own a store you can sell what you wish...but when you work for someone else, you sell what they wish.
Posts: 1901 | Registered: May 2004
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posted
The following is a hypothetical. As far as I know, this has never happened and it is probably far-fetched, but I'm going to go with it anyway.
What if a clerk in a grocery store refused to sell a bottle of wine, which the store offers for sale, to a patron because he or she (the clerk) is morally opposed to drinking, even after the patron produces age ID and is demonstrably eligible to buy this legal product. What if the clerk cites the fact that if a pregnant woman happened to drink the wine it could conceivably harm her pregnancy? Or if he or she cited the general health risks of drinking alcohol? The clerk would have a point - it could do that, conceivably. But, he doesn't know that a pregnant woman is even going to drink the wine. He doesn't know if it is going to be used for drinking or in cooking (which would, of course, take care of the alcohol content). Would that clerk have a valid defense? What if it were cigarettes that the clerk refused to ring up? What if the clerk, in either case, then proceeded to lecture the patron who is attempting to purchase the product - which I understand has happened on occasion in the case of pharmacists and birth control pills?
This all just occurred to me as I read this thread.
quote:What if a clerk in a grocery store refused to sell a bottle of wine, which the store offers for sale, to a patron because he or she (the clerk) is morally opposed to drinking, even after the patron produces age ID and is demonstrably eligible to buy this legal product...
If the clerk owns the store (or the boss approves) I see nothing wrong with refusing to sell certain products. Of course if you descriminate agaist certain people (ie: be willing to sell wine to someone who is white but not to someone who is black) then that would be your right. Of course like I said before, if the clerk did not own the store, they should expect to be fired for costing the store sales.
Posts: 1901 | Registered: May 2004
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posted
When my ex worked for Dominicks (10-15 years ago now) he had a coworker that as a cashier refused to ring up an alcohol purchase because SHE was a teetotaller and apparently felt that everyone should be, and further refused to call another cashier over to her lane to complete the transaction. She was told by management that if she had issues with ringing up certain items, she needed to find a job where those items were not present. They didn't fire her, although I think she did get a short suspension for her actions.
Posts: 4515 | Registered: Jul 2004
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posted
Okay, this presents another question. Why should an owner have the right to take this "conscience" position of not selling something that is legal, but someone who is not an owner seemingly not have the same right to take positions based on conscience without having to possibly sacrifice his or her livelihood? Isn't that discrimination based on economic status?
And anyway, as I understand it, many of the pharmacists who have refused to sell birth control pills are not the owners of the pharmacies but are employees of chain pharmacies (places like Rite Aid, Sav-on, or Walgreens). Yet the organization that is supporting their right to refuse to sell seems to be claiming that they have the right to do that without losing their jobs. Does that mean that someone who has a job that requires a university degree has the right to impose their morality on others, but someone who has a job that requires only a high school education, if that, does not have the right to do so? Again, that seems to me too much a discrimination based on economic or social status.
Posts: 2454 | Registered: Jan 2003
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posted
what is so hard to understand about this? You have a right to do as you feel you have to, but you don't have a right to avoid the consequences of that behavior.
It isn't about rights, or economic factors, it is about responsibilities. If you feel you owe more to your personal beliefs than to a patients right to have access to legal treatments, that is fine...but since you were hired to do a specific job, your employer has the right to terminate you for refusing to do it.
Your personal views should not be imposed on another person, unless you are willing to accept the consequences of doing so, up to and including termination.
Posts: 15082 | Registered: Jul 2001
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quote:Your personal views should not be imposed on another person, unless you are willing to accept the consequences of doing so, up to and including termination.
So, what you're saying is that if you are not of the ownership class it is acceptable for there to be more consequences for imposing your views on another than if you are an owner - obviously, the owner cannot be fired for forcing his or her views on others. I don't think it is realistic to say that the owner is risking having his or her business go under for not selling one item (birth control pills) or class of items (alcoholic beverages or tobacco products), because there are other things he or she can sell. It still sounds like discrimination to me.
posted
Um, in a word, yes. When you own a business, you are providing a service to others. It is up to you to choose which services to provide - or do you advocate that people who are unemployed should be forced to work in legal brothels? If people don't like the services you provide, they shop elsewhere and you go bankrupt.
Conversely, when you work for someone else, you are providing them a service; and if they don't like the services you provide, they are free to shop elsewhere. That's fair.
Posts: 10645 | Registered: Jul 2004
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quote:So, what you're saying is that if you are not of the ownership class it is acceptable for there to be more consequences for imposing your views on another than if you are an owner - obviously, the owner cannot be fired for forcing his or her views on others.
More consequences for the employee? The employer has much more at stake; if people stop patronizing the establishment, the owner can lose the business and all that's been invested in it. When it's your cash on the line, you ought to get to make the rules.
Posts: 884 | Registered: Mar 2005
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posted
I'm in favor of pharmacies creating policies for their employees that can honor their beliefs - filling birth control prescriptions by a non-objecting pharmacist. This can almost always be done with appropriate planning. I've picked up prescriptions filled by pharmacists earlier in the day but handed to me by a regular cashier. The objecting employees would have to submit their objections in advance of being hired for planning purposes, and be willing to take the crappy schedule when changes are needed to accomodate them.
But this should be the employer's choice as to whether or not to allow it. I do think it would be a good thing if the employer made room for the exercise of conscience. Of course, I'd like this same kind of freedom to be given to all companies in choosing whether to provide prescription coverage for birth control.
posted
Sighs. I guess I just didn't get the capatilism gene. It reminds me way too much of an instructor I had in community college who was of the opinion that if you don't have a doctorate, you aren't entitled to have an opinion. This just smacks too much to me of "if you don't have sufficient social/economic status, you have to submit to the morals of those who have higher status." Sort of like in the old days in Europe, when all the people in a jurisdiction had to profess the religion of the king/prince/lord who ruled that area.
Never mind. I should know better than to get into these discussions.
Posts: 2454 | Registered: Jan 2003
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quote:Okay, this presents another question. Why should an owner have the right to take this "conscience" position of not selling something that is legal, but someone who is not an owner seemingly not have the same right to take positions based on conscience without having to possibly sacrifice his or her livelihood? Isn't that discrimination based on economic status?
In the case of a store (as in my example), the owner has the right to decide what products the store is going to carry and sell. If a grocery decides not to carry alcohol at all, then a customer would have to go elsewhere to obtain it. A stock clerk or cashier doesn't have the right to tell a customer that they cannot buy something that the store sells unless there is a legal reason (i.e. age restriction) preventing the sale to that customer. I totally did not agree with the management of that grocery store telling the employee that "if you don't like it, you can find somewhere else to work". Even though they were not terminating her, it sure came across to me as a threat. (by the way, that company is unionized, I'm sure there was some action taken as a result, but by then, idiot no longer worked there)
I think stock control is what is going to happen in the birth control situation. Pharmacists who have moral issues with dispensing are going to do what they can (and I don't know how much control they have, to be honest) to make sure that they don't have "offending products" in their stock, thereby forcing a customer to go elsewhere to have their prescription filled. The way I read the news articles covering the IL regulation was that if the pharmacy carries it, the pharmacist must dispense, but that if the pharmacy does not carry, they transfer that scrip to another pharmacy that does. So if pharmacies legitimately do not stock birth control for whatever reason, then they can't be held responsible for not filling the scrip and the potential customer has to go elsewhere.
(and now I feel like I'm starting to repeat myself so I'm getting out of this thread for the night LOL)
Posts: 4515 | Registered: Jul 2004
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posted
It has very little to do with capitalism at all, even if you won't see it.
If someone hires you to do a job, they have the right to expect you to do it. If you suddenly change your mind about doing it, but still expect to get paid, you are not being reasonable.
At no point do I say that someone HAS to work at a place where they have to do this...they are free to find another job in a field that can make allowances for this type of thing. However, the medical field probably isn't the best field for someone who believes this, because in our society the main emphasis is placed on informed consent of the patient and patient autonomy.
There are any number of jobs available to people, but there is no right to any specific job if you don't meet the standards set for that job, plain and simple.
Posts: 15082 | Registered: Jul 2001
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You go through basic training and are sent to Iraq. One day, your unit comes under fire. Everybody shoots back except you. When your commanding officer demands to know why, you explain that as a Christian, you have moral objections to killing people.
I'd wager most of us would think you a couple companies short of a full battalion. If you agree, then you're going to love -- by which I mean, hate -- what's happening with your local pharmacist.
Well, maybe not your personal pharmacist. Maybe yours isn't one of those who are refusing to fill prescriptions on religious grounds, imposing their moral decisions on your medical decisions. Maybe yours isn't, in other words, one of the crazy ones. If so, count your blessings. Some of your fellow Americans are less fortunate.
I give you the state of Illinois by way of illustration. On the first of this month, Gov. Rod Blagojevich felt compelled to issue an emergency rule requiring pharmacies to fill prescriptions for the so-called ''morning after'' anti-contraceptive pill that works by preventing ovulation but can also block fertilization and keep already-fertilized eggs from implanting in the uterus. He acted after a pharmacist in his state refused to provide the pills to two women.
This week, Blagojevich moved to make the rule permanent.
TROUBLING PATTERN
But this isn't just Illinois' headache. Though no one seems to have hard numbers, published reports suggest a widespread pattern of ''Christian'' pharmacists refusing to fill prescriptions with which they disagree. And a chilling report last month in the Washington Post suggests that some have gone even further. It told of pharmacists who refuse to dispense birth control pills to unmarried women, of those who will not sell contraceptive devices to anybody, period, and of those who not only won't fill morning after prescriptions, but who hold the prescriptions hostage, refusing to return them to customers, knowing time is of the essence because the pill is less effective if taken too long after intercourse.
As maddening as all that is, what's more galling is that laws have been passed in four states -- and are under consideration in 12 others -- that legitimize this lunacy, allowing pharmacists with moral objections to refuse to fill contraceptive prescriptions.
In words of one syllable: What a crock.
People have an absolute right -- indeed, an absolute duty -- to oppose abortion if conscience so dictates. They have the right to pen letters to the editor, to support politicians who share their views, to demonstrate and agitate.
But no one has the right to refuse to perform some foreseeable aspect of their job. I mean, if pharmacies of the future began dispensing crack, OK I might sympathize with the pharmacist who refused on moral grounds. How was she to know that would become part of the job description when she signed on?
A DAY'S WORK
However, just as the soldier in the scenario should have known that shooting people might be part of his day's work, so should a candidate for a pharmacy job understand that she might have to hand out contraceptive pills and devices.
She should either resolve to mind her own business or keep searching the want ads.
I mean, what's next? Can the clerk at Blockbuster refuse to rent R-rated movies because he objects to explicit language? Can the vegan who works at McDonald's refuse to take orders for Big Macs? Tobacco kills 440,000 Americans a year. If I work at 7-Eleven, can I refuse to sell Marlboros?
Of course not. So by what right do these ''activist'' pharmacists get to impose their morals on the rest of us? And by what logic do lawmakers legitimize their ability do so?
There's no moral puzzler here, folks. In fact, the solution is real simple. You don't like what the job requires? Fine.
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That's probably why it killed the thread -- after your post, who had anything left to say? 
