Washington’s pharmacy board unanimously ruled that pharmacists have a duty to fill prescriptions despite any personal objections.
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The whole concept of pharmacists not filling a prescription on the same basis as a physician declining to provide certain services to patients is ludicrous. There is in most situations a physician patient relationship that goes beyond mere technicianhood. There must be a communication, sometimes of sensitive information. Shared decision-making is then followed by an agreement to provide what any other circumstance would be a physical assault.
Pharmacists have no therapeutic relationship with clients, take no medical history, indulge no sensitive issues, make no joint decisions. They fill a prescription; often without seeing the patient (as in when I go to the drive through and pick up my mother in law’s meds). For pharmacists to claim conscientious objection to the patient’s care plan sight unseen is shear garbage.
I live here in Washington and this has been one of the more contentious healthcare issues for the last few years. The BOP’s first decision was to allow a pharmacist to refuse to fill scripts based on personal beliefs. After quite the media uproar and the Governor threatening to replace the BOP members, they arrived at the latest decision. I will be interested to see if any litigation is filed. Some of the groups opposing it have already been discussing this.
“Pharmacists have no therapeutic relationship with clients, take no medical history, indulge no sensitive issues, make no joint decisions. They fill a prescription; often without seeing the patient (as in when I go to the drive through and pick up my mother in law’s meds). For pharmacists to claim conscientious objection to the patient’s care plan sight unseen is shear garbage.”
I agree that pharmacists shouldn’t be able to decline to dispense a certain prescription, but you are DEAD WRONG on that entire paragraph.
Looks to me as though it’s pharmacies, not the individual pharmacist. If they can get another pharmacist to do so, they can still not personally fill it.
It comes down to adding another layer of burden to what may already be a complicated and difficult decision. Suppose you’re a dermatologist and after careful evaluation and consultation, you prescribe your young female patient a course of Accutane, carefully complying with all the requirements to do so. When she gets to the pharmacy, should the pharmacist be able to say, “Sorry, I don’t believe the risks of this drug outweigh its benefits for you. No fill.” Is that their choice? Should she have to go to one pharmacy after another trying to justify your decision to them?
One of two things need to happen. Either the Drs. decide what drugs someone needs and the pharmacist fills it for them, or the Drs. lose prescription authority and instead they write out diagnosis for the pharmacist and the pharmacist make the drug choice decisions. In honesty Im not real sure who is the most qualified in this area. Drs. certainly have the medical knowledge and expert at diagnosis but pharmacists may well be more drug knowledgeable than Physicians??? But, it seems like there is battle between the two of them, and as usual, the patient is who is stuck in the middle.
The only physician that a pharmacist might know more about drugs than is a family practice doc. That would only be becuase they have to manage so many different drugs, yet the amount of information a good primary doc knows about the most common drugs they use is simply outstanding. Are you telling me that you think a pharmacist knows more about heart medications then a cardiogist. Drugs are huge focus in cardilogy. Do you think a pharmacist should be able to overrule you oncologist on which cancer drug is best for you? The idea that the physician hands the pharmacist who has no training is disease progression a diagnosis and then they decide which drug makes no sense to anyone who has ever prescribed drugs.
So much for liberty.
The idea that pharmacists can refuse to dispense the prescribed meds is ridiculous. I have friends who are pharmacists, many of them are in medschool right now. They know the drugs, sure, but they have no clinical judgment. The decision making has not been taught to them and this is why they are in medschool.
If as a pharmacist you think I made a mistake, call me and ask me why I made this particular choice. I will be thankful if you pick up an error, suggest a better choice, teach me about a new therapeutic option. Make your suggestions. I am always open to suggestions. I may or may not agree, but I will listen and will consider.
What more, the whole commotion is not about heart meds either. This debate would never be if it wasn’t for the morning after pill… Do you think? If for whatever reason you think morning after pill is Satan’s creation… I have a simple solution – Don’t take it! Let my patients make the decision if they want to have babies. At the end of the road they are the ones who chose to live their lives however they want to and I am the one who is responsible for my prescribing… It’s got nothing to do with pharmacists and they should stay out of it…
So YEY to the ruling!
“Let my patients make the decision if they want to have babies. At the end of the road they are the ones who chose to live their lives . . .”
And you and I and those pharmacist who object chose how to live our lives, and for some pharmacists, that means dedicating themselves to role in healing, not killing, a decision that they have every right to make, the Board of Pharmacy ruling notwithstanding. Pharmacists who refuse to dispense to dispense abortificants are not taking away anyone elses liberty, only insisting on their own liberty to practice the simple and clear ethical imperative to not participate in a killing. The liberty of patients to do so in no way confers an obligation on anyone else, any physician, nurse, pharmacist, or anyone else, to assist them in doing so. I would agree that the pharmacist has no right to destroy the prescription–it is not his property, but he has no obligation to fill it or do anything to it other than return the piece of paper to the patient with whatever comments he care to make. The Board’s opinion to the contrary is plain morally wrong and should be disobeyed by those with an issue of conscience.
If specific job’s requirements might interfere with your personal beliefs you don’t have to choose the job.
If you are a pacifist and object to all wars, nobody will force you to join the army. If your beliefs forbid you to participate in any kind of violence regardless of the reason, you don’t have to become a policeman. But once you become a policeman, you cannot say “I can’t carry a gun”. If you become a dancer you cannot say “I cannot wear these clothes they are too revealing, my religion requires me to dress modestly”.
Same here. When you decided to become a pharmacist you knew you may be asked to dispense birth control pills or plan B or whatever. You cannot choose a profession and then refuse to do your job.
Incidentally, there are plenty of reasons for these medications that don’t involve contraception or abortion as you probably know (or should know); are we women supposed to explain to you our medical conditions?
RJS just doesn’t get it.
Now that most prescriptions are filled by drive-through or mail order, there can no longer be any pretense of theraputic relationship between pharmacist and patient.
By abdicating this relationship, the profession has lost its right to invoke their personal feelings about the effects of drug therapy.
Birth control has been around for the entire working life of every working pharmacist. There are no new issues since any of them chose their profession. It is disingenuous now to be claiming that birth control prescription is now somehow contrary to their personal ethics. Get over it guys.
RJS: you have no clue what you are talking about as the above poster mentioned. The fact is the vast majority of pharmacist’s have NO therapeutic relationship with their patients..period. I will leave out the hospital pharmD’s
who take an active role in management. I rely on them on a regular basis for their expertise.
But they are clearly the exception
not the rule.
Anon 10:36 –
It is of course of value that pharmacists practice with a strong code of ethics, particularly one that favors life, a shared value in our society. However, physicians are now learning to practice with the patient’s prerogative as the first priority (except in emergency care, when it is necessary to first stabilize the patient’s condition); pharmacists should do the same.
Intensivists/ICU doctors may carry strong personal values and convictions to save lives at all costs, but they also must consider the values and desires of their patients: some may wish to die rather than potentially live with great disability, pain, and/or burden to their families. Medical technology can now keep people alive when they otherwise would die without significant life support – take locked-in syndrome as an example. Patients may not have the right to demand treatment, but they do have the right to have treatment withheld when they otherwise would die.
In this situation, one might contend that these women requesting the morning-after pill may not “have the right to demand this treatment.” However, the prescription was given by a physician who presumably discussed a range of options and the risks and benefits with the patient. This may not be the case, and the patient may be uninformed. However, if the pharmacist truly believes that he/she is acting in the interest of the patient and her potential child, he/she would do best by sitting down with the patient and having that same conversation regarding discussing the risks and benefits and other options. Otherwise, the pharmacist is no better than the intensivist who forces treatment on otherwise dying patients and berates them for wanting to die.
Note: I say this while harboring interests in training to be an intensivist. The fact is, one cannot practice ethically and morally by enforcing one’s values on another person.
Anon 10:36 pm:
There’s no killing involved with emergency contraception. There’s not even a pregnancy to terminate.
Doctors and pharmacists *know that.* We can pretend we don’t know that, but come *on,* it’s as simple as any other medication action. We have the education and the mandate to understand the medications we prescribe and dispense.
Considering emergency contraception in the same breath as killing demonstrates an unacceptable level of ignorance, and I can see why patients are losing respect for us and our treatment advice.
This decision is only common sense.
Many of the posts above fail to recognize the fundamental principle of liberty. There is a vast difference between compelling a person to act, and forbiding a person to act. Regarding the parallel to intensivists withholding vs providing care, it fails to recognize the vast gulf between withholding care which is intended to prevent the natural course of illness–electing to not act versus acting to end a life which will continue to develop if left to it’s natural course. Much of the above displays moral competence as well as a shameful, for Americans, lack of respect for personal liberty and conscience.
The military is a killing profession, the police are a coercive profession. Medicine and it’s ancillaries are not killing professions, although it’s technology can and sometimes is used for that purpose. Adherence to the millenia old ethics in this regard is the one area where medical professionals are and should be above the law of any state, and above the opinion of the majority.
Medical professionals should be above the law of any state?!! So you don’t answer to anybody? I wouldn’t get within 10 miles of any medical practitioner with that level of arrogance. The fact that the state gives you a pharmacy license doesn’t entitle you to run other people’s lives.
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