This week we are continuing our discussion of conscientious objection. To add information to our discussion, I would like you to review these articles published in NEJM and Obstet Gynecol.
Update for the mentors:
I introduced this topic last week and we had an hour long discussion of the topic today in class. Both sides of the issue have been presented, discussed, refuted and defended. The students were very engaged, to put it mildly.
I would like the mentors to begin adding their comments on this topic. While the focus has clearly been on Plan B and euthanasia issues, remember that the overall question is whether or not pharmacists should have the right to refuse based on moral or ethical beliefs. Please refer to the previous post to make sure you understand what we're NOT talking about before submitting your comments.
Lastly, please be thinking about what topics you would like to suggest for our discussions during the final two weeks of the course. You may submit these suggestions here.
8 comments:
I don't think pharmacist should be able to refuse to fill a prescription due to their opinions or beliefs, unless they are willing to provide a referral to another pharmacy that will be able to assist the patient. If a pharmacist does not want to be faced with this dilemma, then he or she should seek a position that would not require them to be faced with dispensing Plan B.
I do believe pharmacists should be able to refuse to fill a prescription if they feel that it would cause harm to the patient.
During my pharmacy residency we tried to set-up a protocol with OB/GYNs in the area so that their patients would have assess to Plan B at our healthcare center in the local Kerr Drug pharmacy. We thought this would allow an opportunity to educate patients about other forms of contraception in case they were unfamiliar and prevent future need for Plan B. After multiple attempts to set up this Plan B protocol, we were unsuccessful due to the conservative nature of South Carolina.
I do believe that as a pharmacist I have the right to refuse to dispense Plan B. However, along with this right is the expectation that I help that patient find the drug at another pharmacy or to get another pharmacist on staff to dispense it so that I do not jeopardize the patient's health in any way.
I also might add that the pharmacists I work with who do dispense Plan B do NOT in any way counsel these patients. I think we are doing our profession a great disservice by dispensing this drug without proper counseling!
I agree with Dr. Wilson that we need to develop a protocol to educate patients on other forms of contraception. My concern is that this drug is too convenient and that patients will begin to use this as a means of regular contraception.
After closely listening to everyone's opinions regarding the matter of conscientious objection, I know that our class is divided on the subject. Even though there is no clear cut law written in black and white, I think there is a law written in red, the law of our hearts. If we deny what is in our heart, then are we not denying what makes us exist? Basically, if we deny to fill a prescription or to fill a prescription, will our conscience accuse us or excuse us? People say that guns don't kill people, people kill people. If we think back to the Virginia Tech shooting, the guy that sold the student the gun, can you imagine how his conscience is feeling? Albeit, this individual had no idea what the student was going to do with the gun, I am certain that his life has not nor will be the same. Now, as pharmacists, if we dispense a high enough dose of pain medicine to kill a patient (the patient wants to die and the doctor is willing to give him the prescription), would you morally be okay with it? I could not.
I ran across this video clip today, and found it relevant to our topic this week.
http://cosmos.bcst.yahoo.com/up/player/popup/?rn=3906861&cl=10321808&ch=4226713&src=news
I found an article dated 10/21/2008 regarding a pharmacy in VA that refuses to dispense contraceptives of any kind. It's shocking to see that some people have gone too extreme.
http://www.newser.com/article/d93vapig0/pharmacy-in-va-refuses-to-sell-birth-control-gets-blessed-by-catholic-church-draws-boycott.html
I personally have no problem putting aside my beliefs to do what is best for the patient or do what the patient requests. I feel like you are performing a service to that patient that they are paying for. In the case of Plan B, you never know the circumstances that have brought them to that point so it is unfair to refuse it. However, I realize that some pharmacists have deep beliefs and should be allowed to respect those beliefs as long as they direct the patient to where they can get the medication.
When it comes to dispensing medication that you know may harm a patient, I could never do this and I believe it is morally wrong. I could never send out medication knowing that it may be used to end someone's life. It should remain a pharmacist's right to refuse to fill a prescription if they feel uncomfortable with it.
I just feel that whether or not the pharmacist has moral beliefs against filling a prescription, the pertinent matter would be the ability to not fill a prescription. I think if you do not allow a pharmacist to refuse to fill a prescription you might as well pull the title as professional. A professional is supposed to do things in the best interest of others no matter how controversial the decision
This is Zack...
My opinion in general rests with the statements on balance made by the authors of the 2004 NEJM article and the posts from Dr. Wilson and Lauri. I feel that pharmacists should have “a limited right to object” but “it is unacceptable to leave patients to fend for themselves.”
This topic brings me back to my notes from Dr. Supernaw from the Fall of 2004...regarding the foundations of moral medicine...beneficence, nonmaleficence, autonomy, justice, truth and consent.
Above all else…we should do what is best for the patient, without harming them. We should respect their wishes and treat them fairly. And as Lauri stated we must give proper counseling including giving unbiased medical information based on literature not on opinion.
I found parts of the NEJM and MOST of the article by Wall and Brown from Obstetrics & Gynecology to be offensive to our profession. Some examples (including the one referring to HIPAA) were over the top. I have worked with many physicians and nurses who make assumptions and pass unfair judgments on patients. Unfortunately there have been a few overbearing or “intimidating” pharmacists who have withheld care or misinformed patients. I feel that this is wrong and goes against the basic principles of moral medicine and the code of ethics we all recite upon graduation. I agree that we should not let our personal believes obstruct care and the well being of our patients.
I found some interesting statements from the Wall article:
“Pharmacists do not control the use of prescription medications”
“Pharmacists do not exercise full autonomous control and authority over their area of expertise”
“Pharmacists at the counter lack fundamental prerequisites necessary for making clinically sound ethical decisions”
“they do not expect pharmacists to question the diagnosis for which the prescription was written”…”to recommend alternative treatments to their patients”
Just to quote a few…
These articles bring to light issues discussed in a previous scope of practice blog. I will not elaborate on my feelings but pharmacy has a long way to go to convince many physicians of our worth and of what we are capable of (hopefully this will inspire those in our generation of pharmacists to promote the profession and become more active).
The majority of pharmacists in practice go above and beyond the call of duty. Many barriers exist to more extensive counseling and evaluation of the patient (this too is another topic) and there is definitely room for improvement here. We all have a right to stand up for what we believe in we must be careful not to harm others along the way.
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