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.
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.
Lastly, please be thinking about what topics you would like to suggest for our discussions during the final few weeks of the course. You may submit these suggestions here. I will add a voting button to the blog later in the week.
6 comments:
A few things:
1) as much as I hate to hear what is said about pharmacists in the Obstet Gynecol article (it is hard to hear!!) I have to say that it is accurate. We DON'T have the whole picture and it is hard to justify people who don't have a complete understanding being able to counsel on how to address the issues they don't understand.
2) I agree with this article's statement that there is a difference between objecting and obstructing.
3) We are science-oriented healthcare professionals. Science is the foundation of our practices in healthcare, not religion. Not "believing" or agreeing with science and medical studies is not an option. Science is evidence-based and each thing we learn about pharmacy is based on the beliefs that science is correct. It makes no sense to say we trust scientists to tell us that molecules work certain ways in our bodies, for example, but not to trust scientists when they say plan B is a contraceptive. Making medical decisions based on holy books cannot be tolerated.
4) Dr. Nuzum must be giddy with delight anticipating how crazy things will be next week now that abortion is a key word repeated over and over in this article. Surely, people will go berzerk. Dr. Nuzum, why?!?
Do you feel pharmacists should be obligated to dispense Plan B? If not, should they be required to direct the patron elsewhere for help?
Amanda Groppe
an.groppe@wingate.edu
It is difficult to be politically neutral with such a politically polarizing topic, but I will do my best to stay fair and balanced. With that being said, I would like to comment on the articles briefly. The first article from New England Journal paints a very good picture of the problem at hand and demonstrates the the difficulties society as a whole has with making a hard and fast decision in this matter. The second article is only useful in attempting to understand the closed-minded physician that has some incomprehensible hatred toward the profession of pharmacy. This article is little more than an inflammatory piece to insight rage in a community (apparently of OB-GYN's) just like those teasers for the news (Is your child doing drugs at the mall? More at 11) during the football game. I apologize, but i see almost zero redeeming value in it outside seeing how the other side lives- not well.
It is easy, on the one hand, to say that pharmacists should just do as they are told and fill prescription. They aren't "real" doctors anyway. They wear the same uniform as the photolab guy. The problems with this argument are many. But the main issue is that most people have a difficult time doing something the disagree with. The more you disagree with something the harder it is to do. And the more you think about how much you disagree with the thing the harder it is to do. It is difficult for me to answer this exact situation working in a hospital setting. I dispensed Plan B once in my life. It was an uneventful transaction. There were no protesters for either side of the argument. Just me and the patient (not customer).
When decisions like this come up I try to use the good of the patient as a measuring stick. If something that could happen is not in the best interest of the patient I won't do it. I think that too often these crusades miss that by trying to save society by putting their patient in harms way. Right or wrong, you do give up some things in life to become a professional. Physicians give up sleep and time at home to receive the privilege of being a doctor and all that comes with it- status, income, respect. You too will give up some things. One of those things might be the right to impose your morals and values on your patients. If you keep the patient in mind and do what is their best interest you will do well.
I personally do not have any objections in regards to filling any type of prescription, controversially, I have no qualms about dispensing insulin needles to those that request them, therefore it is hard for me to consider turning a patient away from valid medical treatment purely because I do not agree with the reason they are being taken. I feel that as pharmacist, we entered into this profession knowing that there is a circle of care we are a integral part of - the doctor, the patient, and the pharmacist. The patient has a ailment in which they have sought medical advice in which the physician has written a prescription for in which a pharmacist should then fill and counsel on (if the pharmacist feels that the prescription is valid and obtained through a valid prescriber-patient relationship).
Many times pharmacist do not have the whole picture. The likely hottest debate is Plan B - some pharmacist I have worked with have the misconception that the 'morning after pill' causes abortion, this is simply untrue. My argument toward these pharmacists has been that they have no problem filing oral contraceptives, why all the sudden do they now have a problem filing a prescription for virtually the same thing. I understand that as individuals we do not want to be forced into doing something that we do not agree with, but again, as pharmacist we knew what we were entering into - providing medications to the public and counseling on the administration, ADE/SE, DDI, drug-diet interactions, missed doses, storage, and clinical pearls of said medication. We are not to place judgment on individuals as we are a part of a medical team, not a religious one.
If a pharmacist feels strongly against filling a medication and refuses to fill it, I feel that they should do everything in their power to ensure that the prescription is filled in a timely manner, especially as the two articles point out, in time sensitive cases such as with Plan B. I see this as becoming problematic though because if a pharmacist has a moral objection to filling a prescription, they may also have a moral objection to ensuring that the script is filled at all.
If one may refuse to fill Plan B or possible euthanasia prescriptions, are pharmacist then allowed to refuse anything that they disagree with? That creates a slippery slope - for example, those that feel mental illness is not a 'real disease' may refuse to fill antipsychotics and tell a patient to just "suck it up."
Bottom line, pharmacist have an obligation to their patients, an obligation to provide the best medical care possible. Not an obligation to pass judgment, to condemn, to scold, or to demean someone simply because of the pharmacist personal beliefs.
Lisa DePetris, PharmD
Clinical Pharmacist
St. Vincent's Medical Center
lgdepetris@gmail.com
Let’s say, hypothetically, that when you leave school today you decide to stop at McDonalds. You go inside and order a Big Mac meal (supersize of course) and decide that you would like to have a McFlurry rather than a drink. It’s been a long week, and you just feel like having a little junk food before you go home and start your weekend of more reading and studying. When you finish placing your order, the 18-year old high school senior looks at you and says…”I’m sorry ma’am/sir, but I don’t think that you should eat that because I believe you to be in excess of your ideal body weight and I just wouldn’t feel right about enabling your advancement toward heart disease”. He refuses to sell you any fast food and instead starts to lecture you on the recommendation that you get at least 60 minutes of moderate exercise daily. What would you do? This kid doesn’t know anything about you. Doesn’t realize that you barely have enough time to brush your teeth, much less exercise and maintain an ideal body weight. Doesn’t know that you have made a commitment to serve others, advance your profession, and do all of the other stuff that you told the professors during your one-on-one interviews when you were applying to WUSOP. Pretty ridiculous don’t you think?
Now before you get offended and remind me that one day someone will call you “Doctor (insert last name here)”, I am in no way comparing what a pharmacist does to a fast food employee. But I use this scenario to drive home a point. You are going to be pharmacists, and will absolutely make a difference in the lives of others. You are going to help save lives and help old ladies/men become older ladies/men. However, you do NOT have the right to impose your beliefs on the care and well-being of the patients that we serve (MDs don’t either). And before you toss out the “I would refuse to fill Percocet/Tylox/Lortab in situations of abuse” argument, let me just say that there is a difference between clinical judgment and your “moral compass”. I see people in the ICU every day that are there because of the horrendous lifestyle that they lead, stupid decisions that they make, or some other ridiculous reasons that make absolutely no sense to me. But it does not matter what I think of these people and how they live their lives. My JOB is to provide the best care possible to these patients, irrespective of how I feel about the way they live their lives. Period. The patients that we serve must live with the decisions that they make, and it is not up to me/us to play judge and jury with their choices. It is up to me/us, to make sure that the pharmacological aspects of their care are optimized; the philosophical points should be left up to the patients themselves. As for my thoughts on the two articles, I could care less what an MD thinks about pharmacists (or the profession of pharmacy for that matter). I see nothing wrong with dispensing Plan B or any other controversial drug, and I in no way see this as me being a mindless drone that puts no thought into my work. I have no qualms about going to a physician when I feel that a medication is not clinically indicated, but my personal beliefs about moral issues do not factor into the equation. I got into this profession to help all people. Not just the people who live their lives and think as I do.
It seems as though it would be easier to practice your right of Conscientious Objection is a private, independent hospital, rather than a large public one where so much emphasis is placed on filling prescriptions. I was just wondering if any of the mentors have ever been in a situation where they would have liked to use their own conscientious objection, however were either afraid or unable to because of working in a large, public, pharmacy?
Sincerely,
Caitlin Mullins
Wingate University
P1 Student
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