For the next two weeks we will be discussing this topic. We WILL NOT engage in a discussion about what is or is not an abortion and whether or not abortions should be legal. This topic is the main reason there is comment moderation on this blog and I will not hesitate to reject your comment if I feel it is straying into these areas.
Students: For this week, please use any of the electronic resources at your disposal to research the topic. If you find something interesting, feel free to post a summary or a link as a comment.
If you need an area to focus on, here are some suggestions:
- What is conscientious objection as it applies to the profession of pharmacy?
- What states in the U.S. are seeking to pass or have already passed legislation that addresses a pharmacist's right to refuse to dispense a prescription?
- What are the positions of the pharmacy organizations on conscientious objection?
- Are there articles published in the literature on this topic?
- What medications are at the forefront of this issue?
Mentors: hold off on commenting until next week. There will be a new post with more information that prompt you to begin commenting on this topic.
33 comments:
Conscientious objection is based on respecting to pharmacists' moral and beliefs.
Pharmacists in Washington State tend to refuse dispensing drugs involved to lethal prescription intended to assist suicide; and drugs involved to emergency contraceptive, oral contraceptive and abortifacient.
Ngan Tran - P1
Here is a good article from MedScape that covers a lot of the questions presented. http://www.medscape.com/viewarticle/551238
In the article, the ASHP, ACCP, APhA, and Academy of Managed Care Pharmacy all "recognize a pharmacist's right to decline to participate in therapies that he or she finds morally, religiously, or ethically troubling and supports the establishment of systems that protect the patient's right to obtain legally prescribed and medically indicated treatments while reasonably accommodating in a nonpunitive manner the pharmacist's right of conscience."
As for the state legislation, 10 states had enacted laws by May 2006 regarding the pharmacist's right to refusal to fill a prescription. "There are currently 48 such bills in 21 states being considered in the state legislative bodies, 37 of which expressly give pharmacists and other health care providers the right to refuse to participate in activities that they find morally or ethically objectionable. Many of these exempt the health care provider from legal consequences or disciplinary action from his or her employer or state board of pharmacy. Of the 37 proposed bills supporting the right to refuse, 8 specifically mention emergency contraception, 2 deal with family-planning issues, and 7 deal with procedures or products resulting in abortion or termination of pregnancy. Of the 11 proposed bills that expressly prohibit the pharmacist's right to refuse, or impose fines on those who do, none mention specific drugs or procedures."
From what I have read, conscientious objection can be defined as, “a pharmacist’s right to refuse to fill a prescription based on his/her own moral, ethical, or religious beliefs, but must provide a referral to the patient to someone else who can help.” As based upon what I have found on the organizations website, the only two that I can find that take a stance on the issue, is ASHP and ACCP, in which they support the pharmacist’s right to conscientious objection. For myself, I feel that for an individual to feel important in their career, they have to take a stance on things. Therefore, this is America, and I do support this myself. We as professionals should be able to professionally decline a prescription fill if it interferes with our own believes without making judgment on the patient, and refer them to another pharmacist. So I guess my question for the mentors is, “now that you are in practice, how do you feel about this issue? Have you ever been faced with a decision regarding this, and if so, how did you handle it?”
Carly Marcum P1
If a pharmacist is going to refuse filling a prescription due to conscientious objection.
He/she must know a place to where patients can be referred. They cannot be bounced around.
Is it possible that there are no drugs of contraceptive and abortifacient in a pharmacy
because nobody of the staff wants to fill the prescriptions? If there are two pharmacists per
shift, should one of them has no conscientious objection? What is your opinion, mentors?
Tai Tran - P1
Everyone should know right from wrong. More specifically a conscientious objection is the belief behind why an individual feels a decision is the wrong one. The belief usually stems from background experience and personal belief, but it is often a very strong decision that someone holds to be true. A pharmacist should be aware of this objection as they should never "do" something in their profession that goes against this feeling. They have the right to refuse dispensing drugs and they should keep this objection on the tip of their tongue. A pharmacist has an important job which comes with very important responsibilities. Some of these responsibilities include the choice of conscientious objection and being able to say no when situations get down and dirty.
- Nick Conley (p1)
In order to familiarize myself with the topic, I read an article titled Conscientious Objection: A Pharmacist's Right or Professional Negligence? by Emily Evans, PharmD. This article gave a good summary of explaining that conscientious objection is a right that a pharmacist has to refuse to fill a prescription based upon his or her own beliefs. It also went on to point out some opponents of the matter, such as an author who believes that refusing to fill a prescription is a failure in performing the duty of a pharmacist. I personally support the idea, although I may not necessarily agree with some stances, such as the refusal to fill contraceptives or pain medications. It seems that in protecting the interest of the pharmacy itself, the pharmacist does need the right to police what kind of prescriptions are going in and out of the pharmacy. This could be as simple as choosing not to stock certain drugs.
Just to play devil's advocate:
What about the patient's right to receive healthcare that provides the best QoL possible. QoL is subjective ,and can be defined in radically different ways by different people.
Keeping this in mind:
Are 'morning after' drugs acceptable? ED drugs? Contraceptives? Fertility drugs? What aspects of reproduction are sacrosanct? Where should this line be drawn? I'm not sure there is one right answer on such a topic, but we must do our utmost to define our own individual beleifs regarding these matters.
I feel that the main point of pharmacy is the patient. We are employed to serve them. I may be biased because there is nothing I feel so strongly about that I would feel wrong distributing to a patient, though. I have my opinions on things but I would keep this separate from my work. I don't think we should be in a position where we refuse service to a patient needing something. If we were to refuse to fill a prescription it would be almost as if we were judging what the ptient was taking part in. Alot of times as well the controversial drugs are ones that people need immediately, like emergency contraception. We need to follow through and take care of our patients when they need us. By refusing to fill a prescription we could make someone miss their time window for taking that emergency contraception, and I don't think we should be interfering in a patient's care in that way. I hope not to offend anyone, but this is just my opinion.
-Kristen Willard P1
I found a very good webpage that discusses a few of the points we are discussing this week. The website http://www.nm-pharmacy.com/body_rights.htm gives different case scenerios that enable us to put ourselves in the shoes of a declining pharmacist. There are different types of medications at the forefront of this topic including birth control, emergency contraception, assisted suicide, etc. Knowing that a patient is willing to take a lethal dose of a medication is tough to process, but is it possible to understand their position if they are living with a terminal illness?
Mentors - Have you been in a position where a patient openly expressed a willingness to use their medication for something that made you uncomfortable? How did you handle the situation? How did the patient react?
Katelyn Agee P1
Personally, I feel that a pharmacist should have every right to refuse a prescription. Ultimately, all responsibility for the prescription filled will fall on the pharmacist, both legally and morally. If the pharmacist strongly agrees with his/her religion about a certain issue, they should have the right to practice their religious beliefs/customs. Another common form of drugs not including emergency contraceptives includes controlled substances. These are commonly abused and it is the duty of the pharmacist to look out for the patient and only take actions that benefit the health of the patient. If dispensing a drug would harm the patient (because they are abusing it) they pharmacist should refuse to fill the prescription solely based on the face that the pharmacist wants to "help" the patient.
Greg Browning, P1
I just wanted to clarify on my previous post. –if its an opinionated decision based on morals I think that it should be filled, if we think something is being abused I think that is a different story though. We do need to protect our license and do what we know is right.
-Kristen Willard P1
In any given situation, we are never required to do something that we are morally uncomfortable with. I don't see why this should stop when we walk into a pharmacy as a professional. Having said that, I do support conscientious objection in a pharmacy but at the same time I think that it can lead to bad decisions by the pharmacist as well as good ones. Ultimately I feel that I'll never fill anything I don't feel comfortable with, but I don't think that there is no room for error. This is something that there can't really be a rule for, and we need to make the rules for ourselves as individuals as we go.
Mentors,
How do you handle physicians if you call to double check a prescription and they become angry because they think you are questioning their intelligence?
John Miller P1
Here is an article discussing the increase of drug related deaths, mostly focusing on opioid abuse, and expands on what was talked about today. http://www.medscape.com/viewarticle/724186
I didn't know it was this bad. Note: You do have to register to read the full article, but its free, easy and seems to be a good site.
-Ben Gwathmey, P1 student
If a pharmacist is going to refuse filling a prescription due to conscientious objection,
he/she must know a place to where patients can be referred. They cannot be bounced around.
Is it possible that there are no drugs of contraceptive and abortifacient in a pharmacy
because nobody of the staff wants to fill the prescriptions? If there are two pharmacists per
shift, should one of them has no conscientious objection?
Tai Tran - P1
Conscientious objection is something that a pharmacist should have the right to do if they feel it is necessary. This is particularly true of the situation involves the safety or health concerns of the patient. A pharmacist may refuse to fill a prescription if he or she feels the individual is misusing or adducted to his/her medicine. This looks out for the safety and well-being of the patient. It is a wonderful thing that pharmacists have the jurisdiction to do this. It can prevent a lot of issues surrounding medication-induced morbidity and mortality. Even though the patient may become irate or flustered, ultimately they will one day realize the great thing that the particular pharmacist did for them.
-Sarah Helms (P1)
In most of the literature i have read focuses on oral contraceptives and plan B pills contradicting a pharmacist's religious beliefs. I feel they should have a right to decline but need a back up location or number such as a local planned parenthood etc. for the patient because our oath is focused on the needs of the patient. A pharmacist should always respect the patient and hear their reasoning for the medication before saying no immediately as well. For the mentors: Have any of you turned down a medication based on religious beliefs, or have known of a pharmacist who has? I am just curious how common this would be and how this could be professionally handled without disrespecting the patient.
Leanne Wentz- P1
Mentors,
I believe every pharmacist has their own right to dispense or refuse a prescription if in their professional judgment it would be harmful to the recipient or if the validity of the prescription is in question. What do you believe should be done about this topic of Conscientious Objection, and should the government step in and pass a law to set guidelines?
Shawn Jessup
WUSOP P1
I also read the article that Kris referenced and feel that as professionals we are entitled to hold up our moral beliefs, especially when it comes to keeping our license. Conscientious objection is something that we all are going to have to deal with no matter what. However, the article does mention the changes that are going on in the legislation of different states and whether they allow pharmacists the right to refuse filling. We should all be familiar with the state's laws that we practice in before refusing to fill.
Chad Chriscoe. P1
I agree with what Kristen Willard's post, especially the fact that we are employed to serve the patient. No matter our backgrounds, each student takes an oath to apply their knowledge, experience, and skills to the best of their ability to assure optimal outcomes for their patients. We do not, however, take an oath to apply personal morals and values to the decisions we make regarding patients. Therefore, a person with said objection is fully aware of the responsibilities of this voluntary oath. I feel that any conscientious objection should be separated from the profession of pharmacy when when it involves personal morals and values (one's religion and birth control, for example). However, I also agree with Kristen when she says that conscientious objection due to patient abuse of a medication or situation is completely acceptable. Prescription drug use is illegal and a pharmacist has every right to protect their license by not giving in to the demands of a patient.
Amanda Flores - P1
Week 6 Conscientious Objection
After the class discussion on this topic Tuesday morning, I had a good idea of what I thought conscientious objection was. However after reading about the topic I have discovered that I did not have an all encompassing view of what I am really going to be faced with regarding decisions to fill a prescription when I become a pharmacist. I read an article that was discussing the rights of a pharmacist to refuse to fill a prescription based on their ethical, moral, and religious views. I was surprised to see that the pharmacist does not always have as much autonomy as we may think when it comes to denying to fill a prescription. For example some prescriptions mentioned were erectile dysfunction drugs for HIV patients and medications for assisted suicide. Some of the pharmacists were being held accountable for their choices not to fill and I don’t agree with this. I feel like if a person devotes themselves to a profession and receives a degree they should have the right to practice the way they wish according to their judgment about the medications benefits to the patient and those involved with the affects of filling those medications. I would expect a physician to act in the same way. If a medication was not going to be of the best benefit to a patient as well as the society who will encounter the patient and possibly become affected by the interactions of the medication and the patient, then the physician should not prescribe for the patient nor be held accountable because of this judgment call. After all that is why we are professionals and have been educated, so that we can make these decisions on behalf of others. I believe as health care professionals we have a responsibility to ensure the benefit of society one individual at a time, but not forget about society as a whole. The article did mention that if a pharmacist could not accept that duty to fill some medications that is beyond their level of comfort as part of the job description then they have chosen the wrong field. I do not agree with this either. Again I say that a person has the right to do many things in this country for example, practicing a religion, freedom of speech, or expressing oneself as they see fit do so. I feel that this gives the pharmacist the right to use their discretion in dispensing medications that will affect their personal view points on life. Any health care provider should be able to freely practice this way as well in my opinion.
Tiffany Benfield P1
I guess it’s because I have not worked in a pharmacy, but I fell to see the argument as to why pharmacist should administer drugs if they feel, whether be because of religious beliefs, personal beliefs or whatever the case may be. So I’m asking what am I missing? Because I feel that in a business such as pharmacy you have the right to refuse any service you do not feel comfortable doing. Sam W
I think it's excellent that a pharmacist has the right to refuse a prescription. I think that line should be drawn when it comes to things like birth controls, emergency contraceptives, etc. I don't believe a pharmacist should be keeping the patient from getting what they need. I believe that we should only be allowed to refuse a prescription only if the patient's safety comes into play.
To the mentors:
I however, have worked with a pharmacist who refused to sell Plan B to men--when I asked her why she made a valid point--"Because I don't know how old the female is who will be taking this." I know some girls are too embarrassed to buy it for themselves--but I was curious:
How do you mentors feel about dispensing emergency contraceptives to males?
I believe that a pharmacist has the right to refuse to fill a prescription. Ultimately, responsibility for any prescription filled relies on the pharmacist. If a pharmacist is uncomfortable filling a prescription because they believe it has tampered with or forged, or if they think the patient is requesting the drug in order to sell part or the entire quantity of the drug, they reserve the right to refuse to fill it. A pharmacist would not risk losing their license to fill a prescription for someone they believe is a drug abuser. As pharmacists, non-maleficence is required on our part, meaning that we are to do no harm to patients. Assisting in the continuation of drug abuse would violate the oath of a Pharmacist and the principles of patient-centered care. Additionally, if a pharmacist has religious or moral opposition to filling certain drug orders such as emergency contraception (Plan-B), they should be allowed to uphold their values and refuse any prescription that makes them uncomfortable.
Kirsten Wood
P1 Student
In my opinion, pharmacists should be flexible when doing their job. I don't see the point when they have the rights to refuse dispense drugs. It's just about their beliefs. Right now, in many states, pharmacists are given the right to do that. It's understandable when someone wants to buy drug for suicide, we can't dispense that drug because of nonmalfience. But I just read the article said a raped victim came to pharmacy store and asked for emergency contraceptive and be refused. That pharmacist got fired. I don't comment about whether it is right or wrong. I just want to say that in some cases, we should put our beliefs aside and do our job.
Ngan Tran- P1
http://docs.google.com/viewer?a=v&q=cache:9PA3n8g7RK8J:vip2.uvm.edu/~vlrs/Health/birthcontrolandpharmacists.pdf+What+states+in+the+U.S.+are+seeking+to+pass+or+have+already+passed+legislation+that+addresses+a+pharmacist's+right+to+refuse+to+dispense+a+prescription%3F&hl=en&gl=us&pid=bl&srcid=ADGEESh-whHmHIySoRWMRcVUHIOEWpaioVjgBM_-jMqF_SUXjcAcKm72Ls_doUV5-pG9eu_nMGXjsG_9GmZ3mjKxaQ9a61guTdfeJ5qJIu9EYEdKjfD9fVEEqe5tKKTiuMs3tCsneXtw&sig=AHIEtbSCkCQRsr1bzk2dKkfNeX_jtDB9uQ
This publication from University of Vermont. It shows states are passed the legislation of conscientious objection; and so on. It contains the chart and pretty clear. So I think it will be helpful for us.
Ngan Tran - P1
I think pharmacist have every right to refuse to dispense a drug to a patient if it is against her morals and might endanger the patient. Besides, some of these patients might be drug abusers, etc. Plus, the Freaky Friday video, demonstrated how a pharmacist should properly handle a situation concerning conscientious objections.
I might not have years of pharmacy experience as the next person but if someone asked for a suicidal medication, I won't give it to that person.
In class discussion, we focused mostly on the right of a pharmacist to object to filling a prescription if the pharmacist suspects that there is some illegal activity occurring. However, to me, conscientious objection does not include refusal to fill a prescription for legal reasons. If a pharmacist is aware of or suspects illegal activity, it is his or her responsibility to take action and protect his or her own license.
Instead, I think that conscientious objection applies to situations and prescriptions that are legal, but may not be considered ethical or moral by the individual. With that said, I do not believe that pharmacists should be able to refuse to fill a prescription on moral grounds. We are all aware of the duties that this job entails before we earn our degrees, and we are there to assist the patient – we are not there to judge them and label their actions "unethical". A patient should never suffer or fail to receive treatment based upon the morals of his or her pharmacist. For the most part, if a person has a moral issue related to a job, they find a different job. If a pharmacist has a problem with dispensing certain medications they should probably seek out an area of the profession where they will not be faced with the situations they find amoral. There are aspects of every job that people may not enjoy or agree with, but they must be done regardless. If filling prescriptions for legal use is part of a pharmacist’s job description, then that is what they should do, regardless of personal feelings.
Carolyn Kilbane (P1)
Conscientious objection is a sticky subject and rightly so. It is getting at the core of most people’s beliefs (or their morals). I’ve gone back and forth about this issue since I’ve started thinking about it and I think I’ve decided that I can’t possibly take a stand to totally support or totally reject this idea of conscientious objection. Each of us have different morals and different ideas of what is right and what is wrong so I think that sometimes it is unfair for us to bring these ideas into our pharmacy practice. I think rather than a pharmacist saying that they will never dispense a certain drug that they feel strongly about, it should rather be taken on a case to case basis. The pharmacist is supposed to be well-educated and I believe that we should take extra care to use our brains to decipher whether or not the drug should be dispensed. I believe that it’s not necessarily a matter of morals but I matter of having the correct information available to decide whether or not to fill a certain prescription. This involves getting to know patients, something that we continue to come back to.
--Hollee Kitts, P1
Conscientious objection is a sticky subject and rightly so. It is getting at the core of most people’s beliefs (or their morals). I’ve gone back and forth about this issue since I’ve started thinking about it and I think I’ve decided that I can’t possibly take a stand to totally support or totally reject this idea of conscientious objection. Each of us have different morals and different ideas of what is right and what is wrong so I think that sometimes it is unfair for us to bring these ideas into our pharmacy practice. I think rather than a pharmacist saying that they will never dispense a certain drug that they feel strongly about, it should rather be taken on a case to case basis. The pharmacist is supposed to be well-educated and I believe that we should take extra care to use our brains to decipher whether or not the drug should be dispensed. I believe that it’s not necessarily a matter of morals but I matter of having the correct information available to decide whether or not to fill a certain prescription. This involves getting to know patients, something that we continue to come back to.
--Hollee Kitts, P1
I read an article based on a survey of 668 pharmacists practicing in the state of Nevada. In Nevada there is a mandatory law to transfer prescriptions you are unwilling to fill to another pharmacy. The article focused on oral contraceptives, infertility medications, erectile dysfuntion medication, medical abortifacients, and emergency contraception. The study compared whether or not pharmacists would fill each prescription, based on their religion, age and gender. Despite the mandatory transfer law 36 pharmacists would not even transfer a valid prescription for medical abortifacients and 15 wouldn't transfer one for emergency contraceptives. Over 80% of the pharmacists breaking the law and refusing to transfer the prescription explain it as against their religious beliefs to dispense such medication. I completely support pharmacists being able to refuse to fill a prescription. In class we talked about refusing to fill a prescription for someone you feel is abusing a controlled substance, I would definitely refuse to fill this prescription, looking out for the safety of the patient and those around them. On the other hand, the article I read was focused more on contraceptives and turning someone down, and even refusing to transfer their prescription based on your own religious and moral objections to the idea. Despite whether or not I object to contraceptives, I have never felt the personal authority to encroach my beliefs on someone else. I feel as if our professional code implies a duty to serve patients regardless of moral convictions so I wouldn't turn down a prescription for oral or emergency contraceptives.
We talked in class about controlled substance databases that could be used to see if a patient is doctor-shopping or abusing medications. I know that North Carolina has such a system in place.
Mentors,
Do you feel that pharmacists are made aware of these databases or have adequate access to them?
-Matthew Jones P1
In a lot of scenarios a pharmacist is allowed to use their own discretion to fill or not fill a prescription. If it’s a legitimate prescription, sometimes the patient is suggested to go to another pharmacy. Conscientious objection, to me, is no different. Everyone should be allowed to follow their own principles, and in extreme situations, accept the consequences.
Community pharmacies usually state in their handbook that if a pharmacist refuses to fill some type of controversial prescription then they must direct that patient to another pharmacy. If it’s some type of OTC then any member of the staff can sell that medication to the customer. It is rare to have only one pharmacy serving a certain area. I just cannot think of a situation where a patient could not get their prescription filled somewhere else. And if it was an emergency, where I would assume/hope the patient is in a hospital, the pharmacy would have one more than one pharmacist on staff and doctors.
In response to Matthews Post:
In SC, after about a year after pharmacies were required to register with and submit prescription information to the program, many pharmacists still did not know the program even began. What happens is that, for example, if you were working for a large chain the district office did all of this paperwork for you, including submitting prescription information about each control substance you dispensed. Even though there is this database out there, none of my pharmacists (I sometimes floated at different pharmacies) ever accessed it. My boyfriend, a pharmacist, says he doesn’t use it and neither do any of the pharmacists he spoke with. If I remember correctly, it’s like a website you access with a login password and code (at least for SC it is)
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