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 of this issue typically surrounds one or two situations, 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 weeks of the course. I will be asking for suggestions soon and will add a voting element to the blog for mentors and students to select their preference.
45 comments:
To mentor,
I know that grant pharmacists to right to refusal to dispense contraceptive would open the door to abuse. But such priviledge has been granted to lawyers, doctors, and other medical professionals. i felt very disappointed when pharmacy was referred to as an incomplete profession. That's an insult to what we pharmacist are. I believe that we we should have such right as physicians do, to conscienctious objection. After, pharmacist are just as valuable as physicians. We deserve that right.
Have you ever had a time when you had to resort to conscientious objection? What did you do?
I agree with both article that patient should be put in the first position; and pharmacists should give the right to refuse filling prescriptions, however, this right should be somehow restricted. As I commented last week, pharmacists should be flexible and think about patients' aspect when they make a decision whether prescribe medication or not. For example, it is very reasonable if a girl who is a raped victim wants to take emergency contraceptive drug to prevent pregnant. Pharmacists think that their prescribed action will kill a person but if they don't give drugs for that girl what happens to her after that. She will suffer an un-end pain if she gets pregnant.
However, if a person want to suicide, pharmacists should not prescribed drugs because they can looking for a solution for that person. Pharmacists can recommend that person to go to psychologists or else to prevent them killing themselves.
So giving the right to refuse dispensing drugs but limiting it is the good solution for this issue.
Ngan Tran -P1
I agree completely with the "middle road" that the NEJM article laid out: I think pharmacists should be allowed to retain their right to refuse a prescription, but they should also be required to provide a reasonable alternative so that the patient CAN get the drug.
As for the "Obstet Gynecol" article, the true and hypothetical examples provided an unfortunate reality of how some very insensitive and ill-informed pharmacists may react to seeing a prescription, but it brings up some good points about pharmacy, particularly community pharmacy in general:that the system needs to change. I very strongly believe that medical charts/history/labs should be accessible on a highly protected/encrypted electronic database so that all health care professionals can have access to the patient's medical history. Not only might this relieve at least some confusion with conscientious objection, but it will also increase the scope of the pharmacist so that the pharmacist can actually do something more clinical rather than just dispense drugs.
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.
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.
I think that pharmacists should have the right to conscientious objection due to the ethical and moral beliefs but use that priviledge wisely. Being given the such priviledge does open the door a wide range of abuse. It's natural to refuse to give a patient an emergancy contraceptive becuse it could lead to abortion. But pharmacists must be careful to not let their personal feelings cloud their judgement. They must be careful in what they are refusing becuase we do not know the circumstances of the patient. I know some pharmacists have a personal agenda against patients who abuse drugs but we ought not to use conscientious objection as a instrument against the patients.
Take the hypothetical Betty Jones case. The pharmacist refused to give Betty Plan B based solely on his own preconceptions. He also lacked the clinical understanding of this patient’s circumstances.
Also, he lacked the basic prerequisites for making an adequate, acceptable,ethical judgment.
I not saying that pharmacists should not refuse to fill perscriptions becuase they feel may
cause a potentially fatal drug interaction. Those pharmacists are doing their job. It's just those 'evangelist pharmacists' who refuse to fill legitimate prescriptions
for medications because
of their personal values and opinions.
To mentors,
Have you ever being in a situation where you had to use conscientious objection? What did you do?
"I promise to devote myself to a lifetime of service to others through the profession of pharmacy. In fulfilling this vow:
* I will consider the welfare of humanity and relief of suffering my primary concerns.
* I will apply my knowledge, experience, and skills to the best of my ability to assure optimal outcomes for my patients.
* I will respect and protect all personal and health information entrusted to me.
* I will accept the lifelong obligation to improve my professional knowledge and competence.
* I will hold myself and my colleagues to the highest principles of our profession’s moral, ethical and legal conduct.
* I will embrace and advocate changes that improve patient care.
* I will utilize my knowledge, skills, experiences, and values to prepare the next generation of pharmacists.
I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.”
Sound familiar to anyone? This is the new and improved revised Oath of a Pharmacist that was adopted by the AACP House of Delegates in mid 2007. Now, within the vows devoted to our profession, to our patients, and to our selves, can you find where is says "I will consider my personal ethical and moral principles before dispensing a prescription?" Because I couldn't.
Eric Beamon
WUSOP P1
I feel that a pharmacist should have every right to refuse any prescription they are not comfortable filling or is against their moral/religious beliefs. No one should be forced to do something they find morally wrong. There are many different views on the use of emergency contraceptives. This variety of opinions exists in the profession of pharmacy as well. For every pharmacist refusing to provide emergency contraceptives there will be another that is more than willing. There is no need to force someone to sell something they do not want to sell if a problem could be avoided by letting the patient know the product is available elsewhere. Of course, a refusing pharmacist may not provide the location that does sell the product to the patient; however, if the product is extremely important to the patient, there will be more than enough sources to help them find a location. After all, this is the United States, a country defined by freedom of choice and this freedom should be applied in the topic being discussed this week.
Greg Browning, P-1
I feel that both articles raise some really good points that all pharmacists should think about and consider. The article entitled “The Limits of Conscientious Objection” raises some good points by mentioning that lawyers, physicians, nurses, and physician assistants are almost always allowed to follow their moral values with regards to professional duties. Pharmacists are professionals too and I feel should be allowed to chose not to fill a prescription. If the reason for not filling a prescription is due to moral or religious reasons it seems reasonable to require the pharmacist to redirect that patient to a pharmacist who will fill their prescription in a timely manner. The article entitled “Refusals by Pharmacists to Dispense Emergency Contraception” brought up some good scenarios for pharmacists. One scenario mentioned a 14 year old girl that that needed birth control pills due to medical reasons, but a pharmacist would not fill her prescription and accused her of “trying to produce an abortion.” It is obvious that the pharmacist acted unprofessionally by falsely accusing the patient. In such cases it is often hard to know the intent behind a prescription. If a pharmacist does not know the intent or feels uncomfortable about filling the prescription a pharmacist should be required to redirect the patient in a professional manner to a pharmacist that would fill their prescription.
-Kevin Morris P1
A pharmacist should have the right to refuse anything that they are uncomfortable with. This would include an emergency plan B prescription. I think this is justified by the sheer number of pharmacies within a town. It is very common for a town to have 6 or 7 pharmacies and if one pharmacist doesn't feel comfortable, then that pharmacist should redirect that patient to someone else. This is a subject that I feel is all "hush hush", but in all honesty it needs to be taught and trained so that when the situation does arise it can be handled correctly. If you do not feel comfortable filling or dispensing a drug, then notify the patient, but direct them elsewhere. As long as the refusal is handled directly then I don't see how or why a pharmacist should get fired for such actions. I do think the confusion from this protocol comes from the fact that no one is really training pharmacist how to handle this problem correctly.
- Nick Conley (P1)
According to the document Refusals by Pharmacists to Dispense Emergency Contraception, I am sensing a biased report concerning the view of a pharmacist’s right to decline to fill a prescription for oral contraceptives. There were numerous statements made in the document that suggests the assumption that all pharmacists who choose to refrain from filling will also give their personal condemnation statement belittling the patient, and also develop an opinion of their patients based on their appearance, social class and ethnic background. I do not think that is the case with every refusal to fill. Also I am certain that if a pharmacist was awarded full protection to not fill an emergency contraceptive when they felt it violated their morals, they would be willing to agree to any contracts regarding the withholding of their personal opinions. A few pharmacists may slip through the cracks, which have a strong opposition to abortion, but these are the few who should then be reprimanded for their actions. For the most part a person who completes their pharmacy degree and holds a licensure is a professional person and should be expected to use their sound judgment as to when to refrain from expressing such personal opinions in public and also condemning their patients. The article seemed to portray a pharmacist as someone who simply has some advanced training in medicine and has no control over their professional attitude. The author also portrayed the pharmacist as a member of healthcare that did not deserve the same rights as a physician or lawyer. This seems unfair when the result of the actions of the pharmacist, either directly or indirectly will affect the quality of life for the patient as well as possibly life or death.
The author then goes on to compare the retail pharmacist and their discretion to that of a realtor. Pharmacists are not going to decline a prescription with regard to racial discrimination nor should they ever consider it. However the point the author is making is unfair because pharmacists are health care professionals with the ultimate goal to save a person, not as the author goes on to suggest, withhold life saving medications to allow a patient’s death due to bias or moral opinion. The author is clearly misunderstanding/ misconceiving the role and the mindset of a professional pharmacist as well as the education they receive and the training they possesses to deliver such methods of training.
In regard to the reading from the New England Journal of Medicine, there are some valid suggestions offered as to how a pharmacist can refuse or politely decline to fill a prescription for oral contraceptive and then advice a patient where to make the purchase instead. In my opinion this is legitimate and allows the patient’s needs to be met, while the pharmacist can uphold their moral standards.
To the mentors: What is your opinion? Do you feel that as a practicing pharmacist you should be given the same right to conscientious objection that a physician or a lawyer receives with regard to filling a prescription for emergency contraception? Or do feel that as a provider of pharmaceuticals it is your requirement to put all personal morals aside and dispense all medications?
Tiffany Benfield P1
Many people have different values and beliefs, and just because we will be pharmacists, it does not mean we gain a right to decide what is right or wrong for a person morally. Yes, we have every right to deny filling a prescription if something is wrong with the prescription or will harm the patient medically, but refusing to fill something because you personally do not agree with it, is not appropriate. We are no one to judge patients and we do not have the reasons behind the patient needing a certain medication. Our main priority is to give the patient pharmaceutical care via their medication.
-Maryann Choy-Ames, P1
I agree as to what some have said about “middle ground” on this issue. If I have learned only one thing in our critical course this semester it would be that things are not always black or white. There needs to be gray area. I personally, morally do not condone Plan B, however if someone came to me with a prescription for this drug and I knew she had been raped, I would fill it. I believe such extreme circumstances do fall under the criteria for “gray area”.
I agree as to what some have said about “middle ground” on this issue. If I have learned only one thing in our critical course this semester it would be that things are not always black or white. There needs to be gray area. I personally, morally do not condone Plan B, however if someone came to me with a prescription for this drug and I knew she had been raped, I would fill it. I believe such extreme circumstances do fall under the criteria for “gray area”. –Sam Weatherspoon
The NEJM article was an interesting article about birth control. I feel that a pharmacist should have the right to choose what prescription they fill. If something makes you uncomfortable, you should have the right to refuse it. I think that taking any freedoms away from a pharmacist could produce a “snowball” effect and then the question will be: What will they take away next? However, I feel it is important to point out that you still hold an obligation to help the patient. Remember that we are still professionals. This means that you could recommend another pharmacy that will fill the prescription or that will sell Plan B. Berating a customer based on your moral values is ridiculous. Those are your moral values, no one else’s. That’s why were professionals.
Evan MacDonald P1
The article about a pharmacist’s right to refuse the sale of emergency contraception brought up some very good points that most people do not consider when an issue arises. Before reading this article, I never gave much thought to denying the sale of emergency contraception. I was appalled by the pharmacist that refused the sale to a rape victim. That was not the woman’s choice to be raped, so how can the pharmacist deny her the medication? The article brought up a very valid point that should be considered before denying a sale. The emergency contraception prevents pregnancy….if in fact the woman is pregnant. So if the woman is not pregnant, then emergency contraception isn’t acting as an abortion, it is simply a high dose of hormones. In my opinion, the only way a pharmacist should deny the sale of emergency contraception is if the woman requesting it is simply not of age to purchase it. Who are we as pharmacists to judge the ethical decisions that a woman makes regarding a possible pregnancy. We are not enabling an abortion, we are simply providing the means to prevent a potential pregnancy. If the pharmacist is that concerned with the well-being of the patient, then it becomes his or her obligation to thoroughly discuss Plan B with the patient and educate her on the potential side effects of the medication. We are health care providers, not the patient’s conscience!
To the mentors: Have you ever encountered a situation in which you normally would sell Plan B to a patient, but chose to refuse the sale? If so, what was your reason for denying the sale?
~~Chrissi Tyrrell, P1
Plan B, known to some as the morning after pill. As stated in one of the articles, it is a common belief by medical, government, and a lot of religious groups this is not tied to abortion. Plan B and similar hormones have no effect on an established pregnancy. The controversy is whether one believes a pregnancy starts at implantation or fertilization? Could one not argue the fact that birth control is considered a Plan A? Someone is taking birth control every day to prevent pregnancy, while someone else is taking Plan B to prevent pregnancy all at once. I read an article one time that stated “Plan B is nothing more than taking a half pack of birth control”. So who are we as pharmacists to judge the actions of others? Why is one medication given out on a daily basis and the other is condemned because of its street beliefs? I still believe that we are here for the benefit of the patient and sometimes we must set aside our moral values, stop judging, and help the soul person in need. My argument goes the same way when it comes to pain medication; just because we see someone who is addicted to morphine or oxycotin does this give us the right to refuse giving them their medication that has a reliable prescription for? Now in no way am I saying that we should pat those addicts on the back and fill their every need. We should counsel them with their problem, just like plan B, talk to the patient and who knows, this one prescription may be the wakeup call they needed or a counseling session with an addict that shows them they have a lot in life that is important. We as pharmacist shouldn’t stand in the way of patient’s futures; but stand alongside and help them along with some minor speed bumps in their life.
Josh Waters P1
I believe pharmacists should reserve the right to refuse to fill a prescription that they are not comfortable with, but only with the best interests of the patient in mind. After all, our focus should be on the patient and his or her needs. If the situation puts the patient's health or well-being at risk, or it becomes a question of the patient abusing their medication, I believe the pharmacist should be permitted to refuse to fill the prescription. However, I do not believe that a pharmacist should deny a controversial drug (such as Plan B) to a patient based solely on his or her own beliefs or opinions. It's not about leaving your morals outside of work, but rather considering that your patient's beliefs may be quite different from your own, and I think we should respect that. I do not mean to offend anyone, but I did want to state my opinion.
-Brittany Samples, P1
In my opinion, a Pharmacist always has the right to say no to any customer that they feel uncomfortable filling a prescription for. If they feel that there is something in their gut telling them not to fill it then most likely something is not right. I have found that in most cases your gut is right. I know that we are always supposed to do what is in the best interest of the patient and sometimes that may include declining to fill their prescription. In the end, it is our license and our career that is on the line and we have to do what is right to defend and protect that. I would really like to hear some feedback from the mentors about stories in which they felt it was best to decline a fill. Thanks
Jamie Nix P1
I find it interesting, in the “Limits of Conscientious Objection” article, they mention that physicians, nurses, and PA’s are allowed to refuse participation in abortions. I think an important distinguishing factor here is that not all physicians are qualified to give abortions, not all nurses have experience with these types of patients, and not all PA’s are educated in this type of procedure. Many times the physicians, nurses, or PA’s who do these abortions have the desire to help these patients and pursue this area of study and are the ones qualified to carry out these procedures and services. As pharmacists we are trained to manage drug therapy, identify adverse drug effects, and dispense medications to patients.
I believe as pharmacists, we have a professional obligation to our patients to protect and to serve them. As professionals we should use our judgment and have the right to refuse to fill a prescription, if we believe the patient is harming them self. However, as professionals we also have an obligation to serve our patients and fill a prescription even if it is against our religious belief system. Pharmacists should use their best judgment and not their religious or ethical views to decide which prescriptions to fill and which not to fill.
Sendra Yang P-1
After reading both articles, i agree with the "middle ground" that is suggested in the NEJM article. As members of the health care profession, we all took an oath to put the needs of the patient above our own. I believe that we have the right to protect our license by refusing to fill questionable prescriptions, in regards to dosage quantity and strength. However, we should not refuse to fill prescriptions based on the premise that it conflicts with our moral/ ethical standards. The welfare of the patient should take priority over our personal beliefs.
Allison Hoyle- P1
I completely agree with Eric's post. The Oath of a Pharmacist does not include anything about ethics or personal beliefs. Therefore, any legal prescription should be filled. I understand how certain situations can make a pharmacist feel uncomfortable, but the responsibility to the patient is too great.
As far as large count prescriptions, if it is legal and verified by the doctor, it should be filled as written. I feel there are exceptions to this point, such as a script from a doctor that is not local to the general area. As a pharmacist, you do not know this doctor and it is more difficult to tell if the patient is "doctor or pharmacist shopping".
I disagree with refusing to dispense medications, but if a pharmacist does, they should be obligated to recommend a store that will fill the perscription.
This is definitely a topic that people will always have differing opinions on. I think it is a pharmacists right to refuse the sale of a prescription depending on certain situations but at the same time, I think the reasoning behind the pharmacists refusal has to be a valid one. Also, your opinions and views might also be different depending on the place of work. For example, if you are working in a independent pharmacy, you might have the ability to express your personal opinion in this situation. But most likely if you are in a chain pharmacy you will have to abide by the rules of corporate and their viewpoints. I think this is a very controversial topic but I think the pharmacist should have some say in what medication they are dispensing, after all it is their license and their job that is at stake.
As Lawyers choose who to represent and Physicians choose what kind of patient to see, Pharmacists should have the right to choose what medication to dispense and not to dispense. As part of the health care professionals, Pharmacists have the obligation to maintain the best interest patients. However, pharmacists’ personal values and opinion regarding conscious objections should be respected. It should be up to the pharmacist that is in charge for that shift to decide what kind of medication to dispense and not to dispense. The MJAM article presents measurable points from both sides of the argument. In order to preserve the integrity of both patients and pharmacists, coming up with systemic solution can abate some of the issues we’re facing now. As smile as displaying a poster that shows Plan B is not available and directing patients where they can get access to this drug can beneficial for both patients and the pharmacists.
F_Assefa
To mentors,
Even though pharmacists have that right, there are high risks of getting in trouble with the law. So, is having the right to conscientious objection really worth it?
I feel that the only time pharmacists should be able to refuse to dispense a medication is if the medication could harm the patient. If a patient is abusing, misusing, or inappropriately mixing medications, it is the pharmacist’s duty NOT to dispense these medications. However, some medications (such as Plan-B) have moral issues that surround them. Some people view this as an abortion, while others view it as being an alternative method to birth control. These medications don’t necessarily cause the patient harm. In this case, I feel that pharmacists should dispense the medication due to the fact that it surrounds issues involving personal choices that particular patients make. As pharmacists, we can be 100% sure that a patient will properly use a medication and follow our advice. In cases like this, pharmacists must hope that those individuals follow their heart and do what they feel is right from a moral standpoint.
-Sarah Helms (P1)
(My previous post had a typo. Can should have been can't. Please disregard.)
I feel that the only time pharmacists should be able to refuse to dispense a medication is if the medication could harm the patient. If a patient is abusing, misusing, or inappropriately mixing medications, it is the pharmacist’s duty NOT to dispense these medications. However, some medications (such as Plan-B) have moral issues that surround them. Some people view this as an abortion, while others view it as being an alternative method to birth control. These medications don’t necessarily cause the patient harm. In this case, I feel that pharmacists should dispense the medication due to the fact that it surrounds issues involving personal choices that particular patients make. As pharmacists, we can’t be 100% sure that a patient will properly use a medication and follow our advice. In cases like this, pharmacists must hope that those individuals follow their heart and do what they feel is right from a moral standpoint.
-Sarah Helms (P1)
I think that Eric made an excellent point. I don’t see where my personal morals come into play with patient care.
I feel like the moment we make a decision about the health of a patient based on our own personal morals, we have passed judgment on a patient and completely dismissed the oath that we took when we embarked on the journey to becoming pharmacists.
If there is one lesson I am continuously learning, it is that beneath the surface, I have no idea what people are dealing with on a day to day basis. I think a lot of the time we want to jump to conclusions and write people off. Sometimes, it seems as though it is in our nature to discount the lives of others when we are unaware of their circumstances. We, as humans, have complex problems and we experience pain, sorrow, fear, etc… The Obstet Gynecol article only reminded me once more of this.
How unfortunate is it that in a time when a patient may be seeking compassion and help that simply encountering the “wrong pharmacist” can dash their hope and trust in our profession? I think the patients that are directly affected by conscientious objection are quite often the ones that are looking for our assistance, care, and “lack of judgment” the most.
~Amanda Hill, P1 Student
"42 percent objected to prescribing birth control for adolescents without parental approval, and 52 percent opposed abortion for failed contraception. While a majority of the physicians surveyed believed that it is their responsibility to refer patients to other physicians who would be willing to perform procedures or prescribe medications that they, because of moral or religious beliefs, would not be willing to do themselves, 18% maintained that they were under no professional or ethical obligation to do so."
I found this recent statistic. We can see that pharmacists try to prevent abortion; in other words, it can be considered as helping patients because emergency contraceptive can cause some harms to patients. But to patients' aspects, they don't want to give birth so they will be very upset if been refused. In some cases, pharmacists get fired. SO I think we should respect what patients' needs and protect our license.
Ngan Tran - P1
WOW.
Does anyone else take as much offense to the Obstet article as I do?
“Pharmacists exercise only technical supervision over the dispensation of medications that are prescribed by physicians.”
“Indeed, pharmacists in general (and commercial retail pharmacists in particular) usually have more in common with corporate managers, retailers, and the general business community than they do with members of the traditional learned professions.”
I find it hard to take an article like this seriously when I feel it is full of biases.
Granted the pharmacist from the first scenario should be reported to the BOP and even fired but for his behavior, not his refusal to fill the prescription. To hold “pharmacists who engage in such activities[…] liable for sanctions, including the loss of their licenses, and employers should be able to use such behavior by pharmacists as legitimate grounds for terminating their employment” absurd! Most pharmacies allow a pharmacist to refuse to fill a prescription but must give the patient (or as the Obstet authors prefer us to call them our “customers” –which is fine by me) alternatives.
I just love how one profession defines another, but that first profession would cause a storm if their role was questioned or defined. I wonder what argument Dr. Wall and Dr. Brown would make about conscientious objection within the medical field?
Suemi Coaxum P1
I agree with Eric Beamon's post. I can understand that many people live their life according to certain morals and values, but as a pharmacist, we take an oath to help patients. I believe that in becoming a pharmacist, we become the leading expert on medications, and people come to us for their medications. If we start denying people medications like Plan B because it is against our moral values, where would the line be drawn? Do we stop giving out birth control too?
Mentors, when have you had to use conscientious objection? How did it make you feel?
Christine Atkinson
P1 student
One thing I have noticed through reading these articles and some of the discussions posted on the board is the use of the word patient vs. the word customer. The article by the Ob/Gyn group refers to pharmacists as serving customers while many of the students in the class and professors of pharmacy at Wingate refer to people as patients.
I was curious as to whether anyone thinks that there is a huge difference between the two or if it is just a matter of syntax.
The Ob/Gyn group seems to see pharmacists as only there to fill orders by the doctors, thus making our relationship with the public simply a matter of "customer" service. In their view, since we are there only to fill orders and make sure there are no mistakes, it should not be our job to object to valid prescriptions written legitimately.
Any thoughts?
-Laura MacCall, P1
I believe that all pharmacists should dispense emergency contraceptives, without having the right to “refuse service”. Drugs are made for patients to use. One might morally disagree with a girl having unprotected sex, but that was her decision to make, not yours. She wants to use the drug in order to prevent an unwanted pregnancy to occur. Her life decisions are not your business, and you should take into consideration what is in her best interest, which could very easily be to not become a mother. This is a COMPLETELY separate issue from abortion; they are not related whatsoever.
Drug abusers on the other hand, are a completely different situation. I think that it is necessary for a pharmacist to have the right to refuse to dispense if he or she thinks something “fishy” is going on. It is hard for me to say what I personally would do in a situation like that because I’ve never had to deal with this before.
I think a pharmacist has the right to refuse to fill a prescription provided they feel the patient is an addict or doctor shopping. I do not believe a pharmacist has the right to refuse based on moral belief in the case of birth control pills etc. If they have such beliefs they need to work in a pharmacy that does not carry those medications. I believe if a pharmacist has such beliefs they need to state that in a job application and retail stores such as Target, Walgreens, CVS should have the right to refuse employment to those who have such beliefs because it compromises the service they offer their patient. We have no right to impose our beliefs on others and must respect their right to choose.
I also believe that in the case of customers who are addicted to pain killers and are caught in the act of doctor shopping that it is never ok for a pharmacist to lie and say we are "out" of the drug in lieu of being honest as to the reasons for refusal. But we have to take it a step more in trying to council that patient to get counciling for their addiction. If we're going to talk about pharmaceutical care how can we cop out on such an opportunity to help a person with an addiction. Sending that person out to the street after refusing to fill their prescription is synonymous with sealing their fate and eventual death by this addiction. I believe we have a professional obligation to do more in this case even if we feel our efforts may be futile.
It is highly debated whether emergency contraceptives are or are not considered a type of abortion. This idea varies with the different religious beliefs in this country. If the USA allows freedom of religion it should not object to pharmacists' refusal to fill a prescription if a pharmacist considers it to be against his/her religious beliefs. It's as simple as that.
WUSOP P1 Student
I feel that pharmacists should not be able to refuse filling or selling a prescription or product due to their personal beliefs. When we took the oath, we agreed to put the care of the patient above all else. Our personal beliefs were not a part of the oath, and we were all aware of that. Just because the pharmacist is a professional, I have not seen anything that states the values of the pharmacist override the values of the patient. I do feel that a pharmacist should be able to excercise conscientious objection if it places their license in jeopardy. The "Obstet Gynecol" article states that pharmacists, "lack the fundamental prerequisites necessary for making clinically sound ethical decisions, that is, they do not have access to the patient's complete medical background or the patient's own ethical preferences, have not discussed relative quality-of-life issues with the patient, and do not understand the context in which the patient's clinical problem is occurring." I believe that this further validates the idea that a pharmacist should not be able to refuse something solely based on their personal beliefs and biases. The example of the 14 yo girl in this article highlights the fact that as pharmacists, we do not always know why a patient is in need of a particular medication. We may think we do based on everything we learn in school, but drugs are experimentally used all the time in an attempt to treat conditions besides what they were approved to treat.
One could apply the idea of conscientious objection to any disease state or situation if they so desired. If a pharmacist doesn't believe in high blood pressure, would they refuse to dispense every prescription for hypertensive medications to all those patients? Or more realistically, the article discusses a prescription a pharmacist receives for a cocktail drugs used to treat HIV. Would that pharmacist refuse to fill the prescription because they feel that the patient is morally wrong for having had intercourse and contracting the disease in the first place? What about medications used to prevent travelers to foreign countries from obtaining a disease while in that country? Let's suppose that pharmacist discovered to which country the patient was travelling. Would that pharmacist refuse to fill that prescription if they did not agree with the religious beliefs (or any other aspect) of that particular country? What about someone who doesn't even believe in taking medications, but they become a pharmacist because they "wanna' help people." They could not impose their belief and still be a pharmacist. Therefore, why should we pick and choose which beliefs we impose. Sort of like the saying, "If you don't have anything nice to say, don't say anything at all." I believe that anyone who joins the profession of pharmacy should hold true to the idea of putting the care of the patient above all else and not only if it happens to agree with their beliefs.
P1 - Amanda Flores
I just thought about this during dinner talking about this with my wife...Am I infringing on the rights and beliefs of the patient by imposing on them my own beliefs and morals through my refusal to fill or give access to certain medications?
What do you think ?
Raean
I agree with most of the comments posted by my fellow students. A pharmacist should have the right to refuse to fill a prescription, however I believe that the reason behind why they refuse to fill it should determine the actions they need to take. For instance, if the pharmacist is refusing to fill it because he/she is afraid that the medicine is being abused, then I don't think telling them where they can get it will help the patient; but if the pharmacist is refusing to fill it because of ethical beliefs, religion, etc. then sure, perhaps telling the patient where they can get the prescription filled is the way to go. Before all else, our job is to care for the patient, therefore we should do all that we can to fulfill our duties as healthcare providers.
I think pharmacist should retain the right to refuse to fill a prescription. With that said, they also have a professional responsibility to the patient and i believe the spirit of pharmaceutical care dictates patients needs be put first. If a pharmacist decideds not to fill a prescription then they should be obliged to advise the patient based on professional principles not personal beliefs. There should be professional and legal minimum requirements on what to do without limiting the pharmacist's right to say no. At any rate a pharmacist who is oppossed to selling a particular drug shouldnt be working for an employer who promotes the sell of the said drug.
Jonathan M.
Pharmacists should never be fired when refusing to fill a prescription due to their conscientious objection. However, I think pharmacists violate their oath to help a patient if they do not tell her where she can get the medication immediately. If plan B is only effective within 24 hours, the patient might take the drug late and get pregnant. Then it is more likely leading to an abortion which certainly causes harm to the patient than providing her a pill to avoid a possible pregnancy.
Tai Tran, P1
I agree with most of the posts from my classmates. I do believe that pharmacists should be doing their duty to protect patients from abuse and potential drug interactions, however I feel that pharmacists should not refuse the fill of a prescription that is against their ethically religious beliefs. Again reiterating some of the comments already posted on this blog, pharmacists are available to provide health care, to answer patient's drug-related questions, to provide recommendations; ultimately after a pharmacists dispenses a medication, the choice whether to take a medication or not is on the patient just like with any other type of medication.
On another side note, "Conscientious objection" is an important characteristic that a "professional" should have because it factors somewhere into the complete morale of that person. Whether we help a patient obtain a prescription that we do not agree upon or not, that patient will simply go to another pharmacy. Even if we refer the patient to another pharmacy that will fill the prescription (like the law says that pharmacists are required to do in some states), would that not still be on our conscience that this patient passed through our hands? At the end of the day if they still are able to take the medication, wouldn't that be on our conscience too?
This is tricky business, and I say that as long as the drug is being made available and people are demanding it, it will be hard to continue to keep refusing this medication (because that is just like putting a band-aid over your conscience dilemma).
Malia Yang
P1
As a new practicing pharmacist, I feel very strongly about protecting the pharmacist's right to refuse filling ANY prescription. As a student, I only had considered the scenario presented in eMentor regarding birth control, Plan B, etc. and felt that as a person who's liberties fall under the same constitutional rights as others, pharmacists should be able to refuse a prescription based on moral ground while ensuring that the patient was still able to obtain their script from other means (i.e. return the script to the patient).
Today, after seeing the liberties that a few unscrupulous prescribers are taking with current holes in Florida law regarding pain clinics, I very much value the right to refuse the filling of a prescription. Countless times I have given back a script due to its meeting multiple suspicious reasons; the patient is new to us, is from out of town/state, only has a script for controls, has multiple prescribers writing controls, has a script written by a questionable prescriber (e.g. under investigation, has mark on licensure), wants to only pay cash. I hate feeling like a cop but my instinct is screaming possible misuse/abuse from signs such as a car load of people arriving in a wave all wanting the same 'cocktail' of meds and are exhibiting the classic signs of withdrawal learned from patient assessment; I question a valid patient-prescriber relationship if the patient is from out of town, has only driven down for the day, and admits to not being screened/examined by the prescriber.
In conclusion, I know that there may be instances when the patient could experience a delay in therapy due to my refusal to fill their prescription, but as a trusted professional I feel that it is my clinical right to refuse any script that I do not feel comfortable filling. Not only do I have the same moral rights and freedoms as others in this country, I also have been granted the clinical right to refuse any script I have issues with. What if the prescriber refuses your clinical recommendation regarding a deadly contraindication; would you simply fill a script that could result in hospitalization or death just because the prescriber wrote for it and bullied you upon contacting them? I hope not. And as their advocate, the patient prays that you don't.
Lisa DePetris, PharmD
St Vincen'ts Medical Center
O'Steens Pharmacy
As a professional, a pharmacist has the sole right to refuse medication if he/she does not agree with a prescription. I tend to agree with some of my classmates on the issue that these issues fall in a "gray area" as far as moral ambiguity. Morally, I have an objection to "murder," whether emergency contraceptions can be classified in this category is a bit ambiguous but that is another argument. If a woman was raped, who am I to withhold medication in such a situation? Even if I were to refuse to fill the script, she could go to any number of pharmacies with pharmacists who are more concerned with the business aspect of pharmacy. This does not give pharmacists clearance to do as they please to "make a buck" but counsel and be conscientuous when filling scripts. We are imposing our beliefs on another person when we make conscientuous objections but we do the same when we counsel patients or provide MTM. Does that mean pharmacists have to stop counseling and providing MTM? I believe that to be great pharmacists we have to suspend judgement and separate emotional and logical thinking in order to critically think and provide patients with the best possible care.
Jeremy Efird
P1
Pharmacists are participating in the therapeutic side of the healthcare profession and desevre the right of conscientous objection for the well-being of the patient. If the right to conscientious object is taken away, pharmacists will lose their position inthe healthcare arena and pharmacy will ocne again become an assembly line of just dispensing drugs.
I think that maintianing the right to refuse is important in our profession, but I do not think that we have the right to push our beliefs onto someone else, like Raean posted. Also, if filling a script could cause my lisence to be revoked, I probably would not fill it. However, unless it is an extreme case, as Dr. DePetris has mentioned, I feel that we have a responsibility to our patients.
If a prescription is legal, without any suspicion, it should be filled and dispensed. It is not our business to pick around our patinets private lives.
I agree with Sarah that pharmacists should have the right to refuse filling a prescription if the patient could possibly be harmed by the medication dispensed. However, when it comes to contraceptives pharmacists should not have the right to refuse filling a prescription based on moral beliefs. Females may take contraceptives for other reasons than to prevent pregnancy, such as to prevent ovarian cysts or to just to regulate hormone levels. How can a pharmacist refuse dispensing a contraceptive when he/she may not even be aware of why the patient is taking the medication? I believe pharmacists should do what is in the best interest for the patient and not let moral issues stand in the way.
-Tiffany Humber(P1)
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