Disclaimer: The purpose of this discussion is really to focus on a pharmacist's right to refuse the filling of a prescription based on their moral or ethical beliefs. It is NOT about what constitutes an abortion and whether abortion should be legal. I will not hesitate to reject comments that I feel are straying into this area.
Take a look at these articles from NEJM and Obstet Gynecol. While the main topic surrounds one or two scenarios in particular, what are some other instances or medications where conscientious objection becomes controversial?
Mentors, what guidance can you give the students as they begin to form their professional opinion of a difficult subject?
What opinions do the pharmacy organizations have on this subject?
What states have laws addressing a pharmacist's right to refuse?
What are your thoughts? I'm sure that we'll have some good discussion of this topic.
39 comments:
I think that as pharmacists we need to remember who keeps us employed, the customer. Having moral opinions should not restrict the tasks of your job. If you have an opinion there is a place and time to express that opinion but that place is not the workplace.
To give my input very simply on what people were saying in class: I would not fill the Rx because that is my belief, whether it matches everyone else's opinion or not. It would be on my conscience at the end of the day. I mean, there are a ton of pharmacies that will fill it. Once I refuse, it is out of my hands.
Just to add to my comment earlier teachers are not allowed to teach about God in school no matter what their beliefs are. So why should it be different for us?
I think the bottom line here is respect.In as much as we have our morals amd beliefs we should respect the fact that patients actually have rights as humans to do what they want to do with their lives. we can help the situation by medication counselling. what we can do in such a situation where prescriptions which go against our morals or values should be or remain within the the jurisdiction of our proffession. just telling the patient you will not fill it because of thought that they may be doing something immoral is being quite judgemental and we are not in the position to do so.
My question though here is in a case where it not about contraceptives but say neddles and drugs that can be abused is there a law protecting the pharmacist in a case where the patient decides to use any of these things?
Thank you.
Jennifer Adjei (P1)
I do not think pharmacists should have the option to refuse filling a prescription based on their personal moral or religious beliefs. It is not a pharmacists' job to push their personal beliefs on their patients. I believe it is extremely unprofessional to do so. A prescription should be refused because of legal issues or if it will harm the patient. On the other hand, refusing to fill based on your religious beliefs is not acceptable and leads down a slippery slope.
Holly Stallings
Like I stated in class, I feel like it is not on the pharmacist to make the decision whether to give or not give out a prescription. I feel like if your morals tell you that taking a certain medication is wrong, then that is on oneself to decide whether or not to take the medication. This decision should not belong to someone one else including the pharmacist.
I think that as pharmacists, we need to put the health and safety of our patients above any moral misgivings we may have. I believe it is unprofessional of us to force our beliefs upon another person. Especially in a situation where that individual is coming to us for help. Deciding what to do about an unwanted or potential pregnancy is a very personal decision. By coming into the pharmacy and asking for Plan B, that individual is asking for help. If we refuse to abide by the patient's decision, then we become responsible for the outcome of that decision, be it nothing, or an unwanted pregnancy, or a later abortion. Our role is to protect the health of the patient, not pass moral judgments.
I agree with the idea that pharmacists should be allowed to refuse to fill certain prescriptions. There are situations where filling prescriptions would be against the moral and ethical principles of the pharmacist. If a pharmacist finds fault in filling a prescription than it should be accepted, given the fact that filling the prescription would conflict with their beliefs. We must not limit or prevent the decision the pharmacist makes in that situation, as it is a decision based on their principles and not allowing them to express this would be encroaching upon their beliefs. Pharmacists work under a system of morals that often coincides with their religious beliefs, so in the event that a conscious decision is made by a pharmacist, refusing to acknowledge the validity of that decision is essentially disrespectful to that pharmacist. I also do not believe that pharmacists who refuse services on personal grounds should be punished for their decisions, as this too shows a lack of respect.
I believe the NEJM article makes a good statement that pharmacist's hold the right to object but not obstruct. And to my knowledge most states accept this statement as well, and allow pharmacists to refuse medications however it is the responsibility of the pharmacist to find somewhere for the patient to fill their prescription. My only exception to this statement would be with Plan B. Plan B should only be sold to women. As the law stands now, Plan B may be bought be anyone over the age of 17, however the medication is something only a female can take and therefore males should have no need to purchase this medication.
I believe that a pharmacist should have the right to refuse to fill a perscription if they choose to do so as long as it is done in a professional manner. They should never be rude or inflict guilt upon anyone that they do refuse though. It is true that many people abuse drugs, but that doesn't mean that all people that want a particular drug are doing this. If it is obvious that a person is abusing a drug then yes they should be refused, however it cannot be an opinion that the drug is being abused it must be a fact.
Other medications that are often seen as being abused but could easily be underdosed or otherwise are pain medications. It is very rare that one of these drugs is talked about being refused but does it not follow the same morals as plan B. But this one is allowed more leniency for some reason. Pain medications are addictive and if overdosed can be very toxic and harmful to the body. These should also be considered to be refused at times. The problem comes with the opinion of the pharmacist. Sometimes the right thing to do may not be what you would normally do, but you need to be able to be a profesional and look past yourself sometimes to do the right thing, whatever it may be due to the situation at hand.
No one should force their opinion on someone else. We, as pharmacists, should handle every situation professionally. This is another person's choice, and that personal choice should be respected despite how we feel. I can suggest advising the patient of the consequence, outcome, or maybe an alternative route.
I think that as professionals we should suspend our judgment and gather all the information we can before we make a decision on whether or not we fill a prescription, whether its for plan B, birth control, needles or even viagra. Medications can be used for several purposes. Viagra is often given to male cancer patients to help with chemo related sexual dysfunction. As professionals we should not assume anything. We should also be able to handle a situation that we may not morally agree with in a professional manner. There is no need to yell at a patient over a piece of paper, we should simply say that we don't have it and point them to someone who does. I for one think about the possible downstream affects of what something like dispensing Plan B or needles. I try to think about how an unwanted pregnancy will affect the development of a child or how sharing needles could help spread diseases such as HIV or Hepatitis. Everyone has their own individual beliefs on this matter so I think it would be unfair to prevent peoples right to choose or even fire someone because of their choice.
I think that this issue is a very sensitive subject and it is difficult to say either way what the clear answer is. However, we do live in a country that has a clear separation of church and state. I know that not everyone agrees with this separation, but that doesn't negate the fact that it exists. As healthcare professionals, I believe it goes against the oath we take to refuse filling a legal and valid prescription presented to us by a patient. We are rarely aware of the exact circumstances behind the reason why certain patients have certain prescriptions. It is not our place to judge. Nor is it just our place to dispense and hand the drug over. We do reserve the right to counsel a patient and perhaps steer them towards a better option of therapy. In any case, as pharmacists we have a lot of power. I think we need to be very careful of the choices we make so that we don't cross the line and abuse that power.
Courtney Black
WUSOP 2015
I believe that it is the pharmacists duty to, as the first article states is true of all professionals, "place the interests of their clients above their own immediate interests". Personal moral beliefs should not interfere with professional duties. Would a Jehovah Witness doctor be a good doctor if he refused to give a blood transfusion to a patient in need? Would a good pharmacist refuse contraception because it interfered with their religious or moral beliefs? I think no on both accounts.
On the other hand, I have worked with pharmacists who have denied to fill controls to shady-looking people if they can not quickly verify the validity of the prescription. This is a little different,as it does not involve moral beliefs, and I do believe there is a situation in which this may be necessary.
Mentors, do you have experience denying to dispense a drug? What were the circumstances? I'm curious to understand a more specific example.
Kim Tooker, P1
I do not personally think that a pharmacist should be allowed to refuse to dispense emergency contraception to a patient. I understand that some people are not comfortable with it, but I do not think it is the pharmacist's right to shove their ideals and morals onto their patients. This is especially true in states where the patient has already gotten a prescription from a physician for their emergency contraception.
This of course is a very sensitive subject. I'm not sure that the controversy over pro-life and pro-choice will ever truly be resolved. I know that dispensing Plan B seems to be one of the main issues involving community pharmacists. I personally have dispensed Plan B without objection. I reason that it is sort of like dispensing narcotics - maybe the person is abusing, but I will not withhold dispensing for the people who truly need pain relief.
I feel that a pharmacist should not have the option of refusing to fill a prescription based on their morals and beliefs. We all have the right to our beliefs and we can each choose how to live our own life, but we don't have the right to impose our beliefs or opinions on others. This is especially true in a professional workplace. It is pharmacist's job to fill the patient's perscreption, whether it agrees with with their morals or not. At the end of the day, it is the patient, not the pharmacist, who chooses to take the drug.
Sonja Keranovic P1
I believe that pharmacists should be allowed to refuse a prescription. Though professionalism is an important part of our job, I think maintaining ourselves and what we believe in is just as important. This is especially applicable in independent and community pharmacies. If the patient has a problem with the pharmacist's opinion, then there is no reason that patient can't just leave and go to another pharmacy. Of course this all must be done in a non-imposing and respectful manner. Pharmacists want more responsibilities and a decision of not filling a prescription that goes against the values of the pharmacist is perfectly within those boundaries of responsibility according to me. We must keep in mind that no pharmacist is going to refuse a medication that will cause/prolong harm to the patient, and one who does, should not have a job in the first place.
Mentors: Have you ever been put in a situation like this? How did you react?
Kyle Crisco, P1
Class of 2015
In response to Kim Tooker...
Not personally, but when it does happen, the customer is outraged and takes it personally. It can get really ugly really quick. Being professional often comes across as being "higher than thou". There really is no good way to refuse.
This is a very difficult situation and I do not believe there is a clear solution. As soon as one view becomes mandated there will be the rare exception (as there always is in health care) to blow it to pieces. The idea of "objecting but not obstructing" doesn't seem like a truly fair answer, but it may be the best possibility so far. To direct a patient where to get the medication you refuse to dispense is just like filling it yourself. They're still getting the med by your advice. Maybe a physician could direct patients to pharmacies that are willing to fill certain orders. They know for a fact that the patient they're sending with the prescription is in actual medical need of it whereas a pharmacist may not have access to that information.
Morgan Bourne
P1
Both the patient and the pharmacist have rights. I believe that the pharmacist should have the right to refuse certain medications. However, I think that the refusal should have nothing to do with the pharmacist’s morals or beliefs. A main part of the profession of pharmacy is to help the patient to the best of our ability on any issues pertaining to medicine and to not cause the patient harm. If a patient truly wants to not become pregnant because of any circumstance, it is their right to use a drug treatment. If a certain medication has the possibility to cause harm than I would surely let the patient know of all of the risks associated with the specific medication, but the final decision should be the patients to choose whether or not they take a medication or not. With that said, if the pharmacist knows that a medication will cause the patient harm in some way, I think that they have a right to refuse the medication to the patient with an explanation of why. An example of this could be with pain medications. If it is blatantly obvious that someone is completely out of it wanting more pain medications and you have proof that shows you they are most likely abusing the medication than I think the pharmacist should have the right to refuse. As a pharmacist you do not want to continue leading your patient down a slope where they could end up overdosing or dying from any other side effect. There could definitely be more laws put in place for this topic. For example, no man should be allowed to buy Plan B because it doesn’t pertain directly to them. I feel like it should be a law that only the woman involved in the situation should be allowed to buy Plan B because ultimately it should be her decision.
Nathan Batchelder, P1
It is my opinion that a pharmacist has the responsibility to the patient to give them the medications that they need to improve their quality of life. If this includes dispensing plan B to an eighteen year old girl who made a mistake and who can not support a child at the time so be it. This hypothetical girl could even have been raped, or maybe she is on her own making minimum wage barely supporting herself. She may be getting plan B because she is not able to support herself let alone a child. Or she could be getting plan B every other day because she's a little promiscuous. The point I'm getting too is we just do not know the situation that the patient is in, and frankly we don't need to know most of the time. We are entitled to our beliefs just as our patients are entitled to theirs. I know I get a little irritated when someone relentlessly tries to push their beliefs on me, and I'm sure many others of you have felt this way at times too. By refusing to fill a prescription because of your moral beliefs is in my opinion, pushing your beliefs on someone else. I do not think this is right, so therefore I believe we as pharmacists should not be allowed to refuse to fill a prescription.
I believe that it is not up to us as pharmacists to decide what medications we think are morally correct to distribute. Each patient has the right to acquire the medications they need/want regardless of our own opinion and we should not pass judgement on them. I think that if a pharmacist feels that strongly about not distributing a certain kind of medication, then they don't have to but then they need to tell the patient where they can get those medications. In the end, it is about helping the patient even if you are not comfortable with it.
While I believe pharmacists have a right to be conscientious objectors, there are more effective ways to advocate for your position. A person who feels strongly against Plan B should work through their professional organizations or directly through their legislature to advocate for change.
I think that we should not refuse to sell a customer something based on our own morals or opinions. If they dont buy something from you, they will just go somewhere else to buy it. If selling something bothers you that much, then maybe counsel them on the purchase and let the customer choose for themselves.
I believe that it is important to have values and morals, but it cannot get in the way of being professional. We do not know the situation and it is not good to assume that a person is good or bad for using a particular drug. In North Carolina we have the authority to refuse to prescribe plan B but it should not be our intention. There are many different circumstances and it is better to prescribe it and talk about the medication, because the patient can go and get it somewhere else. So you should prescribe the medication and not let your personal morals get in the way.
John Kastanis P1
You should always do what is in the patient's best interest. It is unprofessional to force your views onto your patients, so it is important to remember the patient has a prescription and it is your job to fill it. You also want that customer to continue to come back, not send them to another pharmacy!
I think that when it comes to your professional life, you need to keep a professional opinion. Your personal opinions should not be affecting your ability to dispense a medication to a patient. A patient who needs Plan B should not have to go to multiple pharmacies to try to find someone who is willing to dispense it to them. If a drug is legal, a patient has the right to it, regardless of the pharmacist's personal beliefs. I think that a pharmacist should not be allowed to object.
Stormi Gale
I personally believe that moral beliefs should not influence whether or not you decide to give someone a prescription or not. I believe that you should advise certain patients on the prescription that they are taking, but moral opinions should not restrict your job. I would do not have much experience in pharmacies so I cannot give too much insight so I would like to invite anyone who has worked in a pharmacy or is a practicing pharmacist to continue posting their opinions on this topic. I think this is a very controversial topic and a difficult question to answer.
J.Crump
I think that it is definitely in the rights of the pharmacist to refuse any prescription to a patient. The pharmacist should act in a professional manner when doing so. By that I mean that the pharmacist needs to use his/her best judgement in assessing the abuse potential of the drug and the patient. Many times pain meds are abused and patients bring in prescriptions from different doctors for the same condition and they feel that just because they got a different doctor to write the prescription that they are able to get the new one filled also. Pharmacists have ability to curb abuse in patients. With regards to plan B, I feel that it is completely within the rights of the patient to get that medicine. Not everyone will agree with why you are getting it, but I feel the girl who has to carry the baby overrules all beliefs.
After listening to a few comments in class, I'm wondering if any of the mentor have been in a position where they refuse to dispense a medication to a patient because of a personal belief. I am also wondering how did you deal with it? And can you give specific examples or examples of one of your fellow pharmacists who have experience this?
I don't think a pharmacist should use their moral or religious beliefs to decide whether or not to fill a prescription. However, I don't think pharmacists should have to fill every prescription that comes to the pharmacy. If the pharmacist feels like a prescription may be fake or bad for the patients health then they should have the right to refuse dispensing the medication.
I agree with Nick. There is a time and a place for personal opinions and the work place is not the appropriate venue for expressing those opinions, be those opinions moral, ethical or political.
However, without state law requiring pharmacies to stock certain drugs, pharmacists will be able to refuse to fill based solely on the inavailability of the drug.
Not dispensing any medication that could help a patient is wrong in my opinion. As a pharmacist, we are privileged to help people and objecting to helping someone clearly goes against our role as a health professional. Also, if pharmacists were more educated about the emergency contraceptive they would know that it contains the same ingredients as the birth control they dispense on a daily basis. So why dispense one and not the other? This is not a case of legality, but of morality, and therefore should be left to the patient, not the pharmacist on deciding whether it is right or wrong to use. We should make it readily available and easy to access for those who deem it within their moral standards to obtain and obstructing that is wrong in my opinion.
This is a very sensitive subject to talk about. Not only does it tie into the controversies of the responsibilities found a professional environment, but it also crosses the line into religious viewpoints and simply put, personal moral standards. Having said that, it is important to remember that we are not in school to become priests, guidance counselors, or personal advisors. The people that come see us are not our children. They are customers, and more importantly, our patients. It is not our responsibility to pass judgment on the medications that they require or have prescriptions filled for. We are not their physicians. We are not their parents. We are their pharmacists, and therefore we must comply with the job description that pharmacy entails. If you don't like it, you're probably a very opinionated person and quite possibly in the wrong profession. The world is filled with controversies, and personal opinion needs to be left at home, with friends and family. In a pharmacy, you are a pharmacist, a professional consultant there to dispense medication and advise your patient on how to take that medication properly. The second you fail to realize this and comply with your professional responsibilities is the second in which your own professional stature can and will become compromised.
I think that it is out of our hands to be honest. If someone needs the medicine, we should not judge them for it. We have no idea why they want it or why they need it. It is out of our hands and I think that it would actually be wrong for us not to fill it because if that person really does need the medicine and we deny them then we are the ones being wrong, not the consumer.
Matt Nettesheim
America is a country of choice. We are free to choose and make decisions as we see fit. One decision is whether or not pharmacists should dispense controversial medications such as Plan B or assisted suicide drugs. Honestly I think that it should be mandatory for governmental institutions like the health department and even some large chain pharmacies to carry these drugs, but it could be optional for independent pharmacies. Again, it is up to the owner of the pharmacy or the pharmacist to dispense a drug solely based on personal beliefs alone. If this is the case, a pharmacist could lose their job; but again this is a choice. With Plan B, it is based on their definition of abortion and if it is actually an abortion pill as many call it. Assisted suicide drugs on the other hand, go against life itself. A principle focus of the pharmacist is to improve the life of an individual, and helping some die would not be honoring that specific code.
I don't think patients are paying us for our morals. They are paying us for our critical thinking skills. You should never let your own personal belief conflict with a professional situation. You have no idea why the patient needs the prescription and to assume you know better could pose a health risk on the patient which should conflict with why you are a pharmacist in the first place.
Patients always have right to choose and refuse medications. It is their autonomous right to be able to select their medications and pharmacists should act in the best interest of patients. I also believe that pharmacists hold the right to object but not obstruct. Pharmacists are there to serve patients and if they refuse to help patients then they are very unprofessional. Plan B has been over the counter since 2006 and it was only prescription medication in 1999. Many pharmacists choose not to sell Plan B considering ethical and moral values but what if the patient has a prescription for the similar kind of drug. Ella, prescription-only emergency contraception, has been in the drug market since August2010.Pharmacists cannot refuse to fill it if the patients come with a written prescription. Personal opinions should not affect the professional responsibility.
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