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. Comments that head in this direction will be deleted.
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.
52 comments:
After reading both articles, I have come to the conclusion that pharmacists have a professional obligation to fill prescriptions unless those prescriptions will ultimately harm the patient. I understand that we, as humans, have moral and ethical standards ingrained in our belief system, however if pharmacists start to refuse care based on personal beliefs then in actuality these pharmacists are not upholding pharmaceutical care but their own sense of what is right regardless of the patient. Where will the line be drawn in what medications the pharmacists can decline to fill? The line is so thin it is almost transparent and can easily be crossed over. Both articles contained the idea that pharmacists could, if upholding their beliefs, refuse to fill antiretroviral therapy or diabetic medications for specific patients they feel may caused their disease state. One can further go on to state that pharmacists could then decline to fill pain medications, cholesterol medications, and even in some instances heart medications. As health care professionals there comes a point when we have to lay aside our beliefs for the overall health and safety of the patient, and without a comprehensive overview of a patient's medical, family, and social history we are powerless to make sound judgments concerning a patient's care. According to the first article, only three states have instituted a law to protect pharmacists who refuse to fill a prescription. The first article stated the question of whether one should refuse a prescription. This article stated that "the beliefs of health care providers should not trump patient care", and I firmly believe this.
Rebecca Andersen
Doctor of Pharmacy Candidate 2017
WUSOP
I believe that pharmacists have the right to deny filling any prescription if it goes against their beliefs. However, it is important to remember that as pharmacists, it is our job to look after the health of the patient. Although some medications may go against our own beliefs, there were specific reasons for prescribing that medication and it is our job to fulfill the wishes of the patient to ensure their optimal health. As a pharmacist, it is our job to protect and promote the health of our patients and by doing so, we may have to do things that aren't necessarily what we believe. In the case of Plan B, I feel that pharmacists should have the right to decide whether or not they want to dispense the drug. I do not feel that this drug is ultimately used to help the patient in a life or death situation. After reading the articles, I feel that they indicated that pharmacists should feel certain medications that may go against their beliefs only when the health of the patient is at risk. Personally, I believe that things such as blood pressure medications, cholesterol medications are used to enhance the quality of life of the patient, therefore I do not see any reason why any pharmacist would not be comfortable in feeling such medications. On the other hands, medications such as narcotics can be somewhat troublesome. The pharmacist has the right to deny filling a prescription when the think that it is a forgery or that the patient is misusing the medication. It is then ultimately up to the pharmacist at that point to decide whether or not to feel the script. Although we may one day be faced with the problem of whether or not to feel a prescription, it is our job as pharmacists to look after the well-being of the patient. If we look after our patients to our utmost ability, then all should be well.
Amanda Bradsher
Doctor of Pharmacy Candidate 2017
WUSOP
After reading these articles, I don’t believe that a pharmacist should be able to decide which prescriptions they will fill and which ones they will not. If this was allowed, can you honestly tell someone where that line would be drawn? In other words, the line that says these are the medications you absolutely have to fill regardless of how you feel about it and the list of drugs you do not have to fill if it goes against your beliefs. As a professional, it is their obligation and duty to help patients regardless of their need. Who is one person to pass judgment on someone that does not have the same beliefs as they do? I am not saying that a pharmacist is by any means obligate to change their beliefs in any way, shape, or form, I am simply stating that it is a pharmacists responsibility to lay aside their personal feelings and above all else consider what the patient’s needs and wants are. The medical profession is taught that above all else, it is the patient and their needs and wants that are of utmost importance. How can this be true if we allow personal feelings and judgments to dictate the treatment of a patient? In a sense, if you allow pharmacists the ability to approve or deny the filling of certain prescriptions, they are in essence playing the role of god by dictating which patients are allowed to get better and have a better quality of life and which patients are going to have to suffer and go without. As far as birth control is concerned, there are many other uses for it besides the prevention of unwanted pregnancy and by not filling that particular prescription, a woman that has ulcers will be in incredible pain without it. Even if they patient is using birth control as a contraceptive, it is her choice and as I said before, as a pharmacist, it is their job to set aside judgment and consider why it is that the patient has chosen to take this medication.
Legacy Marsolek
Doctor of Pharmacy Candidate 2017
WUSOP
I do not think that a pharmacist should be able to refuse to fill medications based off of their religious or moral beliefs. Every one is different and has different religious and moral beliefs. Patients shouldn’t have to feel like they’re in the middle of Judgment Day when they approach the pharmacy for emergency contraception or any other drug for that matter. Other drugs that may cause controversy if a pharmacist refuses to fill based off of their religious or moral values are: diabetes medications, weight loss medications, and AIDS medications according to the article, “Refusals by Pharmacists to Dispense Emergency Contraception”. However, I do believe there are others that may cause controversy such as Diazepam and other medications, including pain medications, that are often times prescribed after a patient has had an abortion to help them with any cramps and associated pain they may have. Should the “anti-abortion pharmacist” refuse to fill those medications as well?
Unless direct harm is being caused or will be caused to the patient if they take a certain medication I do not believe that pharmacists should refuse to fill certain medications based off their beliefs. I also don’t believe that a patient should have to spew out their entire medical history to you if they choose not to. They have that right. In the example with the lady that has Eisenmenger’s syndrome I feel like the pharmacist that refused to fill her prescription was 100% wrong. Do I feel like she should have to tell that pharmacist her condition in order for him to consider filling her medication? No.
We cannot live our patient’s lives for them. When we choose to refuse to fill certain medications based off of our beliefs and morals that is what we are doing. We are attempting to keep them from doing something because we don’t think its right and oftentimes we may not know the complete story.
Gkeemia Gibson
Doctor of Pharmacy Candidate 2017
WUSOP
After reading these articles, my opinion has not really changed on the subject. I understand that pharmacists need to have their own opinions and morals, however I do not believe that it is moral to impose those beliefs on others. A pharmacists duty is to help the patient. That does not mean refusing them the type of care they want. I believe this means that if a pharmacist has concerns about how a medicine works, they should counsel a patient on these points, with the patients permission. It is ultimately the patients decision as to what they decide to take or not take.
I believe in a time and place for everything. Personal beliefs have no place in a professional environment. Honestly if you have a problem with the morals of a profession then don't go into that profession. I believe it is a Pharmacist's job to fill legal prescriptions. If I were a Pharmacy owner and I found out that one of my pharmacists was not filling prescriptions based on their personal opinions and beliefs regarding the specific medication, I would fire them. To elaborate, I am not referring to instances in which Pharmacists do not fill a prescription due to reasons of beneficence or non-maleficence because that is part of our professional obligation.
Cristina Negron
Doctor of Pharmacy Class of 2017
Wingate University School of Pharmacy
Although, we have moral rights to refuse to fill a prescription I believe in the same regard we have the professional obligation to fill the prescription. It is a catch 22. We can refuse to fill the prescription, but what about the autonomy of the patient. They have the right to have their prescription filled. As long as filling the prescription will not harm the patient or aid a patients illicit habit the prescription should be filled.
Robert Byrd
I believe a pharmacist has a right to refuse filling a prescription under 2 conditions, if they think it is a forged or invalid prescription or if they think that the medication will harm the patient. Any other reason that has to do with personal beliefs or prejudices I think is unethical, bad for the patient, and just down right bad for business. I agree with the articles when they say that personal beliefs should not compromise a patient's well being. If a pharmacist refused to fill a prescription that is valid, legal, and therapeutically helpful, I would have to question why they are a pharmacist in the first place.
Jacob Gibson
WUSOP
2017 PharmD Candidate
I do not think that someone should ever go against their morals or beliefs in any case. However, as pharmacists we enter a profession where we are focused on patient-centered care. We are professionals taking care of the public and our decisions can influence their lives in a positive or negative way. Someone's personal morals are their personal morals, not necessarily the morals of others. Nobody wants to force their morals on others while nobody wants someone's morals forced on them. With this being said, as pharmacists, we can't let our beliefs influence the lives of our patients. We are a trusted profession and we are supposed to have the patients as our top priority while we are working--that is what we are paid for and should be what we want to do. I believe it should be a pharmacist's responsibility to inform patients about the drugs that they will take. It is up to the pharmacist's discretion if they want to say what they believe or not, but I do think that the choice is up to the patient whether they receive the medication or not. Pharmacists should have a right to refuse the filling of a prescription based on their morals though because then the law would be coercing someone else to do something that is not right in their own opinion. The pharmacist should have a choice, just as the patient has a choice, but as a health-care professional, the pharmacist should take care of the patient first and foremost. The pharmacist doesn't have to take the pill, they are just dispensing it. They can make the patient aware of the risks and effects of the drug and whatever else they want to tell the patient, but ultimately the patient has the choice.
I believe that a pharmacists has the right to refuse filling a patient's prescription. At the end of the day we are human beings with emotions, not just pharmacists. We all have are own believes and our own idea of "patient harm". Both articles stated that it's up to the pharmacists to decide, but in the end the pharmacists is the one losing money, losing a patient, and losing and gaining respect with various groups within their community. I personally think that if a patient wants/needs it, and they won't abuse it, then they deserve it. There is no black and white answer, it's a spectrum. I know personally that NC has the right to refuse dispensing a medication because I have seen it in my own Walmart pharmacy. As the medical world changes, views will change and with that brings new ethical/moral conflict. Pharmacists will need to adapt, some will adapt faster than others and in the end not all of us will make it. It all depends on how we treat our patients and their views of us.
Matthew Ryan Quick
DoPC 2017
WUSOP
After analyzing the situations that were described in each of the articles, I deduced that a pharmacist should not be the one deciding whether or not the patient gets the medication or not. When a doctor prescribes a medication, there is a reason behind it. Whether or not it was for a good purpose or not will be on the doctor's and patient's conscience. There are situations where medications are written for unethical reasons and may cause harm to the patient. Other times, it may seem that way, but in reality it was written that way for that patient because they have a unique situation/disease that is being dealt with. The only time the pharmacist may say "no" to dispensing a medication is if it's a lethal dose or if the patient is unaware of the potential harm. But if a patient is well aware of the medication and the way it's dosed, then it should be dispensed.
And in the end, if a pharmacist refuses to dispense a medication, the patient can and most likely will just go to a different pharmacy and get it filled there. Only thing that the pharmacist did by refusing the fill is loose business and cause frustration for both the pharmacist them-self and the patient.
Edward Plugovoy
WUSOP 2017
I believe that no one has the right to impose his or her beliefs on someone else. As pharmacists, your job is to fill the prescriptions you are given, not to judge the patient. I think that the pharmacist should fill all prescriptions regardless of their personal beliefs. I think the only time a prescription should not be filled is if the patient is abusing their prescription drugs or if the prescription could harm the patient due to an error somewhere in the process. It’s a pharmacist’s job to help patients with their medication needs, if you are refusing to fill prescriptions you are not providing the care for patients as your job requires.
Wendy Sanchezruiz
PharmD Candidate 2017
WUSOP
I do not think it is our duty to restrict a patient from obtaining a specific drug. I find this debate similar to that of not helping a patient if they have AIDS for instance. Just because someone has AIDS does that mean you will refuse to serve them? As pharmacists we must uphold a degree of limiting our preconceived notions. We are not there to judge, we are there to improve the live's of patients regardless of our morals. Avoiding maleficence is a pharmacist's objective. I understand it varies among pharmacists, yet the patient situation cannot be assumed. For instance in the second article the girl was taking the medication that the pharmacist had assumed was an attempt at an abortion rather than her actual health situation. Therefore, a pharmacy is not the time or place to impose your beliefs on someone and pharmacist expectations should be upheld.
Monica White
Doctor of Pharmacy Candidate 2017
WUSOP
I believe a pharmacist's religious beliefs should be put aside when it comes to dispensing Plan B or Birth Control. Birth control and Plan B has been extremely helpful in preventing teenage pregnancy, and has put many parents at ease.Additionally, it has probably helped cut down some the costs associated governmental funding which could be utilized to help support a teenage mother who is not financially stable, and was never given the access to birth control or Plan B.
The only time that a given script should be denied from a patient, is if it has the potential to cause harm to the patient.
-Greg Hanseler
Doctor of Pharmacy Candidate 2017
WUSOP
There are a lot of instances that a health care professional, like a pharmacist, will be involved with conscientious objection controversy. The paper from Obstet Gynecol poses two major ones, while others could be from a personal experience that a certain medication in a class doesn’t particularly work as well as another (dramatic example, hoping this doesn’t happen as often as the instances posed by Obstet Gynecol). I do not see this as being beneficent or nonmaleficent, which is how pharmacists should be acting. We learn everyday in school that pharmacists should be “patient-centered” and focus on the outcome of the patient’s overall quality of life. How can a pharmacist honestly say they are improving the quality of a patient’s life by refusing to fill a prescription for them? We also learn that pharmacists need to put away their own prejudices and biases when it comes to patients. Even if a pharmacist differs in morals compared to a patient, the pharmacist cannot assume anything (if the patient is inappropriately taking a medication) because the patient is always right until you have concrete evidence to the contrary. I agree with the Obstet paper when they say that a pharmacist only has “cursory knowledge of the clinical circumstances” when it comes to a patient’s prescription. The pharmacist really has no definitive answer as to why the patient was prescribed a medication; the pharmacist can only assume the physician prescribed it for the indications of the medication on the script. I know it probably isn’t good for me to say, but a pharmacist really does not control the decision of treatment for the patient; that is the physician’s job. A pharmacist’s job, to be as basic as possible, is to follow the directions of the physician on the prescription and dispense the order.
Although I know Obstet was written with bias, I can agree with the paper. However, I can also agree with points made in the NEJM paper. I understand how other jobs allow a processional to refuse services because of conflicting morals. I am aware that a pharmacist may not want a certain encounter on their conscious…however I just can’t help but to go back to everything we’ve been learning in school. Quality of life for the patient should be the pharmacist’s main focus and to withhold prescriptions without concrete evidence of abuse against the pharmacists’ morals is not ethically right of the pharmacists.
These articles address something I have often wondered about and have had internal conflict with. I believe our job as a pharmacist is to improve a patient's health and quality of life. But there comes a point when you have to determine if some medications are actually helping or hurting a patient, and then the question arises if this is our decision to make or not.
I do believe in this profession we should have the ability to deny filling a prescription if we believe it is not in the patient's best interest, but not just because we ethically do not agree with the therapy. You may never fully know what is going on with a patient, so it is important not to jump to conclusions just based on prescriptions they are having filled.
One gray area that I really go back and forth with is the dispensing of needles over-the-counter to a patient who is not on insulin. I have worked for places that would not sell syringes unless the patient had a valid prescription for insulin, but I have also worked for places that will sell syringes to anyone. The reasoning most places will sell syringes to anyone is so they are at least using clean needles, and because if they don't sell them somewhere else will. However, a lot of pharmacists do not want to be enablers or have it on their conscience if something were to happen to these patients.
At some point or another in this profession we are going to have to make tough decisions on whether to dispense pain medication to someone who may be an addict, emergency contraceptive to adolescents, or needles to someone not on insulin. I believe this should be our discretion, but we should never deprive someone of a necessary medication that impacts their well-being.
The main topic that surrounds the articles is that there have been scenarios in which a patient had a life-threatening condition in which the medicine was really needed and the pharmacist on duty refuse to fill the prescription because it was against their morals. As a P1 at WUSOP, we have been told many times that we should not pass judgement before we know for sure what is going on. We have also been taught that no matter what the circumstance is, we should always act professionally. That being said, to me it seems almost abnormal to have laws that allow pharmacists to refuse to fill a medication. We are not all-knowing and it should be our second nature to understand that although ill-will could be what we see the use of a medication as, that is not always what it is in every situation. Furthermore, in the US everyone is free to do what they believe is acceptable within the limits of the law. Therefore, one pharmacist should not be able to refuse another person the right to take a medicine because they do not believe it should be taken.
Andrea Huneycutt
Doctor of Pharmacy Candidate 2017
Wingate University School of Pharmacy
After reading both articles, I think that pharmacists should not be detoured from filling a prescription based solely off their beliefs or opinions. Pharmacists have a professional obligation to their patients unless there is potential harm for the patient. Then and only then should the pharmacist decline dispensing the medication, but should then contact their physician immediately to resolve the situation. I believe this because the pharmacist isn’t an active member in their lives and will more than likely never know the entire story. So it would be more like judging your patient, which can be very insulting and we are there to care for them, not to judge them morally.
Steven Walls
Doctor of Pharmacy Candidate 2017
WUSOP
After reading the articles and other comments below there are a lot of good points given. I believe that we have a professional right to refuse dispensing drugs based on our morals and ethics. Just like lawyers and other professionals, who earned their degrees, are allowed to choose their clients based on their morals and ethics why shouldn't pharmacists be allowed to do the same. Our advice, during MTM or other situations where you are helping others choose/educate on a medication, and power to dispense is a right that needs morals and ethics to back it up. That being said everyone has their own beliefs and it's important for the patient and pharmacists to be aware of that when choosing a pharmacist/patient they see.
Matthew Thompson
Doctor of Pharmacy Candidate 2017
WUSOP
I believe the pharmacist has the right to deny prescriptions if they feel it may risk their license to practice, however I do not believe pharmacist should be able to deny prescriptions to patients. This act would be infringing on patients’ rights. If a patient brings in a prescription for oxycodone and they look ragged and smell like smoke, this may bring red flags up in some pharmacist minds, but it is not in a pharmacist job description to make judgments based on someone's aesthetics. We are not taught to judge people in pharmacy school. We are taught a science, a system. While I don’t believe we are robots or automated, there is a fine line that must be drawn so that emotions and opinions, both of which should be checked at the door, do not get into the way of our jobs.
Annalisa Fong, P1 HVL
Pharmacists are charged with determining whether a drug is safe, effective and legal. To dispense outside of those guidelines leads to a slippery slope, and like Legacy states, where is the line then drawn? HIV meds were mentioned, but how about hormones for transgenders? Or diabetic supplies for morbidly obese people? Denials due to religious or cultural differences? Yes, we are human and are free to choose our belief system, but we are not free to choose the belief system of others. This is a major consideration that a person needs to examine prior to entering a profession: will their personal belief interfere with their job duties? af
I believe refusing to fill a medication should be limited to some situations, so that every pharmacist would know when to refuse. Lets say if all pharmacists has the right to refuse filling a medication that is a C II in excess level it would not cause any problems since the patient wouldn’t get the prescription from any pharmacy. In addition, this limitation should be done based on what would bring a better quality of the patient life. Even though, everyone has personal believe about a lot of medications, I believe personal believes shouldn’t have any place in the professional field.
Helen Nure
Doctor of Pharmacy Candidate, 2017
WUSOP
I won’t go as far as saying we shouldn’t have the right to refuse to fill a prescription. However, I don’t think it is appropriate for pharmacists to refuse to fill a prescription based on our own morals or beliefs. We enter this profession with the intention of helping people, not to change the beliefs of others. As I mentioned in class, refusing to fill a prescription may potentially cause unnecessary harm to the patient. There are better and more effective methods to be an activist for your beliefs in settings outside of the workplace. I decided to look up the topic of conscientious objection to gain a better perspective. An article came up about the Boston Marathon bombings and the nurses that were asked to treat the bombing suspect, Dzhokhar Tsarnaev. They all agreed to do so, despite their personal disagreements with the bombers actions and morals. Additionally, they mentioned that they often are asked to treat drunk drivers, prisoners, gang members etc. In all of these cases, it was their responsibility to provide care to all patients despite their circumstances. The same should be expected when dispensing medications to patients.
Here is the link to the article I mentioned:
http://www.forbes.com/sites/davidkroll/2013/05/22/what-pharmacist-conscientious-objectors-might-learn-from-boston-bombing-suspects-nurses/
Laura Bowers
Doctor of Pharmacy Candidate 2017
WUSOP
I think that conscientious objection can become controversial in some other instances such as drugs used to treat HIV and medicinal marijuana. I think that these can cause controversy within the pharmacy community if someone feels like this is morally right for them to dispense.
The American Pharmacists Association allows a referral for the pharmacist to give the patient if the pharmacist refuses to fill a prescription as mentioned in one of the articles.
Illinois pharmacists have to fill all contraceptive prescriptions. In Nevada, you can refuse to fill a prescription but you need to transfer the prescription to another pharmacy, such as many other states like Texas and North Carolina. Wisconsin you can’t refuse the right to fill a prescription or transfer the prescription. Four states have laws that allow pharmacists to refuse to fill a prescription theses are Georgia, South Dakota, Arkansas, and Mississippi.
My thought on the matter of the subject is that you need to be a professional in these cases and use your judgment on prescriptions. I think that it is ok not fill a prescription if it causes harm to the patient as in the physician messed up the dosage or it could counter act with another medication the patient is on. I think a pharmacist should also be able not to fill a prescription if the prescription does not look legitimate. In a lot of scenarios the pharmacist does not know the patients background or why the patient is really taking the medication. We can only gather and assume information based on what the medication is used to treat. If we are refusing to fill prescriptions based on assumptions rather than facts then we are not keeping in mind to be patient centered. This could ultimately lead to more harm on the patient if they don’t get there prescription filled. This could also lead to the scenario that the patient will just go somewhere else to get the medication filled. We are not actually stopping the patient from getting the medication if they can just go somewhere else to fill it. This will just lead to frustration on the patients part and will end up for the pharmacy to lose business. It is better to fill a prescription if it does no harm to the patient rather than refuse to fill. We should be patient centered and patients should come first rather than our assumptions.
Kelly Fuhrmann
Doctor of Pharmacy Candidate 2017
WUSOP
Based on the reading, it is clear that there are conflicting ideas regarding conscientious objection. The tone of the articles seems to be against pharmacists’ rights to refuse to fill a prescription. I feel that, as healthcare professionals, it is necessary to leave our personal beliefs and morals out of the work place setting. The focus of our career as pharmacists should be the wellbeing of the patient. Healthcare leaders are obligated to provide medication to better an individual’s quality of life, not bestow judgment upon patients based on the type of medication prescribed to them. Therefore, one should not refuse to fill a given medication, such as an emergency contraceptive, because it is a professional responsibility to provide healthcare that is appropriate and approved for patients. As a pharmacist, one may not know the specifics of why a particular drug was prescribed to a patient. The Obstet Gynecol article brought up an interesting point regarding this. The article mentioned a teenage girl with a health issue for which she was prescribed an oral contraceptive as treatment for her condition. Yet, the girl was refused the medication due to the fact that the pharmacist believed the girl was prescribed the drug for an alternate purpose. This is a good example of how personal beliefs can hinder one from fulfilling his or her professional duty as a pharmacist.
Kimberly Pullium
Doctor of Pharmacy Candidate 2017
WUSOP
I think that pharmacists should have a right to refuse to fill a prescription under conditions such as errors or excessive quantities of a drug being dispensed or if the patient is suspected of misusing the drugs due to an addiction etc. Not filling an emergency contraceptive due to personal beliefs or opinions is unprofessional. A pharmacist has an obligation to the patient to fill the prescriptions in order to improve the patient’s quality of life and well being. The pharmacist’s opinions and obligations are two different things that they have to be separated when working in the professional world.
Pooja Duggaraju
WUSOP
Pharmacists have a right and an obligation to refuse to fill a prescription if they think there was an error in the prescription or if they think it could cause potential harm to the patient. They should also be able to refuse to fill a prescription if they believe it was forged or that the patient is misusing the medication. However, I think that pharmacists should leave out their own personal moral values and religious beliefs. Everyone has different beliefs, and refusing to fill a prescription because you do not believe in something is disrespecting that patient’s beliefs. As healthcare professionals, pharmacists have the responsibility to provide the best quality care to their patients and allow them to decide what therapy is sufficient for them. Birth control pills and emergency contraceptives should not be denied to a patient just because it goes against a pharmacist’s religious beliefs. If they do not believe in them, then they do not have to take them, but as a pharmacist, they should respect their patients enough to provide them the care they want and understand that their beliefs are different. Also, birth control pills are used for various reasons, such as hormone control and acne. The pharmacist may not know the personal reason the patient is taking a medication and should therefore not judge them based on it.
Summer Powell
Doctorate of Pharmacy Candidate
WUSOP Class of 2017
Everyone has made very good points so far. Pharmacists should have the patient in mind at all times, and if the patient needs emergency contraceptive or any other medication, the pharmacist should not deny it to the patient. For me, the most important aspect of pharmacy is helping patients in any way possible and improving their quality of life.
After reading the articles my opinion has stayed the same. However, I was unimpressed by the Obstet Gyencol article because it seemed insulting to the pharmacy profession. They used the term "incomplete professionalism", and said that pharmacists have more in common with corporate managers etc., than with traditional learned professionals. They could have easily made their point without including such statements.
Mary Parsons
PharmD candidate
WUSOP class of 2017
After reading both of the articles, I do not believe that a pharmacist should impose their morals and beliefs in accordance with dispensing medications. If we let ourselves in the way of the overall health of the patient then we are doing no good. I believe that if the medication has a potential to harm the patient, then a phone call has to be made to the doctor for clarification, and then only in that instant, a pharmacist can refuse to fill a prescription. The previous example does not include morals or beliefs; it regards the professional insight of a pharmacist.
Dustin Webster
Doctor of Pharmacy Candidate Class of 2017
WUSOP
While we as pharmacists have the moral right to refuse to fill prescriptions, I do not think that right should normally be exercised. Of course there are situations where it may be appropriate if the pharmacist is undoubtedly sure the patient is harming themselves. However, denying a patient medication because we may not agree with the intent, is completely out of the realms of our job description. This is not to say our job should take away from our morals and beliefs but when it comes to a prescription, it is ultimately about improving the overall health and quality of life for our patients.
Jordan Grubb
Doctor of Pharmacy Candidate 2017
WUSOP
After reading everyone’s comments I would have to agree with the majority who say pharmacists have the right to refuse a prescription in certain incidences. In my opinion those incidences include filling C-II medications when the patient is clearly an addict. Filling the prescription at this point is not helping the patient but only feeding the patients addiction. Therefore, I believe you can refuse to fill this prescription. I don’t believe a pharmacist has the right to refuse plan B prescriptions. That decision was made between the doctor and the patient and it is our responsibility to respect their decision even if we may not agree with the decision.
In North Carolina pharmacists have certain right to refuse certain medication for example: if the prescription was issued by a psychiatrist, or if the prescription order was for prophylactic purposes, such as the ordering of antibiotics by a pediatrician for members of a child's family when the child has a positive strep test. Lastly according to North Carolina law a pharmacist can deny the fill of a prescription order for an emergency order medication related to pregnancy prevention. There are more things listed on this website related to refusing certain medications. http://www.ncbop.org/LawsRules/rules.1800.pdf
I may not agree with all of them but according to North Carolina you have the right to refuse certain medications.
Anna Smaragdis
Doctor of Pharmacy Candidate 2017
WUSOP
I do not think that morals should play a part in a pharmacist's decision to fill a prescription. Pharmacists are there to do their job, and there will always be aspects of every job at some point that we do not agree with. It is a pharmacist's job to fill prescriptions, not judge patients, no put their beliefs off on patients, but to do what is best for their patients.
I do believe that if there is an error in the prescription or if it is an out of state controlled substance in a very large quantity that you have received word about could be from a pill mill, a pharmacists should exercise their good judgement in filling prescriptions in those cases. It is a pharmacist's duty to do what is right and what will benefit their patients.
Nicole Free
Doctor of Pharmacy Candidate 2017
WUSOP
I believe that the pharmacist should have a right to deny filling a prescription, but only if it is harmful to the patient or there is a problem with the prescription. A pharmacist should not let their own beliefs influence whether or not they fill a prescription for a patient. We know that by choosing this career we will have to deal with filling and dispensing medications that are controversial and we may not personally believe in. However, we have to put aside our own beliefs in these situations because we are there for the patient. We do not always know the background information as to why the patient is receiving a medication and as professionals we should not make assumptions. Therefore, with a valid prescription the patient has a right to the medication and we should dispense it.
Justin Ledford
WUSOP Doctor of Pharmacy Candidate 2017
After reading through the articles, I believe that this topic is a teachable moment for anyone who has very strong morals and intends to enforce it, even when it infringes on other people’s rights. I believe that everyone is entitled to their opinions and morals and it would be offensive if a pharmacist decided not to fill a prescription, except in situations when that prescription may be harmful to a patient.
On the other hand, I understand how a pharmacist may also feel that their own right is been violated, when they are asked to fill a prescription, when they believe that it is not the right thing for them to do. Based on the above scenario, I believe that it is important that a pharmacist with such inhibitions be very selective, when choosing a place of employment or career path. Not all Pharmacists need to fill prescriptions. Many are in management, academia and in research fields. In the end what is important is that we all live by the live and let live principle, where we steer clear of controversy and live a life that in the end we have very few regrets.
Adaobi Obika
WUSOP
Doctor of Pharmacy Candidate
Class of 2017
I don't think that pharmacists have the right to refuse to give any patient medication. Pharmacists can have morals but they gave them up when they decided they wanted to become a pharmacist. A pharmacists job is not to implement their morals on patient it is to help the patient. The pharmacist can talk to the patient about what they drug does to your body, but it is the patients choice. The pharmacist cannot deny medication to patients. It is a pharmacists obligation to help others in whatever they may need.
Becca Giannetti
I think that it is nice that we have the opportunity to refuse to fill a prescription, but I don't think that we should use that option for moral or religious reasons. As pharmacists we have an obligation to science and treating the patient. I don't think that our own beliefs should ever interfere with that. I think the only time we should refuse to fill a prescription is if we suspect the patient is abusing the drug and thus doing harm to themselves. In that case I feel that we must refuse to fill the prescription. In situations like birth control or emergency contraception we don't have the right to choose what enters the patient's body.
Mitch Speer
Although I believe everyone is entitled to their own opinion, I do not think that opinion should prevent a patient from getting their prescription filled. Pharmacist know what they sign up for when they go into the profession and just as pharmacist have their own opinions and beliefs about a subject, a patient has their right to autonomy and getting their prescription filled. I believe that any one who enters the health care profession does so for the greater good of helping others. Even if you have religious or personal beliefs that differ against some medications, I believe pharmacist need to respect the right of the patient’s choice. I think the only reason a pharmacist should choose not to fill a prescription is if they feel it has been forged or is invalid or if they truly believe that by filling the prescription could bring harm to the patient. Otherwise I believe pharmacist should be professional and keep their personal opinions to themselves and respect the choices made by their patients.
Kerri Greene
Doctor of Pharmacy Candidate 2017
WUSOP
After reading both of the articles, I do not believe that a pharmacist should impose their morals and beliefs in accordance with dispensing medications. If we let ourselves in the way of the overall health of the patient then we are doing no good. I believe that if the medication has a potential to harm the patient, then a phone call has to be made to the doctor for clarification, and then only in that instant, a pharmacist can refuse to fill a prescription. The previous example does not include morals or beliefs; it regards the professional insight of a pharmacist.
Dustin Webster
Doctor of Pharmacy Candidate Class of 2017
WUSOP
In reading the online articles involving prescription ethics and morals, I believe that one's own ethics should not be considered when under a regulating pharmacy code of ethics. If we have a system with guidelines already implemented then what is the purpose of pharmacist trying to use their own ethics in decision making. Overall Pharmacy is a business in the healthcare filed and thats what it should hold itself to be in the future. If we had the right to not fill prescriptions with specific medications that could do bodily harm then we wouldn't be able to dispense any medication. It is the patients decision to utilize prescribed medications. A Pharmacist is their to console, and provide information to the patient.
Charles Whisnant
Doctor of Pharmacy Candidate Class of 2017
WUSOP
I can see where this can be a touchy subject for different people. Pharmacists came into this profession knowing that they were going to have to dispense such drugs that could possibly go against their morals. If they could not deal with doing so, then this was not the job for them. I do believe that they should have to fill all prescriptions unless it could harm the patients or if it seems like a forged prescription. It is not our choice to restrict patients from drugs that they want. The patient’s quality of life should be one of our main concerns.
Courtney Harrell
Doctor of Pharmacy Candidate 2017
WUSOP
As a pharmacist, our duty is to provide the best care for our patients. If a patient wants a certain drug filled at our pharmacy, ideally, we should dispense it as long as it is a lawful prescription. However, moral beliefs can cause a dilemma between the patient and the pharmacist. If a pharmacist feels uncomfortable filling a prescription, I do not think they should have to. Many retail pharmacies do not allow a pharmacist to refuse filling a prescription, so this problem may only pertain to independent pharmacies. Because there are so many options to patients, I think pharmacists at independent pharmacies should be allowed to decide whether or not to dispense the prescription. If a pharmacist does not feel comfortable dispensing a certain prescription, the patient can always take it to another pharmacy. This is a touchy subject to discuss, but I can understand both sides of the argument.
Jordan Richmond
Doctor of Pharmacy Candidate 2017
Wingate University School of Pharmacy
After reading these articles, I still believe that we should still have the right to refuse any prescription we are not comfortable filling. This doesn’t just apply to abortive or emergency contraception. What if a patient brings you a C2 prescription that is 3 years old and they don’t take it regularly. I wouldn’t fill it because I don’t believe it is therapeutically beneficial. I believe we have the right to question whatever we want because our license could be at stake if something goes wrong. I do feel that as medical professionals, we shouldn’t wear our personal beliefs on our shoulders. If you know that a script is from an abortion clinic and you don’t want to fill it, professionally refuse it. If you don’t want to fill it, you don’t have to tell them why, but you should call another pharmacy and make sure they have the medication and direct the patient there. You shouldn’t have to fill anything you don’t want to but that decision shouldn’t be a knee-jerk reaction. I should be able to refuse to sell a woman Plan B who is just using it as contraception. I believe that doing that will be detrimental to the patient’s health because forcing a period over and over may cause her damage.
Tavie Laws
Doctor of Pharmacy Candidate 2017
I feel that it is the pharmacists obligation to fill the prescriptions presented to their pharmacy. However, they do need to keep in mind the ultimate health of the patient. There is a thin line between what is appropriate in our society and what is inappropriate. Everyone has different beliefs and opinions. Filling prescriptions based on what you believe is suitable will cause controversy and issues. Morals and ethics should be left out of your professional job as a pharmacist. As a pharmacist, when you receive a prescription, your main concern should be to help the patient and make sure that the drug will not hurt them. Even if the pharmacist does not believe in the medication prescribed, there was a specific reason that the patient has a prescription for that drug and it is our obligation to help optimize their overall health by filling the prescription. We should make sure that we know the background of a patient before judging. Pharmacist do have the right to deny filling a prescription if they feel that the patient is abusing it. This, is appropriate. The patient's overall health is the main concern and if they are abusing their prescribed drugs, this is negatively effecting their health. Also, the pharmacist would have the right to refuse filling if the physician made a mistake on the prescription or if there is a drug-drug interaction. I do not feel that we should be able to refuse medication to patients based on our beliefs or morals. We are always supposed to be for the benefit of the patient, not for us.
I believe this topic is a really wishy-washy subject. I do believe to some degree that the right to deny selling should be present, however, I don't believe any religious or personal beliefs should take over the priority of benefiting the patient. For instance, a very controversial medication, Plan B, could be a medication that is refused in some pharmacies. I believe that this is wrong. Denying the patient this medication is solely based upon a personal belief, rather than science and the healthcare of the patient. In a professional setting, you should remain professional- this does not include forcing your beliefs on a patient.
In other instances, such as controlled substances, the patient may be harmed if the prescription were filled. For instance, if there were a known drug addict bringing in a new prescription for Percocet, is it really proper to fill the prescription? This harms the patient's addiction and ultimately the patient's quality of life. It is medically backed to refuse this medication.
Ultimately, it really comes down to one thing: patient care. This is about the patient's life and their own health. That doesn't include an individual pharmacist's beliefs. In the end, it is our responsibility as pharmacists to educate and better the health of the community. Beliefs are not involved in this.
Karen Ross
Doctor of Pharmacy Candidate 2017
Wingate University School of Pharmacy
I believe that when we decide to pursue a career in pharmacy, we understand that the needs of the patient are of utmost importance. This includes filling the prescriptions which the patients bring into the pharmacy. As professionals, we do reserve the right to deny a service, but we should also understand that we must remain professional. Professionalism entails remaining respectful of other's opinions and wishes, therefore we should not impose our beliefs or morals upon those we disagree with. While we have the right to not fill a prescription due to disagreements in morals or values, it should not be abused. The health of the patient should be more important than our personal beliefs while we are in the professional world of pharmacy.
Maegan Wells
Doctor of Pharmacy Candidate 2017
WUSOP
While having morals and ethics to abide by is good, those should be left at the door before entering the pharmacy. The duty of pharmacists is to provide and deliver service to patients, even if it goes against their morals. As long as filling the prescription does not cause harm to the patient, then the pharmacists should fill it. If the pharmacist is strongly against filling a specific prescription, then they should counsel the patients on alternatives rather than completely turning them down because it may bring negativity to the pharmacy; also, that prescription will get filled either by that pharmacist or another pharmacist that is willing to do so. Pharmacists should keep in mind that not everyone will share the same morals or ethics; so, while filling a specific prescription may go against their own beliefs, it may not be going against the beliefs of patients. Therefore, pharmacists should not impose their own beliefs to patients. Also, pharmacists should not judge their patients because it is unprofessional to have complete bias against specific prescriptions.
Sheng Vue
WUSOP
Doctor of Pharmacy Candidate 2017
Personally I do not believe that pharmacists should have the right to refuse to fill a prescription solely based on morals, beliefs, etc. The only time I feel pharmacists should be able to refuse a fill is when it could potentially harm the patient. The only judgement the pharmacist should have when filling a prescription is whether or not the medication is being abused or misused. Although we are biased because we are pursuing a career in pharmacy, we have to understand we are entering a patient-centered career so we have to put the patient first. As a patient would we really be okay with a pharmacist judging us and refusing to fill a prescription because their beliefs are different than our own? And would we really be okay with explaining every situation we have and expressing why we need each medicine? Probably not. Most of society feels that pharmacists, as professionals, are not judgmental and this is what makes us so accessible to them. Patients enjoy being counseled by pharmacists and coming to us with their concerns. Would we want a pharmacist to counsel us who has refused to fill our prescription in the past? Again, probably not. We must keep the patient in mind and must put their health and well-being before our personal beliefs.
Whitney C. Smith
Wingate University School of Pharmacy
Doctor of PHarmacy Candidate, Class of 2017
I believe every pharmacist has the right to refuse or to fill a prescription for any reason and also that every patient has the right to fill a prescription. Therefore, if a pharmacist will not fill a script, it is her duty as a HCP to direct the patient where to fill it. Pharmacists' and patients' autonomy should both be respected.
Kristin Payne
WUSOP Class of 2017
I think everyone is entitled to their own believes and moral values. However, when it comes to the workplace, care must be taken in order not to impose ones believes and moral values on customers. If there is a legitimate reason for a pharmacist to refuse to fill a medication, then there is no objection to failing to fill that prescription. However, if the refusal to fill is based on personal reasons, then that could constitute imposing personal morals and believes on others. Also, the problem of where to draw the line comes into this discussion. For example, if a pharmacist refuse to fill an emergency contraceptive such as plan b, then he could be putting himself in tight situations. This is because the active ingredient in plan b is the same active ingredient in many of the oral birth controls, except that the active ingredient is expressed at higher strength in plan b. Would that mean that a pharmacist that refuse to fill plan b should also refuse to fill some of these oral contraceptives? Technically he should because of the stance he is taking on refusing to dispense plan b. However, these pharmacist that refuse to fill plan b do not refuse to fill these oral contraceptive. Hence, they are more or less contradicting themselves or a double standard in that regard. This is one of the many problems associated with conscientious objection or refusal to fill some medications based on personal believes or morals.
I think everyone is entitled to their own believes and moral values. However, when it comes to the workplace, care must be taken in order not to impose ones believes and moral values on customers. If there is a legitimate reason for a pharmacist to refuse to fill a medication, then there is no objection to failing to fill that prescription. However, if the refusal to fill is based on personal reasons, then that could constitute imposing personal morals and believes on others. Also, the problem of where to draw the line comes into this discussion. For example, if a pharmacist refuse to fill an emergency contraceptive such as plan b, then he could be putting himself in tight situations. This is because the active ingredient in plan b is the same active ingredient in many of the oral birth controls, except that the active ingredient is expressed at higher strength in plan b. Would that mean that a pharmacist that refuse to fill plan b should also refuse to fill some of these oral contraceptives? Technically he should because of the stance he is taking on refusing to dispense plan b. However, these pharmacist that refuse to fill plan b do not refuse to fill these oral contraceptive. Hence, they are more or less contradicting themselves or a double standard in that regard. This is one of the many problems associated with conscientious objection or refusal to fill some medications based on personal believes or morals.
I understand what each of the articles is saying. Each makes a few valid points, but the AMA has gone a bit too far by implying that physicians should have the right, as professionals, to decide when, or when not, to perform a service, but pharmacists do not have such a right. I am not sure if this was their intent, but I almost feel as if they are implying that pharmacists are not professionals at all. I hope that is not what they were implying as that would be as absolutely inflammatory a point of view as it is an archaic one.
Michael Russell
Doctor of Pharmacy Candidate 2017
WUSOP
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