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March 30, 2005

Fill Out My Prescription, Dammit!

Bitch Ph.D is one of many bloggers writing about pharmacists who refuse to fill birth control prescriptions. She quotes a Washington Post article:

"He's a devout Roman Catholic and believes participating in any action that inhibits or prohibits human life is a sin," said Aden of the Christian Legal Society. "The rights of pharmacists like him should be respected."

What about my right to have my prescription filled? Your "moral issues" end where my health care begins. If you have a problem in your job filling out prescriptions because you find the person who wants to have the prescription filled "morally objectionable," get another job.

I haven't heard any cases of pharmacists objecting to fill prescriptions of Viagra. Why not? How do you know these men aren't cheating on their wives? There have been reports that men taking Viagra have cheated on their wives. What about men who buy condoms? Will the pharmacist demand to see a marriage license to be sure these men aren't having affairs or sex out of wedlock? Is the pharmacist going to grill these men to find out if they are being unfaithful, and then refuse to fill the prescription or hand over the condoms on moral grounds?

I don't think so.

The bigger issue of pharmacists refusing to fill birth control prescriptions is really about men taking control of women's reproduction. The "moral police" are doing that by rolling back the availability of abortion as well. Welcome to "The Handmaid's Tale."

Posted on March 30, 2005 at 08:07 AM | Permalink

Comments

I'm a pharmacist. We are ethically permitted to refuse to fill any prescription, anytime, anywhere, for any reason.

This issue has been debated endlessly in our trade publications, and you would be surprised at how many of the BCP refusers are women. I don't get it either. One woman said she did not fill BCP Rxs for unmarried women, which just doesn't make sense. It's none of her business, and many women use BCPs for reasons other than birth control.

As for Viagra, that's none of our business either. I once had a gay male customer who used it, and there are people who would take issue with that. As for me, who cares? It's even being used by some women for their own sexual dysfunction, although the results are not as reliable - but if it works for them, good!

Posted by: kohoutekdriver8 at Mar 30, 2005 11:35:47 AM

kohoutekdriver8: not to be catty, but can you explain that ethical refusal for any reason, anytime business for me? I mean, I'm an electrician, and while I can refuse to do a specific job for specific safety reasons, I can't unilaterallly refuse to do my job without getting fired. I can say, "I don't have the right tools or equipment to do that safely at this time" or "that can't be done safely at any time----it has to be done differently"; I can't say, "naah, you don't really need that done, I'm not going to do it."

And that's how I see the pharmacist's job; if there's an ethical question about giving out certain medicines, or to certain people, why on earth should that pharmacist retain their job, any more than anyone else who refuses to do work that is clearly within the parameters of their occupation? Didn't they choose the wrong line of work?

You brought up a good point about some women taking BCP for reasons other than birth control. Who is the pharmacist to read the minds of the doctors and patients? What's next, some rabid anti-drug-abuse pharmacist refusing pain medication to terminal cancer patients, because they might be abusing drugs? Or anti-depressants because they think what the patient really needs is some healthy food and fresh air? I see the potential for a helluva lot of abuse here, and quite a bit of potential harm for patients. I don't understand this business of open-ended, carte-blanche right to refuse to dispense medication for any reason. How is that not goldbricking at best, discriminatory, or even possibly dangerous?

Posted by: La Lubu at Mar 30, 2005 12:20:16 PM

"I'm a pharmacist. We are ethically permitted to refuse to fill any prescription, anytime, anywhere, for any reason."

That's not true and I happen to know that since I worked in a national chain pharmacy, not as a pharmacist however...but a pharm tech...

You know darn well that's not true...that's something you all came up with recently trying to piggyback onto the laws that permit doctors and nurses to refuse to perform or participate in actual abortions...Now that law has been in existence for years and makes sense for doctors and nurses...

However, what you're saying does not make sense and just started probably in some red states...

Basically your job vis-a-vis dispensing birth control consists of imputing information into a computer and printing up a label which is posted on the package as those pills and other bc devices are ALL pre-packed today...

So stop this nonsense...about your ethics...it has nothing to do with it...

Any pharmacist who starts pulling stunts like this should be fired...just as I would have been fired if I, for instance, refused to service customers if their purchase contained any animal by-products claiming I'm a supporter of animal rights...

I am, but would have been fired instantly if I had tried to pull that stunt on my job...and so should any pharmacist who tries this one...

Posted by: NYMOM at Mar 30, 2005 12:37:01 PM

Yes, we can refuse to do things but if we carried it too far, yes, we could be fired or censured by the state board. There are probably pharmacists who refuse to fill prescriptions just because they can but I have never met one. When they turn someone away, it's usually justified.

I have heard of pharmacists who refused to fill narcotic prescriptions that they considered excessive, not realizing that the patient had a painful condition and not checking further. These were usually relief personnel unfamiliar with the patient.

I have also had colleagues who treated Medicaid patients poorly - and got on my case for not doing this as well. Telling them it would be an hour and making them wait an hour when it wasn't busy, for example.

What about pharmacists who refuse to fill ADD/ADHD meds for 1-year-olds? I know people who have done that.

Ask your pharmacist if what I said was true. Betcha s/he'll agree with me.

Posted by: kohoutekdriver8 at Mar 30, 2005 1:16:32 PM

I think the implications of ethics vis a vis your profession is an interesting one, particularly as to whether you have any moral responsibility for your actions.

Do you have any ethical responsibility if you designed the rail system that brought Jews to Aushwitz?

Do you have any ethical responsibiity for designing a computer system used to administer apartheid in South Africa?

What if you did primary research on nuclear physics, and your work was used to design weapons that killed thousands of people?

Take La Luba's profession. I agree that it would be enormously petty for her not to repair the wiring of someone she might have disliked for reasons of religion, politics, or what have you. But what if someone wanted to hire her to rig up an electric chair for torturing or killing prisoners? Should she refuse that if she believes that such a purpose is wrong?

Unfortunately, professional ethics is often sterotyped as a petty way to justify your own prejudices (like pharmacists and bc pills). I don't agree with that. However, I do think it is important not to throw out the baby with the bathwater. I think there is room for progressive people to think about the ethical implications of their professional actions. However, it may also be the case that if you find your ethics are consistenly compromised by what you do, then maybe you need to do something else. If you are a strong believer in peace, then don't bitch about working for the Pentagon or a major weapons manufacturer.

Posted by: silverside at Mar 30, 2005 1:21:39 PM

I'm also reminded of that phrase of Hannah Arendt re the banality of evil. That evil doesn't always arise from villains who deliberately do wrong. It is also arises from mindless bureaucracies of professionals who are "just doing my job." It's something to think about, just where you would draw the line and what kind of world are you creating by the kind of work you do.

Posted by: silverside at Mar 30, 2005 1:32:07 PM

Aren't pharmacists given discretion if a patient appears to be abusing drugs?

Posted by: Amanda at Mar 30, 2005 2:24:37 PM

"Ask your pharmacist if what I said was true. Betcha s/he'll agree with me.

Well I don't work there anymore, but we are still friends so I'll mention it to him someday if I remember...but I still think you overstated the case for pharmacist discretion...Frequently I heard our pharmacist discussing with a patient or a doctor even, a mistake he caught in dosage or something, but that's different then what you are talking about...

You are talking about people making a moral judgment about an unmarried woman, for instance, not being allowed to use birth control...NOW that's a different issue and I assure you would NOT be tolerated in any pharmacy I ever heard of...not for a minute...

The law is that a doctor or a nurse cannot NOT be forced to perform or assist in performing an abortion...that's a different issue where clearly you cannot FORCE people to participate in doing that...that's a true ethical issue but this business now of refusing to put a label on prepacked bc pills is quite a stretch to include within the law originally passed to protect doctors and nurses (and patients to a certain extent) from being forced to be active participants in PERFORMING an abortion...

Totally and completely different...

Posted by: NYMOM at Mar 30, 2005 2:28:07 PM

"I'm also reminded of that phrase of Hannah Arendt re the banality of evil. That evil doesn't always arise from villains who deliberately do wrong. It is also arises from mindless bureaucracies of professionals who are "just doing my job." It's something to think about, just where you would draw the line and what kind of world are you creating by the kind of work you do."


Well it's a little bit of a stretch to compare a pharmacist putting a label on a package of bc pills for an unmarried women with a guard or other civil service worker who actively participated in building or maintaining a whole network of concentration camps that killed millions throughout Europe...

I think we have a 'law' about that here btw, which states that the first person who mentions Hitler, Nazis, or concentration camps automatically loses the debate...

LOL...

Sorry it's just too easy for somebody to use that analogy to try to win...

Like I said I'm a supporter of treating animals ethnically, I shouldn't go so far as to say they have 'rights', nevertheless I would never ever have presumed to stop a purchase by a customer of something that contained animal by-products. It seems to be crossing some line that you have no right to cross in my opinion when you do things like that...and that line in the sand should be saved for the really really serious issues...like if a pharmacist had involvement with Terri Schiavo and refused to fill a morphine prescription or a doctor refused to removed the feeding tube...the kind of ethnical 'protests' kohoutek8driver is talking about seem that they should be reserved for issues like this...not putting a label on prepackaged bc pills...it has the potential to demean the whole ethical point if you 'waste' your protest on issues like that...

Posted by: NYMOM at Mar 30, 2005 2:41:15 PM

I'm not using it as an analogy at all. I'm using it as an example. I could just as well come up with any number of other examples. Providing "defense" training for "death squad" people in Latin America at one extreme (perfectly legal, but repulsive). Or by what you fail do at the other extreme: deciding not to whistleblow against companies that falsify records that their products killed innocent people. Or are destroying the environment. Or are blatantly exploiting and discriminating against certain classes of employees. (When I was in college, I was asked by an employer to mark the race of applicants on the application so he could throw out the applications of black candidates. I refused to do so, but in looking into it I found out that civil rights law apparently did not apply because he didn't hire enough people for the law to be applicable. I still refused. I don't believe in furthering a world of racism.)

What if you are asked to dump illegal chemicals as part of your job. Do you say no? Sometimes what you are being asked to do is against the law, sometimes not. Sometimes you may get hounded, fired and harrassed for doing the right thing. Would Karen Silkwood be remembered today if she just minded her own business, did her job, and went home?

The point is that it's easy to point out the ridiculous nature of a pharamacist who refuses to fill a bc prescription or a prescription for viagra or painkillers, or a salesperson who won't ring up a leather coat because he or she is pro-animal rights.

My point is that poking holes and laughing at the silly issues dodges the point that there may very well be a time when someone's professional obligations bring up serious ethical dilemmas. We laugh at the kooky right wing ones, or the oh-so-PC left ones. But that doesn't mean that you can entirely walk away from the human implications of what you do to earn a buck. The kind of world you are creating, supporting or encouraging by the work you do.

Posted by: silverside at Mar 30, 2005 3:35:07 PM

"My point is that poking holes and laughing at the silly issues dodges the point that there may very well be a time when someone's professional obligations bring up serious ethical dilemmas. We laugh at the kooky right wing ones, or the oh-so-PC left ones. But that doesn't mean that you can entirely walk away from the human implications of what you do to earn a buck. The kind of world you are creating, supporting or encouraging by the work you do."

I'm not laughing at pharmicists who do that at all...What made you think I thought what he was talking about was funny...I don't think it's funny at all...I find it very serious that people like this can be allowed to decide whether or not a woman can get birth control based upon their own personal moral convictions and pretty much nothing else...They are twisting the original intent of the law, which was to protect doctors, nurses and patients, to a certain extent, and using it to impose their own morality on others...

AND this will become a bigger issue in years to come if we allow it to continue unchecked...as I can see dozens of implications if we allow others to impose their personal beliefs on others and refuse them service or products because of it...


Posted by: NYMOM at Mar 30, 2005 3:50:03 PM

BTW, one other point...

I saw on another blog the idea that what is to stop doctors from treating gay or lesbian patients or pharmacists from filing their prescriptions if you are going to allow people to 'opt out' of doing their jobs whenever their personal morality is infringed upon...

Posted by: NYMOM at Mar 30, 2005 4:16:32 PM

Here's a real life dilemma I faced recently. Our Head Start program was eligible to get money from the Fatherhood Initiative program. I am dedicated to ending this kind of stuff, as I think it is an ineffective piece of pork barrel spending at best, and darn right dangerous to women and children at worst. But cash is cash in the grant biz. They wanted the money. They kicked around several options. One of the options in the application packet was a custody "education" program just for fathers. A staff person even brought it up as a possibility. I voiced my objections, without going into my personal history. That I though it was extremely discriminatory to provide that kind of advise and support for fathers and not for mothers. They sort of nodded along. They ended up going for a program of a "dads night out with the kids." They used the money to buy books for the dads to read to the kids, and games the dads could play with the kids. I didn't like or support the general intent, but it was relatively benign. Plus, at least we get to keep the books and games for the program. I am not thrilled with this. But it was the best I could do without potentially losing my job. I consider this something of a moral compromise, but not of the worst sort. Still, I don't feel good about it and I certainly don't want to get into the habit of doing this sort of grant.

I did lose some sleep as to what I would do if they did decided to do a custodial "education" program. I decide that I could not live with myself in preparing this kind of grant. It would be slicing my own throat, helping and abetting all the people who have made my life a misery. I support two kids. I need a job. But I decided that if it came to it, I would refuse to do the application and risk getting fired. I'm not lending my abilities to the "dark side"

I can see Trish getting into a similar dilemma. She is an expert on family law issues. What if a FR think tank offered her buckets of money if she would work for them, lending her knowledge and expertise to the "other side." Would she be able to justify her existence by doing her "own" work in her free time, while undermining all that from 9 to 5? I don't think so. And I think enough of Trish to know that she wouldn't consider such a thing.

Posted by: silverside at Mar 30, 2005 4:18:52 PM

I'm not saying that the pharmacist who refuses to fill a bc prescritpion is "funny." I am saying that it's easy to find the absurdity in this, the outrage in what s/he is doing. In fact, we might even say his or her actions are unethical rather than ethical.

Still, you are assuming that "imposing your beliefs" is either right-wing or PC left. Are you going to tell me that their are no ethical implications regarding what you do for a living? Because that is a delusion. Our ethics aren't what we think or believe on some abstract plane. It's how we conduct our lives. I disagree with the pharmacist's actions. I think that person is in the wrong profession. But I strongly believe that people need to take seriously the implications of what they do in this world and how it affects our world and the lives of others. I am totally uninterested in people telling me how committed they are to they are to creating a better world, when there is absolutely nothing in their actions to suggest that they are doing anything about it at all. And in fact are doing quite the opposite in their work lives.

Posted by: silverside at Mar 30, 2005 4:35:26 PM

I'm not saying that the pharmacist who refuses to fill a bc prescritpion is "funny." I am saying that it's easy to find the absurdity in this, the outrage in what s/he is doing. In fact, we might even say his or her actions are unethical rather than ethical.

Still, you are assuming that "imposing your beliefs" is either right-wing or PC left. Are you going to tell me that their are no ethical implications regarding what you do for a living? Because that is a delusion. Our ethics aren't what we think or believe on some abstract plane. It's how we conduct our lives. I disagree with the pharmacist's actions. I think that person is in the wrong profession. But I strongly believe that people need to take seriously the implications of what they do in this world and how it affects our world and the lives of others. I am totally uninterested in people telling me how committed they are to they are to creating a better world, when there is absolutely nothing in their actions to suggest that they are doing anything about it at all. And in fact are doing quite the opposite in their work lives.

Posted by: silverside at Mar 30, 2005 4:35:56 PM

Silverside, I agree that we need to think about the ethical implications of our professions. But I also think your analogy is deeply flawed. Trish hasn't applied for a job to do academic legwork for any think tank at another's discretion. But a pharmacist has applied for a job whose description is to fill prescriptions for any person at their doctor's discretion.

Pharmacists, like the rest of us, absolutely should think of the ethical ramifications of their jobs. But if they have strong ethical problems with an integral part of their job, the correct response is to take up another line of work.

In the example you gave regarding La Lubu's profession, for instance, the correct thing for La Lubu to do would be to refuse to take a job in a prison to avoid making electric chairs, because making electric chairs is an integral part of working as an electrician in this hypothetical prison. The correct thing would not be to take the job in the prison and then say 'I can only fix lights.'

Posted by: Linnet at Mar 30, 2005 6:49:56 PM

Actually, I wasn't making the argument that the pharmacist was ethically correct. If you have deep-seated ethical objections to providing legal and safe drugs or medications, than you're in the wrong profession. As I mentioned above, don't work for the Pentagon if you believe in peaceful, non-violent action. There's nothing there you could do that wouldn't be an ethical compromise for you. What you are objecting to is the normal operation of what you do everyday.
My point is that how you run your life and earn your living does have ethical implications. I DO think that people need to recognize this, and not simply dismiss all decisionmaking as "imposing your values."
As a pharmacist, refusing to prescribe legal and safe birth control is one thing. As a marketing person at pharmaceutical company, refusing to market a medication which you KNOW to be dangerous (because you know the research behind it has been distorted or covered up) is not. The latter is not "imposing" your values. It is acting on your values. I'm just wanting to point out that not all ethical thinking in terms of your job is wrong or petty.

Posted by: silverside at Mar 30, 2005 8:49:56 PM

"What about men who buy condoms? Will the pharmacist demand to see a marriage license to be sure these men aren't having affairs or sex out of wedlock?"

Trish, I hardly think that matters if they're married or not, as the people who object to birth control pills, object to any and all birth control devices used by anyone, married couples included... Has nothing to do with marriage, other than the same people believe marriage out of wedlock shouldn't be happening at all.

Viagra is not objectionable to these people probably because they think it can make more babies perhaps? Though I do see hypocricy if a pharmacist is refusing to dispense birth control pills, but dispenses Viagra to unmarried men.

Or even men they suspect might be unfaithful... since birth control pills are used for treatment of things other than prevention of pregnancy - so a pharmacist would have to merely guessing that the pills are going to be used for birth control (since they're not given the patient's diagnosis, I assume).

As for the ethical protest issue. If I can't go to work in a retail store and refuse to sell certain various things based upon my moral beliefs whatever they may be, then I don't think pharmacists should be allowed to refuse to fill prescriptions. Nobody is forcing pharmacists to work in pharmacies that sell the drugs.

As for doctors & nurses refusing to perform or assist in abortions. I just hope I'm never pregnant, trapped in a hospital in the boondocks when some life or death situation means that I'll die without an abortion, and all the health care workers there morally refuse to save my life.

Posted by: Chloe at Mar 31, 2005 1:47:47 AM

While I haven't applied for any jobs at a fathers' rights think tank, if I were to I'd offer a different perspective on fathering that isn't offered by the essentialists. I don't see fatherhood as a zero-sum game either that many fathers' rights activists see it as.

I agree that if you hold a particular political view that clashes with a job you shouldn't apply for it. It just seems that the only moral objections related to work that gets printed up in the news are ones involving women's bodies.

Posted by: Trish Wilson at Mar 31, 2005 7:07:41 AM

"Here's a real life dilemma I faced recently. Our Head Start program was eligible to get money from the Fatherhood Initiative program. I am dedicated to ending this kind of stuff, as I think it is an ineffective piece of pork barrel spending at best, and darn right dangerous to women and children at worst. But cash is cash in the grant biz. They wanted the money. They kicked around several options. One of the options in the application packet was a custody "education" program just for fathers. A staff person even brought it up as a possibility. I voiced my objections, without going into my personal history. That I though it was extremely discriminatory to provide that kind of advise and support for fathers and not for mothers. They sort of nodded along. They ended up going for a program of a "dads night out with the kids."


It's good you saw through that too...as MOST of the programs that get money from the government for 'fatherhood' programs use it EXACTLY for this discrimatory purpose...funding semi-legal clinics to give men advice about how to get custody for themselves (and of course avoid paying child support) using all kinds of sneaky tricks including using abduction and getting custody through this manner...

For instance, many people aren't aware that if a single mother does not have legal custody through the courts and a child is NOT returned from a visit by it's father, this is not considered an abduction in many states EVEN IF FATHER'S NAME IS NOT ON BIRTH CERTIFICATE. Many police on the local level won't even look at the child's birth certificate if you don't have a paper stating you have legal custody through the courts; so this is how a lot of fathers get custody...and who advises them to do this...many of these 'legal clinics' set up with funds by fatherhood project federal dollars...

So women are paying to fund this nonsense...

I'm glad you were on top of this and stopped your agency from using our tax dollars in this disreputable manner...I think people who misuse our federal dollars in this fashion should be put in jail...facing the charges they would be facing if they had kidnapped these kids themselves since they aid and abet these criminals by advising them in the how to of these schemes...

It was good you were on top of that one...

Posted by: NYMOM at Mar 31, 2005 10:00:31 AM