Caveat: I haven't read all the responses, so I may be off base on where this thread has gone, but I want to keep my response uninfluenced before I post.
A pharmacist is an independent professional businessman. He either works for himself or a corporation. He has an absolute right to dispense only the medications he feels are not harmful. If an incompetent physician writes a prescription for a harmful dose of medication, the pharmacist is obligated to contact the physician and question the prescription before dispensing the medication. The pharmacist is not a servant of the physician, but a licensed retailer of the drugs that the physician himself cannot sell. The system is a system of checks and balances, and has saved the patient more times than it has harmed the patient.
Likewise, a nurse (I am a nurse) has an obligation to question any dose or medication the physician has ordered if she (or he) believes it will cause harm to the patient. They have an obligation to call the order into question before administering the drug. The nurse is also an independent professional businessperson. The nurse is no longer a servant of the physician, but the strongest patient advocate in the health care system. The nurses role is also to provide a system of checks and balances, and this system has saved far more patients than it has harmed. I cannot count the number of patients I, myself have saved in this fashion.
If our society was to require that pharmacists and nurses follow the physician's orders like robots, robots would suffice. In many hospitals, medication dispensing devices have been instituted in an attempt to cut back on nursing staff. Nurse Techs distribute medications. Patients do not know the difference. Looks like a nurse, must be a nurse, right? In these hospitals the nursing staff was cut back severely. Mortality rates rose dramatically. The system of checks and balances was gone. You cannot have this system of checks and balances without pharmacist and nurse autonomy.
The pharmacist who owns his own pharmacy has a right to say whether he will sell Hallmark cards, and whether he will sell anything else, regardless of what your physician ordered. It is his business and he will live and die by his business practices. If he holds a moral, whether rightfully or not, above business, he alone suffers the consequence or reaps the benefit of his decision.
The pharmacist who works for a chain has an obligation to abide by his employers wishes. If he does not agree with them, he can seek employment elsewhere, or start his own store. FWIW, this is why there is a so called nursing shortage in the hospitals. Nurses have seeked employment elsewhere. Did the patient benefit because the hospitals tried to use force to make nurses comply with their demands? No, The experienced nurses either began practicing privately or found employment outside of nursing. As a result, the mean level of experience of a critical care nurse is now approximately 1 year. In 1990 it was 7 years. The patient suffers, not the hospitals, and not the nurses. When chain pharmacies begin to do the same with pharmacists, only new pharmacists will work in the chain stores. You will have a less experienced person deciphering and considering your prescription. You will have a less experienced person scraping medications into your bottle. We've already seen that trend, haven't we?
A customer has a right to take his business anywhere he likes. He can take his business elsewhere on financial, moral, philishopical, or any other grounds he chooses. He does not have a right to force a Dodge dealer to sell Toyotas and he does not have a right to force any pharmacist to sell a medication that is contrary to the pharmacist's moral standards. You do have a right to be pissed off if you have to drive elsewhere, but you do not have a right to question any other person's morality.
Ok, off my soapbox. Now I'm off to read the responses that came before mine.
edited to add:
That would mean a doctor could refuse to suggest "immoral chemo therapy" for a child under 5, because by his belief's children under 5 should be left in the Lord's hands. And for the parent's who accept his word and their children die ... well, it was his personal business, right?
Yes, a physician as well as a nurse can and will refuse treatment if they feel the refusal is proper. Your chosen example is an extreme to make a point, but I will play along. If the parents disagree, they have a right to find another physician at any time. If the hospital disagrees, they have a right to terminate their contract with the physician. Physicians, nurses and pharmacists are not prisoners of the general population's whims. The patient has a right to make choices. So does the practioner. I, myself, have refused service on numerous occasions. When I refuse, I must find other patients just as the patient must find another practioner. I'll use my own extreme since you did. I had a patient that sprayed WD40 in his mouth for his diabetes. He was noncompliant with any medical intervention. I tried to teach and help him for about 4 months. I saw I could do no good, and discharged him from my services. A few years later, I saw him again with no feet and on dialysis, both as a result of uncontrolled diabetes. He later died. I felt no guilt. I will not waste my time with those who are noncompliant. I am not a magician, and I cannot control illness without the patient's participation.
In small towns, like the many here in Nevada, THE pharmacist may be the only one for 4 hours in any direction. Take your business elsewhere? Your doctor tells you to take _____ as soon as possible, but you first have to drive yourself to Vegas. That is at least a bit coercive.
You are responsible for your own health care, not your doctor, and not your pharmacist. If you cannot get services you desire where you live, you need to move or at least drive to where they are provided rather than try to coerce other free people to bend to your wishes. Your physician should have given you samples to take until you could obtain the medication. Your physician in a small town with one pharmacy should also have told you that the medication would be difficult to obtain.
The US is coming close to a state of health care emergency. The number of providers of all types is greatly decreased (especially RNs). The amount of choice we have in seeking care is only shrinking, and that includes the number of overworked pharmacists available to you. If we support the few crackpots right to decide if they want to provide the Pill or not, we're just asking for INCREASED government regulation of ALL pharmacists, or state run pharmacies - kind of like the formation of TSA.
Interesting. We agree. To have an adequate number of pharmacists to serve patients, you must have an adequate number of people entering pharmacy and staying in pharmacy. See above. The reason for the nursing shortage is simple. More people leave nursing every year than become nurses, while the patient population continues to grow. Why do they leave? The number one reason is not low pay and long hours. Nurses in the hospitals expect that. The number one reason that experienced nurses leave the hospitals as soon as possible or nursing altogether is because they are not given autonomy and they are treated as subhuman by physicians, administrators and patients themselves in the hospital setting. I am a very experienced registered nurse. I could run most hospitals, and I can perform almost any task needed. In fact I subsitute running a major hospital from 7PM to 7AM at times. I also do a bit of CCU, surgical, and ER work as a subsitute in the same hospital. The bulk of my practice is elsewhere though. When I left the hospital floor over ten years ago, I made myself a promise. I will roof houses in the heat of summer and do plumbing in the dead of winter before I ever provide patient care on a hospital floor again. I have done both roofing and plumbing. I am making an informed decision and I stand by it. I cannot say how bad it is in nursing any more emphatically than that. Who suffers? Not the administrators, or the physicians. The patients suffer.
I'm glad we can at least agree on that Handy.
edited one more time to add: An unseen tragedy is occuring in health care. Not only are registered nurses leaving in droves, but so are our brightest physicians. Many physicians who have other options because they are brilliant men leave medicine before they have practiced ten years because insurance adjusters and medicare representatives dictate their standards of care. We are approaching a time when health care will no longer be undertaken by our best and brightest people. Only the physicians to dull to leave medicine will remain, just as only the nurses to dull or to new remain on the hospital floors. My Father in Law was one physician that left a practice that he built over the course of 30 years simply because he did not want medicare representatives dictating how he would practice medicine any longer. As a result, even more patients suffered, as did the new physicians and nurses who would have learned from him before he left his practice.
