Pharmacist's "moral" rights.

[Handy]

Xavier,

I think it odd that you make items of PROFESSIONAL judgement equivalent to moral judgement for medical professionals. It was my understanding the Hypocratic oath delineates these as almost opposites - the HEALTH of the patient overriding their politics.

You also fail to address how this new wrinkle relates (or fails) to equal rights in general. You have coached the debate in terms of the pharmacist choosing what products to sell, but that really isn't the issue. The pharmacist is actually choosing to WHOM they will sell certain meds to. Being selective about who you do business with is not a inalienable right (or hasn't been, since the sixties).


A pharmacist may choose to dispense female hormones to a menopausal woman, but not to a teenager due to his "morals". They didn't choose not to sell a product, but to not sell to a particular patron. What would you think of a gun store that didn't sell to women or Mexicans? Is that not within the FFL's rights?


Having several close friends that are RNs, I can sympathise with your feelings on the decline of nursing. You call for higher levels of professionalism on the part of doctors and administrators. I'm calling for more of the same from pharmacists.

 

[XavierBreath]

You also fail to address how this new wrinkle relates (or fails) to equal rights in general. You have coached the debate in terms of the pharmacist choosing what products to sell, but that really isn't the issue. The pharmacist is actually choosing to WHOM they will sell certain meds to. Being selective about who you do business with is not a inalienable right (or hasn't been, since the sixties).

I'm sorry Handy, I must have misread your post and done a heck of a lot of typing in vain.

A pharmacist may choose to dispense female hormones to a menopausal woman, but not to a teenager due to his "morals". They didn't choose not to sell a product, but to not sell to a particular patron.

Unfortunately, I also believe that a businessman has a right to do business with who he chooses. I am not aware of any law that requires a businessman to sell or do business with someone he does not want to do business with, for any reason. I was also not aware that a teenager had the same rights as an adult. Mine don't.

As a grocer, I can choose whether I want to go across the tracks to deliver groceries. As a storeowner, I can choose not only what I sell, but whether I want to sell to those without a shirt or shoes. As a pharmacist, I can also choose to discriminate on merchandise or customers. Sure, some forms of discrimination are not acceptable, and others are illegal. Choosing not to sell birth control to minors is neither. In fact, it could become a liability when a 15 year old girl contracts HIV through unprotected sex. If a barowner can be held accountable for a drunk driver killing an innocent person, then cannot a pharmacist be held accountable for a teen contracting HIV?

You call for higher levels of professionalism on the part of doctors and administrators.

No, I'm not calling for higher levels of professionalism from doctors and administrators. These people are already pretty darned professional. I am calling for the respect that pharmacists and nurses deserve. That is all. People enter professions not only for the financial benefit, but also for respect. They leave because they don't get respect, the money they are making does not replace respect, and they can get both elsewhere. It's that simple.

FWIW, as a nurse I not only choose the services I will provide, but the patients I will serve. I try not to make my choices based on factors the patient cannot control, such as race, religion, or lifestyle (but I could). My choice is tempered by location, qualification and security. If I have to drive an hour to see you, chances are I will not, unless your case is particularly interesting or inspiring. If I am not qualified to meet a patient's needs, I will not seek qualifications. I will seek other patients. I will not rule out a patient simply because they live in a bad area, but I will not put my own safety at risk unnecessasarily. As I stated before, If I have a patient who has a history of noncompliance with my plan of care, I discharge them from my services.

I did not take the Hypocratic oath. I practice nursing to provide for my family and if I get the chance, to make a small positive difference in a few people's lives. That is why I stuck with it, and when I can no longer do that, I too, will leave nursing.

 

[Handy]

For clarification: "Teenager" was used to contrast age. Read that as "19 year old adult".


And if you think you have the right to deny medical attention based on non-medical criteria (like race or religion), then we have nothing to talk about.

 

[XavierBreath]

And if you think you have the right to deny medical attention based on non-medical criteria (like race or religion), then we have nothing to talk about.

This is not my belief, but my State Board of Nursing's belief. Contact your own State Board of Nursing for your particular location. As I said, I do not deny nursing services (a physician provides medical attention) based on those criteria. They are criteria that must be considered in a therapeutic relationship between patient and practioner.

Let me clarify, because I do not want to be misunderstood or have my words twisted here.........If I have a black patient who is hostile towards me because I am a white man entering their home (a not uncommon occurance in Louisiana) I try not to let any decision about the care I give or whether I give care at all be influenced by thier hostility towards me as a white man. My state board has ruled that racial hostility from a patient is enough to give the practicioner cause to terminate the relationship. I try to go beyond that and help if I can. I may terminate the relationship because I am unable to help due to racial hostility, but not because of racial hostility. As a result, I often end up as friends with those who initially found my presence in thier homes abborent. If I have to terminate the relationship for these reasons, I try to get a black nurse in the home to take my place. It's thier home, and I do not have a right to force my presence on them, nor do I have to tolerate the hostility towards me. I will tolerate it if I believe I can work through it however.

I find it odd that you would choose to terminate conversation on moral/racial grounds, yet would want a nurse or a physician to practice on a patient that they had one of these issues with. Is it not better for the issue to be recognized and another practioner provided? Or is it better to have a nurse practice on a patient when they hold racist views against them? In a perfect world, there would be no racism. No health care providers would be racists in a perfect world. Our world is not perfect. Some doctors and nurses are racists. Some patients are racists. A therapeutic relationship is destroyed when racism is present. You cannot get rid of the racism as fast as you can get another practioner into the relationship.

Clear?

For clarification: "Teenager" was used to contrast age. Read that as "19 year old adult".

You may subsitute 19 year old for 15 year old if you like.

 

[shaggy]

I'm with Handy on this.

First off, prescription drugs are not like the Playboy magazines not sold by Walmart. Prescription drugs are heavily regulated and not sold over the counter. If you want Playboys and Walmart doesn't sell them, you can go to any number of retailers and buy one, or you can even buy a subscription directly from Playboy. Some of you talk about a free market, but the market for prescription drugs is NOT a free market. The sources and suppliers of products like Playboy magazines are not statutorily restrited by heavy government regulation as are prescription drugs. The regulations regarding who can buy and sell prescription drugs ultimately change the nature of the marketplace for prescription drugs to one that is not completely free. Additionally the structure of the prescription drug industry is such that it is not a free market. Is no one aware of the number of anti-trust suits and investigations against the pharmaceutical industry lately?

Second, there is the heavy involvement of the health insurance industry in the market for prescription drugs. Most health care coverage has a limited area of coverage. For example,I purchase my health insurance through my Delaware company. I can get prescriptions at most pharmacies in the Delaware/Philadelphia area. However, when I am in NYC there are no pharmacies that would be covered by my insurance due to the distance. To return to Handy's point :

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.​

By the pharmacists decision NOT to sell a certain prescription, he may have significantly increased the cost to obtain certain drugs to the buyer. Not only through the increased cost of finding another pharmacy, but in possibly causing them to lose their insurance coverage for that prescription by travelling too far out of their area.

Incidently, I think a lot of this issue could be easily remedied by the insurance industry and the government without hurting the "free market" or mandating through legislation that any pharmacy change its practices. If insurance companies would decline to deal with pharmacies who would not provide the full range of drugs on a supplier's or distributor's formulary, I think the pharmacies would likely stop this practice. Additionally, if the government also denied Medicare coverage payments to pharmacies who made moral decisions about what drugs to supply, I think the pharmacies would also give up this practice. ie. if Joe's Pharmacy doesn't want to supply contraceptives, he would not be entitled to accept co-payments from any government program such as Medicare or co-payments by private insurance. In neither the case of the government or the insurance companies mandating this would it realy offend the principles of a "free market" any more than has been the case in the marketplace for prescription drugs. A pharmacy could still choose to allow their value judgements to guide what they sell, but they would have to compete without the benefit of accepting co-payments.

 

[Handy]

I find it odd that you would choose to terminate conversation on moral/racial grounds, yet would want a nurse or a physician to practice on a patient that they had one of these issues with.

This contains multiple misunderstandings.

"We have nothing to talk about." I was saying that if we can't agree on anything this fundamental, then there is no way to have a dialogue. That is not "moral grounds".


You also completely misconstrued my race/gender example. The patient is not the "racist", the practitioner is. I'm talking about the Doctor/RN/pharmacist's non-medical attitude toward his patient. You're talking about the reverse.


It works like this:
"I'd like these pills, please," patient.
"I have these pills, but suspect that you might be using them for something I disagree with, though it is not considered illegal or generally immoral. Therefore, I will deny you the pills your doctor instructed you to take," Rx.
"Where might I get these pills, then?" patient.
"Again, do to my narrow beliefs, I can not tell you which of the two other pharmacists within four hours of here can help, but they are also Catholic (or whatever) and I assume they won't help either. But I would be happy to fill that Accutane prescription," Rx.


Which doesn't even get into the pharmacists that are refusing to return the prescription to the patient.


Ultimately, a medical professional that brings his medical baggage to work is ineffective, since they are demonstrating that they cannot make logical MEDICAL decisions. Such people should have chosen another line of work that doesn't pose a constant moral struggle.

 

[dolanp]

A lot of people say "Oh no big deal go to the next pharmacy" but that's not always a possibility. What if you live in some uber-conservative rural area where this is only one pharmacy within reasonable driving distance and the pharmacist thinks he's committing a sin by allowing you to have birth control? The doctor has already examined you and prescribed it, so there is no argument of course for the pharmacist to site health reasons. Just because some nutters think prevention of conception and abortion are the same thing doesn't mean they should be allowed to deny medical services. A hospital, even though a private business in most aspects, cannot deny you entry if you are in need of emergency services.

 

[Number 6]

My course of treatment

is determined by the doctor after examination and consulation with me. Period.

Officious intermeddling by some self-righteous pharmacist is unnecessary, unprofessional and wholly inappropriate.

We are not talking about the pharmacist spotting a conflict in medications; we are talking about a supposed health care professional imposing his/her "morality" on third parties by denying a treatment professional responsibility obligates him/her to provide. Pharmaceuticals are highly regulated, as are those who handle and disseminate them. This is not in the realm of "free market" economics.

If the pill-counters want to preach, they should have gone to divinity school. Get the right meds in the right dose, count out the right number of doses, and give me my prescription.

If I want a sermon, I already have a church. I don't need yours :barf:

 

[bastiat]

A lot of people say "Oh no big deal go to the next pharmacy" but that's not always a possibility. What if you live in some uber-conservative rural area where this is only one pharmacy within reasonable driving distance and the pharmacist thinks he's committing a sin by allowing you to have birth control?

Answer: Drugstore.com.

To follow that line of thought, what if a large pharmacy chain doesn't want to serve rural areas? Do they have a right to decide that on their own? Should the government mandate that every pharmacy with more than X number of stores MUST place a certain number of stores in rural areas?

It's the same thing, just a matter of degrees. People here are trying to make a pharmacy into some quasi-government function where the whims of the majority (or minority) can make business decisions for the owner. Screw the guy taking the risk and investing his money and life in his business. He has to sell what I want, damnit! If he doesn't, I'll get the government and the force of law to get him to do it!

And the parade of nanny staters marches on...

 

[XavierBreath]

I'm glad to see you post Handy. It's a good conversation. I think the crux of the matter is that you see the pharmacist as being bound by some higher authority or law that requires him to perform certain transactions.
I see him as a business man with a license to dispense medications.

I do live in an area where some pharmacists refuse to stock birth control on moral grounds. I have nothing against birth control. So, on the basis of the argument, I agree with you. A little known fact is that many pharmacies only stock medications the physicians in their area prescribe. If you come to Louisiana with some esoteric prescription from Maryland, you had better call ahead. It won't be in stock. This is especially true of the small town pharmacy which operates on a thin margin of profit. No pharmacy, not even a large hospital pharmacy stocks all medications.

So, While you see:

It works like this:
"I'd like these pills, please," patient.
"I have these pills, but suspect that you might be using them for something I disagree with, though it is not considered illegal or generally immoral. Therefore, I will deny you the pills your doctor instructed you to take," Rx.
"Where might I get these pills, then?" patient.
"Again, do to my narrow beliefs, I can not tell you which of the two other pharmacists within four hours of here can help, but they are also Catholic (or whatever) and I assume they won't help either. But I would be happy to fill that Accutane perscription," Rx.

I see:
"I'd like a Whopper" consumer
"I'm sorry sir, we sell pizza." businessman
"If I don't get my Whopper from you, I'll sue and make your life a living 'ell" consumer
"I'm sorry sir, this is a pizza parlor. Would you like some pizza?" businessman
"It's a place to eat and I want my Whopper" consumer
etc etc etc

Anyway, each state has it's own board of pharmacy the same as it has it's own board of nursing and board of medicine. All three entities are self governing and operate in concert, but independently of each other. This is necessary to ensure quality of care remains the focus of their rulings. These boards grant and revoke licenses. If this matter is so troubling, then you should petition your state's board of pharmacy to revoke the pharmacist's license on the grounds you cite.

Of course, you will likely get nowhere, as the pharmacists is likely working within the board's rulings and regulations. Contacting your congressman will have little effect. The boards are set up so that outside influence will not affect the rulings. Your congressman will get nowhere.

There is another option. Become a pharmacist yourself. Dispense whatever you want in accordance with whatever beliefs you hold dear within the bounds of the law. Heck, then you can possibly serve on your state's Board of Pharmacy someday and perhaps get a ruling passed that will make all pharmacists bow to your beliefs. I doubt it though, you would only have one vote, and nobody would let your proposal get past the proposal stage.

What if you live in some uber-conservative rural area where this is only one pharmacy within reasonable driving distance and the pharmacist thinks he's committing a sin by allowing you to have birth control? The doctor has already examined you and prescribed it, so there is no argument of course for the pharmacist to site health reasons. Just because some nutters think prevention of conception and abortion are the same thing doesn't mean they should be allowed to deny medical services.

This is just like my area. I don't think a pharmacist doing this is right, but I will defend his right to sell and not sell what he pleases. There is a difference between refusing service and denying service. Refusal means you yourself do not serve/provide. Denial means you prevent service from being rendered. Refusing to buy, stock, and sell a particular medication is not denial of medical services.

Again, I am not against birth control, but I am for a pharmacist's right to run his business as he wants. Otherwise, expect him to close his doors and go into another endeavor.

 

[dolanp]

Either a pharmacist has a duty to fulfill a prescription unless he is physically unable (out of stock, etc) or not. You can't have it both ways. If you think a pharmacist can deny a woman a morning-after pill then he should be able to deny insulin because he thinks diabetic people are fat lazy people who brought it upon themselves. That is no way to run a business in the medical profession.

 

[XavierBreath]

Show me a board ruling from any state that requires a pharmacist to fill any prescription brought to him.

All this talk of duty, professionalism and such is hogwash. Show me the ruling from a Board of Pharmacy in any state that requires a pharmacist to fill any prescription brought to him.

Anything less is only your opinion of what should be.

FWIW, some pharmacies don't stock insulin.

Again, not deny, refusal to stock and sell.

 

[shaggy]

It's the same thing, just a matter of degrees. People here are trying to make a pharmacy into some quasi-government function where the whims of the majority (or minority) can make business decisions for the owner. Screw the guy taking the risk and investing his money and life in his business. He has to sell what I want, damnit! If he doesn't, I'll get the government and the force of law to get him to do it!

Which is all well and good IF the pharmacy is not a business that benefits from government regulation and public monies, but pharmacies DO benefit from the regulations and they DO accept public funds and taxpayer dollars from the federal and state governments. As such I don't think its out of the question for the government to step in and demand they carry such reasonable and widely used drugs as contraceptives. To my knowledge, most are now available as generics.

On the other hand, I think contraceptive medications should be available over the counter without a prescription. If that was the case, it would make far less difference if Joe's pharmacy didn't carry it; you could simply go to Walmart and pick it up off the shelf like a bottle of Advil.

 

[XavierBreath]

they DO accept public funds and taxpayer dollars from the federal and state governments.

You mean to tell me the small town pharmacist who owns and runs his own shop is on the public dole?

I had no clue.

 

[jefnvk]

A pharmacist is a GOVERNMENT licensed professional. While not exactly the same as a cop, they are still considered important enough to the proper working of our society that their credentials are of public interest. The US does not use state run health care, but instead relies on state REGULATED health care in an attempt to insure a minimum standard.

Guess what? Hair cutters are government licensed professionals. Should a barber be able to refuse to cut the word SEX into my hair because he feels it isn't moral?

Even better, FFL holders are government licensed professionals, dealing in a restricted good. Should they be able to not sell me an AR because of their beliefs, even thought it is legal for me to own one? Hell yes. Can I choose to go to another store who will take my business? Hell yes.

Restaurant owners are licensed professionals. Should a Jewish or Muslim owner be forced to serve me bacon and ham, with alcohol?

Someone may think it immoral to let black people take up seats on a bus. Are you guys arguing that situation should be equally acceptable?

If the bus is privately owned, they are free to do as they wish. I am also free to choose not to use them.

I think the problem is here that there are two different ways of looking at pharmacies.

The first, the one that I am in, is seeing pharmacies as a business. No different than a gun store or book store. They are free to stock what they want, and sell what they want. Their right to sell trumps the patient's right to get what they want.

The second sees pharmacies as something required. That the owner should have no say in what is sold or stocked, because of their beliefs. They are required to sel what the government says is safe for people to use, nothing more, nothing less. The patient's rights to get what tehy want trump their right to do business as they please.

If you think a pharmacist can deny a woman a morning-after pill then he should be able to deny insulin because he thinks diabetic people are fat lazy people who brought it upon themselves. That is no way to run a business in the medical profession.

I am a diabetic. Not the fat, lazy type, the my pancreas decided to shut off on its own type. I hold the opinion that no one should be forced to sell me insulin. I would die within weeks, if not days, if not for insulin, but I don't think that the government should step in and force them to sell to me. I will go to another pharmacy to get what I need. See, in a capitalistic society, someone will be there to cater to you, if you have the money.

 

[Handy]

Xavier,

Your examples avoid a particular issue. It is NOT a question of what is being dispensed, but WHOM dispensed to.

I gave you the example of having hormones, but only dispensing them to older women, instead of any woman. You keep bringing it back to choosing not to sell a product, missing that critical difference.


It's an issue of discrimination. The pharmacist is choosing WHOM to serve based on his suspicians of their motivations. Same notion as "I don't sell guns to Blacks - they'll just rob a liquor store." "We don't sell pizza to fat people."


Please address this point in your comments.

 

[shaggy]

You mean to tell me the small town pharmacist who owns and runs his own shop is on the public dole?

I had no clue.

Does Medicare ring a bell?

They do benefit from public monies and taxpayer dollars. If they didn't accept Medicare or insurance co-pays, they would have to compete in a real "free-market" which many here are yelping about.

 

[XavierBreath]

I'm sorry Handy, it seems the conversation is going both ways, and I neglected your direction.

In regards to WHOM, how many times have you seen the sign "No Shirt, No Shoes, No Service"?

Again, the owner can choose who he sells to. A bar owner can refuse to sell liquor to a drunk, eventhough the drunk can legally buy it.

Can you address my issue I brought up before now? I'll quote it for you here.

As a storeowner, I can choose not only what I sell, but whether I want to sell to those without a shirt or shoes. As a pharmacist, I can also choose to discriminate on merchandise or customers. Sure, some forms of discrimination are not acceptable, and others are illegal. Choosing not to sell birth control to minors is neither. In fact, it could become a liability when a 15 year old girl contracts HIV through unprotected sex. If a barowner can be held accountable for a drunk driver killing an innocent person, then cannot a pharmacist be held accountable for a teen contracting HIV?

If they didn't accept Medicare or insurance co-pays, they would have to compete in a real "free-market" which many here are yelping about.

Many small town pharmacies require cash. Same as many physicians.

 

[Handy]

Sure. All of your examples involve BEHAVIOR. My examples involve people who meet all basic requirements for service.


Not serving someone because their behavior is either disruptive to your business or a liability is a fine idea.

Not serving someone because of their vital statistics (gender, age, race, weight) is what we call discrimination in the US.



In many of the incidents involved, the pharmacist had no information as to why the prescription was called for. He made an assumption, which conflicted with his non-medical moral system and denied service.


It comes down to this: Does ANY US business have the right to discriminate between one KIND of person or another? Substantially, the legal answer has been "No" for the last forty years. Your race, age, beliefs or whatever is NOT a legal criteria for denial of service. If a black man can sue McDonalds for denial of Big Mac, how is someone that provides medical services off the hook?

 

[shaggy]

Many small town pharmacies require cash. Same as many physicians.

They may require the patient make their co-pay in cash, but they still accept the government funds for the remainder of the payment. The vast majority, however, are more than happy to accept Uncle Sam's money...taxpayer money...OUR money. And they seem to be quite happy with government involvement when it limits the field of possible competition, or when it comes in the form of a check. But its somehow different when it comes in the form of a mandate to act like a professional and provide certain drugs without regard to their own personal judgements and beliefs?