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i've been working on this problem for about 15 years.
in 1991, a pharmacist named michael katsonis, who was employed by the university of florida’s student health center pharmacy, refused to dispense the morning after pill, citing his religious beliefs. after much protest, he was asked to resign.*
the apha [american pharmaceutical association] is the largest pharmacy association in the us, and has some position papers or policies that address this directly. here’s an excerpt from the code of ethics on the apha website [italics and bold mine]:
I.A pharmacist respects the covenantal relationship between the patient and pharmacist.
Considering the patient-pharmacist relationship as a covenant means that a pharmacist has moral obligations in response to the gift of trust received from society. In return for this gift, a pharmacist promises to help individuals achieve optimum benefit from their medications, to be committed to their welfare, and to maintain their trust.
III.A pharmacist respects the autonomy and dignity of each patient.
A pharmacist promotes the right of self-determination and recognizes individual self-worth by encouraging patients to participate in decisions about their health. A pharmacist communicates with patients in terms that are understandable. In all cases, a pharmacist respects personal and cultural differences among patients.
VI.A pharmacist respects the values and abilities of colleagues and other health professionals.
When appropriate, a pharmacist asks for the consultation of colleagues or other health professionals or refers the patient. A pharmacist acknowledges that colleagues and other health professionals may differ in the beliefs and values they apply to the care of the patient.
i am unclear as to how the actions of these pharmacists are respecting the covenental relationship, the autonomy and dignity of the patient, and/or acknowledging the differing values and beliefs of their colleagues.
another policy statement excerpt:
The American Pharmacists Association’s (APhA) two-part policy statement supports the ability of the pharmacist to step away from participating in activity to which they have personal objections—but not step in the way.
and:
Similar to the situation where a medication is simply out of stock on any given day, if the pharmacist is unable to dispense the prescription, then the patient must be made aware of the options available to them to fulfill his or her medication needs. The pharmacist should not use their position of power to berate the patient, to share their own personal beliefs, or obstruct patient access to therapy—such as refusing to return a patient’s legally valid, clinically appropriate prescription. In most states this activity is prohibited by law.
it seems pretty clear to me that pharmacists who refuse to fill or return women’s rx’s are not using the conscience clause in the manner intended. my husband works as a pharmacist for walgreens. he has refused to fill rx's because a child was prescribed an adult dose, or the rx is for a drug the patient is allergic to, or the patient is taking another drug that will potentiate harmful side effects. however, in all of these cases, he has called the prescriber, explained the problem, and gotten a substitution.
a pharmacist who refuses to fill a morning after pill rx is not trying to prevent harm such as a dangerous side effect, allergic reaction, or overdose. he is attempting to prevent the patient from receiving the therapeutic benefit of the medication, when it has already been determined by her health care provider that she is in need of this therapy. this is akin to a patient with a cold coming in with an rx for an antibiotic and having the pharmacist say, 'you don't need this, most colds are caused by viruses, i'm morally opposed to contributing to antibiotic resistance, so i'm not going to fill it and i'm going to keep the prescription.'
the interference with non-contraceptive medications started arouind 2000-2002 with drugs like accutane. it is prescribed for acne and will definitely cause severe birth defects. congressional representatives have been demanding a national registry of women prescribed accutane and a protocol requiring a blood pregnancy test every month, with results reported directly to the pharmacist, who will then determine whether or not to dispense the drug. of course, if the test is positive, it will provide the pharmacist with an opportunity to harrass the woman about her pregnancy. also, when accutane is prescribed, birth control is prescribed along with it. a pharmacist who refused to fill a birth control rx for a patient on accutane who gets pregnant as a result and has a baby with severe birth defects might find himself slapped with a big ol' lawsuit. many psych & pain meds also cause birth defects, and have birth control prescribed with them. incidentally, even though accutane is also linked to suicidal ideation/suicide, no one seems to care about protecting the guys by having them register.
*however, the student health center continued its demeaning and unnecessary policy of requiring women who requested the morning-after pill to sign a statement promising to immediately start using a reliable form of birth control and answer questions such as where the sex occurred, how she’d met her partner, what his name was, and how long she’d known him. male students treated for sexually transmitted diseases have never been asked to sign a statement promising to immediately start using condoms, or answer any of the other questions. this, too, was protested and in 1998 infirmary director michael huey responded by revising the consent and intake forms, and removing the requirement that women promise to immediately start using reliable birth control. |
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