Y'all are familiar with the various instances of pharmacists refusing to fill patients' prescriptions of the morning after pill
and birth control pills
, right? Some pharmacists even went as far as to refuse to transfer the prescription
A while back, on the Heated Debate tribe in Tribe.net, we debated this issue. Was a pharmacist obligated to provide a prescribed medication to a person, even if it ran counter to their moral beliefs?
A relatively large number of people thought it was no big deal, and that the pharmacist shouldn't have to fill the scrip. This appalled me on several levels, and I couldn't help but think that people's laissez-faire attitude towards this was largely informed by the type of medication being dispensed. Hey, it's just birth control pills, right? Just a buncha harlots wanting to fuck without paying the consequences.
To which I say: well, yeah, and that's the harlot's business, and none of the pharmacist's. But that's ignoring all the other conditions for which the birth control pill is prescribed. I was on BC for many years because of oligomenorrhea, for example--I wouldn't get my period for a year or two, and then when it arrived, I'd bleed for a month, sometimes two. Not fun. A friend of mine was prescribed the pill because it helped with her debilitating menstrual cramps, and missing a dose made her ill, so getting her prescription filled on time was definitely an issue.
But aside from that, allowing conscientious objection presented real problems to people in small towns with only one pharmacy. If the one pharmacy refused to fill the scrip, people would sometimes be forced to travel long distances to get it filled, and sometimes, health conditions, work schedules and/or lack of funds made this sort of travel impractical, so the prescription would be filled late, if at all.
In short, allowing pharmacists to refuse to fill prescriptions was basically taking the personal health decisions out of the patients' (and the doctors') hands and putting them more-or-less squarely in the pharmacist's. And hell, most of the time, we're not even necessarily talking about health--we're talking moral
objections, here. By giving the pharmacists the freedom to choose which medications to dispense and which ones not to, the patient's ability to make healthcare decisions are infringed upon.
(I also personally think that any pharmacists stupid enough to seriously believe that birth control and Plan B are abortifacients deserve to have their licenses yanked, because goddamn, what kind of crappy biology and biochemistry classes did they take?)
I also think this policy sets incredibly bad precedent. What if it weren't birth control at stake? Let's say there's a health nut pharmacist, and one day an overweight guy walks up to the counter to fill a prescription for, say, cholestrol-lowering medication. The pharmacist could, conceivably, offer a moral objection to this: clearly, if this man exercised more and ate a reasonable quantity of healthy food, he wouldn't need these medications. That he would have such an easy out was repugnant to the pharmacist; if he wanted to eat his own weight in Twinkies, then by God he should have to pay the consequences. No Lipitor for you, one year!
My example was pshawed as an example of slippery slope reasoning.
Then today, I read about a pharmacist who refused to fill somebody's post-surgery Vicodin prescription
, subtituting it instead with a medication containing codeine which, surprise surprise, the patient was allergic to. Luckily, the patient spotted the codeine and sent it back with an explanation, but the pharmacy still refused to dispense the Vicodin until they heard from her doctor and confirmed her codeine allergy. Unfortunately, by the time the whole rigamarole was played out, the doctor's office was closed, and the woman had to make do with aspirin the whole night.
I don't think my slope was all that slippery after all.
Abel Pharmboy, a pharmacy professor with a PhD in pharmacology has more words on this issue
, all of them worth reading. I think he has it right: because of their unique position, pharmacists need to put the welfare of the patients ahead of their own values system. If the prescription is valid, they need to fill it. Otherwise, you get a system in which a pharmacist can conceivably refuse to fill prescriptions because they don't believe in opioid usage, or because they think birth control pills cause abortions, or because overweight people with high cholesterol offend their health nut sensibilities. Allowing some pharmacists to stand in judgement of somebody's healthcare choices is an incredibly bad idea--especially when some of them don't display signs of ominiscience so much as nulliscience.