Monday, March 28, 2005

FROM TODAY'S WASHINGTON POST, an article about the growing number of pharmacists refusing to fill prescriptions for emergency contraception or birth control pills. Yes, even birth control pills. An increasing number of pharmacists across the country are turning away teenagers and unmarried women with birth control prescriptions; some will not fill any birth control prescriptions for any woman. Even worse, some of these pharmacists attempt to prevent women from filling their doctors' prescriptions anywhere; they will not give the prescription back to the woman, and they will not refer the woman to another pharmacy.

People who support the right of pharmacists to keep prescriptions in their possession and to refuse to refer women elsewhere say that, since birth control and emergency contraception are murder, allowing someone else to fill the prescription or giving it back to the woman would be tantamount to helping that other pharmacist commit the murder.

"That's like saying, 'I don't kill people myself but let me tell you about the guy down the street who does.' What's that saying? 'I will not off your husband, but I know a buddy who will?' It's the same thing," said Brauer [Karen Brauer, who was fired from a pharmacy in Ohio for refusing to fill birth control prescriptions].

By Brauer's logic, it would be necessary for me, as someone who opposes war and believes war is murder, to block the entrances to recruiting centers and to do everything in my power to prevent men and women from going into the military. It wouldn't be enough to work for peace and try to win others over to my viewpoints by the influence of my example. I would have to actively bar others from doing what I believe is murder, or have to consider myself a murderer as well.

This is more than troubling; it's downright scary. These are the voices of the Taliban and mullahs speaking to us in Western dress. Primitive and narrowly religious ways of viewing women and treating women are making a comeback. When the rights of a pharmacist or a doctor to refuse medical treatment or deny access to needed medications are considered essential; and the rights of women, or anyone, to get medical products or services is considered secondary or of no importance at all, then how long is it before women are considered to be made by God exclusively for childbearing and pleasing their husbands? How long before women start to be pressured to wear clothes that cover their entire bodies? How long before women who go outside in pants or dresses that show arms and legs are hissed, stared at, called names, stoned?

Since when has it become a "right" for a pharmacist to refuse to fill a legal prescription from a licensed physician? Not to mention that refusing to fill a birth control prescription and denying the woman any other means of getting it filled is a violation of the Pharmacists Code of Ethics, which says, in part:

II. A pharmacist promotes the good of every patient in a caring, compassionate, and confidential manner.

A pharmacist places concern for the well-being of the patient at the center of professional practice. In doing so, a pharmacist considers needs stated by the patient as well as those defined by health science. A pharmacist is dedicated to protecting the dignity of the patient. With a caring attitude and a compassionate spirit, a pharmacist focuses on serving the patient in a private and confidential manner.

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.

If pharmacists are now to be given the legal right to pick and choose which prescriptions they will fill, we are taking a giant step on the slippery slope to imposing personal beliefs on patients in any number of other ways. How about pharmacists refusing to fill Zoloft or Paxil prescriptions for teenage patients, because they don't believe in prescribing antidepressants to teenagers? Or how about pharmacists refusing to fill any psychotropic medications at all, because they find such medications morally objectionable? Some pharmacists might find prescriptions for steroids offensive, even if they are being prescribed for medical reasons unrelated to pumping up. Maybe the next "morally objectionable" pharmacy item will be condoms, or prescriptions for i.u.d.'s or diaphragms. Perhaps doctors will begin to refuse to perform tubal ligations because they "stop human life." I'm sure many of us could come up with any number of other possibilities for medications that might be "morally objectionable" or "offensive" to some pharmacists or doctors.

The American Pharmacists Association's policy on all this is to permit pharmacists to turn down prescriptions they find offensive to their beliefs, as long as they give the patient another way to get the prescription filled. If that is going to work, though, pharmacists cannot refuse to refer the patient to another pharmacy. In fact, as far as I am concerned, it is completely unacceptable for a patient to be referred to another pharmacy at all. As the Post article points out, asking a woman to go to a different pharmacy is a major hardship when every moment counts, as it does with emergency contraception. It's also humiliating and intimidating to be told to go somewhere else because the pharmacist thinks your prescription is immoral. Plus, in many parts of the country, going to another pharmacy isn't even a realistic option: There isn't any other pharmacy anywhere near.

The only way such a policy could work would be for every pharmacy to have several other pharmacists on staff at any given time, so that if a prescription were handed to a pharmacist who didn't want to fill it, he could just hand it to one of the other pharmacists.

Even better than that would be if would-be pharmacists or doctors who have personal objections to specific medications or medical procedures simply choose some other line of work. If you think birth control, or antidepressants for teenagers, or steroids, or condoms are immoral, then don't become a pharmacist.

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