Declining Abortion Meds soon to be a reality?

[PharmNerdMatt]

law =/= ethics =/= morals

ethics, in this sense, refers to a set of principles that govern the practices of a group. pharmacists are health care providers; their professional duty is to provide patients with medications that are safe and effective. birth control pills, EC, etc -- these are therapies that, whatever one's moral objections, are evidence-based and part of appropriate care. i think therefore that it is unethical to refuse to dispense birth control or emergency contraception. as a counter-example, i refuse to sell cigarettes at my pharmacy counter, because i feel it would be unethical for me, as a health-care provider, to do so. the evidence that cigarettes are harmful is ver clear.

all of this, of course refers to ethics, not law. in most places, pharmacists may be free to refuse to dispense these kinds of things. this would be legal, though i would argue it would be unethical

the access issue can be a real thing. i float in rural vermont. once i worked at a store with a sign in front of the pharmacy counter that said "needles will be dispensed only with a prescription" or something along those lines(selling needles OTC is legal in vermont). the only other pharmacy anywhere close, right across the street, had the same policy; in effect the pharmacists in town had colluded to prevent IVDUs access to clean needles. (i disregarded the policy when i covered that store)

Here is the rub. You have defined an area in Vermont as "critical access" in regards to pharmacies. After looking at the map of pharmacies in vermont, I would say that there isn't an area there that qualifies as "critical access" in regards to this subject. Are you saying that you worked at a pharmacy that was more than 2 hours away from the next pharmacy?

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[Vain Brother]

i don't believe i said anything of the sort, but i'm bored, so i'll play along: what's your point?

 

[SClENCE]

if the drive is too far they can always get mail order. ends this stupid arguement

 

[dpmd]

if the drive is too far they can always get mail order. ends this stupid arguement

Getting time sensitive meds mail order sounds like an excellent plan

 

[SClENCE]

I was referring to contraceptives. If the pharmacist is against plan b just make the tech ring them out... I don't even see how this can be an issue unless the pharmacist wants to make it an issue.

Now birth control is a bit of a different story, and in my opinion you cannot force someone to do something against their religious beliefs. People argue that "the pharmacist is imposing his/her beliefs on the patient". Well what about the pharmacist? You are imposing your beliefs on him/her as well by forcing him to fill it.

If there is a pharmacy across the street it is okay to refuse it, but if the next closest pharmacy is 4 hours away suddenly the beliefs of the pharmacist are irrelevant? This is stupid. If the patient wants it they should have to go get it elsewhere... I don't see how the pharmacist is obligated to get it filled considering the patient's health is not at all at risk.

Me personally? I couldn't give a damn less what other people do with their life. I'll keep my employer happy and fill them.

 

[Vain Brother]

I was referring to contraceptives. If the pharmacist is against plan b just make the tech ring them out... I don't even see how this can be an issue unless the pharmacist wants to make it an issue.

Now birth control is a bit of a different story, and in my opinion you cannot force someone to do something against their religious beliefs. People argue that "the pharmacist is imposing his/her beliefs on the patient". Well what about the pharmacist? You are imposing your beliefs on him/her as well by forcing him to fill it.

If there is a pharmacy across the street it is okay to refuse it, but if the next closest pharmacy is 4 hours away suddenly the beliefs of the pharmacist are irrelevant? This is stupid. If the patient wants it they should have to go get it elsewhere... I don't see how the pharmacist is obligated to get it filled considering the patient's health is not at all at risk.

Me personally? I couldn't give a damn less what other people do with their life. I'll keep my employer happy and fill them.

contraceptives serve a legitimate medical purpose, so it's unethical for a pharmacist to refuse to dispense them. full stop. the pharmacist would in many cases be protected by law, but this has nothing to do with the ethical question

 

[touchpause13]

I'm confused on why someone morally opposed to bc would want to be a pharmacist. It's gotta be one of the most common drugs out there.

 

[dpmd]

Not to mention some people take oral contraceptives for reasons completely unrelated to contraception and may not even be having sex. If someone has a moral opposition to contraception they should just tell themselves all their patients are doing it for those other reasons so they don't feel bad (because the reason they are taking them isn't really any of their business so for all they know it might be true)

 

[Vain Brother]

if you've got an afternoon to kill, there's some good reading you can do on the law and ethics of this sort of thing


http://caselaw.findlaw.com/us-9th-circuit/1399273.html

here's the 9th circuit of appeals on the legitimacy of a law in WA that prohibited pharmacists from refusing to sell plan B. much of the text focuses on background, questions of legal standing, and precedents, but the pertinent point is that "the right to freely exercise one's religion, however, “does not relieve an individual of the obligation to comply with a ‘valid and neutral law of general applicability on the ground that the law proscribes (or prescribes) conduct that his religion prescribes (or proscribes)." in other words, as long as the law does not specifically target a particular religious group, a citizen is not exempt from complying with a law that his religion happens to forbid.

http://www.ncbi.nlm.nih.gov/pubmed/21797914

this is behind a paywall, so i'll have to read it when i get home, but this was one of the first search results on pubmed for "pharmacy ethics contraception". you can see where it's going by reading the abstract

edit: some more paywalled papers i've found that look interesting based on the abstracts

http://www.ncbi.nlm.nih.gov/pubmed/17077256 , http://www.ncbi.nlm.nih.gov/pubmed/16648422 , http://www.ncbi.nlm.nih.gov/pubmed/17940123 , http://www.ncbi.nlm.nih.gov/pubmed/17091559

 

[owlegrad]

(because the reason they are taking them isn't really any of their business so for all they know it might be true)

Right, why would a pharmacist need to know why a patient is taking a particular medication?

 

[dpmd]

Right, why would a pharmacist need to know why a patient is taking a particular medication?

How would the pharmacy management change if a patient is taking oral contraceptives for dysmenorrhea versus contraception? I have had many different prescriptions filled in my lifetime and none have ever listed why i was getting them including a few meds i was taking for a reason unrelated to the usual reason for use. I suppose if it matters to how you will counsel them to use it then it would be appropriate to ask, i just don't see how the above distinction would change that. So yeah, if you only want to know because you will fill for one reason but not the other i maintain that it is none of your business.

 

[BenJammin]

I'm confused on why someone morally opposed to bc would want to be a pharmacist. It's gotta be one of the most common drugs out there.

The same could be said to the medical community. I'm confused on why someone morally opposed to abortion would want to be a doctor.

 

[touchpause13]

The same could be said to the medical community. I'm confused on why someone morally opposed to abortion would want to be a doctor.

How?
The vast majority of physicians never perform an abortion. The vast majority of pharmacists refill birth control.

 

[BenJammin]

How?
The vast majority of physicians never perform an abortion. The vast majority of pharmacists refill birth control.

Outside of the days I help out at the outpatient clinic, I never have to deal with birth control. What's your point? A pharmacist isn't allowed to refuse to dispense birth control but a physician can be morally opposed to abortion? Pick a side.

 

[SClENCE]

How would the pharmacy management change if a patient is taking oral contraceptives for dysmenorrhea versus contraception? I have had many different prescriptions filled in my lifetime and none have ever listed why i was getting them including a few meds i was taking for a reason unrelated to the usual reason for use. I suppose if it matters to how you will counsel them to use it then it would be appropriate to ask, i just don't see how the above distinction would change that. So yeah, if you only want to know because you will fill for one reason but not the other i maintain that it is none of your business.

Dysmenorrhea is a medical condition in which it is in the best interest of the patient to treat. In cases where it is used for contraception, the patient is in a healthy state. Being as the pharmacist is invested in the health of the patient, and being as the patient is healthy, I see no obligation to fill.

A birth control used for contraception is legitimate in terms of medical purpose while at the same time not at all relevant to the health of the patient.

Just like a boob job, it is a legitimate medical procedure that in no way benefits the patient in terms of health.

 

[touchpause13]

Outside of the days I help out at the outpatient clinic, I never have to deal with birth control. What's your point? A pharmacist isn't allowed to refuse to dispense birth control but a physician can be morally opposed to abortion? Pick a side.

I can see the logic behind if you actually think abortion is murder why you would be opposed to it. Birth control isn't like that. And to address SCIENCE - contraception does have legitimate medical purpose. There is a reason why women's life span has increased so drastically over the course of the past century, and it's not just abx. Being able to space out pregnancies is fundamental to women's health. Limiting the number of pregnancies is fundamental to women's health.

 

[SClENCE]

I can see the logic behind if you actually think abortion is murder why you would be opposed to it. Birth control isn't like that. And to address SCIENCE - contraception does have legitimate medical purpose. There is a reason why women's life span has increased so drastically over the course of the past century, and it's not just abx. Being able to space out pregnancies is fundamental to women's health. Limiting the number of pregnancies is fundamental to women's health.

Fundamental? Are you kidding? Show me one legitimate peer reviewed study that even indicates this.

Not to mention that there is an even better way to limit pregnancy, it's actually 100% effective.

 

[touchpause13]

Fundamental? Are you kidding? Show me one legitimate peer reviewed study that even indicates this.

Not to mention that there is an even better way to limit pregnancy, it's actually 100% effective.

I like realistic solutions because I don't actually live in fantasy land. View must be nice from where you are sitting though.

Sorry I can't seem to find the full article for this, but I got the abstract - http://www.bmj.com/content/340/bmj.c927.abstract

 

[dpmd]

Dysmenorrhea is a medical condition in which it is in the best interest of the patient to treat. In cases where it is used for contraception, the patient is in a healthy state. Being as the pharmacist is invested in the health of the patient, and being as the patient is healthy, I see no obligation to fill.

A birth control used for contraception is legitimate in terms of medical purpose while at the same time not at all relevant to the health of the patient.

Just like a boob job, it is a legitimate medical procedure that in no way benefits the patient in terms of health.

Explain why you think you have a right to know which purpose the patient is using it for so that you can then apply your personal morals to the transaction.

 

[SClENCE]

I like realistic solutions because I don't actually live in fantasy land. View must be nice from where you are sitting though.

Sorry I can't seem to find the full article for this, but I got the abstract - http://www.bmj.com/content/340/bmj.c927.abstract

http://www.bmj.com/content/318/7176/96

This is the same study. Look at table 3. The more recently you have taken oral contraceptives the higher the mortality rate.

 

[touchpause13]

This study is a complete joke.

Cool story bro, tell it again.

Women having control over our fertility has been crucial for our health and for our lives.

 

[deleted480308]

Cool story bro, tell it again.

Women having control over our fertility has been crucial for our health and for our lives.

Despite my belief that no one should be able to force a provider to sell a product (shy of their employer) I think it's pretty clear that birth control has been pretty helpful to the health of women over history

 

[SClENCE]

I have edited my post.

 

[SClENCE]

Explain why you think you have a right to know which purpose the patient is using it for so that you can then apply your personal morals to the transaction.

It is just beyond me how someone can be forced by law to sell something that they are religiously opposed to when it is not relevant to the patient's health. I personally am not opposed to it, but it's scary that women's apparent right to have unlimited sex (smoothly worded by feminists as a women's right to control her body) have essentially trumped the religious rights of healthcare professionals.

But your right, it is better for the patient and doctor that the pharmacist has no information on the medical condition of the patient and is in the dark when it comes to what their medications are being used for. This is most certainly how pharmacists will be able to contribute to the health of the patient in the most optimal way.

 

[touchpause13]

http://www.bmj.com/content/318/7176/96

This is the same study. Look at table 3. The more recently you have taken oral contraceptives the higher the mortality rate.

Over a lifetime the rewards outweigh the risks. Also everything else I have mentioned - just think for a moment what it was like pre-1960. No access to birth control pill and very likely no access to abortion, these things do not yield well for maternal or fetal health. You should know the adverse effects of women having becoming pregnant multiple times within a short period of time.

Despite my belief that no one should be able to force a provider to sell a product (shy of their employer) I think it's pretty clear that birth control has been pretty helpful to the health of women over history

Honestly, I thought this was just common knowledge.

 

[SClENCE]

At the end of the day, though, I don't give a crap. None of these situations effect me because I have no religious objections. I just don't believe that it's a human right to have birth control, nor do I believe that birth control increases lifespan when there is no evidence that suggests this

You are basically suggesting that since some study in the UK suggests that birth control might make patients live longer, the pharmacist has an obligation to fill all birth controls because the patient will live longer. This is absurd. Not to mention that this article doesn't even suggest that pregnancy lowers lifespan and it also states that oral contraceptives increase the risk of certain cancers.

 

[SClENCE]

Boob jobs and oral contraceptives are both medically legitimate, but neither effect the health of the patient. As the pharmacist is invested in the health of the patient, and neither effect the health of the patient, I see no obligation to fill birth control in cases where it is used to prevent pregnancy.

The only way you could possibly beat this argument is by saying that birth control, even when used for contraception, has health benefits. And you actually tried to!!! Lol

"Hmm... okay ma'm, I'm religiously opposed to birth control for contraception, but since a study in the UK suggests that oral contraceptives possibly increase lifespan I guess this is completly justified."

LOL

 

[dpmd]

But your right, it is better for the patient and doctor that the pharmacist has no information on the medical condition of the patient and is in the dark when it comes to what their medications are being used for. This is most certainly how pharmacists will be able to contribute to the health of the patient in the most optimal way.

If it comes down to filling the script or not because of that extra information and the patient isn't harmed by the pharmacist not knowing, then yes it absolutely is the most optimal way for the pharmacist to contribute.

 

[SClENCE]

If it comes down to filling the script or not because of that extra information and the patient isn't harmed by the pharmacist not knowing, then yes it absolutely is the most optimal way for the pharmacist to contribute.

Does the pharmacist the the right to know if he is contributing to something that is against his/her religion?

 

[dpmd]

Boob jobs and oral contraceptives are both medically legitimate, but neither effect the health of the patient. As the pharmacist is invested in the health of the patient, and neither effect the health of the patient, I see no obligation to fill birth control in cases where it is used to prevent pregnancy.

So would you also see no obligation to fill a sedative presciption for a someone getting a boob job if you are morally opposed to cosmetic surgery? Just wondering how consistently you are willing to apply this theory that the pharmacist can determine whether something affects the health of the patient and if they think it doesn't they can go ahead and refuse to fill. And are you advocating that those with a moral opposition to contraception grill the patient as to their intentions prior to deciding whether to fill it or just assume they are all ****** and refuse to fill(based on your desription above I would guess this would be an adjective you would use) unless they offer up an alternate reason for it.

 

[dpmd]

Does the pharmacist the the right to know if he is contributing to something that is against his/her religion?

I don't see why. Most religions that tell you to not do certain things aren't going to ding you as long as you were trying to follow the rules. So there is no ill effect to the pharmacist if the unknowingly allow access to contraception. Just like no one is going to fault a pharmacist filling a viagra prescription that is then used to commit adultery or sodomy.

 

[SClENCE]

So would you also see no obligation to fill a sedative presciption for a someone getting a boob job if you are morally opposed to cosmetic surgery? Just wondering how consistently you are willing to apply this theory that the pharmacist can determine whether something affects the health of the patient and if they think it doesn't they can go ahead and refuse to fill. And are you advocating that those with a moral opposition to contraception grill the patient as to their intentions prior to deciding whether to fill it or just assume they are all ****** and refuse to fill(based on your desription above I would guess this would be an adjective you would use) unless they offer up an alternate reason for it.

I have no obligation to fill a sedative for someone getting cosmetic surgery even if im NOT opposed to it on religious grounds. Just like the insurance company has no obligation to pay for it. Why? Because the procedure has nothing to do with the health or well-being of the patient... and in my opinion the health of the patient is the only thing that I am invested in. That being said, there really isn't a good reason not to fill it where with the oral contraceptive there are potential religious reasons.

Like I already stated, I personally would fill all and any of these things. I am just trying to fight for the rights of the pharmacist as opposed to the right of a women to "control her body", as I truly don't see how a pharmacist is obligated by law to fill these medications if his/her investment is solely in the health and well-being of the patient.

 

[Vain Brother]

Dysmenorrhea is a medical condition in which it is in the best interest of the patient to treat. In cases where it is used for contraception, the patient is in a healthy state. Being as the pharmacist is invested in the health of the patient, and being as the patient is healthy, I see no obligation to fill.

A birth control used for contraception is legitimate in terms of medical purpose while at the same time not at all relevant to the health of the patient.

Just like a boob job, it is a legitimate medical procedure that in no way benefits the patient in terms of health.

this is an astoundingly facile analogy. one could argue that a patient who comes in with a statin prescription is likewise healthy and has no immediate health threats. can i ethically refuse to fill this? you're a pharmacy student, and not an especially bright one. maybe sit this discussion out

 

[SClENCE]

this is an astoundingly facile analogy. one could argue that a patient who comes in with a statin prescription is likewise healthy and has no immediate health threats. can i ethically refuse to fill this? you're a pharmacy student, and not an especially bright one. maybe sit this discussion out

Are you kidding me? A statin clearly impacts the health of the patient. Birth control does not when used for contraception. And you are calling me dumb

 

[Vain Brother]

a pharmacist may refuse, on moral principle, to dispense any prescription that comes across his counter. more power to him. no one disputes this. when this interferes with a legitimate medical therapy, that pharmacist is imposing his beliefs on the patient and cannot rest assured that he is ethically justified in doing so. furthermore, as the court case i posted today made clear, there is no 1st amendment right to refuse to fill a prescription on moral grounds

 

[SClENCE]

a pharmacist may refuse, on moral principle, to dispense any prescription that comes across his counter. more power to him. no one disputes this. when this interferes with a legitimate medical therapy, that pharmacist is imposing his beliefs on the patient and cannot rest assured that he is ethically justified in doing so. furthermore, as the court case i posted today made clear, there is no 1st amendment right to refuse to fill a prescription on moral grounds

This has nothing to do with the 1st amendment. It has to do with state conscience clauses.

 

[Vain Brother]

sure, if a state or any other jurisdiction has passed a law allowing pharmacists to refuse to fill a prescription, then there's no question of the legality in that jurisdiction. there is no such common law right, though. and i'd argue that it's still unethical

 

[SClENCE]

sure, if a state or any other jurisdiction has passed a law allowing pharmacists to refuse to fill a prescription, then there's no question of the legality in that jurisdiction. there is no such common law right, though. and i'd argue that it's still unethical

Why is it unethical? Is the aparent right of a woman to have sex and not get pregnant greater than the religious beliefs of the pharmacist?

 

[Vain Brother]

that's not how i would phrase it, but in short, yes

 

[SClENCE]

that's not how i would phrase it, but in short, yes

In that case all I can say is that I respectfully disagree

 

[touchpause13]

Why is it unethical? Is the aparent right of a woman to have sex and not get pregnant greater than the religious beliefs of the pharmacist?

Yes essentially

 

[dpmd]

Are you kidding me? A statin clearly impacts the health of the patient. Birth control does not when used for contraception. And you are calling me dumb

Might want to check the most recent literature about that statement (especially if we are talking about an otherwise healthy patient) if you are so concerned about only giving meds that affect the health of the patient in ways objectively obvious.

 

[WVUPharm2007]

Why is it unethical? Is the aparent right of a woman to have sex and not get pregnant greater than the religious beliefs of the pharmacist?

Didn't you read that long, drawn out post of mine? A woman's right to reproductive choice and contraception is more important than anything, including the right to live. This has been firmly established by law, as I had proven earlier. And for whatever reason a bunch of people are fine with this. In fact, many think a woman's right to not be slightly inconvenienced while in search of contraception trumps another person's personal ethics.

I mean, I think its bordering insane and solutions much more amicable to all would be possible, but whatever. The mob has spoken. Being able to maneuver in complex gray areas isn't the strong suit of your typical STEM person, anyway. So it doesn't surprise me that the discussion is so bland. You got your typical feminist-brainwashed liberal types. You got the token typical brainwashed libertarian complete with Ron from Parks and Rec as his/her sig. You got your traditional conservative view. Boring and predictable, the lot of you.

Someone PM me when a person with something resembling an independent thought rolls by.

 

[touchpause13]

Bye Felicia

 

[WVUPharm2007]

Bye Felicia

Yo momma so stupid she tried to divide by zero.

 

[SClENCE]

I vote that we kill this thread. Let it die RIP

 

[touchpause13]

Yo momma so stupid she tried to divide by zero.

That's actually one I haven't heard before, will add to my yo momma collection

 

[PharmNerdMatt]

if you've got an afternoon to kill, there's some good reading you can do on the law and ethics of this sort of thing


http://caselaw.findlaw.com/us-9th-circuit/1399273.html

here's the 9th circuit of appeals on the legitimacy of a law in WA that prohibited pharmacists from refusing to sell plan B. much of the text focuses on background, questions of legal standing, and precedents, but the pertinent point is that "the right to freely exercise one's religion, however, “does not relieve an individual of the obligation to comply with a ‘valid and neutral law of general applicability on the ground that the law proscribes (or prescribes) conduct that his religion prescribes (or proscribes)." in other words, as long as the law does not specifically target a particular religious group, a citizen is not exempt from complying with a law that his religion happens to forbid.

Just a comment on this court case. The 9th circuit decision, does not actually state that the Appellees (the pharmacy) do not deserve relief from the law, but only that the districts court reasoning to provide an immediate injunction to the law was not sound. The court did not rule that the pharmacy could not continue to seek relief from the law.

Importantly, in the section you cite, the circuit court discusses the Freedom to Believe vs the Freedom to Act. Their example is that even though the Mormons believed in polygamy, they were required to abide by the law requiring monogamy. However, their has also been much discussion in other arenas regarding the difference between the Freedom to Act vs the Freedom to Not Act and if one protected more than another.

 

[meister]

Someone PM me when a person with something resembling an independent thought rolls by.

Make it over the counter so annoying homeschooled pharmacists can stop whining about having to dispense meds.

The only pharmacists I ever worked with who whined about plan B or OCPs were, as a rule, the most annoying, judgey pearl-clutchers there were. I'm sure god really cares you slapped a label on that Ortho Evra and not the hundreds of drug highs all those narcotics you dispensed over the years caused.

 

[Corpseman]

Make it over the counter so annoying homeschooled pharmacists can stop whining about having to dispense meds.

The only pharmacists I ever worked with who whined about plan B or OCPs were, as a rule, the most annoying, judgey pearl-clutchers there were. I'm sure god really cares you slapped a label on that Ortho Evra and not the hundreds of drug highs all those narcotics you dispensed over the years caused.

Too bad they didn't learn from the non-judgey folks like yourself.