Pharmacy Board on a Slippery Slope
A growing number of pharmacists are refusing to fill prescriptions for Plan B. This contraceptive has a good record of preventing pregnancies if taken within 72 hours of unprotected sexual relations.
The protesting pharmacists insist prescribing Plan B offends their religious or moral sensibilities and they should not be forced to violate their consciences.
Oregon’s State Board of Pharmacy, struggling to resolve acts of conscience with the need of consumers for lawful prescription drugs, recently approved a policy statement that makes it a duty of licensed pharmacists who refuse to fill a prescription as a matter of conscience to refer consumers to another pharmacist who will. The policy statement also requires each pharmacy to draft procedures outlining a pharmacist’s ethical, moral and professional responsibilities.
More interested in a political statement than a policy statement, Gayle Atteberry of Oregon Right to Life complained it may violate the conscience of some pharmacists to even refer requests for Plan B to another pharmacist.
The Board of Pharmacy is out on a slippery slope without a safety harness because they are reacting to a deliberately contrived political issue by trying to regulate individuals rather than businesses.
For the sake of argument, let’s agree with two principles: (1) No person should be required by law to violate their conscience; (2) every consumer who goes to a pharmacy has a right to have their prescription for any lawful drug filled promptly and without moralizing. A pharmacy already, by law, must make sure the consumer has received the correct prescription, understands the possible side effects and interaction with other drugs and knows whether a generic drug may be as effective and less expensive.
The Board of Pharmacy’s position statement forbids pharmacists from discussing their religious or moral beliefs with consumers.
That probably violates the Oregon Constitution. Article I, Section 8 unambiguously states, “No law shall be passed restraining the free expression of opinion, or restricting the right to speak, write or print freely on any subject whatever; but every person shall be responsible for the abuse of this right.” But employers are under no such restrictions. They can forbid pharmacists from moralizing at customers and may do so as a condition of employment.
The Board of Pharmacy is on firmer ground describing confiscating, destroying or tampering with a prescription as unprofessional behavior.
The problem with writing rules for regulating pharmacists’ behavior is that we don’t know what prescription which religious group might deem immoral tomorrow. Religious objections to long-standing methods of contraception are resurfacing. At the present rate of medical and pharmaceutical innovation it is certain that new drugs will offend some pharmacists’ moral or religious sensibilities.
But that is largely irrelevant.
The State of Oregon’s responsibility is to assure that any legal prescription will be promptly filled. That means laws or rules making the pharmacy, not the pharmacist, responsible for filling prescriptions. If one pharmacist has moral or religious objections, the consumer must be able to promptly turn to another pharmacist to fill the prescription and not rely on the protesting pharmacist to refer the consumer to some other pharmacist. It should be the “duty” of the pharmacy to have sufficient employees on hand to fill any lawful prescription any time the business is open.
There will be staffing problems in smaller towns where Mom and Pop pharmacies are often the only pharmacy. But family-owned pharmacies are dwindling as large corporations and internet sales take over the job of dispensing prescription drugs. The problems of small pharmacies should not become an excuse for inaction or exemption. Large pharmacies can afford to have enough staff on hand to fill lawful prescriptions even if some pharmacists have moral objections.
Pharmacists who accumulate many moral objections or who want to use the dispensing of lawful prescription drugs as a soapbox for political statements, will have some trouble maintaining employment. But the state’s responsibility is not to assure convenient employment for the conscience-stricken or the crusader. The State’s responsibility is merely to assure that no one is compelled to violate their conscience as a condition of employment.
That is why it makes sense to give pharmacies the duty to fill any lawful prescription and the responsibility of hiring pharmacists who will help them comply with that duty instead of trying to regulate the behavior of the individual pharmacist.
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June 17, 2006 |
Russell Sadler
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Comments
Posted by: engineer | Jun 18, 2006 7:24:12 AM
My guess is that the Pharmacy Board can only regulate individuals and not businesses (they are a licensing Board), and thus this is the best compromise they could come up with in terms of regulating an inidvidual licensee. If that is the case, the (sensible) solution RS proposes is beyond the Boards purview. It requires a legislative solution.
Posted by: jami | Jun 18, 2006 8:53:06 AM
here's where the slippery slope leads:
rape victim denied emergency contraception
it's already happened.
you're right that this should be on the stores, and it will be. i hope any woman who is refused a prescription will sue the store. make them pay for the abortion they're necessitating and all the suffering it might cause or for the cost of raising a child for 18 years.
the financial interest of businesses will eventually trump slack-jawed yokels' holier-than-thou "interest" in discriminating against women responsible enough to prevent a pregnancy and avoid an abortion.
pharmacies hire religious extremists who refuse to do their jobs at their peril.
Posted by: Marvin McConoughey | Jun 18, 2006 9:24:40 AM
Pharmacists have every right to exercise religious preferences in their personal lives. But as pharmacists, they are responsible to serve the public within the constraints of law. It is wrong for any pharmacist to choose to withhold legal prescriptions on the basis of his or her personal religious indoctrination. The lack of ethics in such personal interventions betrays the public, which has few alternative choices.
Posted by: Steve Bucknum | Jun 18, 2006 12:07:13 PM
Rebel Dog (who is rapidly becoming my new favorite for inane comments on this blog) writes, "Anything made from petroleum is against my religion. Maybe I should take the Pharm Board test and get a job as a Pharm Tech. I wouldn't have to fill a prescription all day!"
Since that message came to my computer via oil based products, and in fact was produced originally on an oil based product, I will otherwise ignore it.
Russ - another good point. I'm from a small town where we still have some "Mom & Pop" type pharmacies. But even these have a few staff beyond "Mom & Pop" and it would not be a burden to have someone else on staff fill the prescription. If no Pharmacy in my town had Plan B, then the next nearest place is 20 miles away - if you own a car. Not everyone here owns a car. Add all that up, and the weight and balance between free speech, acts of conscience, and access to needed medication shifts to having the Pharmacy being required to fill all prescriptions and figure out how internally they can do this without offending an individuals free speech. It is too much of a burden upon the woman who needs Plan B to figure out how to get 20 miles away within 72 hours otherwise. -- In some cases in Eastern Oregon, it might be 100 miles. Access must be provided. Besides, pharmacies have provided contraceptive prescritions for over a generation. Everyone now a Pharmacist went into the field knowing that they would be providing contraception. It's not a new requirement.
Beyond this example is the more general trend. In the far right religious wing of my family, I have noted a Christian persecution complex that goes something like (and I broadly round off the edges): If anything government does has the effect of violating my religious principals, then that government action must hereby stop and we should spank everyone involved because you have violated my religious freedoms. -- This is of course a crock.
One of my Aunts believes that since the theory of evolution is taught in the school district where she lives, every student is owed full tuition at the private schools that don't teach the theory of evolution, and futhermore that public school should lose its funding, and the teachers involved should be denied retirement benefits - because otherwise she would be forced to pay taxes in support of things she doesn't believe in. Everyday that this situation goes on of having a school district that teachs evolution and everyone with property paying a tax to support it - my Aunt is presecuted to her way of thinking. -- Of course, the solution is one that Christ taught - sell all your posessions and give the proceeds to the poor, but she doesn't want to hear that.
So, when we start caving in to accomodate religious beliefs with government policies - how far do we go?? It is an extremely slippery slope. -- What we really need is a counter point. Someone should bring a lawsuit for unwanted child birth (like a paternity suite) against a Pharmacy that refuses to provide this or any type of contraception - maybe with class action status.
Posted by: DifferentSalemStaffer | Jun 18, 2006 12:59:25 PM
Slippery slope indeed! As I understand it, the owner of a pharmacy can't fire a pharmacist who refuses to fill a prescription based on moral grounds. (Is that true?)
I like the conservative line of "hands off the private sector -- unless we feel otherwise."
I'm thinking of changing my religion to Snake Handler, then I'll get a job at a pharmacy and I won't have to prescribe anything -- ever. What a cush job! Or maybe I'll become a vegan and get a job at a steakhouse... "Sorry boss, I refuse to serve any food based on my moral beliefs. You can't fire me, though!"
I think the Board of Pharmacy needs to have a new policy: If you routinely refuse to dispense certain medication, maybe being a pharmacist is not the job for you.
Posted by: askquestions1st | Jun 18, 2006 2:27:42 PM
I like DifferentSalemStaffer's closing comment.
Beyond that, I'll try to add some arguments that might bolster Russell's well-developed case against this moral outrage.
it is a matter of law in this country that corporations have a fiduciary obligation to operate in a manner that is in the best financial interest of the business (and the fear of a consumer boycott so far hasn't been well-recognized legally as the basis for decision making). As a result, the only right an employee has, except apparently pharmacists, that is protected to some legal degree to refuse to carry out the lawful operation of the business based on moral grounds is to quit.
While I'd personally like to see that legal situation changed in certain ways, and in fact I'd like to see corporations have their "personhood" illegally bestowed by a corrupted Supreme Court of an earlier age revoked in recognition of the sociopathic character such a fiduciary obligation gives to corporations, until that happens it is up to voters to revoke the right of the Pharmacy Board to enact such a licensing waivers (and that is what this is). And because we are not talking about imprisonment or fine, this would in no way violate Russell's posit that (1) No person should be required by law to violate their conscience. As with so many issues in this country right now, it is time to stand up and say firmly and without reservation that this is not only socially unacceptable, it is a false moral argument.
Unfortunately, the rather dubiously qualified folks we send to represent us once every two years in Salem, who are largely too incompetent to draft well-crafted legislation so instead rely on organizations like the Pharmacy Board to write the legislation that affects them.
As we just found out in Eugene, it is more than a little bit difficult for soldiers to refuse to kill or maim - much less refuse to serve to genuinely protect their mental health - because of a contract they signed. Why should we allow a licensing organization like the Pharmacy Board with it's own self-serving professional and financial goals to authorize pharmacists to refuse to fill lawfully issued prescriptions? Does anyone doubt that our state pharmacy schools are turning out folks who will be happy to serve all customers, and they would be excited to receive support from the state to expand their programs to graduate even more folks happy to do so?
Posted by: Mike Austin | Jun 18, 2006 3:41:02 PM
Maybe what we need is a "registry" web site of pharmacists who refuse to fill prescriptions so that the rest of us can boycott them and let them know why they are being boycotted. (Until we can put a law in place, of course.)
I volunteer to help design it.
Posted by: R.U. Nuts | Jun 18, 2006 7:56:23 PM
There are two issues at play here, the first is if we are going to put aside the agenda driven rhetoric and the second is how many more requirements we are going to place on businesses.
Now, let's set aside the fact that Oregon Law already allows physicians and hospitals to refuse abortion services. I think it is in Chapter 435. And a reasonable person could see Plan B as a chemically induced abortion. Why should we force pharmacists to do something we don't force physicians to do? But I digress.
The real issue here is the need for compromise. Both sides need to get off the political soap box and meet in the middle. Let's allow pharmacists to decline to fill any prescription they want but they must provide a list of other pharmacies in the area without any sermons. That seems fair since the person at the pharmacy counter probably drove past 10 pharmacies to get to the one they now are at.
Now I know, here comes the rural person with no car who lives 90 miles from the nearest town. There are always going to be exceptions and you cannot legislate for all of them. However, rural Oregonians are some of the most creative people I have ever met. I am sure they can figure it out. If the pharmacist won't stock Plan B, may be the physician will. Or maybe a good Samaritan in the town can offer to drive the one person a decade who needs Plan B in a town of 14 to the next town over. The bottom line is I have a lot of faith in these Oregonians. They will figure it out.
The real slippery slope here is when we start forcing pharmacies to stock anything. Someone can correct me if I am wrong but I don't believe we have any requirements for what a pharmacy has to carry. In fact I have had my pharmacist tell me he needs to order things more than once. With the cost of drugs these days I can understand why a pharmacist wouldn’t want to stock something that may expire on the shelf. If we require them to stock Plan B, what else are we going to require and who is going to pay for the drugs that expire?
At the end of the day, if we are going to claim we live in a free society we need to practice what we preach and back off all the requirements. That my friends is the slippery slope.
Posted by: askquestions1st | Jun 18, 2006 11:50:55 PM
R.U.Nuts (No, But U. R.) -
Frankly, there is no slippery slope in regulating what pharmacists must stock for the good of the community as a requirement of their license. They will always have the freedom to go into another line of work with no legal or societal repercussions. And if a pharmacist who does not want to properly serve the community is forced out of business, it creates a business opportunity for one who does, thereby levelling the playing field for those who do want to fully serve the community.
Furthermore, physicians should not be allowed to refuse on moral grounds to perform procedures the law requires be available and that their employer makes available pursuant to the law, UNLESS they state in writing that their moral objection impairs their technical ability to properly perform the procedure. As with pharmicists, morality and equity dictates they should not have a right of refusal to perform a task that any other employee of any other business doesn't have. Furthermore, pharmacists chose the quantities they stock of all drugs based on intelligently assessing demand, and they absorb spoilage as part of the legitimate cost of doing business. What is the intellectually honest basis for arguing Plan B be handled any differently than any other drug?
Because the libertarian slant of your post is so transparent and superficial (even true libertarians are not against licensing requirements when societal health and safety are involved), it appears that it could be you that is the "agenda-driven" hypocrit here. The "big-hug" argument that we should meet in the middle argument so popular these days is childish and most often just a lazy dodge. Why should anyone of personal integrity ever compromise on important societal values like this and essentially give the whackjob right wing what it wants through inaction? So why don't you have some guts and state your real agenda? Do you believe abortion and that the morning after pill should be freely available without prescription to any woman who chooses? If so, how do you advocate that the law should affirmatively insure that both of these remain safe and available in rural communities?
M. Austin -
Rather than a website that advocates a boycott, a good thing to do would be to create a registry that folks can report their experiences with individual pharmacists, and then let each person make up his or her mind on what to do with that information. Even those people who support banning Plan B would find such a resource to be equally valuable for their purposes. (Actually, a pretty good argument can be made the state should require that each pharmacist state whether he or she will fill Plan B prescriptions as part of the licensing application and maintain a website providing this consumer information on the basis that it would be of benefit to everyone regardless of their personal views.) I'm sure RUN-NBUR, that you will enthusiastically endorse such a robustly libertarian action as providing consumer information, and letting folks make their own decisions what to do with it, in your forthcoming response to this comment, won't you RUN-NBUR?
Posted by: David Wright | Jun 19, 2006 8:36:03 AM
Interesting discussion... I've posted extensive counter-points on my own blog.
Posted by: QuiteMad | Jun 19, 2006 9:05:44 AM
RUNuts --
You make an interesting point regarding "requirements placed on business" which may make perhaps a sliver of sense if you assume that pharmacists are always their own boss.
But in many cases, the pharmacist works for a company like Fred Meyer or Rite-Aid. Companies that stock Plan B and would like to sell it to their customers. In that case, if a pharmacist refuses to dispense it on moral grounds, do you think that their boss should be able to fire them?
To say otherwise constitutes, it seems, an unnecessary "requirement placed on a business"... to keep an employee who simply refuses to fulfill the job function for which they were hired.
Posted by: Rebel Dog | Jun 19, 2006 2:50:43 PM
Steve,
...and you're starting to react like a barkeep I knew in Amsterdam that never understood why people found Woody Allen funny. So far you'e missed sarcasm and inane conspiracy theory (one adjective right though). Thank dog I haven't tried anything in the "gotta vent" style!
Posted by: BlueNote | Jun 19, 2006 4:17:33 PM
Are pharmacies private businesses who are free to decide how to conduct their business, or are they quasi-public entities (like PGE) who must provide services to everyone? Reminds me of the liquor license debates in the late 60s, when many license holders (Elks, Moose, etc.) wanted to keep their liquor license but refuse service to women or minorities. It is my understanding that in most cases, the government was able to force private clubs to open their facilties to women and minorities by threatening to cancel liquor licenses. Maybe the same thing would work with pharmacies. If the state adopts a law that all pharmacies must dispense all FDA approved substances as a condition of staying in business, then the pharmacies will figure out a solution or face loss of their license. In turn, I would expect them to hire only those people who will fill all prescriptions.
I do agree that every person should be able to act in accord with his or her personal moral compass, but he/she must be prepared to accept the consequences of doing so which may mean choosing a different career.
It is my understanding (through 2nd hand information) that similar problems have come up with the Oregon death-with-dignity law and that some pharmacies or pharmacists have refused to fill end of life prescriptions even though they were properly written.
Posted by: Jim Holman | Jun 19, 2006 5:08:06 PM
A couple of points:
1) Pharmacies are not regular retail businesses. A "pharmacy" is a legal entity that exists only through the licensing process of the state of Oregon as defined in ORS 689. The guiding principle behind the licensing of pharmacies is the "health, safety, and welfare" of the citizens of Oregon. I believe that if the state pharmacy board found that the required stocking of a particular drug promoted the health, safety, or welfare of Oregonians, they could order it.
2) The central principle of medical ethics is that of patient autonomy. This means that the purpose of medicine is to meet the patient's needs through providing access to medically appropriate information, procedures, medications, etc. It is not the job of the physician or pharmacist to censure information or restrict access. While we allow physicians or pharmacists to opt out of the provision of certain procedures or medications, the guiding principle of patient autonomy means that in protecting the provider's conscience, we don't leave the patient "high and dry."
So I believe that all the discussions of the "rights" of pharmacists or of pharmacy owners need to take place within the context of Oregon laws and the principle of patient autonomy.
Posted by: Anon | Jun 19, 2006 8:12:02 PM
Regarding the career-choice angle, I'm a vegetarian who's not real keen on animal research. But I wanted to work in a lab, and biology labs that don't do any animal research are near-nonexistent, so animal research I do. I could try to pull the "let someone else do it" trick for a while, but my boss would eventually fire me for not doing my job, and I bet I couldn't go crying to the Federalist Society about religious persecution (even if I pretended to be Jainist) when he did.
Mike Austin, that's a great idea. I'm already boycotting Target because they backed up a pharmacist who refused to fill a woman's prescription. They've lost a decent chunk of change that way already, as I used to love the place.
I doubt this would happen much in Portland, given the swift and severe economic repercussions it would have on the store. Can you just picture the Willamette Week article?
Posted by: David B. Wright | Jun 20, 2006 1:47:37 AM
BlueNote, my pharmacist friend relayed similar information about the Death with Dignity issue.
However, that case is very different, as the concerns expressed to me were not merely about issues of conscience, but about the very real potential legal liability that a pharmacist (or doctor for that matter) might expose himself or herself to given the power struggle between state and federal regulation.
In essense, pharmacists were worried about federal prosecution if they filled those prescriptions. So at least one major provider made it a company policy to not fill them as a defensive measure.
Whatever the moral issues surrounding Plan B, at least nobody's threatening to put anybody in jail for filling those prescriptions...
Posted by: askquestions1st | Jun 20, 2006 7:47:09 AM
David Wright -
Not sure of the time frame you spoke to your pharmacist friend but at worst the risk was extremely low, and right now it is non-existent on the basis of the January 2006 Supreme Court decision, the noise being made right now about renewed challenges notwithstanding. So that major firm may have just been conveniently rationalizing to avoid being a responsible licensee.
Posted by: Chris | Jun 20, 2006 8:11:10 AM
I shouldn't have to pay taxes because I am morally offended at paying for a government that murders people. Let the slope slip.
Posted by: nbm | Jun 20, 2006 4:31:02 PM
I remember my sister continually reciting the five principles of Pharmaceutical Practice when she was preparing for her career as a Pharmacist in the late 1980's. To my knowledge, they remain the same today:
1) Nonmaleficence
2) Beneficence
3) Autonomy
4) Loyalty
5) Distributive Justice
Religious or moral sensibilities weren't on the list then, nor are
they now.
Posted by: Kari Chisholm | Jun 22, 2006 3:31:52 AM
I'm with Governor Blagojevich of Illinois on this one... A pharmacist refusing to fill a legal prescription on a moral objection is like a supermarket checkout clerk refusing to check and bag ground beef because s/he is a vegetarian.
No one has a constitutional right to be a pharmacist, but everyone has the legal right to receive legal medications legally prescribed. If your occupation conflicts with your morality, get a different occupation.
Posted by: Zarathustra | Jun 29, 2006 4:58:02 AM
I agree with Kari (hence the intial sarcastic, dismissive comment). It's just another example of some people trying to bring religion into areas where it wasn't publicly expressed, particularly if the area involves/involved science.
It's interesting if you read some of bin Laden's early writings, he is essentially trying to accomplish the same thing. He points to examples where countries like Saudi Arabia cooperated with American corporations by relaxing certain social rules, like permitting abortion clinics and the sale of alcohol. Ultimately his objection is that a secular, pragmatic order has replaced religious authority, and wants to reverse that.
QED, evangelical christianity is un-american...
Posted by: gracey656 | Jul 3, 2006 1:07:10 PM
Re: R.U.Nuts and this comment: "And a reasonable person could see Plan B as a chemically induced abortion."
No a reasonable person would be better informed and would realize that Plan B has nothing to do with having an abortion. This sort of misinformation is put out for purely political reasons and results in women not having access to safe, accurate medical information. To pretend that there is a reasonable debate and that both sides have accurate scientific information to offer is simply wrong.
If you don't believe me than how about Susan Wood. Wood worked for five years as the assistant commissioner for women’s health and as director of the office of women’s health at the Food and Drug Administration. In an article discussing Plan B the author wrote:
"Wood emphasized emergency contraception pills like Plan B differ from abortion pills. Emergency contraception works like a regular birth control pill; they are used to prevent a pregnancy and are not effective if the woman is already pregnant, said Wood. Pills like Plan B simply contain a larger dose of the same hormone contained in a single birth control pill.
"The only link that this product has to abortion is that it can prevent one," Wood said. "If you are comfortable with regular birth control, then you are comfortable with this." "
If you are interested this is a link to a surprisingly good article about the way in which church and government are screwing with women's access to accurate medical information.
http://www.glamour.com/features/healthandbody/articles/060403fewohe
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Posted by: Rebel Dog | Jun 18, 2006 4:30:28 AM
Anything made from petroleum is against my religion. Maybe I should take the Pharm Board test and get a job as a Pharm Tech. I wouldn't have to fill a prescription all day!