I’ve been debating on writing this blog article for 10 months now. I didn’t want to offend any friends with it, since I have a number who are pharmacists, many who are conservatives, still more who are Christians. However, I don’t think they’ll be offended at all if they’ll just read what I have to say.
Pharmacists are like engineers in at least one way: when they make the news, it is almost never a good thing. Last Spring, a number of pharmacists made national headlines when they refused to fill prescriptions for The Morning After Pill
, which isn’t so much a single pill as a short regiment of pills. Brand named Plan‑B, made by Barr Pharmaceuticals, went against these professionals’ religious beliefs and so they stated that they could not in good conscience sell it. The facts have seemed to me hard to pin down on exactly what happened in any one case, but I have found some records 1. Particularly, to what level were these women denied having the prescriptions filled? Some reported that two women were simply told to come back at another time and consult a different pharmacist who would be comfortable dispensing the medication. However, other women stated that a pharmacist had taken their prescription, refused to fill it or even give it back so they could go elsewhere. Further yet, some stated that they were given lectures by pharmacists on abortion and religion.
In response, the governor of Illinois signed into law a rule requiring pharmacists to fill these prescriptions without delay. Five pharmacists from Walgreens were suspended or fired, along with at least one from Target. Several more states are considering a variety of laws, from requiring prescriptions to be filled to providing rights of conscience
for pharmacists and other health care workers. The pharmacists from Walgreens are suing in Illinois, claiming they were fired in violation of the state’s healthcare worker’s rights act for not agreeing to uphold the new without delay
law. More recently, the Massachusetts state Board of Pharmacy required Wal-Mart to begin stocking and selling Plan‑B to comply with the state’s law for stocking all commonly prescribed
medications.
Allow me to attempt to outlay some of the dangers of both sides of this argument. First, as a licensed professional, telling a pharmacists to just ‘shut up and do your job’ has severe dangers entailed. They don’t sell paperclips back behind that counter. Prescription medications are often dangerous or even life threatening if not taken properly. The pharmacist serves as a safety guard between the physician (who typically only has one course in medications and the pamphlets the drug reps leave behind) and the patient. The number of calls made by the pharmacist to a doctor or nurse alone regarding mis-prescribed drugs is enough to merit their role. They do much more, but let’s be clear: they have a license for a reason. They are trained health care professionals whose judgment helps patients’ lives. Telling license professionals to shut up and do their job results in tragedies, and when technically ignorant lawmakers step in to force that mentality, the public is receiving a disservice. Particularly in the case of pharmacists, telling them to just fill whatever comes across the counter is a recipe for forged prescriptions, doctor shopping, and drug abuse.
Now, on the other side, becoming a licensed professional requires one to make certain promises to the public, for it is they in the end who have granted us the license to practice. Through a proxy of a state-board of professionals appointed by an elected government, we answer to the public. Not individually, but by consensus. Further, we do not have the authority to think that any one of our judgments so vastly outweighs those of the rest of our field that we can simply ignore any rule or code. Also, we must not be activists for some cause that is wholly separate from our work when performing those duties. We are not robots, and all have our own morals. However, morals must never be confused with professional ethics2. Again, in the case of pharmacists, they must refrain from forcing their views upon patients. It is not their professional role to judge and enforce laws which aren’t associated with their license.
If a pharmacist is uncomfortable from filling a prescription, for whatever reason, this should be made clear to employers and patients in advance (yes, even posting signs to that effect). When a patient does present such a prescription to the pharmacist, then it is their duty to give them the opportunity to have it filled by another staff member or a pharmacy in the immediate area. Barring that possibility (think rural areas), the pharmacist should fill the prescription. This is essentially what the Illinois law requires and is what the APhA states [pdf] is it’s policy on the matter. The notion of being able to deny health-care services to someone a professional does not feel comfortable providing for is a dangerous concept. I can assure you, someone out there doesn’t want to help you because of something you are or have done. None of us will be benefited by allowing that to happen (fortunately, the vast majority of health care workers understand that their oaths does not allow for moral judgments of others).
Lastly, and more to the point of this case of Plan‑B. I really think that the pharmacists in questions should familiarize themselves more with the science of how the drug works. In laymen’s terms, the drug cannot work if if a woman is already pregnant. All it does is prevent the egg from being released or the sperm from fertilizing the egg (it is just a strong dose of birth control, after all, not RU-486). It is no more an abortificiant than a condom is, or for that matter, the fact that you’re reading this and not having sex is (blog reading is a very efficient form of birth control). If life begins at conception, as many maintain, then this simply cannot be aborting life. Life by that definition has not yet happened. Pharmacists are health care professionals, and it seems a disgraceful mark on the few that don’t wish to be bothered with understanding biology that might conflict with knee-jerk judgment.
My final point: shut up and be a professional. It’s a high standard, but it is what you are trained for.
Am I completely off the mark here? Is everyone offended at this point? I hope not, but say so below. This is your place for discussion as much as it is mine.
I agree that profesionals (that includes medical, engineering, legal, financial, etc), but especially those professionals who influence is paramount to the safety and well-being of their charges, should not be coerced into making choices they find immoral, unsafe, or otherwise undesirable to their charges. That said I am interested in understanding your opinion on whether or not the professional who is in their particular dilemma should remove themselves from making this choice. Please don’t limit this discussion to the Plan B issue as precedence for this issue can certainly be tranposed from other fields (engineering requirements vs cost decisions and attorney-client priveledges come to mind). There must be a large number of circumstances where removing yourself from the decision is possible. This may abdicate the responsibility and therefore I’m not sure that I fully support this. The right choices are not always readily apparent.
My take on this is that life is full of choices and all too often these choices that we must make interfere with other choices. This is life. I personally struggle with what exactly is the moral thing to do when it comes to contraception (pre or post conception) and lots of other issues (when does life begin?, etc). I fully admit that I do not have the answer and I sit the fence, mostly.
As to your concern about offending people; it’s your blog man. Regardless of people’s opinions we should all be able to friendly disagree.
One more thing: One of the problems with letting the internet do our bidding is that it doesn’t always come back with answers that address the opinions of those on both sides an issue. I am pretty sure that Planned Parenthood stands squarely on one side of the fence on this issue. Do you know of parties on the other side of the fence (even if the method of their argument is flawed)?
Sorry to ramble.
Wow. I wish I had a single answer to that. I think from our point of view (as engineers), the answers are so much more clear cut. We have quantitative results which we can rely on. In the matter of ethical choices, I find myself going back to reading my profession’s code of ethics to frame my decision and therefore, my ultimate choice. Hopefully, by using those guidelines that have been so painstakingly put together, I will do the most good for myself, the profession, and the public.
Other professions do not have it so easy (like our wives). They must weigh their decisions against far more abstract ideas such as ‘do no harm.’ (Harm can be relative, I think) While it might not be fair to make them state up front any conscious objection they may have to fulfilling what are considered regular duties (how can we expect anyone to foresee any ethical dilemma that might arise?), we should ask them to make it clear that in principle they might find some roles objectionable.
I once interviewed with a company whose major clients included companies who make cigarettes and others who produce a large amount of pollutants. They indicated their attitude was to help their clients comply with the absolute minimum standards and no more. If I had any ‘green’ sensibilities, it was made clear I’d be unhappy. I politely declined to pursue the position any further. I suppose some other engineer came along and is doing the job, which makes a zero-sum, but my conscience wouldn’t allow me to do it. As a professional, I have a duty to my employer. If I personally disagree with their clients pollution or practices, then I must pursue change in that area outside of my capacity as an engineer. I cannot use that capacity to subvert what is currently legal. Of course, this is more anecdotal argument, but hopefully helps to clarify how I feel about the issue of professionals fulfilling their roles in spite of personal objections.
As far as that fence goes, we all walk it for the most part. Many of us lean one way or the other depending on which way the wind blows, myself included. However, I think the most important thing is to think out a consistent set of principles and follow them. We base these on religious views or on other principles. Not easy, but does help as a guide.
As I mentioned, I had a hard time finding further descriptions of these women’s stories and the PP page had some summaries of most I’d read about previously. I didn’t mean to endorse them or their detractors, either. I had (at one point) found a web site for pro-life pharmacists and other health-care workers, but have since lost it. So, they’re out there, and do have some points to make in their argument. (Here’s one, and it’s not pretty. Not the one I found 10 months ago.)
Hey, like you say, it’s my blog, and rambling is encouraged. Further, I’d say we’re in much more agreement than not.