Thursday, November 08, 2007

So what does a pharmacist do anyway?

U.S. District Court Judge files injunction against Washington State's requirement for pharmacists to fill prescriptions. (namely Plan B)

A federal judge has suspended Washington state's requirement that pharmacists sell "morning-after" birth control pills, a victory for druggists who claim their moral objections to the drug are being bulldozed by the government.

In an injunction signed Thursday, U.S. District Judge Ronald Leighton said pharmacists can refuse to sell the morning-after pill if they refer the customer to another nearby source. Pharmacists' employers also are protected by the order.

I have to ask whether there is a proximity and availability guarantee in this injunction - if the nearest pharmacy is fifty miles away and it is not established whether they will provide Plan B, then this is an unjust and unfair exemption.

"On the issue of free exercise of religion alone, the evidence before the court convinces it that plaintiffs ... have demonstrated both a likelihood of success on the merits and the possibility of irreparable injury," Leighton wrote in reply.

"Irreparable injury" - yes, they seem to be referring to a person's personal religious status and how protecting that is more important than, say, a person being allowed to fill a legal and valid prescription for medication that affects their health. Note that while this specific case affects Plan B, the door is open to refuse any prescription; I have friends who were refused their birth control pills because they were unmarried... they took them for hormonal imbalances, not for contraception. That said, I don't think we will see refusals for other medications that could encourage "immoral behavior" (ED medication, anyone?) anytime soon. Yet again, women are being forced into a position where we have to justify our decisions and prove that we deserve to be treated with a basic level of respect and professionalism.

The issue I would like to see resolved here is the problem with false advertising and deceptive practices. We need to clarify (and if necessary, redefine) the professional label of "pharmacist" and "pharmacy" and require complete transparency in what services are reasonably assumed to be provided and which will be prima facie rejected for personal beliefs. I propose that we make it a requirement that these businesses must explicitly state through a disclaimer that they do not provide all services and will refuse to fill prescriptions for certain medications (which will be specifically listed) in any place they call themselves a pharmacy - signs, advertisements, brochures, commercials, etc. Additionally, such a pseudo-pharmacy should not be allowed to be placed in a remote location where they would be the only pharmacy within a reasonable radius; they cannot be counted on to serve as a real pharmacy and people should not be deceived into thinking they can count on them to dispense legal and valid prescriptions.

Or why don't we reduce the government red tape and let the state of Washington, the only one that, to my knowledge, provides free contraception for anyone of low income who asks (Take Charge) because we recognize the value in people having the power to decide for themselves what is best for their health, their families, and their lives, decide what is best for Washington State?

Addendum: Additionally, I urge everyone to reject the comparison of this passive-aggressive act of refusal to civil disobedience, as it does not fulfill the requirements for this honored course of action in response to unjust laws in a democracy.

John Rawls describes civil disobedience as "a public, nonviolent, and conscientious act contrary to law" and urges that the disobeyer accept arrest and punishment as meted out by officials to demonstrate respect for legal procedures. Thus, Henry David Thoreau accepted his punishment of being jailed for refusing to pay taxes that would support a war; to him, acting within the bounds of his pacifist conscience was more important that staying out of jail. Additionally, nonviolence is a commonly accepted requirement of proper civil disobedience, which could extend to allowing harm to come to another through negligence of duty.

Consequently, we see that prescription refusers act covertly (they do not make it clear ahead of time to the public and authorities), allow harm to befall patients seeking their aid (through the ability to deny any prescription), attempt to circumvent the laws and obligations concerning their profession, and demand protection from legal consequences of their breach of the law. Additionally, their situation more closely matches the concept of "Rule Departure," where an official charged with specific duties refuses to fulfill those duties due to a conflict of conscience; with pharmacists, there is an expectation that they will dispense medications for any legal and valid prescription in a timely fashion, and by refusing to dispense, they violate their vested duties.

Addendum 2 (11/14): I am so excited that people are reading this blog and sharing their own opinions. But I would love to see a reasonable argument engaging the standards I have proposed rather than the usual retreat to ad hominems and overly simplistic moral doctrines. Let's come up with a solution by finding answers.


Anonymous said...

Those of us who are attorneys on this blog might consider devoting some effort to an amicus brief. This decision is sure to be appealed to the Ninth Circuit Court of Appeals.

Terry Tomsick

Anonymous said...

On the subject of the pharmicist, I think there is way too much power being given to the single pharmicist at a single pharmacy. Unless there is an unspoken assumption that there is one pharmicist per pharmacy, this calls into question the decision making power pharamcists have under a company. For pharmacy chains such as Bartell, Walgreens and Rite-Aid, does it take one pharmacist at any shift to say, "It's a sin and my beliefs are more important than your health, so better luck elsewhere." If there are multiple pharmacists, how does one person's preference over rule the others? Unless they choose to open their OWN pharmacy, they need to follow the duties they have agreed to under the business, especially one that is given approval to dispense methods of prescribed and over-the counter medicines.

You can't have it both ways, to give professionals in a position of power over a community to have a choice that will restrict the choices and well-being of the community should be unconstitutional. If religious beliefs are reason enough to give you preferencial advantage in the workplace, then perhaps employess should be chosen based on whether or not they have religious beliefs that would prevent them from being a pharmacist in its entirety. It would be no different than the weed-out process in choosing a jury. On that note, why are we more strict on choosing a jury than choosing a pharmacist?

Aleseides said...

Where's the amicus briefs for the smokers who must go through withdrawal pains in order to fly in airplanes -- or sit in airports? Why can't I buy my specific form of alcoholic beverage in every county? These substances should be protected under the ADA, since some people are addicted to them.

While you may have the right to some substance, you do not have the right to the other person's life, liberty and property in order to obtain that substance.

It would be much simpler to move the willing pharmacists around than to force action on the unwilling.

SabrinaW said...

What does obtaining a medication that has been legally and validly prescribed to treat a medical condition have to do with infringing on a pharmacist's life, liberty or property? None of those are threatened by a law that says that the pharmacist may refuse to provide as long as another employee can fill the prescription.

Your attempt to compare a legally prescribed medication with a recreational drug is insulting and demeaning, and denigrates the medical profession. And your comparison of a woman seeking Plan B (or anyone seeking to fill any prescription) to addict behavior is insulting to patients and disabled people everywhere.

Do your research and actually read what Washington State's policy is before bringing such nonsense here. No action is being forced upon the physicians so long as the patient can fill their prescription at the same pharmacy by another employee who is interested in fulfilling their duties. You are not helping your cause by insulting physicians and patients.

Anonymous said...

"To protect human rights and human life...", I think this is something that no human can argue with. The problem becomes when humans who are threatened by harm to themselves are not allowed treatment, and are instead provided with extra barriers that deny them their human rights.

If you are addicted to a substance that is clinically proven to directly harm the people around the user, forcing everyone else around to ingest the substance with their choice is another way that human rights are being denied and human life is threatened. According to Amer. Dental Assoc., True, it is up the user to use the substance or not, but putting other people in harms way brings more into the equation. In addition to the indisputable environmental health hazard, smoking on planes is a fire hazard, given that the majority of cigarettes disposed are not disposed properly.

Which ADA are we talking about? American Diabetes Association? American Dietic Association? American Dental Association? Or the American Disabilities Association?

1) Outside the normal health factors, the Amer. Diabetes Assoc. says that tobacco is particularly bad for people with diabetes. But consumption of alcohol (e.g. wine, beer, or spirits) in modertation can help improve insulin levels (Hanson, D. NYU 2007).

2) The Amer. Dietic Assoc. focuses on "nutrition and your healh", so I hardly think smoking or alcohol are under their topic criteria.

3) The Amer. Dental Assoc. list gum disease and darkened teeth under the issue of smoking. "People who smoke or use alcohol are increased risk for periodonititis and other conditions, such as oral cancer" (

4) Instead of looking to the Amer. Disabilities Assoc, perhaps NAADD provides us with a better idea of the link between alcohol and drugs to disabilities.

All studies aside, the ONLY restriction in acquiring tobacco/cigarettes and alcohol is age...and no previous legal record of substance abuse. To have access to cigarettes and alcohol to 'serve your addiction', you don't require a doctor's prescription or even a pharmacist. Any highschool 18yrs or older working at a gas station can sell you these items. Yet, despite being ADA compliant, Plan B is being restricted by pharmacists who should have chosen a different that doesn't 'make' them choose between their religious beliefs and there job.

My question to you is if cigarettes and alcohol should be ADA compliant, would you agree that they dispension of these drugs should be under the discretion of pharmacists? If these pharmacists believe that you are harming your body, should they be allowed to prevent you from getting your "specific brand of alcohol" or cigarettes for your withdrawal pains? What if your body is so dependent upon nicotine that you need it within in 24 hrs? Living as a low income individual in a rural community that already frowns upon your addictions, can you manage driving to the next city when you work two full time jobs to pay for food and housing just to get what you need for your body because one pharmacist commands the entire pharmacy, the only pharmacy in your town?

Are withdrawal pains from substance abuse really the thing that is plaguing humans today? Are health professionals from public and private practices just "out to get the smokers and alcoholics"? Yes, because smokers and alcoholics are being denied their human rights and have their lives on the line in lieu of increased restrictions. Yes, because women who need plan B are victims of using TOO MUCH progestin and levonrgestrel, which is why they need to take more plan B.

Apparently smokers and alcoholics are more human than women and fueling substance abuse addiction is on the same level as treating a medical condition with plan B.

Aleseides said...

To the moderator: My answer to SabrinaW from 1 AM today would have also answered many of Aleseides' questions. I'm covering this at my blog.

katiesmily said...

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