Pharmacist's Dilemma
A young woman walked into a drugstore and handed the pharmacist, also a young woman, a prescription. The pharmacist returned the paper saying, "I'm sorry, but dispensing contraceptives is contrary to my moral and religious code." The embarassed customer located the pharmacy manager, who filled the prescription.
I believe that most readers would agree that no one should ever be subjected to the humiliation experienced by the customer in this story. Yet, should the law require anyone to act contrary to his or her religious principles? When the US had a military draft (1948-1973), the law recognized a "Conscientious Objector" (CO) status for those whose religious beliefs prohibited participation in war.(1) CO's could satisfy their military obligation by performing non-combat service (such as working in military hospitals) or through alternative civilian service. If religious belief is sufficient to excuse a man from the obligation to defend the country in wartime, is it not sufficient to excuse a pharmacist from the obligation to fill a prescription?
Seven states require all pharmacists to fill all legal prescriptions, four others provide a legal exemption for "conscientious objection." The Wisconsin legislature is now considering a bill that add our state to those with the exemption. Given the availability of "morning-after" or "Plan B" medications, which violate the principles of pharmacists opposed to abortion, the ethical dilemma will grow.(2) Should this bill pass, and should the Governor sign it?
I believe the answer should be based on the right of a licensed professional to limit his or her practice as the professional sees fit. For example, a physician may limit his practice to obstetrics, podiatry, psychiatry or any other specialty. In an emergency situation, any doctor should expected to assist a sick or injured person, but we would not expect a podiatrist to accept and treat migraine patients on a regular basis. Similarly, other professionals such as lawyers and psychologists may legally limit their practices to the specialties with which they feel most competent and comfortable. Hospitals, too, have the right to limit services to certain types of ailments and treatments.
By the same token, I suggest that the owner of a pharmacy should have the basic right to limit the scope of medications dispensed by his pharmacy, either by including only certain types of drugs, or excluding certain types. However, to prevent embarassment of prospective customers, such a pharmacy should be required to place a conspicuous notice of the limitation between the front door and the prescription counter. For example, the notice might state "LIMITED PRACTICE: This pharmacy does not dispense reproductive medications." Those drugstores not displaying such a notice should be considered "Full Service Pharmacies" and would be required to fill all legal presciptions. The big chain-drugstores such as Walgreens or Osco would not opt for the "Limited Practice" designation, but some small pharmacies probably would.
Applicants for pharmacist jobs would then know in advance where to apply if they had any religious objections to dispensing any type of medication.
Perhaps some rural areas of the State will have no Full Service Pharmacy within hundreds of miles, and patients seeking certain medications will have to travel long distances to get them. That is unfortunate, but is a fair consequence of a free market in medical products. The owner of a pharmacy is not legally obligated to keep his business open at all times, or every day of the week or year, even though when it is closed customers may have to travel far to get a medicine they need at once.
Changing the law to provide for Limited Practice Pharmacies is a compromise that would be more fair to all concerned parties than either the present situation or the bill now before the Legislature. Let's see if the most fervent advocates of "choice" also favor "choice" for pharmacists.
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(1) In 1970 the US Supreme Court ruled that CO status was also available to pacifists whose philosophy was not based on religious belief.
(2) On June 16 the Wisconsin Assembly passed a bill that would ban UW System health clinics from dispensing this type of medication.
I believe that most readers would agree that no one should ever be subjected to the humiliation experienced by the customer in this story. Yet, should the law require anyone to act contrary to his or her religious principles? When the US had a military draft (1948-1973), the law recognized a "Conscientious Objector" (CO) status for those whose religious beliefs prohibited participation in war.(1) CO's could satisfy their military obligation by performing non-combat service (such as working in military hospitals) or through alternative civilian service. If religious belief is sufficient to excuse a man from the obligation to defend the country in wartime, is it not sufficient to excuse a pharmacist from the obligation to fill a prescription?
Seven states require all pharmacists to fill all legal prescriptions, four others provide a legal exemption for "conscientious objection." The Wisconsin legislature is now considering a bill that add our state to those with the exemption. Given the availability of "morning-after" or "Plan B" medications, which violate the principles of pharmacists opposed to abortion, the ethical dilemma will grow.(2) Should this bill pass, and should the Governor sign it?
I believe the answer should be based on the right of a licensed professional to limit his or her practice as the professional sees fit. For example, a physician may limit his practice to obstetrics, podiatry, psychiatry or any other specialty. In an emergency situation, any doctor should expected to assist a sick or injured person, but we would not expect a podiatrist to accept and treat migraine patients on a regular basis. Similarly, other professionals such as lawyers and psychologists may legally limit their practices to the specialties with which they feel most competent and comfortable. Hospitals, too, have the right to limit services to certain types of ailments and treatments.
By the same token, I suggest that the owner of a pharmacy should have the basic right to limit the scope of medications dispensed by his pharmacy, either by including only certain types of drugs, or excluding certain types. However, to prevent embarassment of prospective customers, such a pharmacy should be required to place a conspicuous notice of the limitation between the front door and the prescription counter. For example, the notice might state "LIMITED PRACTICE: This pharmacy does not dispense reproductive medications." Those drugstores not displaying such a notice should be considered "Full Service Pharmacies" and would be required to fill all legal presciptions. The big chain-drugstores such as Walgreens or Osco would not opt for the "Limited Practice" designation, but some small pharmacies probably would.
Applicants for pharmacist jobs would then know in advance where to apply if they had any religious objections to dispensing any type of medication.
Perhaps some rural areas of the State will have no Full Service Pharmacy within hundreds of miles, and patients seeking certain medications will have to travel long distances to get them. That is unfortunate, but is a fair consequence of a free market in medical products. The owner of a pharmacy is not legally obligated to keep his business open at all times, or every day of the week or year, even though when it is closed customers may have to travel far to get a medicine they need at once.
Changing the law to provide for Limited Practice Pharmacies is a compromise that would be more fair to all concerned parties than either the present situation or the bill now before the Legislature. Let's see if the most fervent advocates of "choice" also favor "choice" for pharmacists.
---------------------------------------------------------------------------------------------------------------
(1) In 1970 the US Supreme Court ruled that CO status was also available to pacifists whose philosophy was not based on religious belief.
(2) On June 16 the Wisconsin Assembly passed a bill that would ban UW System health clinics from dispensing this type of medication.
posted by Gerald S Glazer at 7:06 PM
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