I just don’t get this whole thing about pharmacists and doctors being able to refuse to fill prescriptions/ provide care on religious and moral grounds, refill or no refill. I want to know if a white supremacist doctor would be able to refuse care to a black person on grounds that it violates their conscience. Isn’t it the same thing? In fact I remember I read somewhere that southern white women deployed as army nurses in WWI would often refuse to treat injured American soldiers who were black.
I mean one person deeply believes in (a certain reading of) Christianity and another believes in white supremacy. If care providers are able to refuse care based on personal beliefs, why differentiate?

Two things:

First, it seems that CVS has sensible policies, and this is happening only due to pharmacists who are actively violating policy. I'm quite curious to find out what the company is going to do about this.

Second, I'm a little surprised that no criminal charges are being filed. A pharmacist does not have the authority to alter a prescription, and doing so is an act of forgery, as I understand it.

Zed,

Thank you - I was about to ask the exact same thing. Namely, isn't it illegal to alter a prescription? o_O

And I love the "EC = irresponsible" remark. No, honey, planning ahead for emergencies like broken condoms on the weekend is the _definition_ of responsible. "Irresponsible" is altering prescriptions and acting like a 12 year old by throwing a fit when you don't get your way. :D

I would love to hear from any pharmacists out there who work in this field every day. It is strange to me that pharmacists have been in the public lately with such moral qualms- it seems to me that with all the science and education necessary a pharmacist would know that his or her moral reservations had no place in his or her work. Pharmacists have a difficult and important job for sure, and it's good they take pride in helping people- but in judging them and their lifestyles they cross a line. If I get medication for frequent bladder infections, is that indication that I have an irresponsible sex life to a pharmacist (it was to the gyn. that I dropped and replaced with one who recognized that it was stress that caused them). Whatever did the pharmacist who kept filling my prescription think?

That said, my darling baby brother, once a liberal kind of guy when he thought about it, has spent 2 years as a pharm tech, is studying to get his pharmacy degree, and is suddenly a raging Republican. He has horrible things to say about the poor, those on welfare/medicade, how they just get freebies and should get jobs and all this stuff and it's horrifying. I wonder if there is something about the job?

"It is strange to me that pharmacists have been in the public lately with such moral qualms- it seems to me that with all the science and education necessary a pharmacist would know that his or her moral reservations had no place in his or her work."

Usually I would think the same as well.

However I know that in my egyptian community (which is, like the rest of the middle east, extremely conservative) there is a lot of pressure to be a doctor or pharmacist, mostly because of the money and social status that come along with being a professional (as well as breaking the cycle of poverty found in their families). Whether or not they believe in EC or not I am not sure. But i'm certain that the idea of women needing EC because they had sex (more likely out of wedlock)isn't really their cup of tea. I wonder how many other conservative immigrant communities go through this as well.

Why should pharmacists be qualified to decide if we need medication, anyway?

I mean, they are basically glorified pill dispensers. Those EC packs, if they are anything like my Ortho-tricyclen, come prepackaged in the correct dosages. All the pharmy guy does is put it in a bag and hand it to you. The _only_ objection they could have is a religious one, and I don't think I should be incovenienced by other people's religion.

That goes for whether I'm getting my anti-depressants from my Scientological pharmy or my birth control from my Fundy Christian pharmy.

I often wonder--and still haven't been able to find out--what obstacles prevent OB/GYNs from simply dispensing meds through their own offices. Is going through the pharmacy middleman simply a matter of convenience, allowing the docs to avoid extra paperwork and storage problems, or are prescriptions medications legally required to be dispensed only through pharmacies? The latter would seem to be unlikely, given the ability of your doc to hand out free drug samples. It seems like so much of the hassle could be avoided if you could just get the pills from your doctor right when she agrees that you need them.

In response to the comment about racists refusing care to non-whites, I've often wondered if pharmacists, after converting to Scientology, could therefore deny to dispense prescribed antidepression medications.

On another note, why it is that some Christians and right-wingers get so up in arms about their moral objections to birth control and emergency contraception and abortion and whatnot -- believing that it's the irresponsibility of loose women that leads to unwanted pregnancies and simultaneously believing that any existent egg in a woman's uterus is paramount to a live child -- and yet no one even thinks about the man's role in conception, nor has anyone come up with a contraception for men to take that could potentially end the debate, because I don't think anyone is going to argue that semen and sperm are sacred or that each individual one is deserving of it's ability to create a baby. Sorry for that irresponsibly long sentence but I'm truly puzzled.

I was hoping we wouldn't turn to pharmacist bashing... there is a LOT of work involved in being a pharmacist, and the good ones do a lot of work in terms of making sure that your multiple prescriptions from multiple doctors are correct, in checking over the prescriptions, keeping current on the things doctors often don't have time for. Sure, your birth control is easy, but the 12 different medications my grandmother was on towards the end of her life wasn't an easy balance, and her doctors weren't always talking, hence a lot of potential issues.

So the question isn't whether pharmacists are just "glorified pill dispensers" (which, they are not), it's whether anyone in a profession that dispenses products has the right to say certain products or certain people shouldn't have x, y, z. That is what is wrong with the policy. That is what needs to change.

kkc, EVERY sperm is sacred. :)

Maybe we go to different pharmacies.

My pharmy is useless. It's up to me and my doc to keep track of my prescriptions, 'cause they won't. One time they asked if I needed the prescription explained to me and I said, "Yes." They just stammered and finally mumbled something about how I could look it up online. Gee, thanks guys.

I'd much rather go to a mechanized pill dispenser than my pharmy. But if you've got a good one, then that's awesome.

This is probably totally OT, but if you ask to talk to the actual pharmacist instead of the techs, you get the right treatment. Remember when there was the strike at Walgreens? Walgreens kept the pharmacy's running by skirting under some rule about managers and techs being able to do something or another. They? Don't have a clue. Those pharmacies are a nightmare. I had to hunt around to get a good one. I finally got the impetus to do something when I got pregnant and wanted to make sure some of the stuff I needed would be safe. Walgreens looked at me like I was an idiot for asking, the new CVS has pharmacists on staff all hours the pharmacy is open.

I think pharmacists should be able to refuse to provide EC based on strongly held moral or religious beliefs. Doctors aren't required to perform abortions, or even learn about it in medical school, and if a pharmacist is in the 'life begins at conception' camp, then they shouldn't be forced to dispense a drug that will prevent that life from coming to fruition.

As long as patients are referred to another pharmacy or pharmacist who will help them within the 72 hour period, then that pharmacist has done their duty. The sticky situations come when the woman comes to the pharmacy at 70 hours, or if it's a small town and another pharmacist won't be working within that period.

lilianna28 said:
"...there is a LOT of work involved in being a pharmacist, and the good ones do a lot of work in terms of making sure that your multiple prescriptions from multiple doctors are correct, in checking over the prescriptions, keeping current on the things doctors often don't have time for."

I totally agree. Pharmacists do so much work that they don't get credit for. They go to pharmacy school for 4 years (usually after several years of undergrad science courses), do oral and written licensing exams and mandatory continuing education courses, and as a result, they know more about drug compositions, side effects and interactions than most doctors will ever know. Ask any pharmacist and they'll tell you how many times a day they have to phone doctors to fix prescription mistakes.

This is not as issue of pharmacists being "glorified pill dispensers", it's a moral debate that, like most moral debates, can easily degenerate into misinformed insults.

SkylarKD:

Doctors aren't required to perform abortions, or even learn about it in medical school,

A pharmacist refusing to provide EC because of religious belief is in the same category as an allergy specialist refusing to provide allergy treatments because of religious belief, or a Nissan mechanic that refuses to work on foreign cars out of patriotism, or a cop that refuses to arrest white people. No matter what you think of the basic belief, the only ethical time to make it is before you take the job that requires it... or, I suppose, after you've resigned.

Another way to look at it is this: sure, pharmacists shouldn't be required to dispense anything. But they aren't. They can always leave their jobs. Pharmacies, on the other hand, should be required to fill all prescriptions. If they want to employ enough pharmacists that they can have one that will fill all prescriptions, then I suppose it doesn't matter if they have another hired as well that doesn't -- but a pharmacy that refuses to fill prescriptions should lose its license to operate.

and if a pharmacist is in the 'life begins at conception' camp, then they shouldn't be forced to dispense a drug that will prevent that life from coming to fruition.

As long as patients are referred to another pharmacy or pharmacist who will help them within the 72 hour period, then that pharmacist has done their duty. The sticky situations come when the woman comes to the pharmacy at 70 hours, or if it's a small town and another pharmacist won't be working within that period.

Completely agree with Zed, here. I'd also like to add that it seems to be less about "moral reservations" than about a blatant attempt to restrict women's access to contraception. (Not unlike so-called "crisis pregnancy centers"). I couldn't imagine that sort of thing happening in Europe... The parmacist would be immediately fired and probably lose his license.

SkylarKD:

"As long as patients are referred to another pharmacy or pharmacist who will help them within the 72 hour period, then that pharmacist has done their duty. The sticky situations come when the woman comes to the pharmacy at 70 hours, or if it's a small town and another pharmacist won't be working within that period."

Not necessarily true. My friend had to take EC on Monday, and had waited 36 hours to do so. Because she had waited more than 24 hours, and because she's in the middle of her cycle, she also had to get a coil fitted.

SkylarKD:

"As long as patients are referred to another pharmacy or pharmacist who will help them within the 72 hour period, then that pharmacist has done their duty. The sticky situations come when the woman comes to the pharmacy at 70 hours, or if it's a small town and another pharmacist won't be working within that period."

It's not true that a woman won't get pregnant as long as they take EC before the 72 hours are up. My friend had to take EC on Monday, and had waited 36 hours to do so. Because she had waited more than 24 hours, and because she's in the middle of her cycle, she also had to get a coil fitted.

In the end, if someone works as a pharmacist and doesn't want to dispense drugs, they ought to get a different job.

Boy, my unique turns of phrases really do get people worked up, no?

I wasn't pharmy bashing. If I was pharmy bashing, you'd know. My point was just that the main job of the pharmacist is to dispense medication in the correct quantities. NOT to interpret whether the patient "needs" the medication or not - that's the doctor's job. The pharmy isn't qualified to make those assumptions - all they are qualified to do is understand the nature of the meds themselves.

That said, before someone else tells me how effing awesome pharmacists are, I read a few weeks ago that something like 70% of fatal medication accidents are the fault of pharmacists who fucked up the prescription. And I don't want to hear that doctors' handwriting is hard to read - if you're dealing with life and death and there's the slightest question in your mind, you call to make certain you're dispensing proper quantities. So, actually, I would *prefer* a mechanized pill dispenser that measured out exact quantities and wouldn't over/under medicate me. I'm thinking like those paint mixers at the hardware store that add 1 part X, 2 parts Y, and shake like mad. Very efficient, and the side effects could be printed out while you wait.

Also, "4 years of school" doesn't necessarily make you a medical expert. Doctors take, what? Twice that? Three times that? Anecdotally, I have a girlfriend who went to pharmacist school and is now employed at Walgreens. I wouldn't trust her not to serve me bleach if it was next to the Sprite. Nyah.

I seem to remember that there was a fundy pharmacist college out there somewhere that was specifically training misgynist pharmacists to deny meds to women. Does anyone remember this? I can't find it, but I'm sure I read about it.
The organization that seems to have the main heft here is a group of fundy whackos called "Pharmacists for Life". A quick perusal of their website would disabuse anyone of the notion that these are rational people making ethical decisions. On one page they actually state "There is no human right to have sex"**, apparently in defense of their hatred for women who do.
SkylarKD, just because I have to add my two cents...
a pharmacist refusing to dispense EC is akin to a doctor refusing to perform a vasectomy because s/he believes all sex should be an act of procreation. Can you imagine the world of sh*t we'd be in if that were the case?
**For more evidence of the unsound minds of the pharmacists' choice movement, check out the Population Research Institute, which asserts that birth control leads to “increased promiscuity, adultery and prostitution, and to perverse sexual practices, including homosexual practices..� Oddly, they never make it clear what exactly is wrong with that. ;-)

How does birth control lead to homosexual practices? All those lesbians who can now go wild knowing they won't get preggers??

It's stupid, anyway.

First of all, if you think birth control is a form of abortion, you have absolutely no business being in the medical field. Seriously, get out.

Second, pharmacists are NOT doctors. They are not even remotely qualified to decide whether I need a certain medication or not. A lot of women take BC for hormonal purposes. I knew a girl who was (really!) a virgin until her mid-twenties, but she'd been on BC for years on doctor's orders. Without it, her hormones were seriously out of whack. It was funny, because she was a Christian and was afraid that BC would make her slutty, but she later found that BC isn't a magic thigh-spreader (which is what the Christians claim).

Third, your morals are YOUR problem. If you're a Scientologist and you don't want to give out anti-depressants, then for fuck's sake, don't be a pharmacist.

Since when did it become appropriate for other people's religion to incovenience folks? Know what? I've got a new religion. My religion says that if you don't give me my birth control when I need it, I get to smack you in the face with a weasel. Don't like it? Tough shit. :)

Damn, work piles up and I don't sign on for a couple days, and the threads go wild!

I'm converting to your religion, EJ. This is such bullshit.

And just to chime in on this nonsense: "As long as patients are referred to another pharmacy or pharmacist who will help them within the 72 hour period, then that pharmacist has done their duty."

Wrong. Why should I have to put forth extra effort because of somebody else's religious beliefs? When I go to a restaurant and order a steak listed on their menu, the waiter doesn't get to refuse to serve it to me because he or she is a vegetarian and finds meat-eating immoral. The waiter has not done his or her duty if he or she directs me to another restaurant. The waiter has no right to impose his or her religious/moral judgments on me whatsoever. Neither does the pharamacist.

The pharmacist seems to want to hew to his religious beliefs without inconveniencing himself at all. If his religious beliefs are so important to him, he can express that devotion by finding another job. But his religious beliefs are not important to me. Why should I be the one inconvenienced for something I don't believe in? He wants to believe? Then he can carry the weight of that belief.

We'll run out of weasels.

You put it very nicely - Religious devotion should be a burden on the follower. Religious devotion is not expressed by riding down Easy Street and running over pedestrians.

People seem to be really weird these days, though, in terms of their beliefs. I remember two years ago, I was a waitress at a steakhouse. A woman came in and frowned at the menu for a few minutes, then demanded to know what "Vegan" dishes we had. I'm pretty ignorant and don't totally understand the difference between Vegan and Vegetarian. I suggested several salads and/or veggie dishes, but each one was unsuitable for some reason or another (One salad was no good because it had eggs in it. I told her we could leave the eggs off, but she wanted no part of it.)

Eventually she got really furious and shouted at me a bit before a manager noticed the commotion and came over to deal. She ended up walking out without eating.

I never understood her reaction. If you're going to have a specialized diet, surely it can't be totally shocking when some places fail to accommodate you? You do your research, go where you want to eat, and if you fail to find something you like, you politely leave. I especially thought it was odd that she seemed downright offended that a steakhouse would serve meat. It was surreal.

All that to say that some people don't realize that the world wasn't designed to accommodate their special desires.

Addendum: If these pharmacists REALLY want to be pharmacists, yet don't want to give BC, can't they start a non-BC pharmacy?

I'm sure plenty of Christians would take their business there as a gesture of solidarity. And the older, "regular" pharmacies could get on with giving us our medication.

Is that fair compromise, do you think?

Wait a minute--a vegan walked into a steakhouse and was upset that she couldn't find anything to eat?

Jeez, I'd love to see someone try to pull that nonsense at Peter Luger's in Brooklyn. I could suggest the tomato-and-onion salad (slices of beefsteak tomatoes alternate with slices of raw onion--and that's it), and then I could order the porterhouse, and sit back, and watch!

People are so weird. I'm going to try something like this, though. I'm going to walk into my local multiplex and demand that they bring me books to read. Then, later this semester, when my students ask me for grades, I'm going to tell them that I am morally opposed to hierarchical grading systems and that I shouldn't be penalized for my beliefs. I'll report back about how far I get!

EG, have you ever read "The Zen of Motorcycle Maintenance"? A teacher in the book does just that - he refuses to inform the class how they are doing, grade-wise, because he thinks it discourages learning.

Half of them were so afraid they'd lose their scholarships, they dropped out of the class and/or had nervous breakdowns. I know I would. His superiors were pissed.

He thought it was a grand idea, but I thought he was something of a prick. But I dislike it when my profs think it's funny to fuck with my head.

Oh, and it would seem that the Vegan didn't want anything with cheese/butter/milk/cream in it. I've just got to ask, to any Vegans on the board: What do you guys EAT? I think I'd die without milk and cheese.

A teacher in the book does just that - he refuses to inform the class how they are doing, grade-wise, because he thinks it discourages learning.

I thought Phaedrus did more than just that - he wanted to abolish grades entirely, and let students learn on their own without any carrot but knowledge or any stick but ignorance. Then at the end when he asked the class whether he should really do it for that course, saying "yes" was strongly correlated with higher grades, not lower grades.

EJ:

Addendum: If these pharmacists REALLY want to be pharmacists, yet don't want to give BC, can't they start a non-BC pharmacy?

Actually, in retrospect, I think that doesn't work either, though I'd have to consult a lawyer with the appropriate specialization: refusing to fill a prescription based on religious reasons is effectively the same as denying service to a customer on the basis of religion. If a pharmacy is considered a "place of public accomodation" (which I'm not sure it is), or if it receives federal funding (which I'm not sure of either), then there may be a violation of the Civil Rights Act or one of the laws that built upon it.

Meh. I didn't care about his reasoning. It was exactly the sort of shit one of my teachers was trying to pull that year and it pissed me off.

Like it or not, we need some way to rate students - otherwise the frat boys will booze their way through school and the industries won't be able to tell us hard workers from the loafers.

And as long as the system is structured around scholarships, we A students NEED to know how we're doing. Who hasn't had to drop a class or face losing their scholarship? In a situation like that, it's unethical to deny students the right to meaningful feedback.

Plus, the Zen guy was just so smug.

Zed,

Love the name for the "pharmacies".

The cynic in me doubts that the Civil Rights Act would hold up in this case. It's interesting, but the thing is, they don't care what religion *I* am - therefore they aren't discriminating against me. After all, they refuse to provide the pills to everyone equally. Frustrating.

Is that fair compromise, do you think?

In big cities like New York it is. In small towns where there is only one pharmacy, which will likely be non-BC, and where the nearest abortion clinic is a hundred kilometers away, it isn't.

I've just got to ask, to any Vegans on the board: What do you guys EAT? I think I'd die without milk and cheese.

I think that when my ex was vegan, she'd eat various vegetables, tofu, bread, and rice. I know that some very poor first-worlders live on rice and beans, so it is in principle possible to be vegan.

And as long as the system is structured around scholarships, we A students NEED to know how we're doing. Who hasn't had to drop a class or face losing their scholarship?

I'm fairly certain my college classmates in Singapore had little trouble keeping their scholarships, even when they mostly got B's. I've never heard any of them say anything about losing their scholarships if their grades got too low; my scholarship was grade-independent, but it wasn't full.

That's not to say I wasn't concerned by grades. I was obsessed with them, and I loathed the system for enforcing deliberate vagueness about midterm grades. I'd end up constantly asking friendly lecturers things like whether a 78% was a B or an A-. Grade competition isn't a very good thing, but it's better than making post-collegiate achievement based even more on who you know and how well you can con interviewers.

That's why I said they had to start a brand-new pharmacy. That way, there'd always be two in the area: Regular and Fundy.

Re: Grades.
I had to maintain a 3.8 for four years in a system where an A- was a 3.7. In order to get an A, one needed 95% in a class. I was a nervous wreck some years and I literally checked my grades on a weekly basis with my teachers. If I dropped my scholarship, I would have been forced out of school (for monetary reasons) and I didn't want that.

Ouch... I only got my cumulative GPA above 3.8 in my last semester. I applied to grad school with a 3.72.

But yeah, in the system you describe, concealing grades is cruel. That said, it's mostly an argument for making scholarships easier to obtain; there's something wrong with a system that requires you to be brilliant or rich to get a degree.

It wouldn't have been _quite_ so bad if my advisor hadn't put my in a senior level class my first semester. She was a &^%#-ing idiot and swore it would fulfill my Intro to Speech requirement. The class nearly killed me and I couldn't drop it because I had to keep 12 hours (full-time) or lose the scholarship. And, in the end, I had to take Speech anyway. (rolls eyes)

But now I realize I'm VERY off topic so I'm going to shut up before the blogging gods strike down my iNet connection.

I found this particular thread interesting since I am very close to becoming a pharmacist. I graduate in May '07. Do not be afraid to ask your pharmacist ANY questions you have about your medications. Filling/dispensing prescriptions is a small part of a pharmacist's job. We are drug therapy experts, and we are required by law to counsel ALL patients who have questions about the pharmacology of drugs, why they are on a certain medication, and how to properly take their drugs (either OTC or Rx). Pharmacists, since the 1990s, graduate from a Doctorate of Pharmacy program which takes 6 (soon to be 7) years to complete. After your sophomore year in college, you apply to the professional program. Therefore, pharmacists nowadays have earned the title of 'doctor.' After 6 years, many pharmacists choose to enter residencies (2 more years), where they specialize in a certain area of medicine or disease state. As a future clinical pharmacist, I look forward to establishing relationships with each of my patients. I know this is aside from the issue, but if anyone has questions about the future practice of pharmacy (I would be happy to tell you more), please leave me a post. I enjoy my chosen field very much. Lindsey