G'Day Guys. I'm really enjoying being a part of Suicide Girls - it's quite an interesting site, with a lot of stuff that gets my interest.
Of course, being a pharmacist, I thought I'd give the old search engine a bit of a run and see how many other pharmacists are on here.
Not fucking many, I must say.
What did turn up, though, is a whole bunch of outrage . . . . . . .
You see, a few years ago someone posted an article about a pharmacist refusing to supply medication due to their own personal morals. You can see the article in question here.
Target and the Pharmacist Refusal Issue
There is also a blog here, wherein the question is asked, "Do you think a pharmacist has a right to do this? [refuse a sale on moral grounds]"
The comments really are very interesting, and I'm sort of sorry that I wasn't around to make comments at the time. I don't see the point in digging up old threads though, so hence, this post.
So here is the question, what is it that a pharmacist does????
Just as a background - I'm in Australia. there are differences in legislation between countries, but the basic function of a pharmacist is the same.
Our role is to safeguard the use of medications, ensuring that a patient receives the best care that we are able to provide. If we are unable to provide this care, we MUST be capable of ensuring that there is as little delay in doing so.
So, just what the fuck does this actually mean?
Here is a bit of a list of some of the things that a pharmacist does:
- We interpret a doctors intentions, and provide medication prescribed by a doctor IF, in our PROFESSIONAL OPINION, this is in the best interest of the patient's health
- We provide advice on the correct use of medications
That's pretty straight forward, isn't it? Of course, there is a lot involved with the job, otherwise anyone could do it. It is important to note the capitalisation in that first point, though.
Pharmacists are professionals. We do a fuck-ton of training so that we understand human physiology and anatomy to a similar level as other allied health professionals. We also train in the pharmacology of medications (ie their actions at cellular and molecular level). What this means is that our understanding of physiology and anatomy is similar to that of a doctor, but our EXPERTISE in this area is not the same.
On the other hand, when it comes to pharmacology - the action of medications - any pharmacist worth his salt knows far far more than any GP about medications. Sure, there are medical specialists who will have a working knowledge of specific drugs that will be better than mine, but as a general rule, I know more about medication than doctors do.
Why is that even relevant?
Because my role as a pharmacist is to make sure that when a doctor prescribes a medication, he is not in fact harming his patient. In my pharmacy (which is rural), I dispense approximately 250 prescriptions per day, and supply about 400 Over The Counter medications. Bugger me, that's a lot isn't it!
Anyway, of the prescriptions I dispense, I would say I contact the doctor to clarify or CORRECT something about 1 in 10 times - that's 25 times on average a day.
So, to get back to the point, there was a lot of discussion recently about whether a pharmacist has a right to refuse the supply of medication. There was quite a shit-storm, I must say. Of the people who say "No", the majority of the objections were made based on the fact that the medication in question was a form of contraception, and the decision was moral. Of those who say "Yes", the only really outspoken opinion came from the point of "the government can't make you do shit!!!!!!!"
Unfortunately, everyone missed the point. I especially loved this post. Now I don't want to specifically single out people who responded, but this post really does encapsulate the heated nature of people's opinions.
As I stated above, pharmacists are professionals. We are not automatons put in our roles to blindly fill a script just because a doctor wrote it. If that were our role, why would we be here at all? Why not just have doctors in dispensaries? Because health is a fucking complex science, and you can't expect one health professional to be enough to deal with it.
Pharmacists actually have an obligation to refuse the sale of medication if we deem it (in our own opinion - how dare we have an opinion!!!) to be unsafe for the patient (note the wording - I did not say "in their best interest").
So, the next question is, was this what the pharmacist from Target was doing? is this what This Asshole did?
The answer is no. Resoundingly No.
The reason these people are wrong is because they are basing their decision on the REASON someone is doing something, rather than the OUTCOME of them doing it.
Perhaps a bit of my own personal opinions should be revealed here:
1 - I am not religious. I personally feel this makes my job easier, as I form my own opinions, rather than have them guided by doctrine.
2 - I am fairly liberal in my points of view . . .
3 - I believe that a person has a right to make decisions about their own health.
4 - I believe that abortion is an acceptable choice for people to make, but that it is ultimately the choice of the female.
5 - I accept that people will always abuse narcotics and other substances, and that this does not mean they are not entitled to health care. I also believe that any person seeking help for addiction should be given this help with the utmost dignity.
So, where does this leave me standing in the case presented in the blog & news article that I linked to earlier?
As far as moral objections - I don't have any to anything as far as my job is concerned. If you wish to use a medication in the manner than it was intended, and this use does not constitute harm to yourself, then I will sell you the medication in question, and give you guidance on the best way to use that medication for that purpose.
As for professional objections, you bet your fucking ass I will refuse point-blank if i believe that the medication you are seeking will harm yourself or others, or if the purpose for which you intend to use that medication is harmful.
So, how about some examples:
1) Young girl comes to me and asks for emergency contraception. I will counsel this patient on the correct use of the medication, what to do if something goes wrong (like vomiting), and how to follow up (do a test in three weeks, see your doctor for regular contraception, refer for counselling if abuse is involved, etc).
2) male comes to me and asks for the same product - I advise this person that I cannot sell this product to them without counselling the person who will be using the medication. WHY? because they might get it wrong and end up pregnant, or (unfortunately) they may be intending to give this to a sexual partner without their knowledge
It is important to note, as well, that contraceptives don't end a pregnancy. They prevent them. This is irrelevant though, because I'd sell RU486 if I agreed that the patient was not at risk. The reason is because the patient is the woman, not the fetus.
I actually refuse medications on a regular basis. I refuse to sell promethazine (an antihistamine) for children under 2 years of age - even when it has been recommended by a doctor - because it is STRONGLY associated with sudden infant death syndrome in this population. I've had a mother absolutely ropeable with me for refusing this, and said I had no right to refuse a doctor's orders. I still refused, telling her I understand that getting no sleep because your child won't sleep is difficult, but I could not sell it to her. A few weeks later, she talked to me again, and said now that she understood the risks, she is glad I refused.
I regularly refuse the sale of strong pain killers, pseudoephedrine, and prescriptions for valium and similar medications, because in my professional opinion, they were causing more harm than benefit. Should I sell a medication to a drug addict that I know they will misuse? Is it better that they get something "pure" from me rather than see a drug dealer? the answer is no. Abusing the types of pain killers available without a prescription in Australia will lead to rapid liver and kidney failure. If a patient is addicted to narcotics, they can choose to remain addicted, or they can seek treatment. If they choose to instead see a drug dealer, that is their choice. I will always refer them to a treatment programme - if they choose to ignore this and see a dealer, that is THEIR choice, and not a consequence of my refusal.
I have also refused to supply oxycontin to patients. This is a very difficult thing to do, because it can be hard to determine if a patient is in chronic pain, or if they are acting in order to receive narcotics to abuse or sell.
A recent example involved a married couple who were both on very large quantities of these medications. I refused to supply early, because there was no clinical reason for them to have run out of their medications so soon. It turns out they had run out, because they were selling over 16000mg of oxycontin a month. They lived in government housing and drove a shit car, but every room in their house (when it was raided) had a flat screen TV, and no appliance in the house was over a year old.
In this case, not only was I preventing harm to themselves (they were crushing and injection the medications, which cause cause arterial or venous collapse and gangrene, organ failure and death), but I was also preventing them from harming others in the community.
So there you have it - an opinion from someone actually required to make such decisions, on whether refusal to supply is the correct thing to do.
I'll refer to this link in closing - You're entitled to your beliefs - we are entitled to our beliefs, but this is a professional job - our own opinions can't sway our professional obligations - only our professional expertise can. It is, in fact, IMMORAL to inflict your own morals on another person to their detriment. It is also IMMORAL to neglect your professional duty in order to satisfy a patient's demands, or anyone else's demands.
