The Wonders Of Modern Medicine

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. 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 ethics. 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.

Jason Coleman is a licensed professional engineer who practices in Richmond, Virginia. His wife, Angela, is a licensed Doctor of Pharmacy and he never tells her to shut up under any circumstances.

Note: This article was originally published on JasonColeman.net under a Creative Commons license.