Pharmacists, and fulfilling prescriptions against that go against their moral beliefs

Great Debates
41

In Ohio, one of the states proposing/using compounding pharmacies as mentioned in the other thread, at least, we don’t explicitly have a conscience clause law applicable to pharmacists, the way some states do, but we likewise don’t have any law stating that we must fill any given prescription–at least, not that I can find. This pretty much leaves us in a state with conditions matching what Bricker believes should be the case. We can refuse on conscience grounds, but it won’t necessarily protect us from being fired. Personally, I’m ok with this, though I have no problems giving out contraception, and don’t work in a compounding pharmacy where I’d run the risk of having to choose between compounding the pentobarbital or using a judgement of conscience and refusing.

Now, I’m not a lawyer, just a pharmacist with way too much time on his hands today, but I can see a legal out for the pharmacist in the case of the death penalty drugs, at least here in Ohio, since I don’t think you can legally be fired for refusing to break the law (I could be wrong).

Ohio Administrative Code 4729-5-30 (A) states:

A prescription, to be valid, must be issued for a legitimate medical purpose by an individual prescriber acting in the usual course of his/her professional practice. The responsibility for the proper prescribing is upon the prescriber, but a corresponding responsibility rests with the pharmacist who dispenses the prescription. An order purporting to be a prescription issued not in the usual course of bona fide treatment of a patient is not a prescription and the person knowingly dispensing such a purported prescription, as well as the person issuing it, shall be subject to the penalties of law.

(1) It can be argued that preparing a dangerous drug product to be administered for the purposes of execution is not a legitimate medical purpose, since it is neither treating with the intention of helping the patient with a medical complaint, nor is it euthanasia done at the request of a suffering patient with a terminal disease for the purpose of ending their suffering (something not legal in Ohio anyways), thus it fails to satisfy the requirements necessary to fill.

(2) Recognized prescribers are covered under OAC Rule 4729-5-15, yet the Ohio Department of Rehabilitation and Corrections policy on this issue (recently revised to this) allows for the Health Care Administrator or HCA designee to “order execution drugs from a licensed pharmacist at the Central Pharmacy of the Department of Mental Health, or any other licensed pharmacist,” neither of whom are listed in the Rule as recognized prescribers. Assuming the role is currently filled by a physician, Nurse Practitioner, or Physician Assistant, though, you still have to deal with at least the appearance that they aren’t acting in the “usual course of his/her practice” in this regard, and a pharmacist could refuse to fill on those grounds.

(3) You are also stuck with OAC 4729-9-21 (F) which states:
A prescription shall be compounded and dispensed only pursuant to a specific order for an individual patient issued by a prescriber. A limited quantity may be compounded in anticipation of prescription drug orders based on routine, regularly observed prescribing patterns.

One interpretration of this could mean that you can’t therefore legally treat this compound as a drug sale between two Terminal Distributors to get around 4729-5-30. Nor can you use ORC 4729.01(C)(5) or OAC 4729-9-25(A) since the latter specifically ends with “the
preparations are used to treat an emergency situation, an unanticipated procedure for which a time delay would negatively affect a patient outcome, or for diagnostic purposes.” The situation wouldn’t be an emergency, since the ODRC document calls for the Warden to check drug stock status approximately 14 days before the execution is scheduled, nor is it an unanticipated procedure, nor would it negatively affect a patient outcome, nor can you say it is being used for the purposes of diagnosis.

Because of (1)-(3) above, it can be argued that you can’t define use of pentobarbital (or hydromorphone+midazolam) for the purpose of execution as a “usual course in the bona fide treatment of a patient”, and the order is therefore legally not a prescription.

If any/all of these previous statements are true, then a pharmacist cannot fill the prescription, else they are at risk (however minimal) of being found guilty of breaking the law. Of course, the Board of Pharmacy or the State Legislature could change the rules to allow compounding pharmacies to explicitly do this, or decline to prosecute at their discretion, but until I read something official from them, I could see erring on the side of caution when it came to preparing the pentobarbital.

42

I didn’t realize the Medieval Era lasted until 1964 (when the last execution was carried out in the England, your native country).

As for the OP, I have mixed feelings. Since the state licenses the sale of prescription drugs, thus limiting their availability to the public, it would seem reasonable to require al pharmacists to be willing to fulfill all legal prescriptions. OTOH, we have a long history of religious tolerance, especially when it comes to making someone kill against his will. We also have a long history of legal abortion, but not using state funds to finance abortions.

One way to deal with this might be to require pharmacies that employ “conscientious objectors” to display signs indicating that such pharmacists are employed here and to indicated where the nearest place to fill the prescriptions would be. And I don’t think any pharmacy should be required to hire such “conscientious objectors” either.

43

So what would denying birth control have done to me?

Kill me.

I managed to get a sterilization at a very young age because a third pregnancy would very probably have killed me. So instead of horking down a pill every morning, or dying, I got a tubal ligation. If a tubal wasn’t available, my only recourse would have been the pill. And before you mention condoms - being female there is always the mild possibility of rape [and I was actually raped twice, once by violent action and once as date rape.] The pill is the only way a woman can assure that she does not reproduce even in the presence of rape. The pill is one way women with PCOS can control the seriously painful and generally negative physical effects their body puts them through. There are a number of ways that hormone pills are used to balance out the body that are not pregnancy related. It is up to the damned doctor to decide, not the person tasked with dispensing what the doctor considers that patient to require.

Thanks all you jackasses that think that the pill is for harlots. Just dispense the freaking things and shut the hell up. It is not your body nor your decision to make.

44

Your definition of “aggression” is ludicrous. By that reasoning, I’m performing acts of aggression - after all, I’m not selling them birth control either.

45

They do seem to cure recidivism.

46

You aren’t authorized and licensed by the government to be a medical gatekeeper. It’s not your job. So no, that analogy doesn’t work.

And calling it aggression is no more “ludicrous” than calling burning crops in war aggression. They are both attempts to deny someone something they need out of malice.

47

Agreed. Personal ethics compete with company policy in almost every job. If the boss says to dispense birth control or lethal injection drugs, both legal products, then you either do it or face a job loss. If YOU are the boss, then you get to make those choices.

I would add, though, that company owners can’t sit in their ivory tower, secure in the fact that since they own the company, that’s the end of the story. As others have said in the thread, they must report to their customers and face a boycott if they take sides in the culture war instead of just dispensing legal drugs. A business owner treads into the political arena at his own peril. The employee might lose his job. The business owner might lose his house.

48

If I burn their crops, you would have a point. If I burn my crops to deny them to the enemy, that cannot reasonably be called aggression.

49

Certainly it can, when the enemy are your own people and not invaders. Dictators have done that sort of thing all the time to starve populations they dislike or distrust.

Opposition to abortion and contraception is about persecuting women, and women are the enemy whom this aggression is aimed at. They can’t get away with beating women with clubs like, say, Saudi Arabian religious enforcers, so they do things like this instead.

50

Der Trihs, you should know better than this.

In effect, your need to cast those with whom you disagree in the worst possible light can be extremely detrimental to any form of discussion and distracts from reasonable debate.

In the above post, you characterize a group of people with beliefs differing from yours as bullies (by your repeated use of the word ‘aggression’) and bigots. Instead of dealing with people as individuals you seem to prefer to treat them as classes of beings. This is no different than a true bigot holding erroneous beliefs about ‘all jews’ or ‘all blacks’. It is offensive and makes you a lightning rod for those who would - whether intentionally or not - alter the course of what could be a reasonable debate.

And that I will not permit.

Over-the-top comments - which seem to come from you on a regular basis - are out of line. You should think hard before you again accuse an entire group of people of ‘punishing the slut’ or being bigots when they simply disagree with you. Barring direct evidence in posts or public statements such statements as yours serve no purpose. Hell, you equate - in the post above - those who oppose birth control with a straw man that goes around murdering - through the secret denial of life-saving drugs - HIV positive persons. There is no means by which you can justify that statement on a rational basis.

The sad thing is that I - and those paying attention - know that you CAN post in a reasonable manner. You do so in other fora on the boards. You do so the majority of the time in Great Debates. You must learn to control your posting style so that you - the intelligent and passionate man you appear to be - will be taken seriously and stop racking up warnings.

It is not hard to find ways to express disagreement with the viewpoints of others that does not lead to the insult direct or over-the-top accusations. I encourage you to expand your linguistic horizons. In time, I believe you’ll enjoy debate more when you find you don’t need to resort to bomb throwing accusations that mean little and, honestly, only serve to make others - even those who might agree with your politics for the most part - take you less seriously than you might hope.

Of course, if you must do so, the BBQ Pit is one click away. There you may attack and accuse other posters and groups to your hearts content. But in Great Debates you may not.

Warning issued. Don’t do it again.

51

Actually, as someone currently working as a pharmacy tech for CVS that’s not the way it works with pharmacists for a good reason.

For example, I know several pharmacists who will not do early refills on the drug Trazadone because they feel it should be classified as a controlled substance and therefore would be extremely hesitant about filling it early due to concerns about addiction or abuse.

Also, while the FDA allows up to 5 refills on controlled substances levels III-V, many if not most pharmacists will be extremely cautious about too many refills in between a patient visiting the doctor.

I also have never met anyone in the business who would argue that pharmacists shouldn’t have the right to refuse to dispense a medication to someone if they had medical concerns.

Obviously birth control is a completely different story.

I’m reasonably sure if you thought about it you’d reconsider your opinion.

52

(bolding by me)

Neither of your two examples go against ‘moral beliefs’ and both fall under the ‘drug interaction’ principles - the first one is maybe a bit dodgy, but there is no rule requiring you to ‘refill early’ either, and I’m sure you make exceptions when a patient may be headed out of town, etc - so both of these are strawmen arguments and not what is being discussed in this specific thread.

If there is a legitimate medical concern over the prescription - there are controls in place, right? you call the prescribing doctor and/or the patient to discuss - right?

To the bolded part - what do you mean? that the pharmacist should or should not allow their ‘conscience’ to be involved in filling the valid, legal prescription?

53

Ethics and morality are different things. My morality prevents me from being a criminal defense lawyer, which would require me to use a technicality to get a guilty man off, despite the fact that it goes against my personal morals. So I don’t do criminal work. Legal ethics would trump my personal morality if I did that kind of work. Basically, I swear to do my job right and society goes awry if I don’t.

54

I think you’ve misconstrued my post. I was responding to Yog’s post where he claimed that pharmacist have no right to refuse a drug to a valid customer so long as the drug isn’t going to be used for illegal means.

I pointed out this isn’t true and for good reason and gave examples why pharmacists shouldn’t be forced to do so. I should add there are countless other reasons why pharmacists could refuse to dispense that I would classify under legitimate medical reasons.

I wasn’t disputing his implicit argument that a pharmacist who refuses to dispense oral contraceptives should find a new profession. I happen to agree with that.

I don’t see any legitimate reason to refuse to dispense it except for things like it would blunt the effect of another medication the patient was taking, particularly if the other medication was a maintenance medication.

I also think there are some significant differences between dispensing contraceptives and these “execution pills”.

Birth control has been around since the Eisenhower Administration and every who’s gone to Pharmacy school since then has known they’d be expected to dispense it.

Obviously these “execution prescriptions” are something new. In fact, I’m not even sure if most pharmacists have even heard of them turning to local pharmacies instead of the prison pharmacy and they’re not something pharmacists would expect to have to dispense.

Also, the women purchasing the birth control are not being compelled to take them and were the pharmacist to be given some reason to believe that she was doing so under extreme duress(I can’t think of any off the top of my head but people with better imaginations might come up with one) then I would, were I the pharmacist, refuse to dispense the medication and alert the police.

The prisoners by contrast are being forced to take them and there is no medical reason for taking them.

I’d say more but it’s Friday night and I’ve been drinking.

55

In the UK Pharmacists do not have to dispense abortifacients as they are used to destroy a fetus and this makes it an issue of conscience; this is written into the Act that controls Pharmacists.

I see this as reasonable allowance for strongly held feelings- similarly doctors and nurses cannot be required by their employers to participate in terminations of pregnancy.

Medical practitioners and such worldwide are seen to have and awarded special privileges because of their dedication to sanctity of life. Each state should respect that.

I am totally against state killing whether it is death camps in Poland in the forties, gulags in Russia in the fifties, death squads in China or judicial killings in the US. Forcing medical personnel to take part in any of these activities (which were all legal at the time within those states) should be avoided by any country claiming to value human life.

56

I see no problem with this- it is a question of killings by a state in each instance.

The Talmud seems to agree:

Talmud, Sanhedrin 37a states:

“FOR THIS REASON WAS MAN CREATED ALONE, TO TEACH THEE THAT WHOSOEVER DESTROYS A SINGLE SOUL… SCRIPTURE IMPUTES [GUILT] TO HIM AS THOUGH HE HAD DESTROYED A COMPLETE WORLD; AND WHOSOEVER PRESERVES A SINGLE SOUL…, SCRIPTURE ASCRIBES [MERIT] TO HIM AS THOUGH HE HAD PRESERVED A COMPLETE WORLD.”

Each execution by a state is its own holocaust.

57

Shariah Law prescribes the lex talonis- if a man has thrown acid in a woman’s face, he may have acid thrown in his by the prescribed authrities.

I believe the same law is used as a defence for judicial killing in the US.

58

First no, that is not the law that capital punishment is based on in the United States.

Second, the argument about whether a single execution in a first world country is equivalent to the holocaust or death camps or whatever is not an interesting discussion. It’s a nonsense discussion and one that is too absurd to take seriously.

59

Lex Talionis is often quoted in debates in State Legislatures when the question of judicial killing comes up.

The whole basis of this thread is that Legislators are having to scramble for new death drugs now that other countries are refusing to sell the means of judicial killing to the USA on moral grounds. The traditional drugs are not made in the US and other more enlightened countries such as Italy and the UK have made it impossible for them to be supplied for the intention of killing prisoners. Hence the search for a cocktail of drugs that can be sourced in the United States and applications to pharmacies for therapeutic drugs for the purpose of killing. As has been pointed out above, even this may be in contradiction of State Laws on Medicines (Ohio Law was quoted.)

Some of us consider any killing by the state to be obnoxious.

60

It’s not the basis for capital punishment in the United States.

Right, and the thread is specifically about whether or not pharmacists should be able to refuse to provide said drugs on moral grounds. Specifically when you also consider the issue of abortion pills/contraceptives and how many of the same people who oppose the death penalty also support abortion rights and would oppose pharmacists having discretion to dispense or not dispense them.

No one but you is droning on about the US versus the world debate, and as I said–it isn’t an interesting one. It’s not new or novel, and really is a different debate than the one about pharmacy dispensing.