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

Great Debates
61

This is a good analogy, but I don’t agree with your conclusion. You are a lawyer that refuses to do criminal work. Why can’t someone be a pharmacist who refuses to dispense birth control and/or lethal injection drugs?

Just because you are a lawyer doesn’t oblige you to take every case and every type of case that comes through your front door. Being a pharmacist, likewise doesn’t (shouldn’t) obligate him to dispense every single medication in the world.

The parallel argument is that since you became admitted to the Bar, you should be required to do criminal work (6th amendment, notions of justice, etc.) because who else but lawyers would do it, and “society goes awry” if you get to pick and choose which type of clients you represent.

You’ve limited your classification to “not a criminal defense lawyer,” but kept a broad classification for “pharmacists.”

62

I thought technically (and this is based on the worst sort of pop culture knowledge) in some contexts a judge could literally grab a lawyer who just happened to be milling about and make them work a case.

63

Which kind of begs the question - if execution drugs aren’t serving a theraputic purpose, why would pharmacies carry them and how big of a problem is this?

I probably can’t go to my local Target or Walgreens with a prescription for these and get it filled (I’ve had to drive to specialty pharmacies to get specialty antibiotics and steroids at times), and it sounds like these aren’t even really used in a hospital setting for anesthesia, so what kind of pharmacy carries them and how big is this issue. Sounds like pharmacists who object would have lots of options to work in roles where this isn’t an issue.

Its kind of being an associate at a law firm - you work on the cases you get, or you find another law firm. If you think the cases aren’t ethical, that’s a problem, but even mob bosses and cheating dickwad spouses are entitled to representation - the best representation you can give. When you are the partner, you can turn down cases, until then - either suck it up or find a different job.

(I just quit a job this Spring in part due to ethics considerations).

64

Again, this is non-responsive to the thread and the discussion. In addition, you are both arguing with my instructions and failing to heed them.

Warning issued. Any more and things will not go well for you.

65

I believe it’s already been mentioned, several of the execution drugs do have a therapeutic purpose.

Sodium thiopental is a barbiturate used pretty regularly therapeutically. In fact it is, per wiki:

Pancuronium bromide is a muscle relaxant frequently used in surgery.

Potassium chloride is just a salt, and not controlled or limited by manufacture at all. It’s easily obtainable by you or me and is even a table-salt substitute. A huge dose of it stops the heart, but it can’t be used by itself because I believe the effect would basically be akin to giving someone (and making them endure) a heart attack and that’s unlikely to pass the “cruel and unusual” sniff test.

The logic of the three drug cocktail starts with potassium chloride being pretty effective at stopping the heart, so that insures with a high likelihood the person is going to die. Pancuronium bromide when given in execution doses basically shuts down all your muscles including your diaphragm and thus would cause you to asphyxiate (so yet another lethal dose of a drug being administered.) The sodium thiopental is a powerful anesthestic, so the negative/unpleasant experience of being dosed with the other two injections is not experienced by the condemned as sodium thiopental (or pentobarbital) is administered first.

Both pancuronium bromide and potassium chloride would be unpleasant to experience conscious. The pancuronium bromide you’d basically die of suffocation, potassium chloride apparently when injected at a high dose is extremely painful at the IV point and then all the way up the through the vein as it travels, and then eventually it will cause your heart to stop.

So all the materials used in a lethal injection do have therapeutic use. I don’t know if a regular CVS would carry either sodium thiopental or pancuronium bromide as they appear to primarily be used in a surgical setting (I’m guessing they’d be regularly available at a hospital, though.)

One of the longstanding concerns with the three drug cocktail is two of the three drugs would cause a lot of suffering if the person wasn’t properly anesthetized by the first drug. This is why some States have moved towards a one-drug approach using only sodium thiopental or pentobarbital as it basically is “failure proof.” The condemned is just given a massive does of the barbiturate, they lose consciousness and die. No worrying about the other two drugs working.

But it’s also the first drug in the cocktail, the barbiturate, that has been supply limited. A Danish company is the only manufacturer of pentobarbital and an American company with a factory in Italy was the only supplier of sodium thiopental and both sources have taken measures to prevent their product being used in lethal injections. So the States that went to the one drug method don’t have any option for those drugs other than a compounding pharmacy.

They’ve also considered using propofol (of Michael Jackson fame) to replace the barbiturates, but apparently the company in Europe that manufactures it threatened supply restrictions if it was used in an execution so Missouri abandoned its plans to use the drug. [As a side note I find it strange with all the U.S. pharmaceutical companies we don’t appear to have any domestic production of three different anesthetic agents that at least appear to be used somewhat frequently in clinical settings.] I would guess propofol probably is stocked in a regular pharmacy? If Michael Jackson’s GP was able to get it regularly for him, anyway.

In places like the Netherlands that have physician assisted suicide a high barbiturate dose to start followed by using pancuronium bromide to stop breathing is considered part of the standard protocol.

66

I’m against the death penalty in general so don’t really mind supply issues stopping executions, but I do wonder why the execution system was set up using a three-drug cocktail and dependent on drugs that have poor supply availability for such a purpose. I understand that after the Furman decision States had to dramatically alter their execution process and I believe subsequent rulings since then have made things like hanging, firing squad and electrocution no longer a go, too.

But why not just use nitrogen gas? It’s not painful or unpleasant, you just get sleepy, fall asleep, and never wake up. Unlike the gas chambers used in America in the past, it isn’t dangerous to nearby corrections staff and doesn’t really have the same association with Nazi Germany that you have with using the chemical tablet/poison gas system.

Various techniques utilizing nitrogen are heavily promoted by euthanasia advocates as a painless, highly effective way to end your life yourself in places where you cannot get physician assisted suicide (which is most of the world.)

67

snipped and bolded by me - My only point was that the reasons you cited were not ‘morals’ based but based on the bolded part above - a legitimate medical concern -

After discussing the situation with the Dr and/or patient - do you still refuse?

IMHO (wrong forum, I know) - is that the ‘execution prescription’ is a red-herring anyway - I seriously doubt that the pharmacy provider is getting a prescription from Dr. X for Patient Y for ‘1 execution cocktail to be taken with a last meal - be sure to drink plenty of water’ - they are getting orders for the items themselves, and the prison/judicial system is the one doing the rest of the determination.

The whole notion that an individual pharmacist at the local drugstore has any play in that is laughable. Potentially the person pulling the order together might or if its something that has to be ‘compounded’ - then the person/persons doing that might, but even that is a stretch.

68

Thanks, Martin. It sounds like this would be more of an issue for a hospital pharmacist since than your local CVS pharmacist. And I doubt the corrections staff is hopping down to CVS to pick up supplies for the execution anyway. Which means pharmacists who are facing this issue do have a choice, switch specialties away from practicing in a hospital or compounding pharmacy that is close enough to a prison with a death row to have to fill this order.

I’m not a big fan of the death penalty either, but I really don’t see that the pharmacists gets a say in filling prescriptions, unless there is a drug interaction, possible error, or abuse concern, in which case they need to be talking to the physician who makes the call.

69

I think one important test of the soundness of a moral system is: would you want to live in a society where everyone operates under that moral code? So, would you want to live in a society without criminal defense attorneys? A society where people accused of a crime do not have the right to an attorney?

Alternatively, we could allow CDAs who firmly believe a client is guilty (that is, you have clear evidence the person committed the crime) to recuse themselves from the case. In fact, is that not the case in the US? I ask that as an honest question to the lawyers here. If I have video of my client committing murder, mustn’t I disclose that evidence or at least inform the judge? Or, am I on firm legal ground if I suppress that evidence and go about my business getting the guy off on a technicality?

However, if I “think” the client is guilty, that’s not enough. We know where such a system leads.

70

Also since nitrogen is abundantly available in our air, getting it for any purpose is quite easy. Even if all the industrial gas suppliers opted not to supply nitrogen to a prison system, you can straight up buy generators that produce natural gas from compressed air for under $20,000 all in (and for the highly infrequent nature of executions these small scale nitrogen generators would more than fulfill demand–most likely only a single one would need to be purchased per State that wanted to use nitrogen in executions.) Considering I think it costs over $30,000 on average to house an inmate for a single year, and that death row inmates are even more expensive because of the lengthy legal appeals process and the fact they typically are housed separately and in individual cells, and the cost of the nitrogen generator is almost nothing in the grand scheme of a Department of Corrections budget.

71

I always thought defense attorneys couldn’t disclose evidence of guilt they acquired through the attorney-client relationship. But if their client tells them in their office “I’m guilty, I did it” the attorney also can’t lie to the court. So the client admitting guilt limits the type of legal defense strategies the attorney can engage in, but they can still try to get them acquitted or pick apart pieces of the prosecution’s case.

72

I agree with you. All analogies are false and break down if carried far enough. Suppose you are a doctor on a hike with a pregnant woman. Something comes up and she needs an instant abortion or she will die. You are against all abortions. But you are the only person who could possibly do this so she can live. Your ethics as a doctor require it, your morals prohibit it. I think you perform the abortion and deal with your moral breach, or the woman dies and you lose your license in a disciplinary proceeding.

73

Short, short answer: In a minority of U.S. jurisdictions, you must disclose the video. In a majority, you are not required to disclose the video.

However, even under this majority rule, you owe a duty of candor to the court. Knowing that the client was guilty, you couldn’t affirmatively argue that your client was actually in Cancun when the murder took place. You would be limited to arguing constitutional issues and reasonable doubt. That’s why almost all criminal defense lawyers refrain from asking their clients if they are guilty. If the answer is “yes” then they can’t present facts that suggest “no” to the court.

74

I agree with this. Plus **John Mace **is correct in that some jurisdictions in this country, a judge can see you on the street and appoint you to an indigent criminal case. You would be faced with the same choice in that situation.

As a side note, I have no such moral quandary. The guilty child molester has every right to competent representation and a diligent defense in court. In my mind, if I am able to get the guilty child molester off on the charges, it’s the fault of the police and the prosecutors for not doing a better job and/or our constitutional protections being such that the evidence wasn’t good enough to keep him in jail. Amend the constitution or do a better job on the police/prosecutor side. Keep the system honest.

75

That’s my understanding too. I also would make a lousy prosecutor because I would feel terrible about sending most guilty people to prison for too long a term. Same with being a judge. I have no problem with long sentences for violent crimes, but the sentences frequently are too long and for crimes that are not violent enough to justify them. IMHO. I could not seek or impose the death penalty.

76

The pharmacist is licensed gatekeeper to the drugs. He does not own them, he can’t simply decide to do whatever he wants with them

Those all deal with illegal abuse of drugs which I specified was the exception. The pharmacist is within their rights to be on the lookout for abuse, fraud, or dangerous effects of having an unusual amount or type. The opposition to birth control is not about its abuse or illegality but its precise and inherent nature. The proper dosage and use of birth control is what these idiot pharmacists are against. There is nothing except the pharmacist’s own moral component standing in the way, which makes it an arrogant and detestable criteria for him to make women overcome

77

Just to be clear, that was someone else who posted that, not me.

78

We’ve had these debates before and pharmacists are more than medicine dispensation facilitators. They are people with consciences and that conscience might tell them that morning after pills or even birth control is evil. Just like you can’t force a doctor to perform an abortion, you cannot force a pharmacist to dispense a drug. If the doctor is an employee, this refusal can result in termination, just as it can with a pharmacist that is an employee. But a doctor that owns their own practice or a pharmacist that owns their pharmacy can do whatever the fuck they want no matter how much you want that birth control or abortion.

Now there are some state laws that violate this principle by permitting pharmacists to express their personal beliefs (and refuse to dispense abortion pills) without the fear of termination. there are other states that force pharmacists to dispense some drugs against their conscience. But that doesn’t make them right.

So in your case, I think the pharmacist can refuse to dispense the drug if they own their own pharmacy but could get fired for such refusal if they worked for someone else.

79

People act like pharmacists are agents of the state or something. They are no more constrained than doctors or priests or lawyers. I would argue that they are less constrained than any of these.

Lawyers are officers of the court and legal ethics might require them to defend a child rapist even if they are morally offended by the notion of criminal defense.

Doctors have an ethical duty to preserve life so they might have to provide medical services to a child rapist that gets shot by the child’s mother after the child rapist gets off on a technicality.

Pharmacists are also subject to ethical restrictions that might force them to provide anti-biotics and pain-killer for the child rapist. But their ethics do not require them to dispense morning after pills or lethal injection drugs.

80

I’m from Ohio and I am a little familiar with the sourcing debate in regards to lethal injection. A pharmacist does not have to be involved at any stage since any chemical can be purchased from a research chemical supplier online. Pentobarbital can be purchased here:
http://www.sigmaaldrich.com/catalog/product/sigma/p3761?lang=en&region=US
http://chem2drug.blogspot.com/