Allow me to clarify:
Better?
ETA: Directed at stretch.
Your views on abortion might enter into this specific case (re: Plan B), but not the general debate that we’re covering.
I kind of figured. It’s a world of difference, though.
Agreed. It certainly shouldn’t turn into a tit-for-tat kind of situation.
I think this completely overgeneralizes the debate, and makes it too top heavy to work with. For example, if we go this route, then we’d have to include the amount of influence possessed by the pharmaceutical companies, as well. They each have their own separate influences, and should consequently be debated separately.
And I think you might have been oversimplifying what the Pharmacist’s Manual says. This is the main part (bolding mine):
So, you’re right in that the pharmacist should refuse to fill a prescription of Vicodin, for a diagnosis of chickenpox. It’s not really a blank check, though (i.e., he can’t refuse to fill a script for Vicodin just because he thinks some maximum strength Tylenol would work just as well).
I didn’t see any mention of addiction suspicions, though, which I am curious about.
LilShieste
I don’t think that was the confusing part. (See my above post.)
LilShieste
Maintaining an addiction is not considered a valid form of medical treatment.
ETA: I was actually referring to stretch confusion about not seeing the part that said the pharmacist had a legal obligation to refuse a prescription in some cases.
Okay, fair enough. I withdraw the accusation of density.
Care to address my post now? Specifically, please provide a cite to Roe v. Wade that supports your contention that it provides that “ethics shouldn’t overrule morals”, that Plan B is an abortifacient, and that pharmacists in Washington have "the choice on whether or not to particpate in the transaction. "
Ahh, didn’t think of it like that. Thanks for the clarification.
LilShieste
Except that what you are saying is not true. Condoms and regular birth control prevent conception. This pill ‘might’ prevent conception, but mainly prevents the zygote from attaching to the wall of the uterus.
It’s not about ‘My’ views, but about the views of the pharmacist, and they ARE quite relevant. Defining the territory is a common debate tactic, but I’m not buying into it here.
Wrong. It mainly prevents ovulation (and therefore conception), and MIGHT prevent the zygote (if there is one) from attaching to the wall of the uterus, but there is no commonly accepted scientific explanation for how or why it might do so.
I may be a few days late in responding to this but here goes anyways. A Pharm.D goes through the same amount of school as an MD. Each program is 4 years long post-undergrad. With MD’s/DO’s it’s 2 years of didactic (classroom) training, followed by 2 years of clinical training (there’s some crossover, but as overwhelming trends this is true). With a Pharm.D, it’s 3 years didactic, and 1 year actual clinical experience.
The key difference is that by and large, a Residency after graduation from Med school (and passage of 2 of the 3 parts of the USMLE prior to entering the residency) is required, while a Residency after graduation from Pharmacy School is voluntary (the same is true for DVMs, DDSs, and ODs, as far as I know).
Will answers from Princeton suit you?
Here’s one link.
Plan B is no more likely to cause an abortion than regular birth control pills or other hormonal methods.
To be more precise, as far as we’re taught in Pharmacy school, it’s primary mechanism is prevention of ovulation (via feedback inhibition of GnRH). Should ovulation have already occured by the time the pill is taken, it’s secondary method is the same as progestin-only birth control pills (which are roughly 1/10th the dose you get from Plan B)–it thickens the cervical mucus (hereafter referred to as “icky-sticky”) and prevents the sperm from reaching the egg in the uterus. Finally, as a last resort, it prevents implantation by altering the uterine wall so that the egg can’t easily implant (or implant at all). And recent studies seem to suggest this may not happen at all, and that even if it does, it’s a very minor part of it’s mechanism.
You’re blending two issues.
A place of business may, or may not, stock any given product, as decided by its owner.
As for an employee deciding on his own that he doesn’t want to dispense it – well, I’d rather sleep in than go to work, but they pay me to do the latter. If you don’t like doing your job, find another one.
Where does it say they must refuse to fill the scrip based on their supposition of addiction? Where does it say that they must refuse to fill the scrip and substitute their own apparently vastly superior knowledge? There is no way for the pharmacist to know if the patient if maintaining an addiction or is receiving valid medical treatment.
Please explain to me how that language says they must refuse to fill a scrip when they can’t know if it’s medically needed or not without talking to the prescribing physician. I don’t see the language as telling them they get to make this determination on their own.
As far as I’m aware, having a prescription does NOT give you the “right” to receive a medicine. A pharmacist who refuses to dispense a medication is not violating your “right” at all. A prescription is an authorization from a physician to a legally registered terminal distributor (in most cases, a pharmacy) that a patient is allowed to be on x medicine at y dose with z instructions. Were a prescription a right, we could not refuse to give you the medicine even if you couldn’t pay for it.
The laws in most of the pharmacy practice acts that I have read only give you the requirements of what the pharmacist must do if he/she DOES dispense the medicine. None that I have seen, save the 3 states previously mentioned, REQUIRE a pharmacist to dispense. Now, in some cases, we can be held liable if we didn’t dispense a medicine IF not doing so directly resulted in “harm” to the patient, but I’m not entirely sure pregnancy would be considered harm in most states (I doubt it).
Ummm… the references to morals that I could find all refer to the AMA resolution you noted in your first quote. I fail to see how the AMA could rule on Roe v. Wade. Your point remains unproven. Please provide a cite that Roe v. Wade creates the concept that ethics shouldn’t override morals. It’s also worth noting that the AMA resolution speaks specifically to abortion and not any other medical procedure which makes it irrelevant for Plan B and the AMA has no authority over pharmacists so it doesn’t really matter what resolution they passed.
You keep referring to it as abortion. You keep using the ethics/morals of abortion as a justification for the position that the pharmacist is not obligated to assist and yet it’s not necessary to show that Plan B is actually causing an abortion? Seriously, I am completely puzzled here.
Well that’s not what you said, but now we’ve each misinterpreted a post by the other, so we’ll call it draw.
Explicitly? I’m not sure it’s actually stated explicitly in the law. Neither is the right to privacy, nor is Separation of Church & State–but the courts have held that those ARE fact nonetheless. It’s implicit, however, using several other related laws.
First, maintenance of addiction is not, as ladyfoxfyre has pointed out, a legitimate medical use (I know this is true in Ohio where I’m interning at the very least, and as far as I know this is actually based on federal statutes and state statutes both). Treatment of addiction is legitimate; however, for narcotics, only a registered treatment provider can do so–a regular physician in the normal course of his practice cannot.
Secondly, a pharmacist could dispense the medicine to a person suspected of addiction if he/she so chose–but doing so opens him to liability if the addict in question is ever charged or the doctor prescribing is investigated.
Third, in a lot of cases, the pharmacist may actually have a better idea of the patient’s addiction status than a physician would–patients who doctor shop rarely (if ever) share that they are receiving narcotics from different doctors with the prescribing physician–a pharmacist (especially in a chain like Walgreen’s with a centralized database) often has access to medication profiles which show the names of different prescribing doctors for controlled substances while the prescribing physician likely does not. Pharmacists also generally have a good idea of the dosing regimens used to treat pain, versus treatment of addiction, and we’re trained to examine closely for signs of addiction. Of course, in my personal opinion, any pharmacist who suspects addiction should contact any physicians involved and work with them rather than make the determination on their own, but a pharmacist technically can refuse to fill the prescription without doing so.
Please explain to me how that language says they must refuse to fill a scrip when they can’t know if it’s medically needed or not without talking to the prescribing physician. I don’t see the language as telling them they get to make this determination on their own.
[/QUOTE]
The phrase “professional judgement” encompasses decisions such as this, actually. Ideally, the pharmacist WILL contact the physician, but it’s not, strictly speaking, required.
JayRx1981, thank you for your response. I believe that pharmacists should use their best professional judgement. Best professional judgement does not include personal beliefs or personal morals.
I’m cool with them thinking mr.stretch may have a problem, but not refusing to dispense just because they think he may have a problem. I’m cool with them talking with the prescribing doctor and discussing their belief that he may have a problem, and then filling the scrip when the doctor says to do so. I am not happy with them deciding that they can refuse to dispense a med based on their subjective belief that someone may be abusing.
All of this is hypothetical because we’ve never had this problem with a pharmacist–no one has refused to fill mr.stretch’s Percodan over the last 18 months he’s been taking it, or with filling his Vicodin for the year he took an metric assload of that.
I’ve had a different problem with a pharmacist, but that’s a whole 'nother rant. Anyone want to talk about how pharmacists get confused as to HIPPA? We can start a new thread!
Personally, I agree. From a standpoint of professional ethics, I agree as well. However, from a purely legal standpoint, doing so is not illegal in most states (as far as I’m aware–I’m only really able to comment on Ohio as I know its rules the best).
Oftentimes, I’d agree, that the assessment that someone filling a lot of controlled substances is likely abusing them is incorrect. Fairly often, a patient taking more than the prescribed dose over a given days supply is not doing so because he’s addicted–he’s doing it because he’s still in pain and is being undertreated (at least, in my experience and the experience of our pain profs).
Of course, the reason he’s being undertreated is actually related to the reason some pharmacists jump to the worst case scenario for a conclusion–the prescriber himself is thinking of liability and the ever-present threat of a DEA or Board Audit if he gives out “too many” controlled substances in a period. So, at least in regards to pain meds, it usually comes down to liability.
Siege, well then I suppose it is due to your lack of sloth that I am thus edified.
Thank you. I concede.