One Utah

Over at Denialism, PalMD, an internist, writes:

When a pharmacist receives a prescription from a physician that they believe may pose a threat to a patient, they call the doctor. For example, if I were to write a prescription for levothyroxine 125mg daily, the pharmacist would call me up to see if I meant micrograms rather than milligrams (125 mg is a helluva lot of this drug). If I tell the pharmacist to shut up and dispense the damned drug as written, they might refuse to pending further research, discussion, etc. This often happens with opiates. I may prescribe a cancer patient a very large dose of morphine and the pharmacist will call me to confirm. I’ll explain that they have been on this dose and tolerated it well, and the pharmacist will likely be satisfied that I know what I’m doing.

A pharmacist that receives a properly written prescription for a medication that any reasonable doctor would consider safe may not ethically refuse to fill it. The doctor and patient are the ones who make the decision on what meds are proper. In this case the pharmacists only remaining job, after checking for allergies and drug interactions, is to fill the legal prescription. If they don’t wish to do that, they should be fired, just as the check-out clerk would be fired for refusing to ring up a candy bar (and no, it doesn’t matter how fat the customer is). It has come up frequently that pharmacists sometimes refuse to fill birth control pills. This is unconscionable. The doctor and patient have a clinical relationship; the pharmacist in this instance is an intermediary, and could theoretically be replace by a sophisticated vending machine. Hmmm….

Now of course this is written from the doctor’s perspective but it makes sense to me. The doctor and the patient have a clinical relationship. The doctor knows the patient’s history and medical needs and determines the appropriate course of treatment. To have a pharmacist come along and refuse to dispense the medication the doctor and patient have agreed to is a violation. The pharmacist has substituted his uninformed judgement for the doctor’s informed judgment. His actions have the potential to actively and immediately harm the patient.

There have been instances in which rape victims have been forced to visit mulitiple pharmacies to get their legal prescriptions of emergency contraception - because the pharmacists refused to fill such “immoral” prescriptions.

What about an instance in which case a doctor disagrees with a patient’s ethical or moral perspective?

If a young woman comes to me wishing to terminate a pregnancy, and I tell her it is tantamount to killing a child, it means something very different to her than if she sees it on a billboard. If I oppose abortion, and feel I wish to be a “conscientious objector”, to share that with the patient is no longer an act of conscience, but an act of coercion. It is a desertion of my duty as a physician.

This entry was posted Wednesday, August 6th, 2008 at 3:28 pm and is filed under Contraception. You can leave a response, or trackback from your own site.