To be up front about this, I don't think contraception is a bad thing. But I think a pharmacist is within his rights to refuse to stock contraceptives if he doesn't want to. If you need birth control, just go to the nearest pharmacy that does stock it. I don't see what's so terrible about that, unless you live in a rural area where the next-closest pharmacy is ten miles away. However, simply the fact that you don't agree with his views doesn't mean that he shouldn't have the right to express those views.

tdd -

The exception is the problem.

Rural areas in my new home state of Wisconsin are incredibly conservative. Areas where doctors, hospitals and pharmacies are located can be few and far between in the Northwestern part of the state.

So if someone needs birth control and their one and only "local" store doesn't stock it, why should they have to drive an hour or more out of their way to an area that's more centrist than conservative?

As I said in my other, much longer post: you don't go into the medical profession to proselytize. It's not appropriate and grossly against medical ethics. And it's against freedom of religion, which endorses not only tolerance of your beliefs, but tolerance of other beliefs as well.

If you feel that strongly about pro-life issues, then don't put yourself in a professional position where you are forced to make those choices - for yourself or another person.

Well, you may not see it, but it is terrible.

A pharmacist may not agree with sex change operations, breast enhancement, or people getting fat by eating too much, but he cannot and should not withhold prescriptions from people who are undergoing treatments for these things. Same with contraception. Would it not have occurred to someone considering this profession that they would face this issue? They should consider a different profession.

They are entitled to their beliefs, and nothing prohibits them from writing letters or protesting or whatever. But their chosen profession dictates they obey the doctors' decisions, as others have so correctly pointed out. Why should their belief trump a patient's belief that this prescription is needed and ought to be filled?

Do you really want a society in the future in which businesses are lined up along a street separated by religious affiliation? The Catholic Go For It family planning clinic? The Muslim Guzzler car dealership? The Mormon Protective Underwear store? The Baptist Don't Touch dancing academy? The Far Right Aid pharmacy?

I also think that birth control is just fine. I have a problem with the larger issue of telling people what they must or must not sell in their stores.

It isn't too far a leap to see other products, medical or non-medical, being stigmatized for some reason or another. We could easily wind up with a crazy-quilt of conscience and regulation-based inventories, and won't that be fun?

tdd, to say we should 'respect the views' of a pharmacist who's on some kind of moral high horse is quite silly. Would you 'respect the views' of a bank teller who refused to give you your money, because they thought it was for your own good? Or a cashier at your local grocery store who refused to sell you meat because they happened to be vegan? Of course not; you'd think they were being meddlesome and ridiculous, and completely overstepping their bounds. That's essentially what's happening with these pharmacists. Now normally, capitalism would take care of this, but apparently some pharmacies are particularly irrational about money, and it directly affects the health of those it serves. Even you acknowledge that long travel distances are a potential issue here.

crowe:

They are entitled to their beliefs, and nothing prohibits them from writing letters or protesting or whatever. But their chosen profession dictates they obey the doctors' decisions, as others have so correctly pointed out. Why should their belief trump a patient's belief that this prescription is needed and ought to be filled?

I don't mean to pick on you, but the pharmacist profession definitely does not dictate following doctor's decisions. Do you really think a pharmacist goes to school for 6 years to learn to read a prescription and then find it on the shelf and give it to a patient. Pharmacists know drug effects and interaction better than doctors because that is what they study. If a patient is harmed because of a known interaction between drugs they are taking the pharmacist is just as responsible as the doctor. And if a patient's belief on a needed prescription should trump a pharmacist, then why shouldn't it trump their doctor, and then why are prescriptions even needed if the patient's belief is what is important?

While I don't think that drugs should be denied on specifically religious/moral grounds, these arguments always include additional debates such as depression, long-term fertility, effects on future children, etc., which are typically don't have evidence to support the claims, but frequently also lack evident to conclusively repute. These grey areas are not easy to separate.

If you want my solution, I feel there should be a limit for when pharmacists can deny medications based on their beliefs based on access to the drug, i.e. if there are other pharmacies nearby that will provide the drug. I would recommend some sort of monopoly based law (used to restrict phone and cable companies where only one choice is available), and require pharmacies to state outright if they do not provide certain medications so a patient can go to another store.

Why doesn't NOW set one up, just for BCP, Fed Ex. etc for rapid turn around? But some people would rather bitch about than solve problems, and expect the other guy to bend to their will.

rapple37:

crowe:

They are entitled to their beliefs, and nothing prohibits them from writing letters or protesting or whatever. But their chosen profession dictates they obey the doctors' decisions, as others have so correctly pointed out. Why should their belief trump a patient's belief that this prescription is needed and ought to be filled?

I don't mean to pick on you, but the pharmacist profession definitely does not dictate following doctor's decisions. Do you really think a pharmacist goes to school for 6 years to learn to read a prescription and then find it on the shelf and give it to a patient. Pharmacists know drug effects and interaction better than doctors because that is what they study. If a patient is harmed because of a known interaction between drugs they are taking the pharmacist is just as responsible as the doctor. And if a patient's belief on a needed prescription should trump a pharmacist, then why shouldn't it trump their doctor, and then why are prescriptions even needed if the patient's belief is what is important?

While I don't think that drugs should be denied on specifically religious/moral grounds, these arguments always include additional debates such as depression, long-term fertility, effects on future children, etc., which are typically don't have evidence to support the claims, but frequently also lack evident to conclusively repute. These grey areas are not easy to separate.

If you want my solution, I feel there should be a limit for when pharmacists can deny medications based on their beliefs based on access to the drug, i.e. if there are other pharmacies nearby that will provide the drug. I would recommend some sort of monopoly based law (used to restrict phone and cable companies where only one choice is available), and require pharmacies to state outright if they do not provide certain medications so a patient can go to another store.

Pharmacies choose to stock or not stock certain drugs more often than you think. Nobody gets up in arms if a pharmacy decides to stock one anti-depressant over another. Hell, I doubt many people would be that offended if a pharmacy decided they didn't want to stock any of those ubiquitous "male enhancement" pills on moral grounds.

When you refer to birth control as "medically necessary," you're placing it on the same level as, say, heart medication. Unwanted pregnancies are something that should be prevented, but really, condoms (when properly used) are just as effective in achieving that goal, and they have the added bonus of helping to prevent the spread of STDs (though they're not 100 percent effective at that.) And they don't require a prescription to get.

Suppose I own a sporting goods store, but don't want to sell guns, even though they are legal. Are you going to tell me that I have to stock and sell guns?

If I own a grocery store, and don't want to sell meat, I won't sell meat. What makes you think that just becasue I sell flour and apples, I also have to sell meat?

Now, an employee needs to follow his employer's wishes or get a new job. But a business owner should be able to decide on his own product line.

fitzpatrick,

Guns and meat are not medical necessities.

On choosing to enter the medical profession, a pharmacist chooses to enter a business in which public health concerns necessarily outweigh personal moral judgments.

We make laws to protect the public health: places that serve food are required to have bathrooms; restaurants and grocery stores are subject to public health inspections; and while grocery stores are not required to sell milk, they are often required NOT to sell unpasteurized milk

In the interest of public health, it should be illegal for a licensed pharmacist to refuse to fill a doctor's prescription on moral grounds.

Selene212:

fitzpatrick,

Guns and meat are not medical necessities.

On choosing to enter the medical profession, a pharmacist chooses to enter a business in which public health concerns necessarily outweigh personal moral judgments.

We make laws to protect the public health: places that serve food are required to have bathrooms; restaurants and grocery stores are subject to public health inspections; and while grocery stores are not required to sell milk, they are often required NOT to sell unpasteurized milk

In the interest of public health, it should be illegal for a licensed pharmacist to refuse to fill a doctor's prescription on moral grounds.

Dialysis machines are medical necessities, too. Should they be lined up next to the stereos at Best Buy?

Meanwhile, Saletan gave a number of reasons why allowing pharmacists to refuse to dispense certain prescriptions does not endanger the public health. Rather than simply state the opposite, you might provide some support for your statement.

For what it's worth, I completely reject the notion that the arbitrary and nebulous "public health" outweighs my personal moral judgment. It might be nice if laws really worked that way, but they don't and never have. Unpasteurized milk can be safe, while pasteurized milk can be unsafe.

If you're really interested in debating the moral point, check Messy's thread for my question about vaginal closure sutures.

Best Buy is not an establishment that deals with health care.

If you can list on valid reason Saletan offered, I'll happily refute it, but I do not have the time to quote his article here and take you line by line to explain why the things he said are wrong. So you tell me what the convincing ones are, and I will refute them for you.

And public health has to be the end all be all in a health care institution like a pharmacy. Public health is unquestionably more important than the fact that some pharmacist wants to punish women for having sex. And frankly, trying to punish someone with pregnancy is one of the most unethical behaviors I can think of without considering direct physical violence.

tdd:

When you refer to birth control as "medically necessary," you're placing it on the same level as, say, heart medication. Unwanted pregnancies are something that should be prevented, but really, condoms (when properly used) are just as effective in achieving that goal, and they have the added bonus of helping to prevent the spread of STDs (though they're not 100 percent effective at that.) And they don't require a prescription to get.

Hormonal birth control pills can be medically necessary in certain situations. They are not used simply to prevent pregnancy but also to regulate various gynecological issues. For example, painful and irregular periods, ovarian cysts, and endometriosis. I take them primarily to avoid having to take two days off school each month because my cramping was so strong that I would vomit for a day. I tried menstruation specific prescription pain killers but hormonal birth control is the only thing that has really worked.

Further, birth control pills are more effective than condoms even when condoms are used properly. Although I agree that if you are sexually active and you are not in a monogamous relationship, then you should be using a condom probably in combination with hormonal birth control.

However, I think it is a little out of line to suggest that there is no medical reason for birth control pills when there pretty clearly is.

No, the proper exercise of moral judgment is unquestionably more important than public health.

See? I can make unsubstatiated absolute statements, too.

Regarding dialysis: should pharmacies be compelled to provide it? How about hospitals? Please note that not all hospitals provide it, and that many patients travel long distances to receive it. Without it, they would die in a few days.

Here are two of Saletan's more powerful arguments:

'First: "Walling off" women's health care? Beware dramatic metaphors from lawyers. There is no wall. You bring your scrip to the pharmacy, and the guy at the counter says, "Sorry, we don't stock contraceptives." That's annoying and, in my view, stupid. But nobody's walling you in. Your burden consists of finding another pharmacy.'

'Third: "Professional obligations" to provide all health care? Actually, doctors and hospitals draw moral lines around their practices all the time. This doctor won't pull the plug; that one won't do abortions; this other one can't in good conscience collaborate in your faith-based treatment plan.'

Don't forget that Salaten also reported that a total of 7 (count 'em, seven) pharmacies in the U.S. had signed this pact. The rest of 'em want to make money, and that includes WalMart, the conservatives favorite. The problem you will run into is if you require a pharmacy to stock the "morning after" pill. Some pharmacies, who may not want to stock that, may feel compelled to dump all birth control in order to get out of that one. But they are in the minority. There's an EEOC case going on between some former pharmacists and Walgreens, who fired those guys because they refused to dispense the morning after pill. Get that, Walgreens FIRED THEM!!! Really, I don't think it's that big of a problem. Most mom & pop pharmacies have gone under anyway, replaced by big chains like CVS, Walgreens and WalMart, who really want to make money, so really I don't think there's any reason to panic just yet.