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It should come as no surprise to anyone that we have countless ethical and moral dilemmas everyday on this planet. With over six billion people, each with their own upbringing, there are bound to be conflicts between people. So many people having so many different religions; so many others doing as they feel is right, whether that be considered socially right or wrong. Conflicts might as well be expected in this world of ours.
America, the great melting pot of the world, is merely a smaller model of the same situation. A great example of this is what is now known as the Pharmacists Conscience Clause. Many pharmacists are not happy with their work because they are forced to fill a prescribed order for a drug, whether or not they agree with its purpose. This clause, if passed in the legislature of a state, allows the pharmacist, in short, to decide according to their own morals and beliefs whether they will give a prescribed medication to a client.
This is causing huge controversy already, and it has a long way to go before it will be law of the land. Although, it is hoped by many that this will become law of our land as well as all others. On one hand, is this newly created clause giving an absurd amount of power to pharmacists? Or is it enough? Do pharmacists deserve more say in a prescription that this clause will allow them? It is the aim of this paper to answer these questions.
It is my belief that this Conscience Clause, with amendment, will provide a fair amount of power to pharmacists and thus will create a workable solution to the said problem. Before anything, let us show the written Pharmacists Conscience Clause. This clause, as revised by the 1998 American Pharmaceutical Association reads: 1. ) APhA recognizes the individual pharmacists right to exercise conscientious refusal and supports the establishment of systems to ensure patient access to legally prescribed therapy without compromising the pharmacists right of conscientious refusal. 2. ) APhA shall appoint a council to serve as a resource for the profession in addressing and understanding ethical issues. (Brauer, 1) I would agree that this Pharmacists Conscience Clause does a good job of giving power to the Pharmacist. Also, I would agree that the idea of creating a council is a bit of genius.
It is rather obvious that the future will be filled with people challenging different instances. However, I dont feel that enough power is kept in the hands of the people with this Pharmacists Conscience Clause. Pharmacists are obviously very intelligent and skilled people, as they must attend college. However, the average person sees them completing tasks that a robot could finish. For as much as you or I see of them, they merely read a prescription and get the medicine.
Granted, it may take an entire year of college to be able to read a doctors handwriting. Still, this is almost a humiliation for their profession. Why hire college graduates and pay tens of thousands of dollars per year when any person off the street could do this work? Because pharmacists must have a vast knowledge of what any given medication will do to a person. They study chemistry, physics, biology, and various other health science courses which will teach them the effects of all types of drugs. And why is this education necessary if it cannot be used?
This is a question that many pharmacists are asking themselves. A part of the hopeful answer to this problem has come in the form of this conscience clause. According to the Michigan Occupational Information System (MOIS), a pharmacists general job tasks include verifying prescriptions; weighing, measuring and mixing drugs; determining the identity, purity and strength of medications; dispensing medications; ensuring that patients understand instructions on medications; monitoring medication therapy of patients; keeping comprehensive records of patients; sorting and preserving drugs; and finally ordering and maintaining supplies. Because of the extensive records and such that pharmacists keep, they have a good handle on each of their patients. They also, with few exceptions, know much more about the prescribed medication and how it will affect the patient.
For this reason alone they feel they should have the right to counsel their patients to some extent. Some pharmacists feel that they should be allowed to outright hold a medication from a patient. According to Gallup Poll, for the last eight years, pharmacists have been rated as the most trusted [professional] (even above clergy) (Brauer and Gargaro, 1). The true question, however, is whether this trust can last long if a pharmacist cannot legally hold from dispensing medication if they believe it will be harmful to the patient. What boundaries does a pharmacist have with their clients? Do they have a professional, if not moral, obligation to counsel their clients?
Should they go so far as to withhold medication? It is only fair to say that this conscience clause is only hoping to be a step in the right direction. Not all pharmacists support it. In fact, it is most largely supported by pro-life pharmacists.
Currently, it is most often used when a pharmacist doesnt believe in dispensing abortifacient morning after pills (MAP) which are intended for birth control but can be used after conception as a sort of early abortion. Because of this Pharmacists for Life International (PFLI) is most actively behind the Pharmacists Conscience Clause. The biggest problem resides in that pharmacists are using this clause whether or not it is law in their state. Currently, it has been passed in South Dakota, New Jersey, Louisiana, California, Wisconsin, Puerto Rico, and the Canadian province of Alberta (Brauer, 1). Though it is snowballing in its movement around the nation and eventually the world it is far from accepted around the US as a whole. The biggest current problems lie in nationwide chains such as K-Mart and Wal-Mart.
These pharmacists are being required, under penalty of their job, to fulfill all valid prescriptions. This is a case which has been brought into our own home state of Indiana. On Dec. 19, 1996, Karen Brauer, a resident of Lawrenceburg, Indiana, lost her job at a Cincinnati K-Mart because she was unwilling to dispense Micro Nor, a mini pill for the purpose of birth control. However, she feels that the pill is used more often as a MAP than as an actual birth control pill. She had worked for K-Mart for seven years prior to being fired, and her district manager was well aware of her feelings on Micro Nor and other MAPs. However, nationwide pharmacy cutbacks and increased hours provided a new situation for her.
She was now working in two separate K-Marts, one of which was located in Cincinnati, Ohio. Generally, when a patient wished to refill his or her Micro Nor, he or she would be moved to the other pharmacist working, as Karen felt the drug was morally wrong. Unfortunately, one day she happened to be the only pharmacist and was presented with the task of refilling Micro Nor for a patient. She told the client that they were temporarily out of stock and that the prescription could be transferred to another pharmacy. However, as Karen Brauer herself states, In Ohio, a refillable prescription belongs to the patient and must legally be transferred at the patients will. The client filled the prescription at another pharmacy but later found out that Karen had merely chosen not to fill the prescription.
The client called K-Mart headquarters, and the order was given to have Karen either submit to fulfilling such prescriptions in the future or to have her job terminated. She kept with her morals and was subsequently fired from K-Mart. The reasoning behind the termination, in K-marts wording, was as follows You have no way of knowing for what Micro Nor is being prescribed and must assume it is being prescribed for birth control which is Micronor's indication. 2. ) Since you are the only pharmacist on duty you offer the customer no alternative of filling the prescription for Micro Nor but to go elsewhere. 3. ) It is your obligation as a K-Mart employee to accommodate all K-Mart customers and not send them to competition (Personal Interview Record, 1). She was then given one final chance to submit to filling all future valid prescriptions regardless of her beliefs. However, she denied K-Mart of such pleasure by signing her name under a paragraph which read: In order to live in accordance with my conscience, I must refuse to dispense prescriptions with a major abortifacient mechanism or action. I regret coming into conflict with KMart over this issue.
I have been pleased and happy to deliver pharmaceutical care to KMarts pharmacy customers these past seven years (Personal Interview Record, 2). And this same treatment has occurred with other K-Mart and Wal-Mart employees. Enough so that PFLI considers these firms alone a reason why a Pharmacists Conscience Clause is necessary immediately. Now, let us get into what a conscience clause would give, what it would take, and other such details.
First and foremost, it gives piece of mind to the pharmacist. They arent forced to prescribe a drug they feel uneasy about for any reason. And if the client is adamant about receiving the medication, that can still be arranged; it will take only another pharmacist. Most importantly, this gives the client the knowledge that, for one reason or another, the pharmacist does not feel comfortable about the medication.
This knowledge and some time spent counseling the client could help him or her come to a better solution, perhaps even saving them from making a horrendous mistake. But cant some pharmacists abuse this Pharmacists Conscience Clause? Cant they use it as means of escaping some amount of work? Yes, they can, which is an unfortunate side effect but one which can be taken advantage of. With an addendum to the conscience clause this can be taken care of more than it is now. I would include in this clause the fact that a pharmacist who denies filling a prescription must refer the client to another pharmacist.
This way, we will lose the pharmacists who wish to deny prescriptions in order to avoid paperwork, as they will then have to provide details for the client to contact this other pharmacist. Also, this way a pharmacist can help the client not to feel enraged at the idea of the Pharmacists Conscience Clause. Is a pharmacist who denies filling a medication imposing his or her morality on his or her client? Perhaps this is a fear of clients. If their doctor has told them that this medication will solve their problem, why should they be possibly forced to listen to a pharmacist deny their prescription and tell them of their moral error? This is another situation which can be avoided merely by changing the Pharmacists Conscience Clause slightly.
I would propose that a pharmacist who denies filling a prescription must present this dialogue to some extent: Im sorry, I will not fill that prescription for you. Would you like me to tell you the reasons why, or would you rather have me point you to another pharmacist? By doing this, the pharmacist is giving the client the choice on whether he or she would hear reasoning for not honoring the prescription. However, the pharmacist still retains the right not to honor the prescription.
Thus, I would add a third line to the Pharmacists Conscience Clause as written by the 1998 American Pharmaceutical Association. It would read as follows: 3. ) No pharmacist, under penalty of removal from APhA, will give counsel to a client without oral agreement. Similarly, directions for contact with another pharmacist must be given at time of refusal. With this third item added, I feel that the revised Pharmacists Conscience Clause is worthy of the ages. This may not be the absolute biggest issue on every mind, but it certainly affects the vast majority of people at one point or another. And by helping to refine this newly created process from the veritable beginning, it makes any transition much smoother.
As said in the introduction, the Pharmacists Conscience Clause is a formidable clause but in need of some amendment. And that is exactly what it has received. Truly now, the Pharmacists Conscience Clause can stand the test of time.
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