Pharmacists: Just Say Yes

There's a weird debate raging right now in the U.S. If you're not an American, you're going to be baffled by this. Pharmacists want the right to refuse on ethical or moral grounds to fulfill certain prescriptions. Now, now, I know that if you're outside the U.S., you're checking your calendar to see if it's April 1. This isn't about Christian Scientists getting jobs in drugstores and then not selling any drugs (although that would be a great test case). Rather, it's about people with specific religious beliefs wanting to exercise those in a regulated environment to deny legal drugs or devices to people with a prescription from a medical doctor or another professional with a right to prescribe.

Here's The Seattle Times and The Seattle P-I on an information meeting by the state Pharmacy Board in Washington yesterday. The problem isn't someone abusing a drug--I'd like to hear the moral opinions of pharmacists who dispensed massive amounts of hydrocodone and oxycontin--rather, it's this event in the P-I's story: "For example, a pharmacist at a Seattle hospital in May refused to fill a woman's prescription for antibiotics because it came from a facility that provides abortions. The pharmacist cited religious objections, Luftig said."

Yeah, that's just great.

We are ostensibly still a civil society ruled by law, not religious leaders, anti-christs, or oligarchs. (I know, I'm trying to talk about our ideal state.) In a civil society, that which is legal should be obeyed. If you believe the law is unjust--which in the past has typically meant that a law had an onerous effect on a minority of people, such as segregation--then you work for its change through civil disobedience, lobbying, and electing new leaders. (Options outside that are not part of a civil society, such as assassination, intimidation, and outright disregard for law--such as stating that because you're president the law doesn't apply to you when you decide it doesn't.)

Pharmacists who believe that dispensing drugs that will prevent pregnancy (emergency contraception) is against their moral or ethical system will need to stop being pharmacists while they work to have laws changed to prevent those drugs from being legal or allowed to be prescribed. If we all, as a society, individuals to prevent legal access to legal medicine, then there is no slippery slope. It's all downhill. It means that a member of the Aryan Nation whose morals forbid providing medication to black people would have as many rights as a pharmacist who believed in encouraging abortion by withholding emergency contraception.

This is a harsh opinion, of course, but it's not out of line with the principles on which are society is founded.

Update: Some good exchanges in comments with someone diametrically opposed to me but who respects my opinion enough to engage, and I likewise. I disagree with him, but it's so refreshing to hear a frank opinion with logic behind it in this debate instead of seeing bloody fetuses contend with bloody hangers.

One point I didn't originally make above is that my big fear about pharmacists being allowed to pick and choose which drugs, which formulations, and which doctors or institutions for which they fulfill legal prescriptions is that it doesn't allow the average person to know reliably whether any prescription they are written may be fulfilled at any given pharmacy.

If regulations are passed that allow pharmacists to express moral judgments over dispensing drugs--rather than, say, safety or legal judgments that would involve them calling state investigators about overprescription or dangerous combinations a doctor was advising--then the questions will be:

Can a pharmacy choose to only hire pharmacists who adhere to a particular set of moral beliefs and will that involve a written pharmacoepia that they will adhere to?

Conversely, may a pharmacy choose legally to not hire a pharmacist who doesn't sign a pledge agreeing to dispense all legal medications with a legal prescription?

May a pharmacist change his or her mind without losing his or her job?

May a pharmacy post a notice, "This pharmacy dispenses all legal medications"?

Will a pharmacy be required to post a notice that reads, "This pharmacy may choose at its discretion to decline to fill any prescription on moral grounds?"

Will pharmacists be required to provide written moral objections for each prescription they decline? For instance, if a pharmacist (as noted in the P-I story) refuses to dispense drugs that aren't involved with a particular hot-button issue (let's say, birth control) when it's a prescription from an institution that they have a moral objection from, will they face repercussions? For instance, let's say I live in a tiny town, 100 miles from anywhere else, with a single drugstore. Let's say my pediatrician happens to perform abortions on the side. Let's say the druggist, presented with a prescription for critical antibiotics for my child says, "I cannot ethically give you those drugs because my morals prevent me from handling prescriptions written by Dr. X." What happens then?

What's to distinguish racism or other bigotry from moral objections? In the comments, my agile disputant notes that if an Aryan Nation member won't prescribe drugs to a person of color, that discrimination laws would cover that, noting there are no discrimination laws that cover, say, abortion drugs. But I'm not sure that answers the question. If my religion says that left-handed people are an abomination, then when someone tries to sign for their drugs with their left hand and I object based on strongly held religious beliefs, how will I be prosecuted? And will it be a civil or criminal offense?

I'd like to know some answers to this. The ethical issue is being presented quite narrowly as "druggists don't want to give out abortion pills," but I don't see how you can construct in a commercial, civil, and legal solution that provides predicable medical access to drugs without answering these questions.