Thursday, January 13, 2011

On a weird kind of pharmacist power

Okay, so I've brought up the issue of conscience clauses a couple of times before, and the answer has always come out the same: a big, fat chunk of I Don't Know. I'd hate to personally be forced to do something to which I had serious moral objections, but at the same time, isn't there a point at which you have to stop judging and do your job? Particularly when you're in a medical field--your choice to go with your conscience may actually result in someone's death. Whether you're a pharmacist refusing to fill a birth control prescription or a hospital willing to let a woman die rather than provide a treatment that violates their Catholic charter, you're putting your own moral reservations up against a woman's physical well-being and a physician's educated and deeply considered orders.

That's a lot of power, particularly for someone whose white coat spends most of its time behind the pharmacy counter at Walgreens. And it's a lot of responsibility. A pharmacist in Idaho, for instance, had the responsibility of filling a prescription for Methergine, a drug used to prevent or control bleeding of the uterus following childbirth or abortion. She decided not to, because the NP calling it in wouldn't tell her if the patient had had an abortion.

Now, let's be clear: The medicine in question could potentially save a woman from bleeding until she died--but the pharmacist wouldn't dispense it unless she knew the woman was moral enough to be worth saving.

The NP was, of course, prevented by HIPAA to tell a Walgreens pharmacist what had happened behind the closed doors of a doctor's office, and so the prescription was refused. And when the NP asked for a referral to a pharmacy that would fill it, the pharmacist hung up on her.

This is the discussion. This is the bright-line test for conscience clauses. If we are going to decide that a person's right to their own conscience should be honored above all things, how far are we willing to go with it? Is a medical professional required to help someone who will die? What about someone who will probably die? What about someone who will at the very least end up in the hospital if they aren't given the appropriate treatment?

And if the pharmacist is being asked to dispense medicine after the objectionable act has already taken place, isn't she just using her power to punish the patient? What conscience clause allows that?

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