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So much for patient rights

February 10, 2006 06:02 AM / FUBAR .

By DAN K. THOMASSON

So when is a physician not a physician?

Is it when the doctor refuses to offer treatment because of disapproval of the medicine available or the way the patient's disease occurred? How much leeway is there in the Hippocratic oath to allow a doctor to spurn those in medical need because of religious conviction or concept of morality?

And what about pharmacists who refuse to honor legitimate prescriptions or even to stock certain authorized medicines because the drugs run counter to their religious beliefs? Is there a case to be made for the primacy of conscience in those cases, even though a pharmacist's responsibilities are not dissimilar to a doctor's? Is refusing to fill a prescription tantamount to breaking the law and to making a pharmacist's judgment more important than the doctor's?

These and other questions surrounding the dispensing of modern medicine are being asked by state legislatures, ethics boards and public forums throughout the nation in the wake of controversial new research and compounds and treatments that run counter to fundamental religious convictions on such issues as stem-cell development, abortion, AIDS, the right to die. Chances are excellent that before the debate is over, it will change the way health care is dispensed in this country.

According to recent reports, legislation to permit medical providers to refuse care when it clashes with their beliefs is under consideration in a growing number of states. The legislation is just the tip of an iceberg of controversy that is expected to end up in front of Congress, if not the Supreme Court, before it is settled. If ever.

At the center is the age-old battle between conscience and duty, the requirements of the license granted by legal authorities vs. those ideals and standards imposed by religious teachings. It has intensified in a burgeoning atmosphere of evangelicalism that already has dramatically changed the political landscape and brought about major confrontations on a host of social issues between the right and left, in courts and in legislatures.

Many of the bills introduced at the state level would undermine patients' rights by permitting pharmacists to refuse to dispense "before" and "after" birth-control pills, which they believe cause abortions. The furor has increased over the availability of the "morning after" pill and whether it dissolves something that God already has begun. When does life begin? No one seems to know for certain. Legal authorities have been arguing this question forever and some standards have been established for judging criminal cases. The first breath taken by a baby out of the mother's womb is the standard in some cases for legal purposes.

When one enters medical school or decides to undergo training to be a pharmacist, it is doubtful that it is done with a provision that certain patients, treatments or drugs are off-limits, that while it is possible to save a life by performing certain procedures that are legal, the right to deny treatment or healing drugs supersedes any other obligation. Should doctors or drug dispensers or others in the health-care business who impose these limitations be identified with an asterisk by their names in the phone books or medical registries? It might be a good idea.

This is not to challenge the moral imperatives that govern us all. The decision of some doctors not to perform abortions is understandable when there is no emergency medical need. Cloning raises huge issues. But when there is a possibility of death, it is unthinkable that any physician would refuse to administer whatever lifesaving remedy is available. The same would be true for anyone with the state-granted authority to dispense a legal drug authorized by a licensed doctor.

The sound of struggle between religion and science, between bioethics and dogma, and the need to advance life and civilization through science is likely to intensify in the next decades. The doctors and those who depend on them for treatment uncolored by the disapproval of religion are right in the middle. Making it legal to deny recognized treatments is a very bad idea. Those who argue that Americans have a basic right to follow their conscience above all else seem to ignore that one has the right to try to control one's own destiny even in health matters, and not to have to worry about a healer's faith.

Doctors and pharmacists who form associations based on religious convictions seem beholden to standards other than science and the care of all patients required by their oath.

(Dan K. Thomasson is former editor of the Scripps Howard News Service.)


© Copyright 2006 by Capitol Hill Blue

Comments

The Physician Hippocratic Oath is "FIRST DO NO HARM". If a Physician refuses a necessary treatment because of his religious beliefs, this is counter to his Hippocratic Oath, and he should lose his license.Religion does not trump Science and Medicine. Likewise with Physician Assistant Care Workers such as Pharmacists. If a Pharmacist can not fulfill his licensed obligation to first honor the Physicians Prescription than he is not doing the job he was hired for, and must be fired. All the legislation in the world will not change these fundamental facts, and if our illustrious leaders choose to ignore these facts, they likewise must be fired.......ENOUGH IS ENOUGH They can not put the cart before the horse.

Posted by Dr. Bob at February 10, 2006 09:38 AM

And then there are cases like this one:

Posted by Kay at February 10, 2006 10:00 AM

An interesting poser along this line. The employee pharmacist is the actual agent of the pharmacy (principal) he works for. Patient comes in with a prescription for a morning after pill. Pharmacist refuses to fill it because of his religion. By the time patient finds a pharmacy that carries the medication and with a pharmacist who will dispense it, the critical time has passed and she becomes pregnant, creating an injured third party. Patient sues the pharmacy for the cost of the pregnancy, including time missed from work, and for the cost of raising the child. Patient may well be able to win a tort liability lawsuit against the pharmacy because the pharmacist was the agent of the company when he refused to honor the prescription. In addition to violating ethical codes of his/her profession, both the pharmacist who refuses to dispense the medication and his employer may be open to suit in tort for denial of service. Perhaps a new qualification for employment may have to be a contract between the pharmacy and its employees that they are obligated to fill any legal prescription? If the pharmacist then refuses to dispense he would have exceeded the scope of authority and could be sued by the pharmacy for recovery of damages paid to patient. Sounds like the pharmacists in question are trying to start an entirely new line of tort liability suits and fund a new generation of lawyers.

Posted by Law Student at February 10, 2006 10:24 AM

I wonder if Christian soldiers who have an obligation not to kill were to all throw their rifles down in the face of the enemy, sit uppon their "fundaments", stick their fingers in their ears, and start saying "lalalalalalalala! I can't hear you!"; Would the Neocons and fundies be in a huge rush to protect them!

Posted by Stoney Browning at February 10, 2006 12:43 PM

It is my opinion that, since being a pharmacist is a choice, no one should become one unless she or he is prepared to fill all prescriptions, regardless of personal feelings. Once one becomes a pharmacist, therefore, one has an obligation to fill prescriptions, and keep one's personal beliefs to oneself.

Posted by YY4ME at February 10, 2006 03:57 PM

States regulate things like licenses for doctors and pharmacists, marriage licenses, and even plumber's licenses for the benefit of the public at large. Anyone who does not wish to fulfill the requirements of the licensing agency should either find a state where the requirements are acceptable to them or find a new job.

It is the law that we do not force anybody's religion upon anyone else, and that means that a medical provider must work as if they have NO religious prohibitions against treatments and drugs. Further, the law implies that we may not use our religion to harm anyone else or constrain their life. AND, it has always been held that the good of the nation (it's people) supersedes the right of an individual (e.g. shouting Fire in a crowded theater is not a permissible use of free speech), so the pharmacist who objects to abortion drugs should give up their $100K salary and go do abortion counseling for a living.

Posted by Nostradamnthem at February 10, 2006 05:32 PM

I've never read so much biased bull in my life. A pharmacist should NOT be required to kill a potential human being at the whim of a woman who chose to have unprotected sex. This is no deeper than that. It has nothing to do with saving a life, etc.

Posted by carole fazzini at February 10, 2006 08:00 PM

Biased bull my butt. a pharmacist should do his job. if i hire someone, i expect them to do their job. if he doesn't, than anything that happens (like the suing for pregnancy) i would be legally liable for because he is my employee. however, it doesn't matter because he still didn't do what i hired him to do! if they don't want to follow the directions of the job, then they should go into another line of work, not expect sympathy. i bet there is an illegal mexican crossing the border right now that will stand there and sell the stuff while i get a guy who can match a pill to a color chart on the wall to separate them into the damn pill bottles. i just eliminated my pharmacist (who probably wanted upwards of $70k/year) with 2 $20k jobs who will do whatever i say instead of asking for perks. do your damn job and don't complain.

Posted by Magamus at February 10, 2006 10:02 PM

I want to know who these pharmacists are, because I don't want to patronize their businesses. I'm too old to need a morning-after pill, but what about my daughter? I would prefer to deal with professional pharmacists, and not religious fanatics eager to constrain me to their beliefs.

Posted by Relic at February 10, 2006 10:10 PM


I think the most important issue is that a pharmacist is not a doctor. His job is simply to dispense the medications the doctor has ordered.

As most medications have more than one use, if the pharmacist speculates on why they are being dispensed it should actually be a violation of the patient's legal rights of privacy.

Posted by Scott Peterson at February 10, 2006 10:15 PM

you know, thinking about it, i've known even catholics who have gotten abortions because it was too hard a time in their lives, or they didn't want the baby.. i don't need to pay for any more unwanted babies. if they just go into an orphange (not that all do, but a lot) where i have to pay for them to grow up, when i already have to pay for my future kids too... i mean, if i don't give $.20 a day to that poor childrens infomercial, why should i be forced to give it elsewhere. i say that all those who believe that abortions are killing should pay for the nuture and care for those babies. lets see how long before those same christians are opening their own abortion clinic. can anyone say abortion hmo?

Posted by Magamus at February 11, 2006 12:45 AM

you know, thinking about it, i've known even catholics who have gotten abortions because it was too hard a time in their lives, or they didn't want the baby.. i don't need to pay for any more unwanted babies. if they just go into an orphange (not that all do, but a lot) where i have to pay for them to grow up, when i already have to pay for my future kids too... i mean, if i don't give $.20 a day to that poor childrens infomercial, why should i be forced to give it elsewhere. i say that all those who believe that abortions are killing should pay for the nuture and care for those babies. lets see how long before those same christians are opening their own abortion clinic. can anyone say abortion hmo?

Posted by Magamus at February 11, 2006 12:46 AM

Ok, I have been a RN for 24 years this coming June.

I want to digress on to another topic, as an EXAMPLE, that FITS MY line of work, to address THIS topic, and then explain my point. So, please bear with me.

I am basically not pro-abortion. I have to say "basically," because in this tragic world, there are some wretched situations that do happen, that I do not know what I would think about, such has an 11 year old being molested, and pregnant.

There are circumstances where adult women get pregnant, intentionally, or not, and find, after the fact, that it will kill them. Renal failure or Hepatic Coma secondary to Diabetes, Pre-eclampsia (which is almost always in the last trimester, however, and if left to become Eclampsia, they will very likely die, both mother and baby), etc.

In most (not all) of these cases, the mother would die, and the infant, both, if there was not intervention.

I say all of this to say that what I do know I oppose on such an issue is an adult using abortion like a birth control, which is an entirely different matter.

Now, as a RN, although I don't work L & D, nor post-partum, I do get adult, and even adolescent patients, female ones, with histories of abortions, miscarriages (questionable self-induced, on some occasions), and more.

And as a PROFESSIONAL in a CAREER that I ELECTED TO WORK IN, I do NOT have the RIGHT to REFUSE to TREAT them, nor to JUDGE them.

That said, I DO have the right to decline to actively assist with an abortion, but ONLY after my employer has then fulfilled THEIR OBLIGATION to REPLACE me, so that I am not ABANDONING my patient.

Let me make this perfectly clear, I knew the TERMS OF THIS BEFORE I entered nursing. I asked the Dean of the nursin program, directly.

One has a right to live their convictions, but NOT to the point of ABANDONING their PROFESSIONAL OBLIGATION.

No one made me be a nurse.

No one made them be pharmacists.

Where will they draw the line? Should they have the "right" to "refuse" to fill HIV meds if the patient is gay? Should they have the "right" to "refuse" to fill a prescription for chronic Herpes, because the person was, in the pharmacist's presumptive opinion, "immoral"?

Posted by Robert Meek at February 11, 2006 01:09 AM

Isn't the Hippocratic oath kind of a religious oath that supersedes your religion?
If one consider assisting in an abortion to be a human attempt to over rule Gods will, isn't the Hippocratic oath and the practice of helping people in medical need an attempt to over rule Gods will as well?

Posted by Mats Jangdal at February 12, 2006 06:30 AM

To Stoney who asked about Christian soldiers who refuse to kill - apparently you haven't listened to Bush lately. This is Bush's HOLY WAR - he believes that God has told us to attack. Therefore, any soldier refusing to kill would be court-martialed. Although, if better than half of the troops said, "Screw it, I'm out of here", I don't know if they could or would prosecute 10s of thousands of them. What we need right now is a huge dose of civil disobedience!

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Posted by blue valium at February 14, 2006 08:53 AM

If a person can't or won't perform the job that they were hired to do, then they need to get the hell out of the way, and let a more deserving person (one that understands and practices professional integrity) have a shot at earning a decent wage for an honest days work.

When are you fundamental nutcases going to understand - it DOESN'T matter what you believe, or what I believe, beyond the realm of our little personal fiefdoms? In the 'real world (i.e., the public space) the only thing that matters is if you are doing your job competently (i.e., as in 'are you getting results'). Ignoring a doctor's prescription because your precious religious feelings are hurt, is not only unacceptable, it is unlawful, arrogant, and in my opinion, a good example of passive-agressive evil-by-proxy. I hope every last one of yunz who try to intimidate someone with this crap gets their ass handed to them on a solid gold platter.

Here's an idea -- why don't you all start practicing some of what you preach, and leave this judgement buisness to your supreme being (remember, "judge not others lest ye be judged?). If you're half as right as you think you are, then everybody but you and your buddies is gonna go to hell, and you can feel even more righteous and smugly tell us 'I told you so'.

But until then, keep your noses the hell out of my business.

Posted by James at February 16, 2006 03:58 PM

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