Tuesday, June 14, 2005

pharmacy ethics


Medical ethics has been a popular topic as of late, especially regarding pharmacists and their selectivity in filling prescriptions. Unfortunately, those who are the most vociferous on the issue are also giving the least educated opinion, and it shows. As a doctor of pharmacy (Pharm.D.), my hope is to provide a somewhat more erudite and complete picture concerning some of the intricacies involved.

It is true that some overtly religious-minded pharmacists are overstepping the ethical boundary by refusing to fill certain birth control prescriptions based on moral judgments they make, interestingly enough, on the women who come to fill them. Most reasonable people see a problem with this, and their concern is legitimate. Playing God and deciding which women get their birth control pills based on the dictums of our personal religious views is nowhere to be found in our job description.

This criticism is fair and agreeable; however, having said that, there are several occasions when it is perfectly within the legal bounds of our authority to refuse to fill a prescription, or to “pry” into a patient’s personal life, as Mr. Jabari Asim words it. In fact, according to Florida law, under certain circumstances, a pharmacist cannot only refuse to fill a prescription, but can also confiscate it. Florida Pharmacy Law Sec. 893.12 states, “All substances controlled by this chapter…the lawful possession of which is not established or…to which cannot be ascertained, are declared to be contraband, are subject to seizure and confiscation…” What’s more, Sec. 64B16-27.831 not only states that, “Pharmacists should be diligent in preventing the diversion of drugs for illegitimate purposes,” but also that, “…the pharmacist knowingly filling (an illegitimate prescription) shall be subject to penalties for violations of the law.” So you see, not only are we able to act on certain suspicions, but also we can actually be punished legally if we do not. This is why painting with such a broad brush, as many opinion columnists do, is so hazardous.

Also, where is the “right to privacy” advocated in the U.S. Constitution anyway? Is it “intruding on a person’s privacy” to ask them if they smoke, drink, have any diseases, have allergies, have any pets, their date of birth, their social habits, their religious beliefs, whom they live with, etc.? These are all legitimate topics for pharmacists to address with patients. Does a pharmacist have to sell syringes to a drug addict, thus becoming his or her enabler? Must a pharmacist fill a prescription for Plan B (the “morning after” pill) with a year’s worth of refills on it? Should a pharmacist be able to confiscate a narcotic prescription that has been manipulated by a patient, which is a felonious offense? According to Mr. Asim, laws are being debated “that will specifically obligate pharmacists to fill all prescriptions.” Surely he is not suggesting that we ought to mindlessly fill any and all prescriptions. If so, then is this not just one more example of the patently absurd and exceedingly dangerous consequence emanating from self-righteous do-gooders who use “compassion” as a means to obliterate common sense and defile whatever it is that they choose to opine on? Freedom is not unlimited, and the line ought to be drawn when its exercise results in harm to others.

Lastly, one wonders if these indignant columnists are as outraged concerning the prying into Rush Limbaugh’s medical records. If they feel, as Mr. Asim does, that personal beliefs should not interfere with one’s work, then where do they stand on out of control activist judges who legislate from the bench, spineless politicians who refuse to protect our borders, military personnel who flee to Canada at the first sign of potential conflict, or news journalists who not only pick and choose which stories to report on but how to cover them?

There was a time, not long ago, when pharmacists were celebrating a long run as being the most trusted of all professionals in the country. One would hope that, although we have now dropped to number four, that we may still be given the benefit of the doubt before critics begin their barrage of libel and slander.

Jean-Marc Bovee, Pharm.D.

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