Thursday, October 20, 2005

Whose conscience?

Target is in the middle of a brouhaha because a pharmacist at their Fenton, Missouri store refused to fill a prescription for emergency contraception for a customer.

Target's form letter in response to complaints reads, in part, that Target is committed to respecting the diversity of their workforce (I'm paraphrasing, here), and that thus, Target will refer a customer who wants something Target doesn't carry (or in this case, won't prescribe) to another vendor.

This goes back to the issue of conscience clauses for pharmacists. Nurses and doctors have conscience clauses (also known in some places as "safe harbor laws") that allow them not to take part in procedures or practices that don't jive with their belief systems. A number of pharmacist groups, including Pharmacists For Life, the American Pharmacists' Association, and even the AMA, support this sort of clause for pharmacists.

The trouble arises in cases when pharmacists confiscate prescriptions rather than referring customers to other pharmacies (this happened in my very own home town, to a rape victim) or when they use their position to intimidate or shame women looking for EC. (This has also happened in my very own home town, to the extent that one doctor I worked for refused to send her patients to a particular pharmacy for *anything*.)

There's also a second scenario in which a refusal could be troublesome: if you live in a small town, or even a small-ish town, with three or four pharmacies, what if *nobody* will fill your EC prescription? Even barring that complication, driving from one pharmacy to another takes time, and EC is time sensitive. Never mind that if you've just gotten out of the ER after a rape exam, you're probably not in the state of mind to comparison-shop the various pharmacies in a thirty-mile radius of home.

To top it off, there's this: A woman makes the decision, with the help of her doctor or NP, to get emergency contraception; the pharmacist's refusal to fill that prescription feels to me like interfering in that personal decision. It's as though I were to stand in the door of the OR and prevent a patient from getting a VP shunt because I didn't agree with the process.

I can understand why pharmacists want conscience clauses. Thankfully, I've not yet been in a situation where I've had to call foul myself--partly because I've made a conscious decision *not* to work in a field where the standard medical care incorporates a number of things with which I do not agree.*

The other side of me (okay, the other 90% of me), though, is really, really pissed off that pharmacists would refuse EC, or even the Pill, to customers. I've not yet heard stories of a pharmacist refusing Viagra (the classic counter-argument) or pain medications, or indeed of a pharmacist refusing *any* prescription that doesn't directly have to do with women's control of their own sexuality.

And that, I believe, is the root of the argument. These are folks who want to *not* dispense certain drugs to women. That the drugs have a lot to do with sex, and a lot to do with avoiding pregnancy, feeds into the feeling I have that this is primarily about power rather than about harm to a fetus, embryo, or blastocyst. Show me a pharmacist that won't dispense class C drugs to a woman of childbearing age and I might begin to change my mind...but until then I retain the right to remain conflicted and irritated.

*For the record, that field is labor and delivery/newborn care. I hate the idea of circumcision, and I hated having to assist in one. I'm also not crazy about the intrusive monitoring and "lie-down-shut-up" attitudes I saw in L&D units when I was in school. Being a hippie-dippy wacko who's been at, assisted in, and hung out during home births prior to getting schooled probably has a whole lot to do with that. Point remains, though, that the reason I didn't go into L&D is this: I cannot work in a place where women in uncomplicated, healthy labor are considered to have a medical problem rather than people experiencing something normal.


Anonymous said...

I so agree with you on this. I wrote to Target, got their form letter back and wrote back demanding further clarification and telling them that if their policy wasn't filling ALL prescriptions I was gone as a customer. we'll see what happens.

And yes indeed on Labor & Delivery departments - it's why children #2 + #3 were born at home.

Anonymous said...

Another thing I'm livid about is that *they* are holding up the release of a vaccine that would significantly reduce HPV infections. Avoiding the STD would ultimately reduce cervical cancer, which is a big killer in parts of the world. The logic is that it would give girls carte blanche to be sexually active. HALLOOOO!!! They is awreddy!!

I'm gonna get my daughter (now 5) vaccinated, when approved. And I'm gonna teach her about self-respect and all the other things my mom did to keep me on the right path, so hopefully, it will be moot anyway.

I wish all these folks would stop their sanctimonious posturing. They may say they're doing it *for* our daughters. But, I'm a mother & a doc, and they are NOT speaking for me & mine.

Anonymous said...

Oops, forgot to sign that. It was me.


shrimplate said...

As a matter of personal faith, I do not give pain relief medications to Republicans.

Why bother? They're all heartless effing bastards anyways.

Said persons are free to pull their tubes, disconnect their IV's, defy doctor's orders, and leave my institution against medical advice if they wish to patronize other places which will administer the harmful and poisonous narcotic drugs which in my opinion are not even necessary for their recovery from their elective, that is to say, their freely-chosen and entirely voluntary procedures.

They knew what they were getting into. And they should pay the piper for it.

Democrats, however, can get all the freakin' drugs they want from me. Party's ON, dudes and dudettes!

Party-switching is not only allowed, but encouraged.

So is irony.

Jo said...

I loves me some Shrimplate.

Lioness said...


[I likes Shrimplate myself]

Anonymous said...

i know this entry is waaay old, but this is the first time i have read a medblog entry that is anti circ!!! THANK YOU!!