April 24, 2002

5:13 AM

Walgreen's Pharmacist refuses to fill prescription. Do pharmacists have the right to refuse to fill a prescription because of religious beliefs? Should they? Well, they do in Florida.
posted by Stretch (103 comments total)

Supporters of the morning-after pill said that they are frustrated that a pharmacist can deny the medication.

Gee I didn't know that a perscription was like a document that demands medicine must be sold to a person. If the pills belong to the pharmacy, the pharmacy can sell them to whoever they want.

Of course, this means that the pharmacy down the road will pick up the business from this religious pharmacist. I see no reason to go running to "Local 6 News" over this.
posted by Keen at 5:30 AM on April 24, 2002

sure, why not?

there are plenty of pharmacists out there who will fill the prescription if another won't.

and yeah, it may be inconvenient, but lots of things in life are, so there's no use in complaining.
posted by bwg at 5:32 AM on April 24, 2002

No, they should not. Why stock the damn medicine if you can't sell it or won't? Tolerance for this is ridiculous.
posted by bittennails at 5:38 AM on April 24, 2002

Why stock the damn medicine if you can't sell it or won't?

Because it was not Walgreen's policy to refuse the prescription but the pharmacist's. I would imagine that had they tried to fill the prescription there when another pharmacist was on duty, they would have been successful. Besides, Keen is right - a prescription is not a command from a physician to pharmacies to "fill or suffer the consequences."
posted by thatweirdguy2 at 6:05 AM on April 24, 2002

Wow. So if I go to the store with a grocery cart full of beer for a party, does the cashier have the right to refuse to sell it to me, since I Corinthians 6:8-10 clearly states that drunkards will not inherit the kingdom of God?

If I go to the video store with an R-rated film that clearly depicts scenes of a sexual nature, does the clerk have the right to refuse to rent it to me, since Ephesians 5:3 states that there should not even be a hint of immorality among God's people - and renting the video would imply an endorsement of its contents on the part of the clerk?

Granted, these are not equal comparisons to the situation in question, but I seriously doubt that the employees involved in the first two examples would have their jobs for long if they tried imposing their morals on their customers. It would be like me getting a job in the sporting goods department of Wal-Mart, and then refusing to sell rifles or rifle ammo because I don't believe in hunting.

What if you live in an area with a high concentration of religious persons? What if there's not a single pharmacy in your area that will sell you the pill? Believe me, there are places in the United States where this is not an impossible scenario.
posted by tpoh.org at 6:10 AM on April 24, 2002

"According to Walgreen's store policy, pharmacists may refuse to fill a prescription for moral or religious reasons...

Good grief - what's next? This is not a question of religion, this is a question of rights. The FDA approved the morning-after-pill four years ago, abortion is legal in this country and given the morning-after-pill is required to be taken before 72 hours have passed (and before you could even know you are pregnant), where does this logically fit into the conception debate??

As for what pharmacists may or may not do in the State of Florida:
"may not dispense a Schedule II controlled substance,... Schedule III substance or a drug of abuse designated by the Attorney General by rule of the prescription-monitoring system to any individual not personally known to the pharmacist without first obtaining suitable identification and documenting"

Furthermore, a pharmacist may deny prescriptions ONLY IF

the prescription requests more than a 30-day supply of any controlled substance listed as Schedule II or Schedule III drugs (in which case they simply need their doctor to call in a new script)

may not knowingly fill a a prescription that has been mutilated or forged

So says the Senate of the state of Florida here and here. Nowhere could I find that a pharmacist may refuse to fill a prescription under Florida law for religious regions. I guess this begs the question (from me anyway) - can a doctor refuse to treat a patient due to religious bias??? Now that is truly frightening to me...

posted by gloege at 6:20 AM on April 24, 2002

Granted, these are not equal comparisons to the situation in question,

The video and beer analogies are far less serious examples. This woman has been denied health care, and it's a very serious issue. Do I think the law should require pharmacists to fill prescriptions in violation of their beliefs? No, but it's a pretty ridiculous company policy, and I now know where I won't be getting my prescriptions filled in the future.

and yeah, it may be inconvenient, but lots of things in life are, so there's no use in complaining.

that's irony, right?
posted by jpoulos at 6:32 AM on April 24, 2002

What about condoms? Refuse to sell them to me cause the owner does not believe in birth control? I had a convenience store and would not carry filom because in my religion we do not believe in graven images.
posted by Postroad at 6:33 AM on April 24, 2002

Granted, these are not equal comparisons to the situation in question, but I seriously doubt that the employees involved in the first two examples would have their jobs for long if they tried imposing their morals on their customers. It would be like me getting a job in the sporting goods department of Wal-Mart, and then refusing to sell rifles or rifle ammo because I don't believe in hunting.

But you seem to be confusing whether Walgreen could fire a pharmacist who didn't want to sell abortion pills (yes, of course) with whether the society (i.e. the government) should force a pharmacist to sell pills (no).
posted by straight at 6:36 AM on April 24, 2002

This is apalling. As stated above, this could have so many more inane applications. Bottom line is, if it's against your religion to do your job, you're in the wrong business. Very simple.
posted by eas98 at 6:38 AM on April 24, 2002

It is not the job of the pharmacist to fill any and every script, eas98. Their job is to sell medications they feel are worth the money to carry, under guidelines on how to proceed should they choose to do so. If they decide not to fill a script, that is their right as a business, and apparently within the company policy.

There is nothing apalling about it. It's the way business is supposed to work. Or, do you get equally upset about the "no shoes, no shirt, no service" signs?
posted by dwivian at 6:50 AM on April 24, 2002

straight (and, on preview, dwivian) hit the nail on the head. It's all well and good for you guys to talk about "rights," but rights are given and taken away by governments, not Walgreen's. In fact, if anyone's "rights" would be in jeopardy in this situation, it would be the pharmacist's if the government "compelled" him to sell that prescription against his beliefs (please note I do not agree with his beliefs at all, but recognize his right to have them)

The simple solution to this issue is ... go somewhere else. I don't think bwg's "inconvenience" point was ironic at all -- the world would be a lot better place if everyone didn't scream "victim" any time they got inconvenienced and had to go 1/2 mile to a different pharmacy.
posted by pardonyou? at 6:58 AM on April 24, 2002

Or, do you get equally upset about the "no shoes, no shirt, no service" signs?

Generally, buying a slurpee is a different construct than being denied access to health care. Did you read gloege's post dwivian?
posted by machaus at 7:02 AM on April 24, 2002

"It is not the job of the pharmacist to fill any and every script, eas98. Their job is to sell medications they feel are worth the money to carry, under guidelines on how to proceed should they choose to do so. If they decide not to fill a script, that is their right as a business, and apparently within the company policy."

Like doctors, pharmacists take a Pledge of Professionalism and an Oath to Serve the Public. Nowhere in here does it say I will retain the right to refust any and every script I fill is immoral or unethical. Methinks this pharmacist needs to be fired for prejudice (as a doctor would for refusing to treat based on religious or any other reason under the Hyppocratic Oath). Then he can go practice his right to withhold drug treatment on his local street corner for all I care.
posted by gloege at 7:04 AM on April 24, 2002

What if it wasn't a particular pharmacy, but the whole chain? What if Walgreen's made a corporate decision not to allow people to fill their morning-after pill prescription?

Now change the name from Walgreens to Walmart, and you get reality. Walmart decided more than a year ago to not fill any prescriptions for the morning-after pill. And with the voraciousness of Walmart, gobbling up all the smaller marketplaces in every town it moves to, I'd imagine that there are some places where that's the only pharmacy.

Pretty chilling.

My wife and I have been boycotting Walmart for several years because of this -- though the effects don't seem to be showing on Walmart's stock price, unfortunately.
posted by crunchland at 7:09 AM on April 24, 2002

What if a pharmacist belonged to a particular faith that decided it was wrong to medicinally treat hypertension? What if you went to the Walgreens to get your medicine and the pharmacist said no, it's against my religion to sell you this medicine? The material point is not that it was the morning after pill, but rather that a pharmacist made a decision outside the scope of their expertise - deciding what medicine should be distributed. That's a doctor's call. This pharmacist should be immediately fired and expelled from the profession entirely.
posted by gsh at 7:16 AM on April 24, 2002

I'm wondering how this is different than a doctor from the fact that not all doctors perform abortions. I think it's not that different.
posted by RunsWithBandageScissors at 7:20 AM on April 24, 2002

Wow. So if I go to the store with a grocery cart full of beer for a party, does the cashier have the right to refuse to sell it to me, since I Corinthians 6:8-10 clearly states that drunkards will not inherit the kingdom of God?

Yes, absolutely, if said cashier also owns the store and/or the store gives the cashier that option. There is no law that requires a store to sell you anything it happens to have in its inventory.

It's Walgreen's corporate policy of allowing pharmacists to pick and choose their that's the truly stupid thing here. My guess is it's because there's a shortage of pharmacists these days, so the pharmacy chains have to bend a little to fill all their positions. Rather like during the dotcom fraud bubble when all sorts of underqualified, undeserving people could pretty much demand any number of perks (hiring bonus, new car, etc) before accepting a position, because if you didn't give it to them, the dotcom down the street would.
posted by aaron at 7:25 AM on April 24, 2002

Like doctors, pharmacists take a Pledge of Professionalism and an Oath to Serve the Public.

And like pharmacists, doctors violate their oaths all the time. Just as a single example (and a nearly-unlimited number of examples could be brought up here), there are hundreds of thousands of doctors that will absolutely refuse to prescribe any sort of benzodiazapenes (the family of anti-anxiety medications that includes Xanax, Valium, Ativan, etc) to any patient for any reason, no matter how serious and completely debilitating said anxiety disorder might be for that patient. Why? Because the doctors are either a) scared of having to answer to a DEA audit someday, b) afraid they'll get sued if the patient turns out to have an addictive personality and ODs on them, c) simply look down upon all their patients as wannabe addicts who are simply looking for "happy pills." This is pure malpractice, but it happens thousands of times per day all across the nation.

Likewise, most doctors in hospitals steadfastly refused for many decades to properly manage the pain of people in hospitals with serious problems (terminal cancer, post-surgical complications, etc), mainly because they just thought "Fuck 'em, pain's part of having X disease or surgery." Millions of people were literally dying in unimaginable agony from the most horrific diseases, and their doctors were giving them over-the-counter doses of Tylenol and telling them to deal with it. As a result, a year or two ago the FDA was forced to MANDATE a set of extremely rigid pain-management rules for hospitals, directly ordering doctors that they must give all inpatients as much medication as necessary to alleiviate their pain, whether the doctor likes it or not. (They're also required to hand a form to all incoming inpatients informing the patient of these new rights.) If they don't, the doctor risks losing his license and the hospital its accreditation.

Oaths are jokes. They have no legal relevance. They mean nothing unless the person taking the oath has one hell of a lot of honor. And there's not a lot of that going around in the world these days.
posted by aaron at 7:39 AM on April 24, 2002

Unfortuneately, this is a consequence of having private sector medical care. If all pharmacists were gov't employess this wouldn't be an issue. [insert rant against privatized medicine here]
posted by plaino at 7:43 AM on April 24, 2002

If the pharmacist refused to serve the customer because of race, gender, age would there be a violation of law? How about religious affiliation. Is that what is happening here is refusal to serve based on the fact that his religious beliefs don't allow that and he's discriminating against someone who doesn't share those same beliefs?
posted by onegoodmove at 7:48 AM on April 24, 2002

Yeah, I'm just not getting it.

The pharmacist should be able to sell or not sell any drug he wants to any customer he wants, at least within the bounds of civil rights law. For instance, if he didn't want to sell any Tagamet to left handed albino eskimos, then he could concievably be accused of unfair discrimination, but I digress. He should be able to make the final decision about whether a script gets filled or not. That's his job.

Of course, Walgreen's should be able to fire him if they want to, and the guy who wanted his script filled should be able to go somewhere else if he wants to.

Or, lets change the scenario a bit. If the pharmacist had to fill any script that came in, under penalty of law, what if he suspected that a script was fraudulent? Would he have to fill it anyway? (Assuming that the check with the doctor checked out.) Or, what if someone came in with a valid script, but the pharmacy decided not to carry the drug (this is not without precedent)?

Would every pharmacy be compelled to carry every drug that could be prescribed? What would happen if they ran out? Could they get sued by irate customers who don't want to run down the road to another pharmacy?

It just seems to me that as soon as you start requiring pharmacists to fill prescriptions you have to start requiring other acts that don't make sense.
posted by bshort at 7:48 AM on April 24, 2002

Unfortuneately, this is a consequence of having private sector medical care. If all pharmacists were gov't employess this wouldn't be an issue. [insert rant against privatized medicine here]

This is an Almighty Government law that's allowing them to not fill the prescription in the first place.
posted by aaron at 7:50 AM on April 24, 2002

Unfortuneately, this is a consequence of having private sector medical care. If all pharmacists were gov't employess this wouldn't be an issue. [insert rant against privatized medicine here]

There are many things wrong with the way our privatized medical system works. But if you socialize medicine, and the same people who run Walmart infiltrate the policy team that determines what our socialized health care is going to look like (an industry influencing policy? say it ain't so), then you've got a ubiquitous, codified version of Walmart's repressive politics. One that people would go to jail for violating.

I think it's appalling that anybody in the medical field would be denying prescriptions (or care) based on their own religious beliefs, but I seriously doubt that socializing our health care system is going to solve that problem. At least, as things stand now, people have the theorertical option of going elswhere. The problem is when they do live in an area saturated by people of differing morals, or when a company like Walmart has come in and shut down all the local competition.

Then you have a serious social dilemma: are the rights of the people doing the selling as important as the rights of the people doing to buying? And when it comes to something like health care, shouldn't there be an oath or law of some sort (one that has teeth) to protect the availibility of "controversial" but government-approved treatments?

I guess that gets back to the socialized versus privatized debate.

Fuck it. I'm moving to New Zealand.
posted by damn yankee at 8:10 AM on April 24, 2002

"The pharmacist should be able to sell or not sell any drug he wants to any customer he wants, at least within the bounds of civil rights law. For instance, if he didn't want to sell any Tagamet to left handed albino eskimos, then he could concievably be accused of unfair discrimination, but I digress. He should be able to make the final decision about whether a script gets filled or not. That's his job."

WRONG - his job is to properly fill out all Schedule I presciptions to the best of his ability. For Schedule II or Schedule III drugs, he is mandated to follow certain laws deemed by the state government. A typical job description for a pharmacist is here. For more information on a Walgreens pharmacy career, check this out. This is NOT about the right to dispense folks - I think it is clear that Walgreens grants their pharmacists the right to be biased based on religious intolerance. I wonder what the input and thoughts on this story would be had he denied medicine because she was black...
posted by gloege at 8:23 AM on April 24, 2002

I think it is clear that Walgreens grants their pharmacists the right to be biased based on religious intolerance.

This is the point. Where does the line get drawn...?
posted by bittennails at 8:30 AM on April 24, 2002

Generally, buying a slurpee is a different construct than being denied access to health care.

But this is not health care; it is contraception. Pregnancy is not a disease.
posted by kindall at 8:30 AM on April 24, 2002

onegoodmove: "Is that what is happening here is refusal to serve based on the fact that his religious beliefs don't allow that and he's discriminating against someone who doesn't share those same beliefs?"

Actually, it's exactly the opposite. Presumably the pharmacist does not know what, if any, religious beliefs the customer holds -- therefore he's not discriminating on the basis of the customer's religion. It is the pharmacist's religious beliefs that are driving his decision-making. What would be unlawful (indeed, as aaron implies, violative of the First Amendment) would be to compel him under penalty of law to act in violation of those beliefs.
posted by pardonyou? at 8:31 AM on April 24, 2002

gleoge, in follow-up to my post above, your (and others') attempted analogy to other forms of discrimination (such as race) is apples-to-oranges. The pharmacist is not refusing to sell to the customer because he dislikes her religion -- he's refusing to sell because he values his own religious beliefs. I doubt the pharmacist knows whether the customer is Catholic, Presbyterian, Methodist, Jewish, Buddhist, or Hindu. Conversely, let's assume the pharmacist is Catholic. If he was truly discriminating on the basis of religion, he would sell the pill to Catholics, but not to Jews. But obviously he doesn't want to sell the pill to anyone.

Thus, it's not at all the same as refusing selling to a customer because she's black.
posted by pardonyou? at 8:38 AM on April 24, 2002

machaus: Did you read gloege's post dwivian?

Did you stop beating your parents, machaus? I hate questions like that, because it is inherently annoying. Of course I read the post. I wouldn't have made comments if I wasn't reading these things. Now, having gotten that little flame out of my system (and I hope nothing more comes of it).....

The problem with gloege's post is that there are a number of faults in the reasoning. First, there are cites for bills, not law (and not scheduled to become law, even if signed, until 2003). If I'm not supposed to get all wadded over potential charges for email, why should I care about bills with no current effect? A review of Florida Law (through Florida Law Online) found no requirement to MANDATE dispensing of drugs. Check out title XXIII (23), chapter 465 specifically.

Second, the law specifically gives reasons for required FAILURE to dispense. There may be other reaons to fail to dispense that aren't mandated by law, and are not prohibited by it, either. Otherwise, the law would say "a pharmacist is required by law to stock all possible medications prescribed by any doctor anywhere, for potential dispensation, with the following exceptions." As it doesn't say that, the pharmacist may elect how to run their business, so long as they don't dispense that which they are not allowed.

So, again I say, it is Florida law, and business practice, that a pharmacist may decline to do business with a customer. This is not a denial of health care services, as there are many alternatives, including mail order prescriptive services, other pharmacies, etc. And, in the case of this particular medication, failure to receive it is not life threatening (well, not for a few months, at least). The pharmacist is well within their rights to pick who they want to serve.

Oh, and as to the "Oath".... The Florida Board Of Pharmacy requires no oath beyond "I AFFIRM THAT THESE STATEMENTS ARE TRUE AND CORRECT AND RECOGNIZE THAT PROVIDING FALSE INFORMATION MAY RESULT IN DISCIPLINARY ACTION AGAINST MY LICENSE OR CRIMINAL PENALTIES PURSUANT TO SECTIONS 456.067, 775.082, 775.083, 775.084, 465.018, FLORIDA STATUTES", which of course relates to the filling out of a form requesting a license. And, since the "Oath" described was distributed to Universities, one presumes the "Oath" is administered at graduation, where it can be ignored. There is no enforcability involved.

gsh: the doctor's call is not that a medicine be available, but that a medicine would relieve the problem. Availability is always the perview of the chemist. What if your doctor prescribes something that is not in your insurance formulary, is not carried by the pharmacy, and in fact is not legal in your country? Should the law, business, and insurance company bow to the allmighty doctor? Of course not. The doctor cannot REQUIRE a chemist to create a medicine -- only a good business need will make that happen.

pardonyou?: So, could the pharmacist refuse to depense a medication because he himself was black? As long as we are bandying about race, how's that one? *grin*
posted by dwivian at 8:42 AM on April 24, 2002

I'm wondering how this is different than a doctor from the fact that not all doctors perform abortions. I think it's not that different.

Simple: the morning after pill is not an abortion pill. The morning after pill changes the lining of the uterous and causes unfertilized eggs to reject fertilization. If a woman has already become pregnant (an egg has been fertilized and has implanted in the uterous wall), the morning after pill will not end the pregnancy. This is why it's so important to take it as soon as possible. The longer a woman waits to take the morning after pill, the more likely she has become pregnant. Delaying access to this pill increases the likelihood that a woman will become pregnant against her wishes, and will later seek an abortion.

There is an abortion pill, conventionally known as RU486, which causes termination of pregnancy. It should not be confused with the morning after pill, which is a form of contraception.

By denying a woman access to contraception, this pharmacist increased the odds she will later get an abortion. Doesn't this defeat the whole purpose of denying her the pill in the first place?
posted by croutonsupafreak at 8:42 AM on April 24, 2002

So, pardonyou, if I am a pure vegetarian bought on by my religious beliefs, I can refuse to sell you eggs at a market. And, if fired for said action I can sue because it violated my First Amendment rights.
posted by bittennails at 8:48 AM on April 24, 2002

bittennails: Yup. you can sue, and if you can prove your religious vegetarianism, and that your firing was not because you denied a customer their purchases or violation of a service standard in company policy, you might win.

Go for it.
posted by dwivian at 8:50 AM on April 24, 2002

dwivian, no a black pharmacist could not refuse to fill a prescription for a white customer simply because the customer was white. But again, if you really want an analogy to this situation, a blind black pharmacist could refuse to fill a prescription for a medicine he believed was somehow "racist" (not knowing the race of his customer). Remember, the key of discrimination is the person you're supposedly discriminating against, not yourself. If you don't know the religious beliefs of a person, you can't be discriminating against that person because of their religion.
posted by pardonyou? at 8:50 AM on April 24, 2002

This is not a denial of health care services, as there are many alternatives, including mail order prescriptive services, other pharmacies, etc.

This is a morning-after pill. Not a wait for fed-ex pill, not a drive to the next town because the woman in question lives in rural Alaska pill.
posted by machaus at 8:52 AM on April 24, 2002

pardonyou?: That's my point -- what if, as a black pharmacist, I decide that it is against my race to provide certain medications. Is that okay?
posted by dwivian at 8:52 AM on April 24, 2002

Then let's get to the nitty gritty of this debate shall we - the law states that a pharmacist may refuse to fill a prescription based on:

belief that the script is fraudulent

under state laws deeming certain restrictions for filling scripts for Schedule II and Schedule III drugs

I assume if a particular pharmacy does not carry the drug they have to refuse to fill the prescription.

This has everything to do with religious intolerance. For whatever her religious (or lack thereof) beliefs allow, she obviously has the right under her personal values and beliefs and by the federal and state government to have her prescription filled by a licensed pharmacist in the state of Florida. By not filling that script, the pharmacist whose JOB it is to fill that script unless mandated by state or federal law NOT TO (which is NOT the case here) has discriminated against her and her personal needs and beliefs by refusing to do his job and grant her the medicine prescribed by her doctor. This is wrong and I hope she sues the hell out of him and Walgreens.

By the way, the definition of discrimination is: "discrimination

n 1: unfair treatment of a person or group on the basis of prejudice [syn: favoritism, favouritism] 2: the cognitive process whereby differences between two or more stimuli are perceived". I'm sorry - how again is this not discrimination? Where is he not imposing his beliefs and ideas on another due to obvious and profound differences of thought and ideal??? How is he not discriminating just because he imposes his belief on EVERYONE???

posted by gloege at 8:52 AM on April 24, 2002

machaus: This is a morning-after pill. Not a wait for fed-ex pill

Then, maybe it was important enough for the client to check to see if the pill was available before dashing off to the doctor because last nights "10" turned out to be five "2"s. (props to Carlin).
posted by dwivian at 8:54 AM on April 24, 2002

gloege: discrimination against EVERYONE is not illegal. EVERYONE is not a protected class.
posted by dwivian at 8:54 AM on April 24, 2002

bittennails, no absolutely not. A market (or Walgreen's) can't possibly violate the First Amendment, since the First Amendment only applies to governments. (I cannot believe how few people -- on MeFi and in society -- fail to grasp this simple, simple point)

What would be a violation of your First Amendment rights would be if the government tried to prosecute you for your decision. Likewise, if the State of Florida attempted to strip this pharmacist of his license, or prosecuted for refusing to sell, that would be a violation.
posted by pardonyou? at 8:55 AM on April 24, 2002

gloege: the pharmacist whose JOB it is to fill that script unless mandated by state or federal law NOT TO (which is NOT the case here)

WRONG. WRONG WRONG WRONG WRONG

The job of the pharmacist is to dispense medication according to company policy, and to NOT dispense when so directed by law.

The company policy is being followed. The law is moot.

A lawsuit would be interesting, and may have merit, but not in a criminal sense. This is a purely civil matter.
posted by dwivian at 8:58 AM on April 24, 2002

and gloege, I hate to pull out my Black's Law Dictionary, but I think "discrimination" as I'm using it here calls for that definition:

1. The effect of a law or established practice that confers privileges on a certain class or that denies privileges to a certain class because of race, age, sex, nationality, religion, or handicap... 2. Differential treatment, esp., a failure to treat all persons equally when no reasonable distinction can be found between those favored and those not favored.

For discrimination, it takes two to tango -- it has to be directed at a person because of his or her protected class.
posted by pardonyou? at 9:00 AM on April 24, 2002

Aaron -- excellent point. There's no epidemic of women being denied abortions or day after pills (which are abortifacients in many people's opinion) in this country ... but there is an absolutely scandalous epidemic of unmanaged pain. Unfortunately, state and federal government agencies with their prosecutions and reclassifications for OxyContin are probably more than undoing all of the progress that's been made in pain treatment in the past few years.

I personally, would much rather see 10,000 junkies dead from OxyContin overdoses before I'd let one person suffering from profound medical pain go untreated. (I couldn't care less about the damage to the enemy from the war on drugs, but I hate the collateral damage.)
posted by MattD at 9:01 AM on April 24, 2002

By not filling that script, the pharmacist...has discriminated against her and her personal needs and beliefs by refusing to do his job and grant her the medicine prescribed by her doctor.


No. He has made a decision based on his personal needs and beliefs; her beliefs and needs don't come into his view of the situation. She could be essentially anyone with any set of personal beliefs; this pharmacist would still (presumably) not want to fill that prescription.

What he HAS done is put his job in jeopardy (assuming management types side with customers vs. pharmacists on the issue) by choosing to stick to his beliefs in a conflicting situation.
posted by cortex at 9:11 AM on April 24, 2002

Then, maybe it was important enough for the client to check to see if the pill was available before dashing off to the doctor because last nights "10" turned out to be five "2"s

I just knew this would end up being the woman's fault.
posted by Summer at 9:12 AM on April 24, 2002

But this is not health care; it is contraception. Pregnancy is not a disease.

so anything that prevents an unwanted state isn't health care?

I took the morning-after pill myself about 5 years ago. (basically, it's just a super-dose of birth control pills.) we'd had a condom mishap...and for lots and lots of reasons, I was in no condition to have a child. (nor was my partner.) so I went to planned parenthood - I didn't have any regular health care or insurance at the time - they prescribed it. I can't remember now if I got it there or if I had to pick it up elsewhere.

I'm so glad that I didn't run into this kind of bs. it wasn't a happy experience anyway, very embarrassing to say the least. (fyi, it was like having a really bad period.) and for many, I imagine having the pharmacist say "I won't give you that" would be totally demoralizing.

it may be, technically, that this was within his rights, but I still find it a crying shame.

another thing to consider - if Walgreens was the pharmacy of choice for your health insurance, and they wouldn't give you the drug that your provider had specified (going anywhere else means paying out of pocket), what would you do then?
posted by epersonae at 9:12 AM on April 24, 2002

I have the perfect solution:
Porn stores should be able to sell medicine.
posted by octavius at 9:13 AM on April 24, 2002

kindall: But this is not health care; it is contraception. Pregnancy is not a disease.

I never said it was a disease. If I need to see a doctor to get a prescription, and my health care plan covers it, it is health-care. Unless you are advocating that insurance plans shouldn't cover family planning, I don't see your point. Let's look at a hypothetical situation that obviates the whole right-to-life rat-hole. Say that I am a woman with an ob-gyn disorder that makes pregnancy very dangerous for me and the health of a baby. I'm very careful about using condoms and other means of prevention, but the condom breaks, blah blah blah. Should a woman in this situation be obstructed from accessing a medicine that has been established by a doctor as the avenue that is the best for a patient's physical and mental health?
posted by machaus at 9:13 AM on April 24, 2002

"For discrimination, it takes two to tango -- it has to be directed at a person because of his or her protected class."

So if we are in a court of law and I point out that the morning-after pill is required only by women (since last I heard we are the only ones with the ability to get pregnant) that you are discriminating against me as a woman???

"The job of the pharmacist is to dispense medication according to company policy, and to NOT dispense when so directed by law.

The company policy is being followed. The law is moot."

Was it followed? I cannot find anywhere where she was refered to another physician who filled her prescription. Or wait, is THAT not the point either??? *rolls her eyes*
posted by gloege at 9:15 AM on April 24, 2002

oops s/that/then above...

*shoots her typist in a fit of rage but is NOT discriminating against her poor typing skills...*
posted by gloege at 9:16 AM on April 24, 2002

So if we are in a court of law and I point out that the morning-after pill is required only by women (since last I heard we are the only ones with the ability to get pregnant) that you are discriminating against me as a woman???

Only if it can be shown that the pharmacist IS willing to grant the prescription to men.
posted by cortex at 9:23 AM on April 24, 2002

I was unable to find the specific Florida law that says pharmacists can refuse to fill a prescription because it would violate their moral or religious beliefs (Florida's state code site is hideously slow and a usability nightmare), but I found a number of articles indicating that there are a number of states that have such "conscience clauses" allowing pharmacists such latitude.

I wonder if the woman could sue on the grounds that only a female would ever need a morning-after pill (it doesn't have ANY other medical uses, does it?), and thus to refuse to provide it to her is indeed discriminatory. Also, can anyone think of any other medications besides birth-control-related drugs that a pharmacist might potentially have moral or religious qualms about dispensing? (Besides the obvious absurdities such as a Christian Science pharmacist that wouldn't want to dispense anything to anybody.)
posted by aaron at 9:37 AM on April 24, 2002

(Cortex/gloege argued the same point while I was lazily spending fifteen minutes banging out my reply while eating lunch at the same time. *burp*)
posted by aaron at 9:39 AM on April 24, 2002

I just realized I've made two mutually exclusive arguments above. If the state requires pharmacies to allow pharmacists not to fill certain scripts, then it's not "Walgreen's corporate policy of allowing pharmacists to pick and choose their that's the truly stupid thing here," as I said way up top, since they, and all other pharmacies, have no choice in the matter.
posted by aaron at 9:59 AM on April 24, 2002

I, frankly, am sort of surprised she even got the prescription. Florida isn't technically considered the South, but Nashville is hardly a one-horse town, either. That is where I live, and after calling 50 womens' health providers for research for a story on emergency contraception (the "morning-after" misnomer is misrepresentative, as the pill can be taken up to 72 hours after unprotected sex), only 15% of those physicians would consider prescribing it. The others told me flat out when asked that they will not.

While these pills are readily available at Planned Parenthood and the like, private practice doctors (in Middle Tennessee anyway) aren't prescribing them.
posted by brittney at 10:03 AM on April 24, 2002

So this pharmacist has done nothing prohibited by law or by his employer's policy---great for him, must feel good to be able to lawfully inflict your religious beliefs on other people. But it's still, quite simply, all fucked up that some guy at the drugstore can override decisions that my family doctor makes about my health care. That's the bottom line to me. I'm horrified.
posted by Sapphireblue at 10:05 AM on April 24, 2002

kindall: But this is not health care; it is contraception. Pregnancy is not a disease.

What is a disease? A condition which causes pain, discomfort, disability to a person. It needn't be fatal (though pregnancy can be), it needn't be chronic, and it needn't be caused by a virus or bacterial infection (many diseases have genetic or unknown causes). These days depression and even drug addiction are being classified as "disease" - though obviously it's all dependent on context. Someone with symptoms of depression after their husband dies does not have a medical condition. Someone with the same symptoms when everything in life is going extremely well may be said to have one.

Not saying we should call pregnancy a disease, but just pointing out that you're getting stuck on a word here: this is about health care. An unwanted pregnancy is completely analogous to a disease for the woman undergoing it. Pain, discomfort and disability are part of every pregnancy, even the ones seen as the greatest blessing.
posted by mdn at 10:12 AM on April 24, 2002

dwivian -- I would say absolutely (at least as far as the government compelling you is concerned)
posted by pardonyou? at 10:22 AM on April 24, 2002

A former boss, who worked in healthcare, once told me that pregnancy was classified as a disease a long ways back -- a foreign body that depresses a woman's immune system and is expelled in nine months -- so that agencies like Centers for Disease Control could track it. I've looked but can't find any confirmation online -- this was a long time ago, though.

Note that CDC is now CDCP -- Centers for Disease Control and Prevention. :)

In any case, I find this whole thing chilling. S'pose my pharmacist didn't feel like giving me my glaucoma meds on the grounds of his or her religious beliefs? "Nope, sorry, go elsewhere or go blind."
posted by metrocake at 10:27 AM on April 24, 2002

Disease: a condition of the living animal or plant body or of one of its parts that impairs normal functioning

Reproduction is a necessary part of the normal functioning of life. Reproduction is not a disease.
posted by NortonDC at 10:57 AM on April 24, 2002

"Health care" implies that whatever you're doing is being done to prevent or remedy ill health (disease, injury, etc.). I have a hard time seeing pregnancy as unhealthy.

On the other hand, yeah, machaus has a point with "If I have to see a doctor to get a prescription, it's health care."

However, I think you will find that most health insurance doesn't cover contraception, either.
posted by kindall at 11:10 AM on April 24, 2002

Disease: a condition of the living animal or plant body or of one of its parts that impairs normal functioning

Reproduction is a necessary part of the normal functioning of life. Reproduction is not a disease.

while reproduction is part of the normal functioning of life in general, pregnancy absolutely impairs the normal functioning of an individual woman. A woman can choose to impose this on herself in order to gain something she considers well worth it (a child) but the actual experience of pregnancy, as I said, is completely analogous to disease.

Death is part of the normal functioning of life too, on a general level - but death impairs the normal functioning of an individual. In fact, if we're gonna go with this whole "normal functioning" thing, disease is part of the normal functioning of the world. It just impairs the individual.

I have a hard time seeing pregnancy as unhealthy.

obviously, it's necessary for reproduction, so it's not unhealthy in general. But if you don't want a child, the condition of pregnancy is not a positive one. that is, if it were anything other than a new baby in there, we would absolutely see pregnancy as a disease - an alien growth. And if it weren't for those happy maternal hormones, moms would feel that. And moms who don't want to be moms may feel that.

Don't mean to push the point but I feel like a lot of people really don't comprehend what women go through when they are pregnant. Back pain, foot pain, abdominal cramping, incontinence, nausea, and carrying around an additional twenty pounds everywhere you go all the time... everyone go thank yr moms.
posted by mdn at 11:21 AM on April 24, 2002

I'm saying as long as physicians have the right to decline prescribing medication for religious reasons, pharmacists should have that same rule. FYI--I have had a physican refuse to prescribe birth control pills because it was against his religion. I just went to another doctor.
posted by RunsWithBandageScissors at 11:29 AM on April 24, 2002

So, let me ask...

If the clerk was a member of PETA, and he/she decided that she didn't approve of the testing methods of the manufacturer of your drug and therefore refused to give it to you, would any of you supporters of this crap have qualms about that?

And don't say "but PETA's not a religion", because that's a weak argument.
posted by eas98 at 11:33 AM on April 24, 2002

I don't tell you how to do your job, even though you may be un-qualified, and you shouldn't tell me how to do mine, even though you may be qualified. Religion and health care issues are a matter of personal discretion. If I want to go see a good catholic or jewish doctor I can search one out and could find one that will perscribe the drugs I would need, should I happen to need drugs. Should I run into one who will not fill an order, I'm sure 10 others who will. As for Gov't telling everyone how to do their jobs is a joke. Some people need a dose of common sense and not the need to sue everyone. I don't see discrimination here even if a wheel chair bound, gay, black, woman, Haitian, and whatever else is "protected" by law was the either the Physician or customer. Walgreens would more than likely need not ask him/her to step down since that would open up the discrimination lawsuits as it does not hire based on those protected status.
posted by brent at 11:34 AM on April 24, 2002

Sheesh, there are some litigious socialists herein.

This is a nuisance, not an epidemic. Tell the woman she's a ridiculous bitch and hump your ass to another drug store. Problem solved.
posted by glenwood at 11:37 AM on April 24, 2002

"And don't say "but PETA's not a religion", because that's a weak argument."

Um, PETA's not a religion. Not only is that not a weak argument, that pretty much goes to the crux of the issue.

And anyway there's a difference between "having a problem" with something (we're all free to have a problem with something), and claiming that the doing of that thing somehow violates some "right" you think you have vis-a-vis a private company. I'm not saying the customer shouldn't grumble, or stomp her feet, or demand to see the manager, or yell at the top of her lungs that she's never coming in that, or any, Walgreen's again. But many posters in this thread seem to think that the customer has some sort of "right" owed to her by this Walgreen's pharmacist. That's just not true.
posted by pardonyou? at 11:43 AM on April 24, 2002

"Reproduction is a necessary part of the normal functioning of life. Reproduction is not a disease."

Having been pregnant I can unequivocably state that pregnancy was NOT a necessary part of the normal function of life. Pregnancy is not a disease. However, given what a woman's body goes through one might best liken it to having a parasite. For those nine months everything you do good and bad goes to that baby. It you do not eat well then the nutrition you have (and fat stores) go to your fetus to give him or her a fightening chance at life. But if I never had a baby would I not have a normal functioning life? OH COME ON!

Reproduction is a necessary function of perpetuation of the species. It is no more and no less.
posted by gloege at 11:51 AM on April 24, 2002

sterilize florida. avoid future election fiascos.
posted by quonsar at 12:09 PM on April 24, 2002

If the clerk was a member of PETA, and he/she decided that she didn't approve of the testing methods of the manufacturer of your drug and therefore refused to give it to you, would any of you supporters of this crap have qualms about that?

As far as I can tell from the articles I've read, the "conscience clauses" many states have would certainly allow the pharmacist to refuse to give it to you. Most of them seem to allow for religious and moral objections. Would I have qualms about it? Sure, I'd be pissed off. But would I have any right to force him/her to give it to me anyway? Nope.
posted by aaron at 12:19 PM on April 24, 2002

If the clerk was a member of PETA, and he/she decided that she didn't approve of the testing methods of the manufacturer of your drug and therefore refused to give it to you, would any of you supporters of this crap have qualms about that?


I wouldn't have a problem with that. Find yourself another pharmacist. Hell, let's take it to an extreme: I wouldn't have a problem with it if a pharmacist refused to fill a prescription because the pills were orange and the pharmacist doesn't like orange things.
posted by obfusciatrist at 12:52 PM on April 24, 2002

But many posters in this thread seem to think that the customer has some sort of "right" owed to her by this Walgreen's pharmacist. That's just not true.

It may not be a "right" in any legal sense, but what about a hundred years of history? We've heard the phrase "the customer is always right" quite a number of times. This person had a legitimate prescription, the store stocked the medication, but the dispensing pharmacist felt they were obliged to refuse service to someone, based on their personal belief system. While the customer could certainly "vote with their feet" there are circumstances that might make that impossible (for a timely application, or in a remote setting that didn't have any competition), and you have to admit on some level something is most definitely wrong with this situation. Someone visited a doctor with a problem, the doctor prescribed medication, and now a pharmacist is refusing to meet the health needs of a customer due to their moral and religious feelings. I know the "morning after" pill is an ethics minefield, but I would expect trained professionals to do their job to the best of their ability and not factor in personal opinions that discriminate which customers will get what they ask for, and which ones will be refused.

For anyone that doesn't see a problem with it, consider all the similar and related analogies from others here, because that is the next logical step. If this is ok, then other circumstances are certain to follow.
posted by mathowie at 12:54 PM on April 24, 2002

With all respect, I think that some of you -- notably certain female MetaFiliterians -- have let your emotions get in the way of your judgment.

It is plainly true that bookstores don't have an obligation to sell books they find objectionable (ie, pornography). Similarly, television stations need not show programs that they find objectionable. This is the default rule in virtually every business setting. The question is, then: is there something inherently different about health care that justified changing that rule?

If this were the only pharmacy within a reasonable distance, such that a woman who was refused service at this Walgreen's would be practically unable to get service elsewhere in time, then I would say that the answer is yes. Health care, in that instance, should not be given the sort of latitude to moralize that other businesses get. But I would not be alone in that: the law would likely condemn this behavior as well. Not for discrimination (applying discrimination to this situation is legally absurd, though I must admit that stranger claims have prevailed in the touchy-feely domain of discrimination law). But it seems very likely to me that in those circumstances an unreasonable failure to promptly supply a common medicine would leave Walgreen’s liable under some other theory.

However, Walgreen's was NOT the only pharmacy in town. Indeed, I'm sure that there were many other options. Yes, being refused might be frustrating for the woman. It might be even be embarrassing or demoralizing. But none of that is sufficient to override the general presumption that we're not going to force people to sell specific products against their conscience. Even if they happen to be in the same general line of business.

The question is simple and clear. Don't get me wrong, I think that contraceptives are plainly moral. But if it was wrong for Walgreen's to refuse to sell contraceptives against the conscience of one of their employee's, then it is also wrong for a doctor to refuse to perform abortions because of his or her conscience. And it is would also be wrong for a lawyer to refuse to handle divorce cases because of his or her conscience. And it would have to be be wrong for a Christian marriage counselor to refuse to counsel divorce because of his or her conscience.

And that's plainly wrong.
posted by gd779 at 1:19 PM on April 24, 2002

Matt, if I read you correctly, that's pretty much the point I was trying to make. I was only addressing the "legal" right, which many seemed to assume this customer would have. That's the part that isn't true. I agree with you that something may not be right, and I'm not saying that I don't see a problem with it. But who says we're entitled to get everything we want from any store we want? Consider this -- the pharmacy could simply close down if it wanted to. Then everyone would be in the same boat as this "victim," and *gasp* might have to go to the next pharmacy (which, in Southeast Michigan, at least, appears never to exceed 1 mile). I also don't buy the "slippery slope" argument in this case. I doubt there's this mass of pharmacists who might at any moment start denying prescriptions because of their deep-seeded religious beliefs.

In any case, this lady should just get a three-month prescription and get it filled by mail from Merck-Medco. It's cheaper and I doubt it will go unfilled.
posted by pardonyou? at 1:21 PM on April 24, 2002

mathowie: I don't how omniscient you are, but can you prove that the store stocked the medication? If this pharmacist was so moved, and was the head pharmacist at that, maybe this particular Walgreens DOESN'T stock it?

Oh, and the pharmacist is not refusing to meet health needs. The pharmacist is refusing to do business with this individual at this time. This is their right, and should not be violated because someone else thinks their health is paramount.

Or, to put it simply, since you are considering the next logical steps --- how far can I go in preservation of my health, as I perceive it? What of yours can I force you to give up? What can I make you do, just because I demand health? Is my health more important than your use of your time and resources? Or, is my health more important than yours?

The next logical step is to require all citizens to donate platelets, blood, and marrow, because someone, somewhere, needs it. Nevermind the invasion of their body and time -- we musn't refuse to meet the health needs of a citizen!

Overblown, for sure, but it's a logical step.

Why is it that we think that doctors, and now pharmacists, must conduct business without any use of their own ethical framework? If this becomes the standard, watch for all the doctors of ethics to retire or change careers to someplace where they are allowed to think and be themselves.
posted by dwivian at 1:32 PM on April 24, 2002

mdn - Death is part of the normal functioning of life too

Actually, death is the cessation of the normal functioning of life.

the actual experience of pregnancy, as I said, is completely analogous to disease.

No, because disease does not provide you with offspring.

gloege - Having been pregnant I can unequivocably state that pregnancy was NOT a necessary part of the normal function of life.

Definition of Life: (5). Living things reproduce themselves by making copies of themselves. Reproduction can either be sexual or asexual.

Pregnancy is not a disease.

Correct!

However, given what a woman's body goes through one might best liken it to having a parasite.

That would not disqualify my statement. Just because something is necessary to life does not mean it will be without impact or risk.

For those nine months everything you do good and bad goes to that baby. It you do not eat well then the nutrition you have (and fat stores) go to your fetus to give him or her a fightening chance at life. But if I never had a baby would I not have a normal functioning life? OH COME ON!

Actually, had you never reproduced you would have missed out on much of the human experience.
posted by NortonDC at 2:03 PM on April 24, 2002

However, I think you will find that most health insurance doesn't cover contraception, either.

Depends on your state and provider.
http://www.crlp.org/pub_fac_epicc.html

At least 16 states have some degree of requirement for coverage.


Actually, had you never reproduced you would have missed out on much of the human experience.

What a load of crap. I'm sure it feels that way if you have kids [I mean, what, you're going to say how much having kids sucked? Of course not], but children are not a requirement to enjoying life, as any number of childless older people can tell you. There's a lot more to being human than reproduction - after all, any living thing can [by definition] reproduce. That is not what makes us human.
posted by wildcrdj at 5:30 PM on April 24, 2002

Let me be the first to say, who cares if its legal? Many laws are passed and some are challenged and thrown out. This Florida law looks like a contender. I can see a case of religious discrimination here. Obviously the pharmacist knows you are not in his/her faith because you would ask for such a thing. There's no religious identification cards, so we call go on what we pick up on the other person when figuring out who or what they are.

This is a health care issue. The window of opportunity for the morning after pill is only a couple days and someone in a one horse town could be at risk at having an unwanted pregnancy because the pharmacist chose the wrong major in school. Worse, this gives anti-abortionists an opportunity to circumvent roe v. wade by limiting accessibility to a legal product or medical technique. This shit is constantly going on, most recently with the HR 476.

Walgreens might want to rethink their policies, especially hiring policies. If this woman was denied a legal drug and ended up pregnant because of Walgreens tomfoolery then Walgreens could be found liable to support the child. How would like that docked out of your salary?
posted by skallas at 6:02 PM on April 24, 2002

mathowie: I don't how omniscient you are, but can you prove that the store stocked the medication? If this pharmacist was so moved, and was the head pharmacist at that, maybe this particular Walgreens DOESN'T stock it?

I'm assuming from the details of the article, due to it sounding like the pharmacist made a decision not to fill a prescription, that they indeed had the prescription medication available. Otherwise, it would easy for the walgreens employee to simply say "hey, we're out of that" or "I'm sorry, the Walgreens Corp. doesn't stock that medication." Instead, according to the details of the article, the situation hinged entirely on a personal decision by one of their employees, so I would think whether or not a supply of the medication was around wasn't the reasoning in the decision.

In all these business vs. human needs arguments, one thing seems obvious. I'd agree it doesn't make sense for phramacies to stock every medication on earth by law, but it simply doesn't make business sense for them not to sell products that they stock to customers legally requesting said products. If people are pro-business here, why is it ok for a business to refuse service to someone that is not breaking the law and is requesting (with physician approval) something they sell?

It just seems like this situation was clearly different than a typical situation where it is good that retail professionals are afforded the ability to refuse service to people. If it was someone refusing to sell something contreversial, like say a gun, to someone because they "got a bad feeling" about a customer, I could understand that. But we've got someone with a prescription written by a doctor, and instead of filling a customer's health needs, they've decided not to, based on their personal beliefs.
posted by mathowie at 6:12 PM on April 24, 2002

mdn - Death is part of the normal functioning of life too

Actually, death is the cessation of the normal functioning of life.

Death is part of the normal functioning of life on a species level, just as pregnancy is. Death is the cessation of that life, and pregnancy an impairment on it, when we are talking about individual cases. That was the distinction I was making.

(me) the actual experience of pregnancy, as I said, is completely analogous to disease.

No, because disease does not provide you with offspring.

And again, as I said earlier, that is the only difference. Therefore, if you do not WANT offspring, it is very much like a disease.

gloege - Having been pregnant I can unequivocably state that pregnancy was NOT a necessary part of the normal function of life.

Definition of Life: (5). Living things reproduce themselves by making copies of themselves. Reproduction can either be sexual or asexual.

You are once again conflating the individual experience and the species-wide situation. A person who hasn't reproduced is still a person. A person who chooses for the moment not to reproduce is not abnormal.

Actually, had you never reproduced you would have missed out on much of the human experience.

first of all, who are you to define what is necessary to the human experience? Maybe the NortonDC experience requires reproduction in order to be worthy, but that doesn't mean that's true for all humans. Some people might say, if you aren't an artist, you're missing out on the human experience, or, if you aren't religous, or, if you haven't eaten steak or had sex or gone sky-diving or whatever. And yet in every case there will be people who disagree, or who even feel that specifically avoiding those things is important. The human experience is defined by the humans who experience it.

And anyway, having an unwanted pregnancy is definitely not necessary to the human experience. Plenty of women will eventually want children but would rather concentrate on some other aspect of their human experience before committing to that one, and so don't want to undergo the disease-like condition of pregnancy when the one thing, according to your own post, that separates it from being a disease (the offspring) is something they do not want.
posted by mdn at 7:19 PM on April 24, 2002

mdn, no one said it better. thank you.
posted by gloege at 7:23 PM on April 24, 2002

Worse, this gives anti-abortionists an opportunity to circumvent roe v. wade by limiting accessibility to a legal product or medical technique.

Which they have every right to do. Roe v. Wade only says that the government cannot prohibit abortions. It does not force doctors to perform them against their will, nor does it force companies to sell birth-control products.

If people are pro-business here, why is it ok for a business to refuse service to someone that is not breaking the law and is requesting (with physician approval) something they sell?

What do you think being pro-business means? Individual rights are paramount in this nation. A snooty restaurant can turn you away for not wearing a tie, no matter how much you want to eat the filet mignon that they sell. A snootier club can turn you away for no other reason than not being "physically attractive," regardless of how many of their overpriced drinks you intended to purchase there. The drug company that makes the morning-after pill is not even under any obligation to produce it. Drugs are pulled off the market all the time.

I too agree with gd779; a lot of the arguments being made in this thread seem to be of the "But ... but ... this isn't about business, it's about WOMEN and REPRODUCTIVE RIGHTS! That's DIFFERENT!" variety. No it's not.
posted by aaron at 8:55 PM on April 24, 2002

aaron, I didn't say it was illegal, I said they were trying to circumvent something that was legal. There's a difference.

As for legality, Interesting you brought it up. I wonder if a case could be made not only for religious discrimination but as well as violating the Federal Access to Clinic Entrances Act.

it is the purpose of this Act to protect and promote the public safety and health and activities affecting interstate commerce by establishing Federal criminal penalties and civil remedies for certain violent, threatening, obstructive and destructive conduct that is intended to injure, intimidate or interfere with persons seeking to obtain or provide reproductive health services.

If access to drugs falls under 'reproductive health services' then this might get interesting.

I don't think this is only about business. Obviously this policy is a bit more complex than your quick dismissal of it and considering it hasn't yet been challenged in court I wouldn't be so quick to make acute dismissals.
posted by skallas at 9:52 PM on April 24, 2002

I have made a post above addressing potential issues and court challenges raised by this matter, so please don't accuse me of "quick dismissals."

And I don't think the Federal Access to Clinic Entrances Act would apply here at all. It was obviously created to tackle a single issue: psycho anti-abortion protesters that were becoming so overbearing as to be physically preventing women from entering abortion clinics. Besides, simply saying "No" to someone seeking to obtain reproductive health services is not covered under the Act. If it were, no doctor would be able to refuse to perform an abortion once any female asked him/her to do so.
posted by aaron at 11:42 PM on April 24, 2002

If it were, no doctor would be able to refuse to perform an abortion once any female asked him/her to do so.

Where are you getting that form? That's a completly different situation. The woman in this case already has her prescription in hand thus consent from a doctor. Barring the consent through religious protest and possibly violating FACEA is not the same as forcing consent.
posted by skallas at 12:02 AM on April 25, 2002

Not to mention the spirit of the law is obviously to protect women from protestors, which is exactly what our Walgreens employee is. RU486 simply wasn't around when FACEA was passed, but the sentiment looks the same to me. One protestor is blocking access to a drug that certianly falls in the category of reproductive health services.
posted by skallas at 12:13 AM on April 25, 2002

Slight correction. Replace RU486 with an emergency contraception like PlanB. The article doesn't say which drug was denied but RU486 is not generally called a "morning after" pill.
posted by skallas at 12:32 AM on April 25, 2002

Obviously the pharmacist knows you are not in his/her faith because you would ask for such a thing.

The pharmacist knows no such thing. There are people all over the planet who do things in diametric opposition of the teachings of their professed faith -- Catholics all over America, especially, are using contraception in direct contradiction to the demands of their spiritual leader. When polled, even the staunchest pro-life women are split nearly 50/50 on whether or not they'd request the morning after pill if they were victims of a sexual assault. Having a script for the MAP doesn't say anything remotely conclusive about the faith that you adhere to.

This whole issue boils down to this: can a health-care professional be forced by law to provide a service in a non-emergent situation when that service is in direct contradiction to his or her closely held beliefs? Currently, nearly every state says "No" so long as the health care professionals in question are doctors and nurses. Very few states extend the same protection to pharmacists, even though -- as this case demonstrates -- they are often called upon to facilitate abortifacient remedies just like MDs and RNs. If new drug technology is going to bring pharmacists into the middle of the abortion arena, then they deserve the same conscious clause protection as their direct care colleagues.

It flies in the face of liberty to suggest that one's own personal morality can be trumped by force of law in situations which are not an emergency, and in which those affected are free to seek those services from someone else -- in these cases, either another pharmacist at that store, or another store.

On preview -- skallas, there is a fair bit of difference between refusing to fill a prescription and physically preventing a woman from entering a building via human barricades or by barraging her with a litany of verbal intimidation and abuse. There is also the very real issue of the narrow availability of public abortion providers as compared to the wide availability of pharmacies.
posted by Dreama at 1:09 AM on April 25, 2002

Er, conscience clause, not conscious clause. Forgive me. It's 4:11 a.m. here, and I'm running on cappucino and hope.
posted by Dreama at 1:12 AM on April 25, 2002

It flies in the face of liberty to suggest that one's own personal morality can be trumped by force of law in situations which are not an emergency

What's the definition of emergency in this case. The longer one waits the less effecting an EC (emergency contraceptive) will be. That's why doctors give prescriptions for these drugs for women to hold onto until they need them. I would say the window of opportunity argument and how these drugs function do indeed make a type of emergency. Driving all over town to fill a prescription might actually make or break how well this medication works. In a worst case scenario a very conservative town would be full of these types of pharmacists, effectivly cutting this woman off. She can't exactly wait for mail order when she has only 20-40 hours to burn.

The difference between a blockade (which is one of many methods outlawed by FACEA) and denying access to emergency medication - they don't call them emergency contraceptives for nothing, is trivial in today's legal ECs and RU486 world. Worse, a person morally opposed to a drug could be shooting themselves in the foot. RU486 is also a treatment for some types of cancer. Are we now subjected to grilling about how we're going to use our drugs by someone other than our own MD?

Lastly, ethics is a mighty relative thing. For instance there are many people with the belief that morbid obesity is the best treated with excercize and diet and find giving these people drugs like Dexfenfluramine is simply wrong. Absurd? Many doctors refuse to play around with certain drugs because of their their own moral convictions which may have little in common with fact. Take benzodiazepines as an example.

Would you still be defending the ethical position of someone who believes obese people should get on a treadmill instead of "lazily swallowing anti-fat pills?" Or the pharmacist who thinks a benzo prescription is just a "party drug?" At a certain point ethics becomes prejudice and that's what we're seeing here. I think history has shown us that very moral people can do some pretty fucking nasty things.
posted by skallas at 1:33 AM on April 25, 2002

Would you still be defending the ethical position of someone who believes obese people should get on a treadmill instead of "lazily swallowing anti-fat pills?" Or the pharmacist who thinks a benzo prescription is just a "party drug?"

If there exists a sane person on the planet who can offer a reasonable explanation supporting any such positions, then yes, I would. But that's not going on here, and you know it. You're arguing far-fetched "what ifs" while these pharmacists are engaged in a very real battle of "what is" as they are placed in positions where their objections to assisting in an abortifacient action are costing them their jobs while doctors and nurses are exempted from having their similar refusals held against them.

At a certain point ethics becomes prejudice and that's what we're seeing here. I think history has shown us that very moral people can do some pretty fucking nasty things.

What is your proof that this is prejudice in action? Prejudice against whom? Refuse to assist a woman in destroying what you believe to be nascent life makes someone a bigot now?
posted by Dreama at 2:21 AM on April 25, 2002

skallas: "Obviously the pharmacist knows you are not in his/her faith because you would ask for such a thing. "

That's one of the more laughable assertions I've heard in a long time. If you don't think (for example) that Catholics make up a huge portion of the market for contraceptives or morning-after pills, notwithstanding the "official" church position, you're quite naive.

And discrimination requires intent. While it's true that we don't carry religious affiliation cards, that doesn't mean that knowledge of the other's religion isn't required for (unlawful) religious discrimination.
posted by pardonyou? at 6:00 AM on April 25, 2002

I think much of the comparing of this case to doctors and nurses involved with abortions is missing a crucial point: pharmacists, like doctors and nurses, can specialize (their options aren't as many and varied as those of doctors and nurses, but they do have options, they don't all have to work behind the counter in a drug store). Given that a doctor or nurse opposed to abortion likely wouldn't choose to work in an area where they might be called upon to perform or assist with one, this pharmacist probably shouldn't be working in a drug store dispensing medications to the public if they're not prepared to dispense all of the medications they may be called upon to dispense. The picking and choosing should take place when choosing a job, not when doing that job, i.e. before it comes to refusing to dispense legal, properly prescribed, in-stock medication, not after. This pharmacist shouldn't be working in a drug store if they aren't prepared to dispense according to doctor's orders. It's not up to a pharmacist to decide what's appropriate for a patient (unless they detect a drug interaction or something like that, in which case they call the patient's doctor to discuss it), that's well outside the pharmacist's scope of responsibility.
posted by biscotti at 7:03 AM on April 25, 2002

Exactly. The guy's not doing his job. Walgreen's doesn't pay him good money to deny people prescriptions of drugs they have in stock. They don't have those pills sitting there to look pretty -- they are to be sold at a profit.

I'd fire anyone who wouldn't do the job I hired him to do, and so should Walgreen's. If he can't do the job, he should find another line of work.
posted by kindall at 9:28 AM on April 25, 2002

kindall, biscotti -- he is paid to dispense medication, it's true. But, the company SPECIFICALLY EXCLUDES him from dispensing things he finds objectionable. This is in an effort to fill the job in the first place. Had this not been an option (if he had "found another line of work", as you suggest) the position may have remained vacant, and the company would be making NO money from that store. It is in the best interest of the company to allow this concession.

Pharmacists don't dispense according to doctors orders, by the way. The prescription is a formula for medicine that the PATIENT is ordered to take. The pharmacist is NEVER ordered, nor subject to the doctor's orders. They don't act according to doctor's orders, but to CUSTOMER'S REQUESTS FOR SERVICE. The customer is given an order to take medication. To fulfil this order, the formula for the medicine is taken to a BUSINESS that might handle the request. The amount, dosage, and instructions are then translated and, depending on the policy of that business and of the payment broker (in the case of insurance that requires generic substitution), dispensed so that the patient might do as the doctor requires.

If the Doctor was so picky about the meds being available, the Doctor is perfectly capable of having a dispensation service within his clinic/private_practice (I have a doctor that does this very thing). If the patient wants a specific medicine, they need to be sure that they can pay for it, that it is available, and that it can be prescribed. This is the patients obligation (and it isn't "the woman's fault", as others before have blustered. It's every patients responsibility).

The problem is, we expect service without limits. If we take a drug prescription to a pharmacist, we are aghast if substitutions are required. We are agog when we are told we can have two pills, and the remaining 198 have to be picked up in a week. We are flabberghasted when told that the drug is too esoteric to be handled by this chemist/pharmacy/chain, and must be mail ordered. We are, as well, astonished when told that the use of the drug is too immoral for it to be dispensed.

How dare someone not give us gratification! Are we not the customer! Are we not always right?

Er.... no. Now, get over yourself. And, no, I don't expect a tip.
posted by dwivian at 9:49 AM on April 25, 2002

Where are you getting that form? That's a completly different situation. The woman in this case already has her prescription in hand thus consent from a doctor. Barring the consent through religious protest and possibly violating FACEA is not the same as forcing consent.

I'm getting it from the fact that just because a doctor issues an edict, the rest of the country is not required to bow to his commands. The pharmacist did not take the prescription and rip it into pieces; he merely refused to fill it. The couple in question maintained possession of the script; the doctor's consent remained completely valid and intact.

In a worst case scenario a very conservative town would be full of these types of pharmacists, effectivly cutting this woman off. She can't exactly wait for mail order when she has only 20-40 hours to burn.

My guess is that if there are such towns (I know there are lots of places in this country where you have to drive hundreds of miles to get an abortion, but you have to really get out into middle-of-nowhere territory to be in a place where there aren't at least a dozen competing pharmacies in a given 10-15 miles radius), the doctors are well aware of the issue and can either tell the women exactly where to go to get the script filled without a problem, or they can stock up on the MODs themselves in their own offices.

And again, even if this isn't the case, and there are places where a woman really would be completely screwed (no pun intended), completely unable to get an MOD in time, then I'm afraid it just falls into the "shit-outta-luck" category. There are all sorts of medical procedures that you may have to travel hundreds, if not thousands, of miles, to receive. There are hundreds of medications that pharmacies don't have in inventory because they are rarely prescribed and thus must always be special-ordered. If you choose to live in a cabin 100 miles from the nearest town and not even own a car, you don't have the right to force CVS to build a pharmacy right next door to your log cabin just in case you might need some medication on short notice. The fact that we're dealing with a female with a reproductive health matter doesn't make it some sort of special case. There are all sorts of diseases and problems that require almost-immediate treatment with certain medications, and you'd be just as SOL in the hypothetical situations I bring up above.

Not to mention the spirit of the law is obviously to protect women from protestors, which is exactly what our Walgreens employee is. RU486 simply wasn't around when FACEA was passed, but the sentiment looks the same to me. One protestor is blocking access to a drug that certianly falls in the category of reproductive health services.

It's not the same thing, and here's why: The law is about making sure that access cannot be denied by outsiders where reproductive health services are being offered by other human beings. To use an absurdist example: Say there's an abortion clinic that's had a lot of protesters outside it day after day for years, to no effect. But one day, some freaky Svengali comes along that's so hypnotic that he literally manages to convince the entire clinic staff that what they're doing is morally wrong, and the entire staff decides to stop offering services. They show up for work, but just sit there. Maybe they'll switch to becoming a general clinic, give you all the flu shots and blood tests you want, but decide to simply stop all reproductive health services, even though all the necessary medical equipment and drugs and trained doctors are all still there. That would not be a FACEA violation, because you've switched from a situation where protesters are trying to stop you from reaching the place where others are offering a service, to a situation where the service isn't being offered. The pharmacist situation falls into the latter category, not the former. The MOP is an inanimate object, not a service. It's up to the pharmacist to decide whether or not to provide the service of giving it to you.

(I still think such a legal maneuver wouldn't work anyway, for the simple reason that the judicial branch is aware the law was written specifically to cover abortion clinic protesters. Unless you lucked out and got a very liberal judge who has no qualms about legislating from the bench, trying to use FACEA as your main legal argument would probably get you laughed out of the courtroom.)

Lastly, ethics is a mighty relative thing ... Take benzodiazepines as an example.

I did, yesterday. This is the second time you've missed something I posted almost 18 hours earlier. Nothing personal, skallas, but have you read this entire thread yet?

Would you still be defending the ethical position of someone who believes obese people should get on a treadmill instead of "lazily swallowing anti-fat pills?" Or the pharmacist who thinks a benzo prescription is just a "party drug?"

The first example is not relevant because there is nowhere NEAR any agreement in the medical community as to whether the "Anti-fat" pills currently out there even work that well (and of course they stop working entirely the moment you stop taking them), and it's established that even with the pills, the patient would need to be combining the medication with dietary changes and/or exercise if the weight is to stay off once it has been lost (with some exceptions of course, for the usual reasons we've hashed out in way too many threads before). In short, a doctor that refuses to prescribe them is hardly comitting malpractice. The second example is no different from anything else we've been talking about in this thread. If your state has a conscience clause for pharmacists, then he/she has the right to use it. Would I defend their position? No, but I'd defend their right to believe what they want and to take advantage of the protection their state's laws provide them. In fact, I'd be happy to know the pharmacist held such feelings, because then I'd know he was a dangerous and/or hopelessly behind-the-times quack who should be avoided, and I'd take my business elsewhere.
posted by aaron at 10:02 AM on April 25, 2002

dwivian: I think you're missing my point. First, whose orders are involved is irrelevant, regardless of who the recipient of those orders is, the fact remains that it's the doctor and patient who decide on the course of treatment, not the pharmacist. Second, it's not the doctor who's being picky here, the doctor wrote a prescription for a patient for medication which is legal (and, presumably, in an appropriate dosage), unless the doctor/patient state "no substitutions", the pharmacist can, at his own discretion, substitue analogous medication. That's not the issue here either. The other examples you cite: waiting for meds to be ordered, meds not stocked by the pharmacy, are not at all the same as your third example, the "morality" of the medication. The first two are understandable business-related issues, the latter is a subjective moral decision, one which a pharmacist has no business making on behalf of a patient. If you aren't comfortable dispensing legal medication in appropriate doses according to an acceptable prescription, then you shouldn't be a drugstore pharmacist, period.
posted by biscotti at 10:05 AM on April 25, 2002

We're not talking about a drug that was out of stock. This drug, which may be the only thing from keeping this woman from becoming pregnant in the next 30 hours was denied to her. Maybe you're comfortable with the "shit-outta-luck" scenario, but as I already pointed out ECs have a time window and if this doesn't qualify as some kind of emergency I don't know what does. Sometimes one has to lay their ethical bickering aside to help a fellow human. Unfortunately in this case the pro-lifer put a badly formulated argument (more on that later) before the woman and could care less about the circumstances.

I think my scenario of a conservative town/area/state and the time window ECs need could pose a real problem for many women. If this pharmacist wants to play the ethicist all day, perhaps he should find a different job. Worse, pharmacies don't have to stock any drugs, so if they notice PlanB isn't selling for some reason it may quickly disappear from the shelves as a result of this.

Sorry Aaron, but I find your armchair defeatist "shit-outta-luck" attitude to be contributing to allowing someone with an agenda to force their views on someone else.

The doctor doesn't stock this because he knows he can get it from the pharmacy. Obviously, something has changed and perhaps that doctor will have to stock this locally. Its a pretty sad state of affairs when the MD has to have a stock of drugs on hand because the local ethicist refuses to dispense ECs, Benzos, or whatever. Worse, this can increase the price of healthcare because the doctors offices must function as a pharmacy which requires insurance, accounability, security, etc. Planned Parenthood centers work on the same principle. They keep their contraceptives under lock and key because they know that the backwater locals might pull something like this on a woman excercizing her rights.

In fact, the ethical argument is on very shaky ground. The ECs helps avoid fertilization, its not a RU486 drug which causes an abortion. An EC is nothing more than a large dose of birth control pills. Armed with this information, the woman who has been discriminated against for having pro-choice views and wanting to excercize them may megadose on contraceptives which could have a dangerous outcome. Something like the chemical equivalant of the old back door abortion clinic or coat hanger argument. Regardless, the "ethical" pharmacist is doing nothing but denying legal emergency healthcare to this woman and may be responsible for bringing another unwated baby into the world which may or may not lead to a real abortion, not just a hormonal change that would make fertilization impossible as the EC would have done in the first place.
posted by skallas at 1:42 PM on April 25, 2002

if this doesn't qualify as some kind of emergency I don't know what does.

In relation to the conscience clauses which protect other health care workers, it wouldn't. A doctor or nurse can only be forced to perform or assist in an abortion if the life of the patient is in imminent danger -- if she is hemorrhaging from an incomplete abortion, or if the pregnancy is ectopic, for instance. That the patient may become pregnant when she doesn't want to is not an emergency by any definition, it's a personal crisis. There's a big difference when you're speaking in the medical realm.

In fact, the ethical argument is on very shaky ground. The ECs helps avoid fertilization, its not a RU486 drug which causes an abortion.

Not necessarily. The drugs can also alter the endometrium thereby denying a fertilised egg purchase to attach to the uterine wall. If you are of the belief that there is nascent life involved from the moment sperm and egg fuse and the process of cell division has begun, it is consistent to therefore believe that the drugs are, in fact, abortifacient.

I'm still awaiting a good reason why doctors and nurses should be permitted to demur from offering abortifacient remedies and pharmacists should not.
posted by Dreama at 6:26 PM on April 25, 2002

I'm still awaiting a good reason why doctors and nurses should be permitted to demur from offering abortifacient remedies and pharmacists should not.

The reason is simple, and, I would've thought, quite obvious.

In society's estimation, the pharmacist is merely a facilitator. He is a speed bump between patient and doctor-prescribed therapy. His indispensibility is artificially preserved by anachronistic statute and ancient tradition, forged in a bygone era of mortar and pestle. In terms of the nit and grit of the health care process, he is irrelevant. Since he is not considered part of the discretionary flow, he is not granted immunity from the consequences of arbitrarily indulging his personal prejudices.

IOW, there are health care professionals, and there are health care professionals.
posted by Opus Dark at 9:10 PM on April 25, 2002

I'm still awaiting a good reason why doctors and nurses should be permitted to demur from offering abortifacient remedies and pharmacists should not.

Doctors and nurses who wish to demur from offering abortifacients can choose to work in areas where they won't be called upon to do so. Pharmacists have the same option, and should exercise it. It's not that every pharmacist should be required to dispense abortifacients, it's that every pharmacist who's chosen to work in a drug store pharmacy should be required to dispense any medication the pharmacy stocks according to legal prescriptions. As I said, the time to decide what you're prepared to do in the course of your chosen profession is before you're in a position to deny someone access to legal, prescribed medication, not after. The scope of a pharmacist's professional responsibilities does not include forcing their personal morality on their clients by denying said clients access to legal, prescribed medication. If the pharmacist doesn't want to dispense abortifacients, they shouldn't work in an area where they might be called upon to do so. It's not the double standard that Opus Dark refers to, it's that a health care professional whose personal beliefs might interfere with providing care to certain people in certain situations should choose their area of practice accordingly.

skallas: EC's prevent implantation, not fertilization. This is why pro-lifers view it as an abortifacient: the egg may already be fertilized, the EC just stops it from implanting in the uterine wall.
posted by biscotti at 6:51 AM on April 26, 2002

Biscotti, skallas: This is my confusion. Walgreens says the pharmacist can make the moral call. That you may disagree is immaterial -- the relationship between the company and employee gives the pharmacist that right. In several states that same right is enshrined in law. In fact, it seem so intuitive, that I don't know why it is questionable. You should not be required to do things you find objectionable. If your job requires such activity, you can change jobs (as you say). If your job gives you the right to say no, you can stay in your job. It's that easy. At not time should you be compelled to do things you find repugnant.

In this case, no pharmacist is REQUIRED to dispense any medication at all. The scope of the professional responsibilities of a pharmacist includes the right to be human, and to act consistent with the professionalism requirements of their employer. A pharmacist can, legally and contractually, decline to serve a customer, in a professional way (which includes redirecting the customer to where their needs may be met).

They are given the opportunity to do so as an employee of a business, within the guidlines of that business (which includes following the law). I will not accept the argument that you have some right to make someone else serve your needs, just because of their profession.

If your company gives you, explicitly, the right to deny service because otherwise you'll have to quit to avoid doing something you feel to be wrong, then your decision to exercise that right is NEVER in error. Imagine what would have happened had the need to quit arisen? The patient would still be out of luck (no drugs unless she goes elsewhere, which is the same net effect), the pharmacy would still be out the sale, and now is missing a critical employee (and thus requires a rehiring period or schedule shift in order to accomodate customer needs). When you have a lynchpin employee, you give them some personal latitude in order to keep them on staff.

It seems to me that you are deciding that your will, needs, and desires are more important than someone elses. You are telling the pharmacists that they are merely automata, and any attempt to be human should be slaped down because it might inconvenience you not to have your whims catered. I find that somewhat distressing.

Oh, and OpusDark -- if the pharmacist is irrelevant, any decision they make should be necessarily immune to argument -- afterall, they are not needed, so how can they be accountable?

Let's find an alternative profession with such an lynchpin employee -- say, the airline industry. The pilot has significant latitude in who they allow on the aircraft, because they bear significant responsibility (as does a pharmacist). They can elect to reject passengers according to company policy, and have done so and continue to do so. They, in short, refuse to provide a service that their company offers, redirecting the customer to someone else that will (be it a different pilot, or different company).

Am I understanding the opposition to be saying that a person that has issues with allowing "X" kind of passenger on their aircraft should never be a pilot? Even if they can find a company that allows them to fly with that decision authority?
posted by dwivian at 8:53 AM on April 26, 2002