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9th Circuit says Plan B is AOK
July 10, 2009 9:17 PM   Subscribe

Plan B, also called the "morning after pill" is an emergency contraceptive. Some pharmacists have refused to stock and fill the prescription, citing ethical reservations, causing the AMA to affirmatively state its support for the contraceptive and urge pharmacists to sell it and for the FDA to allow over-the-counter distribution. A partial victory was achieved in 2006 to allow OTC dispensing without a doctor's note for those over 18 years of age. However, some pharmacists continued to refuse to fill the prescription, including the owners of Ralph's Thriftway pharmacy chain in Washington State in 2006, causing some to boycott the chain. Ralph's was later found by the Washington State Board of Pharmacy to have violated the state pharmacy code in so doing. Ralph's lawsuit to block the ruling reached the 9th Circuit Court of Appeals which has now ruled against the pharmacy chain, saying ALL pharmacists must stock and dispense the contraceptive.

From the ruling:
"Any refusal to dispense -- regardless of whether it is motivated by religion, morals, conscience, ethics, discriminatory prejudices, or personal distaste for a patient -- violates the rules," the panel said.
posted by darkstar (453 comments total) 40 users marked this as a favorite

 
Fucking A Right.
posted by lazaruslong at 9:19 PM on July 10, 2009 [10 favorites]


It's a Friday night and I'm home* alone, so I don't think this has much relevance for me. Fuck it, time to go out for a beer.
posted by orthogonality at 9:21 PM on July 10, 2009


Hell to the yes.
posted by SkylitDrawl at 9:23 PM on July 10, 2009


[ ! ]
posted by Blazecock Pileon at 9:24 PM on July 10, 2009


Awwwww, orthogonality, I'd totally accidentally have unprotected sex with you, and thus need to take Plan B, rendering this post relevant to you! Wait, what? What do you mean, you don't feel better?
posted by unknowncommand at 9:26 PM on July 10, 2009 [10 favorites]


ALL pharmacies in the great West, yes?
posted by @troy at 9:28 PM on July 10, 2009


Not to get too wonky, but this isn't terribly surprising post Winter v. NRDC. District courts in the 9th Circuit can hand out fewer preliminary injunctions now - which is what happened here.

Yes the pharmacy lost, but they had won at the lower court which had prevented the Washington regulations from going into effect. It seems pretty clear that Wardlaw has it right and that this is a neutral law of general applicability, meaning rational basis and not strict scrutiny. This would effectively deny the pharmacy from having any chance of winning in the lower courts when this is re-heard.

Tough times for those who believe the life begins not at conception or implantation but at fertilization. I wonder if the pharmacy stocked condoms. What go as far as fertilization? Why not say life begins at penetration?
posted by allen.spaulding at 9:31 PM on July 10, 2009


As someone who is both a Christian Scientist and a pharmacist, this saddens me. My job was much easier when I could just stand over the counter saying "No. Next. Uh-uh. Next. Go pray. Next. No..."
posted by Mayor Curley at 9:33 PM on July 10, 2009 [43 favorites]


I wonder if the pharmacy stocked condoms.

I was wondering the same thing. Bonus idiot points to Ralph's if they do.
posted by clorox at 9:35 PM on July 10, 2009


ALL pharmacies in the great West, yes?

I would imagine all pharmacies in Washington and any other state that has similar regulations. This isn't a mandate, it merely upholds the policies of the Washington State Pharmacy Board as non-violative of the Free Exercise Clause.
posted by allen.spaulding at 9:35 PM on July 10, 2009 [1 favorite]


Some basic science on Plan B, for those who aren't familiar with how it works. Recommended reading!
posted by peep at 9:35 PM on July 10, 2009 [28 favorites]


Oh this makes me want to cheer. Yay! Thanks for sharing!

allen.spaulding, what would be required to actually produce unfettered (ok, well you still need a pharmacy and money, but..) access to contraceptives in other states? Does it need to be done legislatively?
posted by nat at 9:43 PM on July 10, 2009


Oh God, I got Plan B confused with Mifepristone with that crack about fertilization. Plan B is exactly like a condom, there is no fertilization.
posted by allen.spaulding at 9:43 PM on July 10, 2009


That's it! I'm gonna go nail that sexy pharmacist right now!

Provided that she would also like to enjoy some sexy nailing and of course only if she has Plan B in stock.
posted by orme at 9:48 PM on July 10, 2009


nat - The FDA has required Plan B to be sold OTC, but there is no affirmative federal requirement for pharmacies to carry it. If states want to require all pharmacies to stock Plan B, they can do so without fearing a lawsuit. It's highly unlikely that a lawsuit could force a pharmacy to carry it without specific legislation or regulation. For big pharmacies, such as WalMart, this is a matter of the bottom-line. Most of the hold outs will be small pharmacies, like the one in this case. To ensure that they carry it, call your state rep. Of course, local pharmacies can always shut down instead of carrying it and that's a real possibility. We might technically have a legal abortion privilege, but that does not provide opportunity or funding or resources, as you noted in your parenthetical.

So give some money to Planned Parenthood while you're at it.
posted by allen.spaulding at 9:48 PM on July 10, 2009


Plan B is my plan A.
posted by knowles at 9:50 PM on July 10, 2009


Well, shoot!

I had a whole list ethical reservations about many things I am asked to do in life, and a corresponding list of refusals.

Now what?

*Shakes fist at judicial system, walks away grumbling*
posted by halcyon_daze at 9:55 PM on July 10, 2009 [1 favorite]


I realize this case is really just a small part of a larger culture war, so it might be difficult to separate the specifics of this case from the larger emotional issues. But I'll try.

The government restricting what a business can sell makes sense. States do this with alcohol licenses all the time. And controlling the quality of how they sell it makes sense as well. Such as health codes in restaurants. But requiring a business to sell a specific product seems a little weird.

Some examples (which are obviously not as important as the Plan B case):

Pabst Blue Ribbon required at all bars
Apple Store now required to sell PCs, to "encourage competition"
Stores in the Bible belt must sell American flags to show 'patriotism'
Local radical bookstore required to sell Ann Coulter diatribes
Vegan restaurant required to sell chicken nuggets
etc...

Obviously not as weighty as this court case, but the government requiring stores to sell certain products seems to set a precedent that could get quite annoying.

I could see this making more sense if it was a life/death issue, such as requiring stores to stock/sell heart defibrillators. But then again, who would go to a store instead of a hospital if their life was in danger?
posted by jsonic at 10:02 PM on July 10, 2009 [8 favorites]


Plan B is exactly like a condom, there is no fertilization

● Levonelle-2 is thought to prevent pregnancy by various mechanisms dependant on the stage of the cycle. It suppresses ovulation, inhibits fertilisation of any eggs released and also causes changes to the endometrium to prevent implantation of the fertilised egg. [PDF]

Won't someone think of the zygotes??
posted by @troy at 10:04 PM on July 10, 2009


Before we get someone in here who says that this is violating the free exercise rights of pharmacists, allow me to interject...

I work in healthcare. I belong to the Church of You Don't Deserve This. I take care of alot of patients who, IMO, don't deserve the medical care that I dispense. I know this is going to make me sound like a total and complete ass, but let me elaborate.

I take care of patients with kidney disease. Some patients got kidney disease through shitty genetics. Others through odd accidents or bizzare infections. Others through cancer. Alot of our patients (like my own father) got kidney disease from letting their diabetes go untreated for 20, 30 years. Regardless of how they got it, the vast majority of my patients refuse to take steps to prolong their life and improve their quality of life.

Dialysis patients, as a whole, are notoriously noncompliant. This is usually because they have a history of non-compliance which usually got them into their situation in the first place.

For example, dialysis patients shouldn't really drink more than a liter of water per day. Yet we have patients who, as soon as they leave our hospital dialysis unit, go home and start chugging gallons of milk or juice. (And are consequently back in the hospital within a few days). We have patients who have two homes: their regular residence and the hospital. They treat themselves badly and then spend 1/3 of an average month in the hospital, racking up hundreds of thousands of dollars in Medicare bills over the course of a year.

You know what I think about these people? I think they don't deserve my services. (yes this includes my dad). I think that my services are wasted on people who refuse take even basic steps to help themselves stay well. I think I'd rather focus my energies on the patients who recognize the seriousness of their condition and take an active role in their self-care.

If I were king of the world, I would tell these people, "Look, we're giving you three months to turn your life around. Start taking better care of yourself, stop drinking yourself to death and take your medications as prescribed or else we're going to withhold treatment until you do. There are alot of people with kidney failure who want to live and we aren't going to divert scarce resources to people who don't care one way or the other if they die or not."

Thats what I would say, if I ran the world. The Church of You Don't Deserve This.

That's not what I say, however.

My profession demands that I dispense medical care to all who need it, regardless of my own personal judgments. My profession demands that I provide care to someone who treats their own body so badly that they have their own PO Box at the local hospital. My profession demands that I care for the unruly, the mean, the stupid and the non-compliant. My profession demands that I provide care for brain-dead patients who are just being kept alive by their families for the monthly social security cheque. My profession demands that I care for everyone who darkens the door at my clinic, regardless of whether or not they are saints or Dick Cheney. My profession demands that I do things, which, in a perfect world, I would be able to not do.

And yet I do them anyway, because it's in the job description.

So is it ethical or moral to have a job which conflicts with your personal beliefs? To a certain extent, I think so. I'm human. I need a job. I need to pay the bills. If it really got to me, if I really believed that I was totally compromising my own personal self (my "soul", if you will), then I would quit -- and I don't think anybody would blame me. I'm not at that point yet in my life.

What would be stupid is if I decided to stick around in my current job, picking and choosing which patients I believe deserve to live or die, and then refusing to treat the bad ones based on my own personal convictions. And then have the unmitigated gall to demand that I keep getting paid and keep being allowed to decide who gets treatment and who doesn't.

I think the problem with these so-called pro-life pharmacists is that they want to have their cake and eat it too. Dispensing contraceptive pills bothers them morally -- maybe really bothers them -- but they still want a nice job to pay for the house and the car and the boat. They refuse to take my approach (.i.e, this bothers me morally but it's not a hill I'm going to die on), they refuse to quit (those mortgage payments are a bitch), so they demand the right to have total control over other people's medical decisions -- something that not even doctors have. Something we wouldn't even GIVE doctors even if they wanted it.

tl:dr: If your job demands that you do immoral things, either learn to live with a certain amount of immorality or quit.
posted by Avenger at 10:09 PM on July 10, 2009 [276 favorites]


But requiring a business to sell a specific product seems a little weird.

Only if you lack the understanding that corporations and commercial practice can and do control people's lives more than governments.

Rational basis tests should be applied to private commerce, either via legislation or simple judicial expansion, too. cf. the Civil Rights Act of 1964. Requiring business to serve non-whites seems a little weird to you too?

IOW, the right to exercise your silly religion ends at the tip of my dick.
posted by @troy at 10:12 PM on July 10, 2009 [1 favorite]


In a funny coincidence, I was just looking at a contacts photos on Flickr and saw not just a photo of Ralph's (selling cherries!), but a also a photo from inside a Ralph's of a product called "Totally Anal". Would have happily linked that last product, but...
posted by pkingdesign at 10:16 PM on July 10, 2009


jsonic,
Pharmacies are a bit different from retail stores. The things you are describing are not needed, they are desired.

Plan B is not something people buy for fun :)

If you carry some of the medications, you must carry all of them (or be willing to order them into the store for a customer). This is a health issue and there are time constraints involved. In some areas, one chain not carrying it would effectively mean that Plan B is not available to the people in that area. When you are in rural areas, there are not drug stores on multiple corners of town.
posted by Librarygeek at 10:16 PM on July 10, 2009


I am torn about this. I'm rabidly pro-choice. But ...

We have never accepted "I was just following orders" as a defense against prosecuting someone who has done something they might acknowledge as being contrary to their morality. Yet here we decide that people must just follow orders, contrary to their morality. It's not a particularly consistent stance.

Are we comfortable saying, "You over there, you are your job. You clock in, we own your actions. Your personal feelings, no matter what, be damned" as a society? I hope to be more than just a cog in a machine. Hit the AskMe's — a lot of questions in there about "Am I being asked to do something unethical?"

Reconciliation here is difficult if we also want to respect the right of the patient to receive treatment and medications lawfully prescribed by their doctors. Perhaps the only thing I can think of in this specific case is that, say, folks who don't want to hand out Plan B must register as conscientious objectors to it to their employers, and that while they may not have to hand out said pill, the business in question must have someone on staff during business hours who is comfortable providing the appropriate medical treatment. The pills get handed out, someone else's beliefs are respected (however ludicrous I may find them), and that's that.

On a larger scale, this is a much more difficult problem. Corporations are already sociopathic and devoid of empathy. Occasionally, the only thing that stops an atrocity (or reveals a coverup) is an individual who acts in accordance with their conscience, such as the nurse who was the one who clued us all in to the Abner Louima/Justin Volpe affair. I can see this going to some fairly ugly places, and I don't know how to balance these issues out.
posted by adipocere at 10:16 PM on July 10, 2009 [12 favorites]


Yays!

My uterus = my business.
posted by kldickson at 10:16 PM on July 10, 2009 [2 favorites]


adipocere, let's not generalize. Concentration camps are not in any way similar to preventing pregnancies.
posted by kldickson at 10:18 PM on July 10, 2009 [1 favorite]


Wish I could favorite Avenger'scomment more than once. It's long but worth it. If you skipped past it go back up and read it -- it's worth the time.
posted by Librarygeek at 10:20 PM on July 10, 2009 [1 favorite]


adiopocere, if a type of work or workplace violates a person's morals, they don't need to work there. The option is there not to work there if they really cannot do the job. There are professional standards that must trump personal ones.
posted by Librarygeek at 10:22 PM on July 10, 2009


allen.spaulding: I wonder if the pharmacy stocked condoms.
clorox: I was wondering the same thing. Bonus idiot points to Ralph's if they do.


According to the author of the Works in Progress piece (7th link of post) Ralph's Thriftway does indeed carry condoms—at least, it did in 2006.
posted by skenfrith at 10:23 PM on July 10, 2009


Yet here we decide that people must just follow orders, contrary to their morality.

Which we've been doing ever since we decided businesses could no loner post "No Irish Need Apply" or "Whites Only"
posted by allen.spaulding at 10:24 PM on July 10, 2009 [15 favorites]


When I was in college, I was sleeping with a girl, and the condom broke. Now, probabilities being what they are, if we had done nothing other than worry and fret, chances are that she wouldn't have gotten pregnant. One occurrence of unprotected sex, at a not-very-fertile moment, isn't all that likely to result in a baby.

But I think it is wonderful that the campus health center was wiling and able to give her Plan B, with no fuss, no guilt, and a cost of $12 (I paid, after sitting nervously in the waiting room). I'm sure she's a wonderful mother now, with her kid and her husband. But that wasn't the right moment for her to become a mother, or me to become a father, especially when we had been doing the best we knew to be safe and protected.

So I'm all for this ruling, if it means that people who aren't privileged to be students at fancy colleges with 24 hour health centers and non-judgmental nurses can receive the same medical care and decency that we did when we needed it. Yes, we all have morals, and feel discomfort when helping people who will immediately return to immoral behavior -- but if you are in the medical profession, you should be held to a very high standard of behavior, and be able to set aside your personal beliefs in order to provide people with the standard of care they deserve.

I feel really strongly about this, because access to Plan B prevented me from perhaps having to help make some really tough choices. People deserve access to the best medical care available, and this is only one part of that.
posted by Forktine at 10:26 PM on July 10, 2009 [19 favorites]


requiring a business to sell a specific product seems a little weird

There is no such requirement.

There is a requirement, under Washington law, for all pharmacies to "maintain at all times a representative assortment of drugs in order to the meet the pharmaceutical needs of its patients." There are also, since then, administrative rules that seem to boil down to "even the ones you think are icky."
posted by ROU_Xenophobe at 10:28 PM on July 10, 2009 [7 favorites]


There is no such requirement.

Oh, so they're NOT required to stock it, eh? I wonder what all the fuss it about then.
posted by jsonic at 10:31 PM on July 10, 2009


This seems like silliness. If the small Christian family-owned pharmacy doesn't want to sell Plan B, then so what? The opinion goes out of its way to point out that there are plenty of pharmacies that do sell it, and that there are others that do not stock Plan B because of lack of demand. What is the harm of leaving well enough alone?
posted by Slap Factory at 10:33 PM on July 10, 2009


Thank you Avenger for responding more eloquently than I could.
posted by device55 at 10:34 PM on July 10, 2009


slap factory, is it the only pharmacy in town?
posted by kldickson at 10:37 PM on July 10, 2009 [3 favorites]


Librarygeek, really? What about all of the whistleblowers? Should they have gone home and clammed up? The nurse who noted that the injuries to Abner Louima's rectum were inconsistent with the police's version of events, that he just liked anal a little rough, should she have buttoned her lip and let it pass by?

I do not believe professional ethics (and they vary so widely by profession, by corporation, by who your manager is) automatically trump personal ethics. I've worked for too many skeezy people who asked skeezy things of me.

And we must generalize. This all sets precedent. It isn't as if cases like this just exist in a void and never influence any other laws or cases, ever. It doesn't work like that.

Oh, and just following orders, kldickson? I was thinking My Lai, not the Nazis. But it's interesting you should bring it up. To some pro-lifers, of which I am not one, current abortion policy is a holocaust for babies. So perhaps the comparison you were thinking of is more apt than my original reference.
posted by adipocere at 10:40 PM on July 10, 2009


If your job demands that you do immoral things, either learn to live with a certain amount of immorality or quit.

OR - Move to another company in the same field that doesn't require you to violate your morals. Unless the state has made this impossible, that is.
posted by jsonic at 10:42 PM on July 10, 2009


Lack of demand is very different from "I refuse to sell this to you because you're a whore of my morals"
posted by device55 at 10:44 PM on July 10, 2009 [1 favorite]


Librarygeek: adiopocere, if a type of work or workplace violates a person's morals, they don't need to work there. The option is there not to work there if they really cannot do the job. There are professional standards that must trump personal ones.

So, if it was 1930 or something and the professional standard was that pharmacies must not sell contraceptives, you'd all gung-ho about cracking down on any pharmacies that did so, right? Because professional standards must trump personal ones and the professional standard on this issue is one of the trumping ones?
posted by XMLicious at 10:44 PM on July 10, 2009 [3 favorites]


If the small Christian family-owned pharmacy doesn't want to sell Plan B, then so what?

I would not accept a power company or department store moralizing over its customers, saying no, we won't supply you with electricity because you'll just use it to watch pornography, or no we won't sell you some sheets because you're a homo and you'll fuck men on them and make baby Jesus cry.

Why on earth should I accept it from just another purely economic actor?

OR - Move to another company in the same field that doesn't require you to violate your morals. Unless the state has made this impossible, that is.

But what they are morally objecting to is the entire function of a pharmacy -- to dispense lawful medication except where it is medically contraindicated.
posted by ROU_Xenophobe at 10:48 PM on July 10, 2009 [3 favorites]


Adipocere, the difference is these pharmacists, in order to become pharmacists, had to get licensed. That license is contingent up on the pharmacist respecting the law with respect to pharmaceuticals.

These guys weren't whistle blowers - they were lawbreakers.

They also had their day(s) in court preceded by an injunction which prevented any sort of legal punishment.

This is very different from an honest person speaking out against a corporation who is asking its employees to break the law.

(and remember, the suit was filed by two pharmacists, and a corporation. This is a court-ordered whistle-blow)
posted by device55 at 10:50 PM on July 10, 2009 [2 favorites]


So, if it was 1930 or something and the professional standard was that pharmacies must not sell contraceptives, you'd all gung-ho about cracking down on any pharmacies that did so, right?

Thats kind of an odd analogy to the current situation. I would say that if I lived in a country where contraceptives were illegal, and I disagreed with the law, and my job was to hunt down those who dispense contraceptives, then I would either get used to being immoral or quit.

I'm kind of surprised at how difficult this is for some people to understand.
posted by Avenger at 10:51 PM on July 10, 2009 [4 favorites]


if it was 1930 or something and the professional standard was that pharmacies must not sell contraceptives, you'd all gung-ho about cracking down on any pharmacies that did so, right?

Yes, of course. Pharmacies should not sell products that are illegal for sale. Also, I think such a law is stupid, and there's no better way to get a stupid law undone than to enforce it vigorously and frequently.

The nurse who noted that the injuries to Abner Louima's rectum were inconsistent with the police's version of events, that he just liked anal a little rough, should she have buttoned her lip and let it pass by?

No, because the proper role of a nurse is not to brutalize people or to conceal criminal assaults. The job of a nurse is to provide care and, when it's appropriate to do so, to maintain notes about patient care and condition that are accurate.

But the proper role of a pharmacy is, in fact, to dispense lawful medication, so your analogy falls rather flat.
posted by ROU_Xenophobe at 10:54 PM on July 10, 2009 [4 favorites]


I would not accept a power company or department store moralizing over its customers, saying no, we won't supply you with electricity because you'll just use it to watch pornography, or no we won't sell you some sheets because you're a homo and you'll fuck men on them and make baby Jesus cry.

What if a power company refused to supply power for electric chair executions?

Thats kind of an odd analogy to the current situation.

Not an analogy to the current situation at all. It's an examination of the statement that professional standards must absolutely trump personal morality. I don't think it's an accident that the professional standards which it's asserted must dominate happen to be ones that Librarygeek agrees with.

Yes, of course. Pharmacies should not sell products that are illegal for sale.

Oh, nice bait and switch there! But I know the difference between "illegal" and "against professional standards."
posted by XMLicious at 10:56 PM on July 10, 2009 [2 favorites]


But what they are morally objecting to is the entire function of a pharmacy

No. They're objecting to selling a product that they think is immoral.

The 'Professional Standards' of the medical community used to be to sterilize the mentally challenged so that they couldn't breed. Was it wrong for doctors to refuse to do these sterilizations due their personal morality? Should they have just quit instead? Should the state have passed a law requiring them to perform the sterilizations?

Moral of the story: It's ok to enforce my morality through law, but it's a violation of my rights when others do it.
posted by jsonic at 10:56 PM on July 10, 2009 [2 favorites]


My IQ has dropped from reading some of the comments, here, yo. (Avenger is right.)
posted by maxwelton at 10:58 PM on July 10, 2009 [3 favorites]


> in a profession like pharmacy, professional standards are often the law.

e.g. doctors, architects, engineers, contractors, home inspectors, restaurants, etc.
posted by device55 at 10:58 PM on July 10, 2009


The 'Professional Standards' of the medical community used to be to sterilize the mentally challenged so that they couldn't breed.

Ok.

Was it wrong for doctors to refuse to do these sterilizations due their personal morality?

No, but if I were a doctor refusing to do a state-mandated procedure, I would have expected to get fired.

Should they have just quit instead?

Probably.

Should the state have passed a law requiring them to perform the sterilizations?

No, that wouldn't be right. But if the State did pass such a law, and I was a doctor, I would either go along with it or quit.
posted by Avenger at 11:02 PM on July 10, 2009


(Me, personally? I would quit if the state told me to sterilize developmentally disabled people. I'd probably then move to some other country where I wouldn't have to do things like that.)
posted by Avenger at 11:04 PM on July 10, 2009


Moral of the story: It's ok to enforce my morality through law, but it's a violation of my rights when others do it.

It's ok to enforce my morality by disregarding other people's rights and violating the terms of my employment and license, but it is a violation of my rights when I file a law suit, have my case heard in federal court (as is my legal right), and lose because I'm breaking the law.
posted by device55 at 11:05 PM on July 10, 2009 [9 favorites]


Their personal morality isn't too moral.
posted by kldickson at 11:16 PM on July 10, 2009


What if a power company refused to supply power for electric chair executions?

You know, just throwing in a liberal dog-whistle isn't going to make us go "OMG MY LOGIC IS DESTROYEDZ!!!". If a power company refused to provide power for a legal government function, then I imagine that they could expect, at the very least, to loose their government contract and possibly even their power-generation license.

And if standing up to capital punishment was really that important to them, they would welcome the consequences, no matter how severe.
posted by Avenger at 11:19 PM on July 10, 2009 [13 favorites]


No, but if I were a doctor refusing to do a state-mandated procedure, I would have expected to get fired.

Pretty much. I wouldn't blame any of these religious pharmacists for quitting, but it's frankly absurd for them to think they can change the entire nature of their profession (from "gives out medicine" to "gives out medicine to whom they judge worth of it.") and think they can continue to get things like state certification.

If I were in a job that required me to do something I found morally objectionable, I could:

a) go along with it. OR
b) not go along with it, knowing that as a consequence I might be fired.

I could also try to get the law changed, but while they remain the same and I disobey them that's the situation and kind of the biggest part of making a moral protest.
posted by Solon and Thanks at 11:22 PM on July 10, 2009


Washington state recently passed an initiative allowing assisted suicide, marketed as 'Death with Dignity'. I can imagine there are many doctors, regardless of religion, who would have serious qualms about actively assisting in killing someone.

How long before a law is passed requiring these doctors to assist in the suicide, or be fired? But I guess those doctors who object are just a bunch of moralizing whiners. Hurray for 'progress'.
posted by jsonic at 11:25 PM on July 10, 2009 [1 favorite]


If you boil this issue down to "should we follow orders, or follow our conscience" then I'm willing to concede that history does not consistently favor one over the other.

...which makes that a pretty pointless characterization of this issue, since you could find yourself losing in the long game no matter which side you choose. Instead, we should talk about this issue in its own terms instead of having the metadebate about following orders.

In its own terms, this is about a set of people who have chosen a career in a highly regulated industry. None of them can act surprised at being told how to do their jobs by the government.

It's about a set of people who have chosen a career involving dispensing, not prescribing, drugs to their customers. None of them can act surprised when their customers -- or their customers' doctors -- request a prescription be filled without a moral consultation from the pharmacist.

It's about a set of people who have framed the debate in terms of protecting the sanctity of life, which they overwhelmingly believe starts at fertilization/conception. However, being in the drug business and self-appointed gatekeepers for this particular drug, they ought to know the information in peep's link which indicates that Plan B drugs (or at least some of them) have nothing whatsoever to do with a fertilized egg. Their stated objections are thus irrelevant and they can't blame us for not giving a damn about their unstated objections.

Finally, it's about a set of people who are happy to cash their paychecks but apparently aren't willing to do their goddamned job. Theirs is not a commendable cause, it's not civil disobedience in the tradition of Gandhi and Martin Luther King. Civil disobedience is when you disobey the rules knowing that you will pay a dear price for it, and accepting that fate. These guys have done no such thing... they've remained in their positions, earned a lot of celebrity and airtime for their misguided little crusade, and I'd bet anything that -- if they were fired over this -- they'd be hitting up The 700 Club that same week playing up the same persecution complex bullshit that always works on that base.

I don't think there should be a law requiring pharmacies to stock this particular set of drugs. I don't love that precedent. But you know what? If the other choice is watching these holier-than-thou assholes act like they get fiat power over the morality and behavior of others then I say bring on the tyranny of the state!
posted by Riki tiki at 11:27 PM on July 10, 2009 [35 favorites]


Librarygeek said: "Wish I could favorite Avenger's comment more than once."

Me too.
posted by pineapple at 11:31 PM on July 10, 2009 [1 favorite]


Washington state regulates businesses to carry a lot of things, and not just for sale.

Did you realize they have to have fire extinguishers in restaurants? And signs in the bathroom telling employees to wash there hands?

These laws are in place to protect the health and well being of the community. A pharmacy is under the same guidelines, being that under Washington state law, they have to carry a minimum of specific things that are deemed essential to the community. This is the same law that ensures a pharmacist can't withhold Tamiflu from a patient because they are black/queer/different/ran over his cat. Or that they think they don't really need to carry Tamiflu at all, instead offering cans of chicken soup.

The individual is perfectly free to operate a business giving out cans of chicken soup, but in order to call themselves a pharmacist, and to be able to distribute other controlled substances, they have to follow specific guidelines to do so. Being a pharmacist is not some free enterprise business, if it were, why would they require prescriptions to get oxycontin or morphine, why not just offer it for $40 a fix, no questions asked?

It is erroneous to compare this to other businesses or fields, because this law does not address them at all, and is specific to the scope of pharmacists. And the pharmacists still have channels they can use if they think a drug is being prescribed inappropriately or excessively on a case by case basis, just as they have with any other substance, but they can't just flat out say "we wont give this to anyone, ever".
posted by mrzarquon at 11:35 PM on July 10, 2009 [33 favorites]


How long before a law is passed requiring these doctors to assist in the suicide, or be fired?

Not anytime soon, I imagine. If you're against a law like that, work hard to ensure that it never passes.

But I guess those doctors who object are just a bunch of moralizing whiners. Hurray for 'progress'.

Okay, jsonic, I know pro-life issues are near and dear to your heart but I get the feeling that you are being willfully obtuse here. You're putting words in people's mouths ("Moralizing whiners?") and lamenting what you see as a decline in moral values disguised as progress.

This isn't about moralizing or about the culture war. It's about holding people to the practices and standards as required by their medical or pharmaceutical license. Everyone is free to object, you are even free to object and perform objectionable actions anyway (like I do). The court is just saying that you are not free to have your pro-life cake and force your patients to eat it too.
posted by Avenger at 11:36 PM on July 10, 2009 [16 favorites]


Why yes, I have mefiMailed unknowncommand.
posted by orthogonality at 11:38 PM on July 10, 2009 [4 favorites]


> How long before a law is passed requiring these doctors to assist in the suicide, or be fired? But I guess those doctors who object are just a bunch of moralizing whiners. Hurray for 'progress'.

The pharmacy has to comply because it is a state sanctioned dispenser of controlled substances. Every single person who calls themselves a pharmacist has to follow those laws in order to remain calling themselves a pharmacist.

Not all medical doctors are the same, and so there is no statute saying "you can't refuse to do a spinal cord surgery just because you are an ENT specialist" and to have one would be silly.

But if you become a licensed "Death with Dignity" specialist, and well, you refuse to assist suicides, you can assume your options are: assist with suicides or stop calling yourself a "Death with Dignity" specialist.

But then I don't think you are actually trying to have a conversation, instead just throw out moral strawmen to see who will engage you in a discussion that it appears you really want: government regulation of morals. Which this is a very poor case if, because it is not enforcing morals on anyone. Just as I can't declare myself a non profit and just proceed to not pay taxes without meeting the state and federal requirements proving as such, a pharmacist can't call themselves a pharmacist if they don't meet the state and federal requirements.
posted by mrzarquon at 11:47 PM on July 10, 2009 [5 favorites]


This isn't about moralizing or about the culture war.

LOL

and force your patients to eat it too

The only entity doing and "forcing" here is the state. The private business isn't forcing anyone to shop there. And if they're the only shop in town, then why doesn't the state make Plan B available themselves?
posted by jsonic at 11:49 PM on July 10, 2009


The private business isn't forcing anyone black to shop there…

Word games are fun!
posted by device55 at 11:54 PM on July 10, 2009 [1 favorite]


Word games are fun!

LOL. Not selling a product is now the same is refusing to sell to a specific race. And I'm supposedly the one being obtuse.
posted by jsonic at 11:57 PM on July 10, 2009


The only entity doing and "forcing" here is the state.

The state is setting standards for medical and pharmaceutical standards and then forcing the licensees to follow them, yes.

The private business isn't forcing anyone to shop there.

Being a "private business" doesn't exclude healthcare providers from following the standards and practices of their license. I work for a private business and if we excluded some patients based on our personal moral code, we would loose our licenses and government contracts very quickly. And rightfully so.

And if they're the only shop in town, then why doesn't the state make Plan B available themselves?

Thats a great idea. I'll bring that up at the next Pro-Death Cabal meeting. In all seriousness though, the state is making an effort to provide Plan B to all its citizens, by requiring state-licensed pharmacies to stock legal drugs in accordance with their licensure.
posted by Avenger at 11:59 PM on July 10, 2009


whoops, I mean to say "The state is setting standards for medical and pharmaceutical licenses"*
posted by Avenger at 11:59 PM on July 10, 2009


LOL. Not selling a product religious bigotry is now the same is refusing to sell to a specific race. And I'm supposedly the one being obtuse

Word games are fun!
posted by device55 at 12:02 AM on July 11, 2009 [1 favorite]


> The only entity doing and "forcing" here is the state. The private business isn't forcing anyone to shop there. And if they're the only shop in town, then why doesn't the state make Plan B available themselves?

To answer you one more time: For a Pharmacist to call themselves a Pharmacist, they have to meet state guidelines, one of which is to provide a minimum level of services as deemed by Washington state law. If they don't want to do that, that's fine, but they can't call themselves a Pharmacist, and they don't get to distribute the drugs they do want to sell.

They don't get to pick and choose which parts of their business license to respect (which by the way, there are various licenses based on what exactly your business does: want to sell hard liquor in your restaurant? you got to carry food and have a licensed bartender.), so just like every other business in Washington state, they have to comply with the license they were issued. If they don't like it, they can petition to change the license, or change their business, or just deal with it.
posted by mrzarquon at 12:03 AM on July 11, 2009 [1 favorite]


They're objecting to selling a product that they think is immoral. and then later
The private business isn't forcing anyone to shop there.

It's a moral decision when you want to let pharmacists refuse to sell it, but a business decision when businesses don't carry it. You don't get to play it both ways - either the pharmacist is an employee of the business in question that can reasonably be expected to perform the duties of their job, or they're an independent moral agent, thus negating the business aspect entirely.
posted by 0xFCAF at 12:05 AM on July 11, 2009 [7 favorites]


How long before a law is passed requiring these doctors to assist in the suicide, or be fired?

Um, around the same time laws are passed in Vermont requiring you to get gay married. Get over the persecution complex already-- there's no slippery slope here.
posted by dersins at 12:06 AM on July 11, 2009 [12 favorites]


I worked for a local pharmacy during my short retail career, and was absolutely astounded by how much the end user used these pharmacists as doctors.

However, I had the fortune to work for an absolute shining light in the industry*, a real "hands on " pharmacist. Bill was considerate, kind, and always, always had the patient's** best interest in mind. Also, he was a 4H kid, and helped with animal pharmacology when he could, I saw more than a few "Mr. SoandSo, (animal) scripts get ran.

Bill was/is a devout Christian, really devout. Tithes and the whole bit.

Bill would punch another pharmacist in the face 'Buzz Aldrin style' if they refused to issue a person a prescription based on their own morals.

The very idea was foreign to him. Tbqh, I find it absolutely repulsive.

One is essentially saying, I think my morality supersedes your doctor.

Pardon my Francais, but Fuck You.

*What I consider.
**I do a/v work now, is this still the proper terminology?
posted by Sphinx at 12:09 AM on July 11, 2009 [7 favorites]


In some areas, one chain not carrying it would effectively mean that Plan B is not available to the people in that area. When you are in rural areas, there are not drug stores on multiple corners of town.

The irony, though, is that this ruling might lead the pharmacists running those rural shops to shutter. And the 30-40-60-100 mile journeys those rural women would need to get Plan B would still have to happen.
posted by dw at 12:11 AM on July 11, 2009


We all understand that the state sets laws. Congratulations.

I have issues with the state forcing a private company to sell a specific product. I would have this qualm regardless of my view of that product.

Many in this thread would probably have qualms if the product in question was something they didn't like. Such as Pat Robertson's Super-Duper-Commemorate-Our-History law by requiring all stores in his state to sell crosses.

But there's a culture war on, so who needs logic.
posted by jsonic at 12:13 AM on July 11, 2009 [1 favorite]


jsonic I think you need to realize you are up against the grim face of Logic and Experience, and fold your hand.

He's right. You're wrong. Don't like it? Organize.
posted by lazaruslong at 12:14 AM on July 11, 2009 [8 favorites]


The irony, though, is that this ruling might lead the pharmacists running those rural shops to shutter. And the 30-40-60-100 mile journeys those rural women would need to get Plan B would still have to happen.

How?
posted by device55 at 12:15 AM on July 11, 2009


Many in this thread would probably have qualms if the product in question was something they didn't like. Such as Pat Robertson's Super-Duper-Commemorate-Our-History law by requiring all stores in his state to sell crosses.

Yes I would have qualms with that. I would work hard to overturn that law. Barring that, I would probably sell the crosses. If selling them violated my personal moral code to such an extreme extent, I'd find a job elsewhere in protest.

But there's a culture war on, so who needs logic.

This seems to be a pretty good description of where you are coming from right now, jsonic.
posted by Avenger at 12:16 AM on July 11, 2009 [7 favorites]


I lived in Olympia, WA for years and had plenty of experience with Ralph's Thriftway and the Stormans family that runs it. They're self-righteous Christian Fundamentalist morons. I've dealt with them personally and they are nasty people. An entire wall of the store (right by the entrance, of course) is filled with "self-help" Christian themed literature they're trying to push onto their customers. Their prices are ridiculous, taking full advantage of their monopoly of supermarkets in the area, and their anti-shoplifting security policy is so militantly aggressive that a 65-year-old man was tasered to death at their other store for shoplifting some small thing.

So, their stance on Plan B was par for the course. I'm glad they got slapped for it at last.
posted by dacoit at 12:16 AM on July 11, 2009 [6 favorites]


Avenger: You know, just throwing in a liberal dog-whistle isn't going to make us go "OMG MY LOGIC IS DESTROYEDZ!!!". If a power company refused to provide power for a legal government function, then I imagine that they could expect, at the very least, to loose their government contract and possibly even their power-generation license.

And if standing up to capital punishment was really that important to them, they would welcome the consequences, no matter how severe.


The point is to demonstrate the inconsistency of the principles espoused by showing how you have to play a shell game with different arguments. "If the state wants to punish people it will punish people" is not at all what ROU_Xenophobe was saying. He was saying that he simply would not stand for a power company moralizing in what it provided power for. But I think it's pretty likely that was a false claim and he or she would accept the moralizing if the morals weren't those of someone else.

And I think that your all-caps theatrics in attempting to distract from the fact that he and others are articulating what are pretty obviously double standards, and your feigned incomprehension (I'm kind of surprised at how difficult this is for some people to understand) are a bit overwrought.

I work for a private business and if we excluded some patients based on our personal moral code,

There aren't any patients being excluded here. They aren't selling Plan B to anyone; they aren't picking and choosing who to give it to.

mrzarquon: To answer you one more time: For a Pharmacist to call themselves a Pharmacist, they have to meet state guidelines, one of which is to provide a minimum level of services as deemed by Washington state law.

Yeah, I think everyone gets that. What we're saying is that we don't think that requiring pharmacists to dispense this product is a "valid and neutral law".
posted by XMLicious at 12:17 AM on July 11, 2009 [1 favorite]


That's a big might, though, would mainly affect independent pharmacies, and I'm guessing it'll more be old folks getting out than young ones fleeing the industry.
posted by dw at 12:19 AM on July 11, 2009


Not selling a product is now the same is refusing to sell to a specific race. And I'm supposedly the one being obtuse.

Why, yes, it is and yes you are.

Remember, St Goldwater of Arizona voted against the Civil Rights Act due to his objection to Title II, which prohibited racial discrimination in private business engaged in "interstate commerce".

His words? "You can't legislate morality."

Goldwater was wrong in 1964 and you're wrong now, unless and until zygotes and blastocytes regain legal protections of a right to life, and the pharmacists in this case are seen in retrospect to be the Rosa Parks of the day.
posted by @troy at 12:20 AM on July 11, 2009 [2 favorites]


What we're saying is that we don't think that requiring pharmacists to dispense this product is a "valid and neutral law".

Fair enough. Write a letter.
posted by lazaruslong at 12:21 AM on July 11, 2009 [1 favorite]


I hate pro-lifers with every fiber of my being allocated for hating.

Yes, they're moralizing whiners, because they're attempting to punish women for having sex.

If you're a pro-life-tard, at least you'd have the decency to push for more contraception, but I guess every sperm is sacred to your stupid ass. Never mind the fact that the barrier between life and non-life is blurrier than you think and is blurring more by the day, and nobody should be saddled with a child they don't want or can't afford. Children are about more than just popping them out; they're also about raising them and educating them and making them competent citizens, not religiotards.

Pro-choicers are more pro-child than you.
posted by kldickson at 12:24 AM on July 11, 2009 [17 favorites]


If selling them violated my personal moral code to such an extreme extent, I'd find a job elsewhere in protest.

I think I see part of our disconnect. I'm saying a business itself shouldn't be forced to sell a product. You seem to be coming from an employee perspective (i.e. the business sells it, but the employee doesn't want to).

In your case, I can see the employee having to quit or be fired. In my case, I'd rather the state sell the product instead of forcing private business to do so.
posted by jsonic at 12:25 AM on July 11, 2009


But there's a culture war on, so who needs logic.

Slippery-slope argumentation is a logical fallacy, not logic per se.
posted by @troy at 12:25 AM on July 11, 2009


I think I see part of our disconnect. I'm saying a business itself shouldn't be forced to sell a product. You seem to be coming from an employee perspective (i.e. the business sells it, but the employee doesn't want to).

In your case, I can see the employee having to quit or be fired. In my case, I'd rather the state sell the product instead of forcing private business to do so.


No, you still don't get it. Private business is a great term, but when it comes to a business that requires specific licensing for operation in the form of a Pharmacist, that choice goes out the window. You cannot choose which of the requirements you fulfill.

That's like saying that a private business that happens to sell liquor should not be required to adhere to the alcohol licensing standards because gosh, it's private.
posted by lazaruslong at 12:28 AM on July 11, 2009 [9 favorites]


"What go as far as fertilization? Why not say life begins at penetration?"

Well for one thing there would be a lot more babies being conceived.

"If you carry some of the medications, you must carry all of them (or be willing to order them into the store for a customer)."

If that is the restriction it seems like a law with no teeth. By which I mean the clock is ticking. You've already been to your doctor (yes some people have preemptive prescriptions) and you've been to the pharmacy. How long is it going to take for the pharmacy to order the stuff in?
posted by Mitheral at 12:28 AM on July 11, 2009


If you're a pro-life-tard

LOL. Such a persuasive argument.
posted by jsonic at 12:28 AM on July 11, 2009


LOL. Such a persuasive argument.

You make the same points over and over, which Avenger and others have refuted with calm logic and reason over and over. Obviously you cannot be persuaded, and are willfully ignorant of the way licensing functions.
posted by lazaruslong at 12:32 AM on July 11, 2009 [6 favorites]


> The irony, though, is that this ruling might lead the pharmacists running those rural shops to shutter. And the 30-40-60-100 mile journeys those rural women would need to get Plan B would still have to happen.

Of course, that would now open the market, assuming the town could support one but not two pharmacists. So a pharmacist who was willing to carry Plan B could take over the market, and probably the building, from the prior pharmacist. Because everyone would probably prefer to not have to do that 30-100 mile drive to get their asthma inhaler, right?

And would more people be happy if there was a generic, and two or three other valid, but different branded / owned, Plan B type medications available? So it wasn't the state mandating a specific product? Just a specific category?
posted by mrzarquon at 12:33 AM on July 11, 2009 [3 favorites]


No, you still don't get it.

This seems to be a common thread in this thread: the state says so, so that's it!

As if the state setting a regulation is somehow writ in stone, proves that regulation is just, and thus trumps any further discussion of the issue.
posted by jsonic at 12:34 AM on July 11, 2009


Fucking. Finally. Thank you Ninth Circuit!

Uck, Ralph's. What none of these articles mention is that Ralph's is at perhaps the single best location for a grocery store in the Olympia area. It's almost dead-on inbetween Oly and Lacey and flanked by a major one-way street on each side and at the top of the Fourth Avenue hill, making it the most accessible store for folks crossing between towns. There's a number of nearby alternatives, but reaching any of them isn't half as easy as getting to Ralph's. You can fight your way up Martin Road until you reach Lilly, where you get to contend with all the hospital and clinic traffic on your way to Albertson's. You can head down the Pacific Avenue side of the (rather steep) 4th Avenue hill and eventually reach the Food Co-Op, which has the best groceries in town but no pharmacy. Or, you can head down the 4th Avenue side of the hill, fight your way through downtown and all the distracted bastards clogging up the grid until you reach the eastern end of the Yashiro Friendship Bridge where you'll find another grocery store and pharmacy but, god damn it, it's another bloody Thriftway! And from there, your grocery options get really grim - either head to the west side, cuss your way up Harrison and go to the Grocery Outlet or, god help me, head south into Tumwater. *shudder*

So, ever since I found out Ralph's has been childishly trying to apply the favorite mythology of its owners and a couple employees to the medical decisions of Olympia's women, it's been pretty goddamn irksome riding my bike past their exceedingly convenient location on my way to a far-off store where the management acts like adults. It just ain't fair that these backwards bastards get to sit pretty right at the nexus of Olympia and Lacey, acting as if their god gets any say in what a woman does with her own womb. It rankles, it does. I'm all about supporting local business, but not under these circumstances. If only Ralph's and the Co-Op would switch places!

I doubt I'll start spending money at Ralph's again, even after this action by the Ninth Circuit. See, they know damn well what a sweet spot they've got and charge about 5%-10% more than the local average for just about everything. Plus, I'm really not all that impressed with them paying their customers compulsory respect. So, none of my fat English Major dollars for them, I'm afraid. It's a shame, too. They've got a damn good beer selection if you like a little misogyny with your beer, which I don't.
posted by EatTheWeak at 12:34 AM on July 11, 2009 [10 favorites]


Question: Will pharmacists still be able to practice their love with women all across this country?
posted by Saxon Kane at 12:35 AM on July 11, 2009


This seems to be a common thread in this thread: the state says so, so that's it!

As if the state setting a regulation is somehow writ in stone, proves that regulation is just, and thus trumps any further discussion of the issue.


Did you even read the links?

Do you even know what entity (or entities) you are referring to when you say "The State"?

Do you understand how democracy works?
posted by lazaruslong at 12:37 AM on July 11, 2009 [1 favorite]


I think we're getting trolled at this point.

To bed! And the pharmacy in the morning! Heh.
posted by lazaruslong at 12:38 AM on July 11, 2009


Yes, yes, and yes.
posted by jsonic at 12:39 AM on July 11, 2009


I'd rather the state sell the product instead of forcing private business to do so.

The State often has to intervene in the wondrous Free Market Capitalist system to work around the various pitfalls it works itself into. That's one of its core missions listed in the Preamble, to preserve the public commons from private encroachment and control.

While the State requiring the vending of particular religious symbols is a non-sequitur, the State potentially requiring taxi drivers to carry passengers with alcohol is not. In this case we could have the State form a competing taxi service, or we could legislate morality and tell the Somalis there to turn in their licenses if they can't fulfill the requirements of providing the public service.
posted by @troy at 12:39 AM on July 11, 2009 [3 favorites]


I'd rather the state sell the product instead of forcing private business to do so.

Hospitals are private businesses. Should they be allowed to refuse treatment to an individual upon the basis of religious belief?

You're equivocating a 'private business' (a quick-e-mart) and a Pharmacy - which is a heavily regulated industry, with a strict code of ethics, a critical part of our medical infrastructure, and whose practitioners spend years in training and must be legally licensed in order to practice.

A law which forces Ma and Pa Kettle to sell religious propaganda in their store is in no way like a ruling which basically says "hey pharm school graduates with a license, yeah you do have to follow the terms of the license which you agreed to honor, which you learned all about during your intensive years of training."

Additionally, this ruling applies to any medication. Not just plan B.

If a Scientologist pharmacist refused to dispense anti-depressants they'd be in just as much hot water.
posted by device55 at 12:40 AM on July 11, 2009 [11 favorites]


Fair enough. Write a letter.

But don't disagree publicly or you'll be forced to pretend you don't understand what we're talking about?
posted by XMLicious at 12:40 AM on July 11, 2009 [2 favorites]


Like some of the others in the thread, I find this a very odd thing.

While I have no particular view on plan B and I understand that in order to practice pharmacy in Washington, you must comply with the Pharmacy Board regulations, I think the rule itself is a bad one.

I'd think there were a whole host of other reasons that a pharmacy would not carry a certain drug. Some business, some financial, some medical.
What if the profit margin sucks on Viagra so it's not worth the investment?
If I think the rep for Pfizer is a ripping me off and I refuse to buy from them?
More far-fetched, what if research says that giving Thalidomide to pregnant women is a mistake, but it's still FDA approved.
Hell, what if the local doctor has a heavy hand and prescribes things that my training says shouldn't be taken in combination?

I thought it strange that the doctors objected on First Amendment grounds, but maybe they'd already tried simply appealing the rule itself. I think it's a big stretch to say they are being persecuted for their beliefs and it's a shame they took that tack.

"The proposal adopted by the Board of Pharmacy says that pharmacists have a "duty to dispense lawfully prescribed ... drugs or medical devices." It also lists exceptions to the rule, which do not include personal beliefs"

Does anyone know what the exceptions referenced above are?
posted by madajb at 12:44 AM on July 11, 2009 [1 favorite]


You're equivocating a 'private business'...

Doesn't change the fact that it's a private business that I'd rather the state didn't force to sell a product that violates the morals of its owners. Where not talking about denying a life saving medical procedure here.

And there are many other ways that the state could make Plan B available that avoid this issue.
posted by jsonic at 12:46 AM on July 11, 2009


As if the state setting a regulation is somehow writ in stone, proves that regulation is just, and thus trumps any further discussion of the issue.

You know, jsonic, if you look carefully, you'll find that many on this thread are saying exactly the opposite. It's entirely possible to find oneself or one's personal convictions on the wrong side of the law or government regulation. Actually, it happens all the time. As I pointed out in my first post in this thread, I find myself in that position all the time. Almost every day, actually.

You are quite right to say that the blessing of the State does not make an action good, right or just. I'm pretty sure that nobody here is saying that. In fact, I'm so sure of it that I'm actually kind of wondering if we are reading the same thread.

What I (and others) are saying is that in areas of personal morality the responsibility of the moral actor is inherently personal. As a moral actor, I have the right to disagree with various aspects of my medical license as I see fit. I have the right to agitate against the parts that I disagree with and to even organize fellow citizens to help me change the parts that I disagree with. If I am required to perform an action by my license which I find morally objectionable, I have a couple options. I can perform the action which I find objectionable (something that, again, I do every day) or I can submit myself to the discipline which my license requires of those who break it's bylaws.

I do not, however, have the right to ignore, violate or otherwise neglect the laws and regulations of which I am professionally bound and still expect to keep my job or my state-issued license intact. You seem to be mistaking this idea for "Whatever the government says is right, as long as it's liberal!". If you go back and read carefully, you'll find thats not what we're saying. Honest.
posted by Avenger at 12:50 AM on July 11, 2009 [16 favorites]


In response to madajib, and probably others:

Plan B is a completely different animal than most other medicine. Its effectiveness is extremely time-sensitive. If I want to get Viagra and the pharmacy doesn't have it, I can wait a few days. If I want to get Plan B, however, I don't have the time to wait. It won't work nearly as well, if at all.

Plan B needs to be in stock because people don't have the luxury of waiting for it.
posted by reductiondesign at 12:51 AM on July 11, 2009 [5 favorites]


Doesn't change the fact that it's a private business that I'd rather the state didn't force to sell a product that violates the morals of its owners.

Should car companies be allowed to sell cars without seatbelts and mirrors? These safety devices reduce a car company's profits, which is antithetical to any company's "morality" that compels it to make money at any cost. By your reasoning, should car companies be allowed to sell their cars without these devices?
posted by Blazecock Pileon at 12:52 AM on July 11, 2009 [2 favorites]


jsonic: "Where not talking about denying a life saving medical procedure here."

I'm nineteen years old with no steady job. If I used Plan B to prevent myself from becoming a father, I'd consider my own life saved. I simply cannot raise a child at this point in my life.
posted by reductiondesign at 12:53 AM on July 11, 2009 [3 favorites]


Avenger, I never argued that these Pharmacists shouldn't expect consequences for their actions. I'm simply trying to get across the idea that I disagree with the state forcing a private company to sell a specific product. And many in this thread would argue the same if this issue wasn't so caught up in the culture war.
posted by jsonic at 12:55 AM on July 11, 2009


The irony, though, is that this ruling might lead the pharmacists running those rural shops to shutter.

Why, yes. If they value their "Christian" morals above making a profit. Somehow, I'm not too worried.
posted by orthogonality at 12:59 AM on July 11, 2009 [6 favorites]


By your reasoning, should car companies be allowed to sell their cars without these devices?

There's a difference between restricting what a business can sell and forcing it to sell a specific product.

The state can solve this by making the product available themselves, or providing incentives to companies that do sell it.
posted by jsonic at 1:00 AM on July 11, 2009


device55:
You're equivocating a 'private business' (a quick-e-mart) and a Pharmacy

Additionally, this ruling applies to any medication. Not just plan B.


Just wanted to repeat that. People seem to think this equates with a store refusing to sell a Shamwow or a Snuggie. It's not the same thing here folks.
posted by P.o.B. at 1:00 AM on July 11, 2009 [1 favorite]


Doesn't change the fact that it's a private business that I'd rather the state didn't force to sell a product that violates the morals of its owners.

More equivocation which does not change the fact that pharmacy a state-regulated industry and is bound by laws in order to operate.
posted by device55 at 1:01 AM on July 11, 2009 [2 favorites]


Where not talking about denying a life saving medical procedure here.

You aren't qualified to decide how badly a given woman might need to purchase Plan B. Neither is a pharmacist. Why bother licensing and regulating them if they're going to be allowed to cherry pick their licensing requirements?

Also, your comments in this thread contain more strawmen than a casting call for The Scarecrow. Admit it, you're just trying to pick a fight at this point.
posted by EatTheWeak at 1:01 AM on July 11, 2009


a state-regulated industry and is bound by laws in order to operate.

You guys keep saying this. Nobody is denying this.
posted by jsonic at 1:03 AM on July 11, 2009


Plan B needs to be in stock because people don't have the luxury of waiting for it.

reductiondesign:
Indeed, I understand the time-sensitive nature of that particular medication.
But I'm not sure that is a compelling enough reason to require a pharmacy to stock something there may not be the demand for.
posted by madajb at 1:05 AM on July 11, 2009


I do not, however, have the right to ignore, violate or otherwise neglect the laws and regulations of which I am professionally bound and still expect to keep my job or my state-issued license intact.

This would be an extremely salient point if anyone was saying "I expect violating laws to not be illegal!" or "I expect regulators to not regulate!" but oddly enough arguing about what the law or the regulations should be doesn't equate to either of those.

...should car companies be allowed to sell their cars without these devices?

Car companies shouldn't be allowed to intentionally make lethal products.

And if a dealership or car company objects to the environmental consequences of selling gas guzzlers on moral grounds there shouldn't be laws requiring them to sell SUVs and Hummers.
posted by XMLicious at 1:06 AM on July 11, 2009 [1 favorite]


Nobody is denying this.

Except you. You keep arguing that these state regulated businesses shouldn't be forced to follow state regulations if they don't want to.
posted by device55 at 1:06 AM on July 11, 2009 [3 favorites]


There's a difference between restricting what a business can sell and forcing it to sell a specific product.

No, you did not comprehend the question: All car companies are forced — by very explicit federal laws — to sell vehicles with safety restraint systems, despite the loss in profits those devices cause. Following your reasoning to its logical conclusion — namely, that the state is forcing private companies to sell a specific product — car companies should not be forced to install safety devices in their products. By your logic, such as it is.

Since you're not answering my question directly, it seems that I have found a counterexample that shows that you don't truly believe what you're espousing above, and that you are likely taking on the guise of a pseudo-libertarian for the purpose of rationalizing your anti-choice agenda. This seems dishonest, to me.
posted by Blazecock Pileon at 1:09 AM on July 11, 2009 [1 favorite]


But I'm not sure that is a compelling enough reason to require a pharmacy to stock something there may not be the demand for.

I think keeping a couple of bottles around for the 48 month period before the expiration date isn't too unreasonable.
posted by device55 at 1:10 AM on July 11, 2009


Except you.

Nope, but thanks for playing. I'm saying the state shouldn't force private companies to sell a product. I've never argued that private companies should expect to flaunt the law without consequences.
posted by jsonic at 1:11 AM on July 11, 2009


Okay. Let's say it's a drug that isn't time sensitive or someone went in to order Plan B ahead of time just in case. Basically they're refusing outright to carry something that they can and lawfully should get easily but are refusing on moral grounds. Nothing else. That's why the law needed to be enacted.
posted by P.o.B. at 1:13 AM on July 11, 2009


Nope, but thanks for playing. I'm saying the state shouldn't force private companies to sell a product. I've never argued that private companies should expect to flaunt the law without consequences.

It's like talking to a tape recorder stuck in a loop.
posted by device55 at 1:14 AM on July 11, 2009 [4 favorites]


Car companies shouldn't be allowed to intentionally make lethal products.

A car is not a lethal product for lack of a seatbelt. All else the same, I can drive my car around the block without wearing a seatbelt, for example, park it and come back indoors. So your comment does not follow.

If you're defending the premise that a governmental entity should not be allowed to compel the behavior of private parties, then I hope you understand the necessity to lobby car companies to keep seat belts out of their products, as just one example among many.
posted by Blazecock Pileon at 1:15 AM on July 11, 2009


it seems that I have found a counterexample

Nope. I think the state can regulate the products that a company does sell. This case is about forcing the private company to sell a specific existing product.

Using your example, it would be like forcing a Ford dealership to sell a Prius since they're so great for the environment.
posted by jsonic at 1:15 AM on July 11, 2009


And if a dealership or car company objects to the environmental consequences of selling gas guzzlers on moral grounds there shouldn't be laws requiring them to sell SUVs and Hummers.

The State involves itself more closely in areas of health and welfare, eg. the regulation of public utilities and product safety regulations. Pharmacies are solidly in this public/private sphere; car dealerships, notsofuckingmuch.

Getting pregnant or not is also rather a central event WRT one's personal health.
posted by @troy at 1:15 AM on July 11, 2009


It's like talking to a tape recorder stuck in a loop.

Says the one who keeps informing us that people should expect consequences if they violate the law. Thanks Capt. Obvious.
posted by jsonic at 1:17 AM on July 11, 2009


I'm saying the state shouldn't force private companies to sell a product.

For the sake of moral and logical consistency, I hope that you drive your car without wearing your seat belt, in protest of our evil government forcing car companies to install such devices.
posted by Blazecock Pileon at 1:17 AM on July 11, 2009


I think keeping a couple of bottles around for the 48 month period before the expiration date isn't too unreasonable.

No, likely not for that medication.
But if I'm a pharmacist in a retirement community, it's still wasted money.

There are thousands of medications out there, do I need to carry one of each? What counts as a timely fashion, does the Board define that?
posted by madajb at 1:17 AM on July 11, 2009


Using your example, it would be like forcing a Ford dealership to sell a Prius since they're so great for the environment.

Funny thing, the State does do that. Bush's EPA negated California's clean air requirements (in a bizarre anti-Federalist move), while Obama's EPA just restored them.

Your logic here is all fucked up and I suggest you revisit it. Plan B is AFAIK the only drug currently available that does what it does to protect the health and welfare of the consumer; should there be other equivalent drugs then the law would loosen up to cover them too.
posted by @troy at 1:19 AM on July 11, 2009


Using your example, it would be like forcing a Ford dealership to sell a Prius since they're so great for the environment.

No, it would be like requiring Ford to have emissions controls and fuel efficiency standards.

The pharmacies are allowed to recommend alternatives (a generic, another type of medication - like a mega-dose of the patient's standard birth control, etc)

Therefore if a patient came into a pharmacy for Plan B, the pharmacist could choose to dispense (with the patient's consent, assuming the drug is safe) Generic Plan Bee and not be a bigoted asshat.
posted by device55 at 1:21 AM on July 11, 2009 [1 favorite]


Okay. Let's say it's a drug that isn't time sensitive or someone went in to order Plan B ahead of time just in case. Basically they're refusing outright to carry something that they can and lawfully should get easily but are refusing on moral grounds. Nothing else. That's why the law needed to be enacted.

...so that would mean that the person looking for Plan B would have to order it ahead of time from... *gasp*... a different pharmacy? This does not create a dramatic sense of imperative like you seem to be expecting it to.

If you're defending the premise that a governmental entity should not be allowed to compel the behavior of private parties

Bzzzt. As has been pointed out again and again, no one has come remotely close to arguing "breaking the law shouldn't be illegal" or "regulators shouldn't regulate" and saying "by your logic..." does not make these any less the straw man.

The State involves itself more closely in areas of health and welfare, eg. the regulation of public utilities and product safety regulations. Pharmacies are solidly in this public/private sphere; car dealerships, notsofuckingmuch.

Ah, so you're saying that this car thing was a poorly contrived mismatched analogy? You probably ought to point that out to the person who came up with it.
posted by XMLicious at 1:22 AM on July 11, 2009


No, it would be like requiring Ford to have emissions controls and fuel efficiency standards.

...and then requiring them to sell every type and format of vehicle, simply because they're all legal.
posted by XMLicious at 1:24 AM on July 11, 2009


If you aren't denying it, you're certainly doing an interesting little quasi-libertarian shimmy where you object to OMGTHE STATEBOOGABOOGA requiring a business they license to behave as the license dictates. Gives you plausible deniability, I guess.

Before I sample any more of your delicious trollbait, let me just address this absurd alternative notion you keep positing, wherein the state of Washington "provides plan B itself" - first of all, Washigton State has no money right now - certainly not the funds it would need to set up a network of Plan B dispensaries throughout the state. Second, such a move would almost certainly be severely controversial and divisive. It's one thing for medical professionals to be required to behave as medical professionals, it's quite another to have the state handing Plan B out directly, especially if the logistics are at taxpayer expense. Our anti-choice population is dwindling, but there's still enough of them that this would get really, really ugly. Third, when a woman needs Plan B, she needs it urgently - like, right then - not after filing for state benefits, awaiting approval, awaiting an available appointment, awaiting service, etc. Nothing but nothing I've requested of Washington State has reached me within 72 hours.
posted by EatTheWeak at 1:25 AM on July 11, 2009 [2 favorites]


No, it would be like requiring Ford to have emissions controls and fuel efficiency standards.

Wrong. Regulating how a company sells products, and restricting what products they can sell, is different from forcing them to sell a specific product.

Maybe my dealership just wants to sell mini-vans. I would find it weird if the state forced me to sell Segway's.
posted by jsonic at 1:25 AM on July 11, 2009


This does not create a dramatic sense of imperative like you seem to be expecting it to.

No it doesn't but it sure does mess with the logic of not carrying or selling the product at all.
posted by P.o.B. at 1:26 AM on July 11, 2009


Bzzzt

By all appearances, you seem to be agreeing with jsonic that the government should not compel a pharmacy to sell reproductive medicine to women. I guess you can "bzzzt" as much as you like, but to the extent that you are basing your disagreement on your personal dislike of a particular product being available, your position (and that of jsonic's) is inconsistent and its logical basis and merits, therefore, suspect.
posted by Blazecock Pileon at 1:28 AM on July 11, 2009 [1 favorite]


OMGTHE STATEBOOGABOOGA requiring a business they license to behave as the license dictates

What? I'm arguing that this regulation shouldn't exist, not that businesses should be immune from it.
posted by jsonic at 1:29 AM on July 11, 2009


There are thousands of medications out there, do I need to carry one of each? What counts as a timely fashion, does the Board define that?

Yes. The ruling (PDF linked up top) includes languages which references the various legitimate reasons a pharmacy may not stock a particular item - explicitly citing lack of demand. However that is out of scope of this ruling.

This ruling specifically states that the state of Washington was violating law by allowing pharmacists to refuse to dispense this drug (which of course assumes it was available, requested, etc). The state mandated that pharmacies must accommodate the religious nutbars and provide either extra staff, referral to another pharmacy, phone prescription services, etc in order to fulfill the patient's prescriptions.

The federal court said "uh. No your right to religious expression does not give you the right to be employed and not do your job" and cited lots of reasons.
posted by device55 at 1:30 AM on July 11, 2009 [2 favorites]


your position (and that of jsonic's) is inconsistent and its logical basis and merits, therefore, suspect.

[citation needed]

There's a difference between regulating the products a company sells, and dictating that they sell a specific product. This wouldn't be such a controversial statement if it was unrelated to the culture war.
posted by jsonic at 1:32 AM on July 11, 2009


Doesn't change the fact that it's a private business that I'd rather the state didn't force to sell a product that violates the morals of its owners.

jsonic, this is the second pro-life themed debate I've had with you. Your debating style is becoming oddly familiar with me. Quiet disagreement followed by increasingly loud histrionics, followed by question dodging, followed by putting words in non-existent people's mouths, followed by more histrionics, followed by intentional obtuseness, followed by enough strawmen to secure a thousand-acre cornfield against an airborne army of crows.

Yes, we know you're Catholic and we know you're pro-life. We know you love the fetuses and the blastocysts and you hate how the world is slowly but surely transforming into a place where 13th century Thomistic treatises on the nature of Human Ends and Virtue no longer count as authoritative when debating public policy. We understand all that.

What you need to understand, however, is that your intentional (and increasingly ridiculous) attempts to stem the tide of logical thinking aren't working, and that the more you ride out on your mighty steed, Don Quixote-style, image of BVM emblazoned upon thy shield, to defend the sanctity of human life, the more that horizon of tomorrow grows ever closer, and the sooner your beliefs will begin to fade slowly into that twilight which all things must pass.

And with that, I'll say goodnight.
posted by Avenger at 1:33 AM on July 11, 2009 [45 favorites]


ah it is a tape loop. Reminds me of bevets. Good night.
posted by @troy at 1:33 AM on July 11, 2009 [1 favorite]


"Using your example, it would be like forcing a Ford dealership to sell a Prius since they're so great for the environment."

Does Washington have the kind of liquor licence, targeted at pubs and restaurants, which requires a food purchase in order to purchase alcohol?
posted by Mitheral at 1:34 AM on July 11, 2009


Let's say there is a new strain of cold virus floating around which can cause miscarriage in the first trimester. The only preventative is a drug made from rabbit hearts. The drug must be dispensed within 24 hours of symptoms showing to save the pregnancy. Certain vegan pharmacists object to dispensing or even stocking the drug in their vegan-owned pharmacies.

A court rules that vegan pharmacists are breaking the law by denying anti-miscarriage drugs to those in need, and that state-licensed pharmacists must stock the drug in question or lose their licenses. Would we see all these gripes about "private enterprise" and "the state says so"?

You don't see a whole lot of Jehovah's Witnesses who are phlebotomists. As Avenger has said many times above, if your morals trump your cushy job duties, then quit and wait for history to vindicate you.
posted by benzenedream at 1:37 AM on July 11, 2009 [11 favorites]


Does Washington have the kind of liquor licence, targeted at pubs and restaurants, which requires a food purchase in order to purchase alcohol?

Not that I know of.
posted by P.o.B. at 1:38 AM on July 11, 2009


Regulating how a company sells products, and restricting what products they can sell, is different from forcing them to sell a specific product.

You don't seem to understand your own position, or perhaps you do, but you're not being forthright about acknowledging the problems with it.

The government compels many different companies to sell specific products, many of which you likely happily and gladly use, such as (yes) a seat belt.

I suspect that you secretly acknowledge that the public has a compelling interest in compelling the behavior of private industry (however much you are now trying to move the goalposts of the discussion) but your personal, emotional objection to reproductive medical care is blocking your ability to acknowledge the inconsistency in your tortured logic.
posted by Blazecock Pileon at 1:38 AM on July 11, 2009 [1 favorite]


If you aren't denying it, you're certainly doing an interesting little quasi-libertarian shimmy where you object to OMGTHE STATEBOOGABOOGA requiring a business they license to behave as the license dictates.

Or, you know, we're saying that the license shouldn't dictate what it dictates. Completely unfathomable and incomprehensible, right? Obviously you're forced to pretend you can't understand the idea of ever objecting to the validity of a regulation. Who's dancing a shimmy again?

No it doesn't but it sure does mess with the logic of not carrying or selling the product at all.

Uh, no, it doesn't. "The consumer would have to pre-order the product from someone else!" wouldn't mess with any logic, not if you put two or even three exclamation points after it.

I guess you can "bzzzt" as much as you like, but to the extent that you are basing your disagreement on your personal dislike of a particular product being available, your position (and that of jsonic's) is inconsistent and its logical basis and merits, therefore, suspect.

Not nearly as suspect as the way you have to drop a new straw man with almost every comment you make and toss out the word "logic" again and again and again to make it seem like your crappy analogies and contrived paraphrasings make sense. I have no objection at all to Plan B and I think that everyone should have access to it.
posted by XMLicious at 1:38 AM on July 11, 2009 [2 favorites]


There's a difference between regulating the products a company sells, and dictating that they sell a specific product

If you'd read the ruling (in handy PDF format, linked at the top) you'd see that the ruling doesn't have anything to do with forcing pharmacies to carry and dispense any particular drug.

Only that a pharmacist cannot refuse to dispense a drug on personal, moral, religious grounds.

Pharmacies are allowed to carry alternative medications, or not stock something if it is not requested or needed, etc, etc.
posted by device55 at 1:41 AM on July 11, 2009 [2 favorites]


Avenger, if I recall correctly, our last argument had you proclaiming that killing doctors, judges, and policemen is the only honest way to fight abortion.

Yet somehow I'm the one with the histrionics. Also, thanks for hating on religion. At least I now know your real motivation.
posted by jsonic at 1:41 AM on July 11, 2009 [1 favorite]


See Wash. Admin. Code §§ 246-869-010(1)(a)-(e), (2) (exempting pharmacies from the general duty to deliver when the prescription cannot be filled due to lack of payment, because it may be fraudulent or erroneous, or because of declared emergencies, lack of specialized equipment or expertise, or unavailability of a drug despite good faith compliance with Washington Administrative Code section 246-869-150, which provides in part that “[t]he pharmacy must maintain at all times a representative assortment of drugs in order to meet the pharmaceutical needs of its
patients”).


Yes. The ruling (PDF linked up top) includes languages which references the various legitimate reasons a pharmacy may not stock a particular item - explicitly citing lack of demand. However that is out of scope of this ruling.

Takes me a while to read 54 pages.
I don't see the lack of demand reference though, must have missed it.
posted by madajb at 1:47 AM on July 11, 2009


In a footnote.
5
See Wash. Admin. Code §§ 246-869-010(1)(a)-(e), (2) (exempting
pharmacies from the general duty to deliver when the prescription cannot
be filled due to lack of payment, because it may be fraudulent or errone-
ous, or because of declared emergencies, lack of specialized equipment or
expertise, or unavailability of a drug despite good faith compliance with
Washington Administrative Code section 246-869-150, which provides in
part that “[t]he pharmacy must maintain at all times a representative
assortment of drugs in order to meet the pharmaceutical needs of its
patients”
).
Emphasis mine.
posted by device55 at 1:50 AM on July 11, 2009


Sorry. I meant to focus just on the relevant part - not the whole footnote

A "representative" assortment of drugs can mean that a retirement community pharmacy may stock more viagra than plan b as that represents the community of patient's needs.
posted by device55 at 1:52 AM on July 11, 2009


The better analogies are probably other health care providers. For example: it is entirely reasonable that, for an ambulance company to be allowed a license to operate, they MUST be stocked with saline I.V.s and provide those in the course of medical care inf needed.

The EMT/ambulance can't claim some ethical or religious objection to saline I.V. administration and thereby simply not stock or provide (i.e., sell) them to patients. The state has the right to set forth standard of care practices and require that anyone seeking licensing adhere to them.

But really, this is not an issue about state regulation of private business, as some would like to frame it. It's really about the pro-life adherents trying their best to undermine reproductive rights not by instituting major legislation (e.g., overturning Roe v. Wade) - which would be wildly unpopular and they could never do, but instead by whittling away all the myriad ways in which reproductive rights manifest in society.

The libertarian, pro-private-business argument is, I am convinced, a red herring, a cover for the real intent which is to fight in every way possible the right of consenting human adults to have control over their own sexuality.
posted by darkstar at 1:53 AM on July 11, 2009 [13 favorites]


Uh, no, it doesn't.

Uh, yes, it does. That is if you're still arguing from the stance that this not economically feasible. Or are we just specifically talking that this isn't right from a regulatory standpoint? Because, hey, let's get rid of all kinds of regulations that people have moral quandaries over and see where that leads us.
Fun time!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
posted by P.o.B. at 1:54 AM on July 11, 2009


The libertarian, pro-private-business argument is, I am convinced, a red herring, a cover for the real intent which is to fight in every way possible the right of consenting human adults to have control over their own sexuality.

Indeed, this summarizes the matter very neatly.
posted by Blazecock Pileon at 1:58 AM on July 11, 2009


The libertarian, pro-private-business argument is, I am convinced, a red herring, a cover for the real intent which is to fight in every way possible the right of consenting human adults to have control over their own sexuality.

This is a bad assumption to make.
Neither my wife nor I are particularly opposed to pre-marital sex, birth control or abortion for that matter, but both of us went "huh?" when this ruling showed up in the paper.

While there are certainly those who would like to use "religious freedom" as a lever to pry into other folk's business, there are legitimate reasons to object to a pharmacy being forced to dispense a particular drug.
posted by madajb at 2:01 AM on July 11, 2009 [1 favorite]


A "representative" assortment of drugs can mean that a retirement community pharmacy may stock more viagra than plan b as that represents the community of patient's needs.

And I suppose that Ralph's Thriftway couldn't make the argument that there is no demand for Plan B in Olympia.
I wonder if a rural pharmacy could successfully.
posted by madajb at 2:05 AM on July 11, 2009


Could you apply those same arguments to an EMT/ambulance company that was forced to dispense saline I.V.s to patience who needed them?

Would a "private business" argument be legitimate to allow them to get out of the requirement?

Would a strongly held religious conviction be a legitimate reasons to allow them keep their license yet refuse to stock or dispense saline I.V.s?

In my opinion, the answers to these questions are clearly "No" and this seems pretty analogous to pharmacists and Plan B.
posted by darkstar at 2:09 AM on July 11, 2009


*patients
posted by darkstar at 2:09 AM on July 11, 2009


I wonder if a rural pharmacy could successfully.

Well being that this isn't some kind of esoteric drug, and it's actually a very common one, I doubt it.
posted by P.o.B. at 2:12 AM on July 11, 2009


Jsonic: "I could see this making more sense if it was a life/death issue, such as requiring stores to stock/sell heart defibrillators."

Several people in this thread have already pointed out the time-sensitive nature of Plan B, which is part of why it makes sense for a pharmacy to have it in stock rather than available on order. You have repeatedly refused to engage this.

It's also revealing that you dismiss averting a pregnancy as not a "life/death" issue and therefore unimportant. Your fixation with the "right" of a business is a foil for your complete lack of interest or concern in the rights of people who need to take this product as quickly as possible for it to work effectively. The court decided the latter trumps the former. Yet you are utterly disinterested in engaging with the legal reasoning, much less reflecting on why you think the only "rights" at stake are those of a business to carry certain items.

You've said earlier that you think an analogy to requiring a pharmacy to carry Plan B is "Vegan restaurant required to sell chicken nuggets." Res ipsa loquitur.
posted by foxy_hedgehog at 2:13 AM on July 11, 2009 [6 favorites]


should have been: "lack of interest in or concern for"
posted by foxy_hedgehog at 2:14 AM on July 11, 2009


darkstar: It's really about the pro-life adherents trying their best to undermine reproductive rights not by instituting major legislation (e.g., overturning Roe v. Wade) - which would be wildly unpopular and they could never do, but instead by whittling away all the myriad ways in which reproductive rights manifest in society.

I do agree that this is probably the agenda for many if not most of the people agitating about this. But similarly I think that arranging situations in which pro-life adherents are required to endorse abortion or things they view as edge cases, which it seems like Plan B is for some people, is similarly a gambit by pro-choice adherents. And I don't think that such gambits are valid any more than an extra-legislative dismantling of Roe v. Wade would be.

P.o.B.: Uh, yes, it does. That is if you're still arguing from the stance that this not economically feasible.

You mean, if it's not economically feasible for an individual to pre-order medications from any pharmacy other than these ones? I didn't realize that people were making this argument, if that's what you meant. If there really are such people, there of course could also be people who can't reach any pharmacy at all. I wouldn't object to some program to make sure that people have access to the medications they need. But doing so by requiring pharmacies or pharmacists with pro-life objections to

Or are we just specifically talking that this isn't right from a regulatory standpoint? Because, hey, let's get rid of all kinds of regulations that people have moral quandaries over and see where that leads us.

Yeah, I think people are primarily saying that this shouldn't be a regulation.
posted by XMLicious at 2:15 AM on July 11, 2009


oops, incomplete sentence above oughta be "But doing so by requiring pharmacies or pharmacists with pro-life objections to provide Plan B seems underhanded and political."
posted by XMLicious at 2:18 AM on July 11, 2009


Well being that this isn't some kind of esoteric drug, and it's actually a very common one, I doubt it.
Likely true.
posted by madajb at 2:19 AM on July 11, 2009


Well, I've gotta get going too at this point. Thanks for the reparteé on the issue, all.
posted by XMLicious at 2:29 AM on July 11, 2009


The main thrust of a statement citing that there shouldn't be a regulation requiring a private business to sell a product is in a general sense an economically inspired one, right? If it is, and we're not talking some hypothetical of requiring every single drug ever, then I don't see the objection to carry time sensitive products with a shelf life of four years. If not and you're pushing the idea from a mere political standpoint then it still seems to be one that is not favored. If it's neither then perhaps a little clarification rather than pointing out how others statements don't hold up?
posted by P.o.B. at 2:35 AM on July 11, 2009


But similarly I think that arranging situations in which pro-life adherents are required to endorse abortion or things they view as edge cases, which it seems like Plan B is for some people, is similarly a gambit by pro-choice adherents.

But this isn't an "edge case." See @troy's link above:

● Levonelle-2 is thought to prevent pregnancy by various mechanisms dependant on the stage of the cycle. It suppresses ovulation, inhibits fertilisation of any eggs released and also causes changes to the endometrium to prevent implantation of the fertilised egg. [PDF]

The anti-choice movement's objections to Plan B reveal that their objection is not simply to abortion but to contraception, and that their long-term goal is not just to overturn Roe v. Wade but Griswold v. Connecticut.
posted by foxy_hedgehog at 2:40 AM on July 11, 2009 [1 favorite]


Some history on how it got to this point.
posted by P.o.B. at 2:41 AM on July 11, 2009


Serious topic. I don't wanna get my Roe all tangled with your Wade, and all, but I do need somewhere to say this:

Plan B is the recipient of Rokusan's Lifetime Achievement Award for Best Product Name Ever.
posted by rokusan at 2:50 AM on July 11, 2009 [7 favorites]


Funny how violating someone else's right of conscience is a-okay if YOU don't agree with them.
posted by St. Alia of the Bunnies at 3:25 AM on July 11, 2009




Funny how violating someone else's right of conscience is a-okay if YOU don't agree with them.

Have you read the previous 167 comments? Users have been wrestling with this issue in detail, and "zing" one-liners like this, without any reference to the ongoing discussion, make it sound like you haven't bothered.
posted by foxy_hedgehog at 3:43 AM on July 11, 2009 [10 favorites]


I'm still curious to hear how folks would defend the right of conscience of an EMT/ambulance company to refuse to provide a saline I.V., for example, to a patient who needed one and for whom the ER doctor back at the hospital had ordered one.

It seems to me that such a situation would be thoroughly unacceptable and the company would and should lose their license.
posted by darkstar at 3:46 AM on July 11, 2009 [1 favorite]


Funny how violating someone else's right of conscience is a-okay if YOU don't agree with them.

You really should insert that way up the top of this thread, before it was refuted over and over again.

No-one's forcing anyone to be a licensed pharmacist.
posted by pompomtom at 3:52 AM on July 11, 2009 [2 favorites]


"zing" one-liners like this, without any reference to the ongoing discussion, make it sound like you haven't bothered.

I seriously doubt that she was.

*zing*
posted by item at 3:58 AM on July 11, 2009


Anti-choice* men are disgusted that sluts women make choices based on their needs. Said men wildly toss around strawmen to try and convince us why this is a bad idea.

or

Freedom-loving, free-market men are disgusted that the State is demanding a private enterprise sell Jonas Brothers CDs if they're going to sell CDs at all (or something along those lines).

Hm. I wonder which is right.

* One assumes that every anti-choice family contains at least one adopted child, surely that is a moral consequence of being anti-choice?
posted by maxwelton at 4:18 AM on July 11, 2009 [1 favorite]


This sort of thing has been going on in GA, too, with some pharmacists even taking the position that men can't purchase plan B. Unfortunately the 9th circuit doesn't cover our pharmacies, so I guess we will have to wait a little longer down here.
posted by TedW at 4:25 AM on July 11, 2009


I did read the posts.

I disagreed with them.
posted by St. Alia of the Bunnies at 4:38 AM on July 11, 2009


We have never accepted "I was just following orders" as a defense against prosecuting someone who has done something they might acknowledge as being contrary to their morality.

More accurately, we haven't accepted "I was just following orders" as a defense against prosecuting someone who did something against the prosecutor's morality.

In my opinion, that's one of the things we got most wrong, coming out of WW2. Conditioning is a powerful force, and people WILL follow orders, even ones they find profoundly repugnant. We've learned a lot about the human psyche since the Nuremberg trials, yet somehow we hold those as exemplars in human morality, when I just don't think they were. We screwed up very badly, given what we've learned since.

On the free-market arguments: a pharmacist is in a position of unusual power in the life of any patient, because we have given them a monopoly on the dispensation of drugs. If ANYONE could carry these drugs behind the counter in any store, without a special license, then the anti-choice and free-marketers would have a strong argument. But we've granted a monopoly to pharmacists, and in exchange for getting the right to dispense drugs, they give up their ability to inflict their moral opinions on their patients.

If pharmacists really don't want the government to be able to tell them what they can dispense, then we need to break the pharmacists' monopoly on drug dispensation. If they want choice, then anyone should be able to buy and sell prescription medicines.

Free-market arguments only work if there's actually a free market.
posted by Malor at 4:41 AM on July 11, 2009 [16 favorites]


It seems like the best solution is to make Plan B truly over the counter. If you could buy it at every grocery store, dollar store, and convenience store in town, then if one or two stores didn't want to carry it it wouldn't matter. This "you don't need a prescription, just the pharmacist's permission" thing for Plan B (and pseudoephedrine), is really a problem in places with few pharmacies with limited hours.

And the argument that Plan B is too dangerous to be easily available is a silly one, given all the news recently about how easy it is to accidentally fry your liver and kill yourself with Tylenol, which you can buy at a gas station.
posted by hydropsyche at 5:29 AM on July 11, 2009 [4 favorites]


I've not read any of this yet so apologies if it has been addressed already, but in Australia (Brisbane, Queensland to be specific) the "Plan B" pill is available over any pharmacy counter, but not to the gentleman, which I learned to my embarassment some time ago. Anybody able to enlighten me as to why this is the case? Not many women are spontaneously self-fertilising.
posted by turgid dahlia at 5:42 AM on July 11, 2009


btw I understand that Plan B doesn't reverse fertilisation, merely prevents it from happening. So I guess "self-unprotected-ejaculating-into", which doesn't sound quite as nice.
posted by turgid dahlia at 5:45 AM on July 11, 2009


And if they're the only shop in town, then why doesn't the state make Plan B available themselves?

because people like you will object that their tax money shouldn't go to things they find morally wrong

the real problem is that people in the u s don't understand what personal boundaries are and where they should be set - they also want to follow a vision of their religion that is against the mainstream without wanting to make the personal sacrifices following that vision might demand

as i've said before in another context, people can choose - but what they can't choose is to have both options - you cannot choose to refuse a society's rules and traditions AND expect the full benefits of those who conform - this is a problem that many people face - whether to go with the culture at large and conform or to go with the beliefs of one's own subculture and pay the price of not conforming

the religious (or non-religious) are no exception to that rule - and although the choice is a complicated one, you can't choose both and that's what these pharmacists are trying to do
posted by pyramid termite at 6:46 AM on July 11, 2009 [2 favorites]


Ok, I still surprised that people aren't talking about the concept of equality here. This is a medication that only affects one group of people, a protected class at that. I alluded to it with the No Irish Need Apply thing, but somehow it just doesn't seem to be a part of this conversation.

Imagine if a pharmacy refused to stock any medication that treated Sickle-Cell Anemia on moral grounds. Should it be allowed to completely disregard the needs of a subordinated social group on moral grounds?

For those who feel like pharmacies shouldn't be forced to carry Plan B, certainly you don't believe it should be forced to carry hydroxyurea.

This is about a culture war - but it's not a war over reproduction. It's over women's rights.
posted by allen.spaulding at 7:21 AM on July 11, 2009 [7 favorites]


It's really simple - pharmacists fill prescriptions. They don't write them, and they don't get to pass judgement on them. If they have a concern or an issue with the prescription, they can contact the prescribing physician.

If their moral problems with a certain drug are that big, then they need to get their medical license and not prescribe that drug.

Otherwise, shut the fuck up and fill it.
posted by Benny Andajetz at 7:35 AM on July 11, 2009 [7 favorites]



This is about a culture war - but it's not a war over reproduction. It's over women's rights.

Absolutely, and it's revealing that this thread has focused overwhelmingly on the rights of pharmacists and businesses. Women, and their rights, get lost in the rhetoric.
posted by foxy_hedgehog at 7:36 AM on July 11, 2009 [7 favorites]


Alia - so for some reason you felt it necessary to signal your disgust or whatever with the decision, but not necessary to actually add anything. You're like a guy that walks into an on-going debate, screams a slogan at the participants, and then stands there looking self-satisfied. You should probably not be proud of this.

Anyway.

The pharmacists in question blew the whistle. They conscientiously objected. They agitated. They did all the stuff you're supposed to do when you disagree with something on moral grounds. They are the power company that refused to provide power for an execution. They shut down the relays or whatever and said "no," and then they went the heroic distance of taking it to court.

The court disagreed with them.

So yes, we have reached the point where we can say "they need sell the drug or get out of the business," without thereby voiding everyone else's responsibility to object when given what they consider to be immoral orders. If, in the course of your life, you are told to do something you object to strongly, I would be surprised indeed if you took it as far as these pharmacists did.

At the end of the day, the court of appeals opined that, yes, the pharmacy industry is required to carry a certain product. If you want to be a pharmacist you will be required to sell certain things, and, as much as we as a country are able, we have determined that is the best way of doing things.

There is no cause for hand-wringing over the loss of moral agency in the private sector, or even agency in general. It is beneficial for the society for regulations to exist, and it is also beneficial for systems for challenging those regulations to exist. The regulations were challenged and upheld. Please stop losing your shit over it.
posted by kavasa at 7:41 AM on July 11, 2009 [5 favorites]


If a Scientologist pharmacist refused to dispense anti-depressants they'd be in just as much hot water.

Device55 is spot on.
What if it were other drugs for other reasons?

Antibiotics because the pharmacist/pharmacy believes they're too often prescribed and believe superbugs are an eminent threat?

Scientology that won't fill a prescription for anti-depressants?

Bitter divorcee that won't fill viagra?

Or your vegan that won't dispense drugs containing animal ingredients.

Or just someone that believes that the side-effects of some medication are too great. (hint - its the doctors job, if they have a concern they can call the doctor just like they do for mistakenly prescribed drug interactions).

I'm sure I could list 100 more.

Because we are a capitalist country we have decided that certain necessities can be provided by private businesses if they meet the requirements. One requirement is providing access to all legal medicines necessary. Regardless of moral standing by the business owner or pharmacist.
posted by [insert clever name here] at 7:50 AM on July 11, 2009 [2 favorites]


I notice that the ruling exempts situations "when the prescription cannot
be filled due to lack of payment." Are pharmacies allowed to set their own prices for drugs? Could someone dodge this ruling by saying "yeah, we sell Plan B, but it'll cost you a gazillion dollars a dose"?
posted by teraflop at 7:56 AM on July 11, 2009


Let's be honest here: Religion is fueling this problem.
posted by kldickson at 8:07 AM on July 11, 2009 [4 favorites]


Yup. The birth control/Viagra thing drives me nuts, and it very much seems to be a women's rights issue to me. I've had insurance that covered Viagra and its ilk, but not my (any) birth control. Not pills, not IUD, whatever. And to some extent, the ED drugs are recreational - or at least over-prescribed to the extent that a good percentage of users are basically using 'em semi-recreationally. So, it seems to me that birth control and ED drugs should be on equal footing as far as the sex-hating mindset would go. But they're not. Why? Well, boners are a man's right, right? (And oh, of course, sex is a part of a healthy marriage and all that.) But women should abstain and not risk catching the preggo? Married folks who can't afford a kid and practice safer sex, but something goes awry (like a condom breaking)? Girl who gets date raped and can't/won't report it and wants to ensure that she doesn't need to get an abortion? Too bad. Yup. That's fair.

Further: preventing conception is not the same as abortion.
posted by sadiehawkinstein at 8:10 AM on July 11, 2009


The birth control/Viagra thing drives me nuts

That's because you seem to be confusing correcting a dysfunction and providing a convenience.
posted by rr at 8:33 AM on July 11, 2009


That's because you seem to be confusing correcting a dysfunction and providing a convenience.


and you seem to be confusing providing a convenience with preserving health and welfare.
posted by @troy at 8:36 AM on July 11, 2009 [5 favorites]


"My profession demands that I dispense medical care to all who need it, regardless of my own personal judgments."

Wow. Really, a paycheck is all that you need in order to surrender your status as a moral agent?
posted by oddman at 8:37 AM on July 11, 2009


Let's be honest here: Religion is fueling this problem.

Hrm. If the Plan-B rejecting pharmacies also refuse to sell condoms, and refuse to stock diaphragms (are these even sold in pharmacies? I have no idea), then I would assume it to be a religious issue.

If the pharmacies in question do provide these other products, but continue to refuse the sale of Plan-B, then I'd assume this had just as much to do with egregious misogyny and willful ignorance as it does with religion.


On preview: Further: preventing conception is not the same as abortion.

During discussions like this, I can't help but think "oh surely all right-thinking people know this already!", but I recall that someone upthread honestly and non-judgementally confused Plan-B with RU486. I don't doubt that there are anti-choicers out there who deliberately and knowingly conflate the two distinctly different products to fuel their arguments, but honest mistakes can and have been made (not with the definition of abortion vs contraception, but as to the function of the two products).
posted by elizardbits at 8:39 AM on July 11, 2009 [1 favorite]


I am so freaking excited about this!!!! Yay!
posted by agregoli at 8:39 AM on July 11, 2009


Don't forget those who believe that life begins *before* fertilization. I mean, who says sperm are not alive? They have a goal, they have mobility, and they use their mobility to achieve their goal. That is life. Is it human life? Well, the sperm has human genetic information, and it's alive, sooo....sure, it's human and it's life. So if there's to be regulation, it really should start with mens' nutsacks. Since I don't want people telling me what I can or cannot do with my balls, I extend to everyone the courtesy of not trying to regulate their own body parts.
posted by jamstigator at 8:41 AM on July 11, 2009 [2 favorites]


Hrm. If the Plan-B rejecting pharmacies also refuse to sell condoms, and refuse to stock diaphragms (are these even sold in pharmacies? I have no idea), then I would assume it to be a religious issue.

The ruling states explicitly that the pharmacies and pharmacists in question refused to dispense this drug for religious reasons. These pharmacies and pharmacists filed suit explicitly claiming infringement of 1st amendment religious freedoms.

No assumption is needed.
posted by device55 at 8:46 AM on July 11, 2009 [1 favorite]


If the loudest people here pretending that they're opposed to this because it's "government oppressing people" or "telling private citizens what to do" then the answer is quite simple, isn't it? Make Plan B available for purchase outside a pharmacy, like Sudafed or Tylenol or condoms. That way if you're a pharmacist who objects to it, someone can much more easily go and get it themselves without having to make your job complicated.

Of course, that's not what you're actually upset about, is it? Because you certainly don't want that at all. You don't want the pill to be available, period.

It's hilarious- absolutely hilarious- to watch the handful of unwavering, fundamentalist anti-choicers, lock-step adamant on preventing a woman from exercising her personal reproductive freedom start bitching about a drug store "having its rights taken away."
posted by XQUZYPHYR at 8:51 AM on July 11, 2009 [22 favorites]


Many people seem to have adopted this position "If a job asks you to be immoral, either be immoral or quit." Which is to say do the wrong thing or shut the hell up. Is that really a productive, moral stance?

Sure many of you may wish to ammend that by saying well, after you quit you should speak against the law or policy and try to get it changed, but if you live in an immoral society this may be neither easy nor safe?

Why not adopt this stance:
If a product is a necessity you are not required to sell it if it is available at some other retailer in your area. If there are no other retailers in your area, than you must carry it. If no business voluntary agrees to carry it in your area, then the business that last came into existence must carry it (i.e. we'll respect seniority).
posted by oddman at 8:53 AM on July 11, 2009


I am so freaking excited about this!!!! Yay!

Still gotta survive SCOTUS review, which should be 66.6% Catholic soon.
posted by @troy at 8:53 AM on July 11, 2009


No assumption is needed.

Sorry, I wasn't especially clear in my comment. I'm absolutely 100% aware that the pharmacists in question are claiming infringement of their first amendment religious freedoms. I was really looking at whether or not they were being 1) enormous hypocrites or 2) willfully ignorant misogynists.
posted by elizardbits at 8:55 AM on July 11, 2009


You don't want the pill to be available, period.

Nice strawman you got there. I, at least, mentioned numerous times that if the state wants this available, it could easily do it themselves. No need to force a private business to sell a specific product.

But that gets in the way of your real motivation: demonizing anyone not in lock-step with your views of morality. See, I can do it too. It's amazing how many people in this thread are convinced they know the true, EVIL, motivation anybody has who disagrees with you. It's Bush's "Either you're with us or against us" used un-ironically by people who hated it when he said it.

Keep telling yourself it's REALLY all about controlling women and punishing sluts. I've heard repetition make it true.
posted by jsonic at 9:03 AM on July 11, 2009 [1 favorite]


> If a product is a necessity you are not required to sell it if it is available at some other retailer in your area.

The injunction that this ruling overturned was very similar to this stance - it was ruled against because constitutionally granted freedoms don't give you the right to break other laws (specifically the laws which govern how a pharmacy does business)

I was really looking at whether or not they were being 1) enormous hypocrites or 2) willfully ignorant misogynists.

Sorry I misread you. Your question? The answer is "yes"
posted by device55 at 9:06 AM on July 11, 2009


I overslept rather dramatically, so I've been absent. but:

What if a power company refused to supply power for electric chair executions?

[ROU_Xenophobe] was saying that he simply would not stand for a power company moralizing in what it provided power for. But I think it's pretty likely that was a false claim and he or she would accept the moralizing if the morals weren't those of someone else.

Well, you're wrong. I wouldn't accept a power company deciding not to supply power to a prison, or to the chair, or to weapons factories, or anything else. Power companies are not moral agents in this capacity (nor are pharmacists in the other), and I would not want to live under a system where people are subject to the petty dictatorships of an interlocked set of business owners instead of democratically-arrived-at laws (and indirectly democratically-arrived-at regulations).

The 'Professional Standards' of the medical community used to be to sterilize the mentally challenged so that they couldn't breed. Was it wrong for doctors to refuse to do these sterilizations due their personal morality? Should they have just quit instead?

Quit and agitated against it. But, yes, quit, or accept being fired.
posted by ROU_Xenophobe at 9:10 AM on July 11, 2009 [2 favorites]


And if they're the only shop in town, then why doesn't the state make Plan B available themselves?

This is a weird argument, isn't it? The state does make Plan B and other controlled substances available by operating a licensing program that allows certain professionals to make a business of selling products that the state wants to be sold. And to participate in that program, the licence holder must agree to sell all of the substances that the state wants sold, including Plan B (and anti-depressants and antibiotics, and products containing animals etc.).
posted by carmen at 9:11 AM on July 11, 2009 [5 favorites]


I have issues with the state forcing a private company to sell a specific product.

THAT. HAS. NOT. HAPPENED.

There is no law that says "You gots to carry Plan B mwuhahaha!"

There is, instead, a law that requires pharmacists to "maintain at all times a representative assortment of drugs in order to the meet the pharmaceutical needs of its patients." The law in no way singles out Plan B for any special treatment in this regard.

So, the pro-pharmacist position in relation to this law seems to be that pharmacies don't have to meet the pharmaceutical needs of their patients, but rather only those pharmaceutical needs that they deem worthy and acceptable.
posted by ROU_Xenophobe at 9:21 AM on July 11, 2009 [1 favorite]


This is a weird argument, isn't it?

Not really. Some states, including Washington, only allow liquor to be sold from state run stores. So it's not weird at all for a state to distribute items themselves. They could do the same with controversial drugs and avoid this specific issue.
posted by jsonic at 9:22 AM on July 11, 2009


Many people seem to have adopted this position "If a job asks you to be immoral, either be immoral or quit." Which is to say do the wrong thing or shut the hell up.

This would be true if, upon quitting a job, people had their vocal cords removed.

Last I checked, people who've lost their job rather than perform core tasks they find morally objectionable remain able to object to the circumstances that led to their job loss.
posted by ROU_Xenophobe at 9:27 AM on July 11, 2009 [2 favorites]


Some states, including Washington, only allow liquor to be sold from state run stores

Well, that in itself is weird. Your argument seems to be going in the wrong direction still.
posted by @troy at 9:28 AM on July 11, 2009


Your argument seems to be going in the wrong direction still.

Ok. Other states do this too.
posted by jsonic at 9:30 AM on July 11, 2009


jsonic, do you think an EMT/ambulance company should be allowed to keep its license if the owner of the company has a moral objection to providing IVs to patients and so refuses to do so even when it's medically indicated and a doctor has ordered one for a patient being transported?
posted by darkstar at 9:33 AM on July 11, 2009


Keep telling yourself it's REALLY all about controlling women and punishing sluts.

I still haven't heard a response to my point that this targets a specific class of individuals. Should a pharmacist be able to refuse to stock drugs that treat Sickle-Cell Anemia if his moral conviction tells him so?
posted by allen.spaulding at 9:34 AM on July 11, 2009


No need to force a private business to sell a specific product.
...
I've heard repetition make it true.



That's not working out very well for you.
posted by XQUZYPHYR at 9:35 AM on July 11, 2009


darkstar, your contrived situation is not analogous.
posted by jsonic at 9:35 AM on July 11, 2009


That's not working out very well for you.

OH SICK BURN! I now see the error of my ways. Thank you enlightened one.
posted by jsonic at 9:36 AM on July 11, 2009


How is it not analogous? A licensed health care provider refuses to dispense a particular medical treatment that a doctor has ordered, citing personal ethical reasons.

Or is it just not analogous to YOU, because the ethical/moral objection in question is not one you personally share?
posted by darkstar at 9:38 AM on July 11, 2009 [5 favorites]


I don't care what the discussion is right now, I'd like to say that the morning after pill was very helpful in my life after an evening where a condom broke. I'm very happy that pharmacies have to dispense it. It is horrifying that reproductive choices are still an issue today.
posted by fuq at 9:41 AM on July 11, 2009 [1 favorite]


madajb said: "there are legitimate reasons to object to a pharmacy being forced to dispense a particular drug.

If so, I'm not sure you named any.

What if the profit margin sucks on Viagra so it's not worth the investment? If I think the rep for Pfizer is a ripping me off and I refuse to buy from them?"

Are those of you who think that the drugs that pharmacists dispense shouldn't have to be regulated by the state but by the free market, also okay with marijuana and other recreational drugs being decriminalized? Why should the state care, right? Let the pharmacists sell whatever they want, as long as it's good for business?

madajb said: "More far-fetched, what if research says that giving Thalidomide to pregnant women is a mistake, but it's still FDA approved. Hell, what if the local doctor has a heavy hand and prescribes things that my training says shouldn't be taken in combination?"

Then you chose the wrong license and training, it appears, and you should have become a doctor, not a pharmacist. The doctor's job is to make medical diagnoses and prescribe medicine. The pharmacist's job is to dispense that medicine and advise on how it should be taken. The two roles are not equivalent. If a pharmacist has a medical concern with a prescription, he should take it up with the doctor, not force his issues onto the patient.

The pharmacist is not empowered to enter the relationship between me and my doctor, no matter what.

And the argument that Plan B is too dangerous to be easily available is a silly one,

Especially since Plan B is basically just a more concentrated dose of the same birth control that many women already have in their cabinet.

Analogizing a pharmacist refusing to dispense a drug he doesn't like to a vegan restaurant electing not to serve meat doesn't work.

More legitimate analogs would be:

- A private school that wants to award state-accredited diplomas to high school seniors, and yet doesn't want to teach the state-mandated science and history curriculums

- A gas station that wants to sell gasoline to consumers but doesn't care for the state weights-and-measures standards and wants to dispense liters instead of gallons

- An attorney who wants to remain a member of the state's bar association and have rights in the courtroom, but would prefer not to adhere to all the ethics laws as prescribed

- A builder that wants to receive city permits for construction, but would really rather than follow the electrical and mechanical codes

darkstar's analogy of the EMT was a good one also, and I look forward to the explanation from jsonic as to why it doesn't work.
posted by pineapple at 9:41 AM on July 11, 2009 [10 favorites]


A builder that wants to receive city permits for construction, but would really rather than doesn't want to follow the electrical and mechanical codes

FTFM.
posted by pineapple at 9:43 AM on July 11, 2009


Once I'm out of school, I'd like to try for a job in my home county's public defender's office. That job will entail, to a large extent, defending people I am sure are guilty. Naturally, I have a moral aversion to assisting a guilty rapist to escape punishment, but that's not actually the question I have to ask myself in determining whether or not I want that job. It's part of the question, sure, but it's far more complex than just a single moral dilemma I am sure to be faced with. The question I have to ask myself is: "do I value the importance and necessity of that kind of work so much that I am willing to do it in spite of the fact that I will be faced with situations that will require me to do something that I find personally repugnant." I have asked myself that question countless times, and the answer is yes. Other people ask themselves that question, and the answer is no. Neither one of us are better or more moral than the other, we just have different values. Public defense work is a job that must be done, and it must be done by people willing to do the work as vigorously as possible (workloads and uncooperative clients and absolutely no investigation budget to speak of notwithstanding) for it to be a meaningful institution, which I believe it must be. And so I'm willing to put my morals and my conscience on the line in the name of work I find incredibly important.

This is what these pharmacists are being asked to do. Not just the pharmacists, but the owners of the pharmacies for what it's worth. They are signing up for a job that will put them in uncomfortable spots vis-a-vis their morality, and if they want the job they're gonna have to figure out a way to work through it. It's not that I don't value their morality or their steadfast commitment to it, it's just that public service jobs aren't really the place for someone who can't deal in a personally gray area from time to time because they entail responsibilities larger than one's commitment to a personal moral code. Or at least, if they do allow for an overriding personal moral code, they require one that allows one to subsume one's personal feelings for the larger responsibilities of the work.
posted by Doublewhiskeycokenoice at 9:47 AM on July 11, 2009 [28 favorites]


I'm sure jsonic or similar won't give me an actual answer to this - or perhaps I missed it upthread? - but still, I'm curious.

You're fine with a pharmacist who has moral objections to dispensing:

* antibiotics
* Viagra
* regular birth control pills
* HIV meds

not having to dispense those medications, despite the ruling that says they must "maintain at all times a representative assortment of drugs in order to the meet the pharmaceutical needs of its patients."

According to you, this is the state forcing a private business to carry and sell items they find morally objectionable. So. Really. It would be okay with you if they refused to carry and sell the items above?
posted by rtha at 9:48 AM on July 11, 2009


jsonic, I don't understand what you are referring to when you suggest that the state could easily make Plan B available if they wanted to. Do you think Plan B should be sold over the counter? Should we set up dispensing stations on street corners? Are you proposing an alternate state-operated pharmacy system to complement the existing state-regulated industry? Are you going to pay the taxes necessary to set up this state-run pharmacy? In that case, what happens when pharmacists in that system object to dispensing Plan B? Or are you suggesting that the state should take over pharmacies entirely? Something tells me your political philosophy is opposed to that idea.

I simply do not understand what you are suggesting, though you've been repeating it, well, repeatedly.
posted by dosterm at 9:51 AM on July 11, 2009


You're fine with a pharmacist who has moral objections to dispensing...

Sure. Maybe a pharmacist wants to run a pharmacy that deals with diabetic patients only. So they only stock and sell insulin. It's their business, they should be able to sell only the products they want to sell.
posted by jsonic at 9:57 AM on July 11, 2009


I simply do not understand what you are suggesting

I'm suggesting that the state shouldn't force a private company to sell a specific product. The state can restrict what products a company can sell, and they can regulate how the sell it (health codes, etc). This really isn't a controversial statement.
posted by jsonic at 10:02 AM on July 11, 2009


The pharmacist is not empowered to enter the relationship between me and my doctor, no matter what.

Yes. This.
posted by Benny Andajetz at 10:04 AM on July 11, 2009 [3 favorites]


The pharmacist is not empowered to enter the relationship between me and my doctor, no matter what.

They're not 'entering' your relationship with your doctor. These pharmacists would actually rather stay out of your relationship with your doctor in the case of Plan B. The state, however, won't let them stay out of your relationship.
posted by jsonic at 10:07 AM on July 11, 2009


It's their business, they should be able to sell only the products they want to sell.

Even if that's racially discriminatory? You keep answering questions that don't include the equality component. You're really ok with a pharmacy refusing to sell pills that only Black people take? Or Jews? It's ok to refuse to fill prescriptions for diseases that only affect Jews?
posted by allen.spaulding at 10:07 AM on July 11, 2009


I am a little curious.

Clearly St Alia and jsonic are actually against the Plan B drug. Can either of you tell me why that is? It certainly doesn't kill a fetus; it simply prevents conception. Is it that you don't believe in contraception under any circumstances?
posted by lupus_yonderboy at 10:12 AM on July 11, 2009


I'm suggesting that the state shouldn't force a private company to sell a specific product.

Do you, honestly, not see the difference between a pharmacy and a, say, grocery store? I can live without a loaf of bread, but without my insulin I'm a dead man.

What if some moronic pharmacist could say, "I'm not gonna fill your insulin prescription 'cause it's God's Will that made your pancreas go belly up"?

That's ludicrous. A pharmacy is SECONDARILY a business. It is PRIMARILY a state-sanctioned deliverer of medication.
posted by Benny Andajetz at 10:12 AM on July 11, 2009 [3 favorites]


"We've learned a lot about the human psyche since the Nuremberg trials, yet somehow we hold those as exemplars in human morality, when I just don't think they were. We screwed up very badly, given what we've learned since."

This is the usual case though that extreme cases make bad law. I doubt this precedent will change before the last person who knew someone who was alive then is dead.

"And the argument that Plan B is too dangerous to be easily available is a silly one, given all the news recently about how easy it is to accidentally fry your liver and kill yourself with Tylenol, which you can buy at a gas station."

There are lots of drugs that seem to be on the wrong side of this line. Napraxen in Canada for example. Or pseudoephedrine in the states.
posted by Mitheral at 10:12 AM on July 11, 2009


You keep answering questions that don't include the equality component.

Should my local deli be forced to sell kosher sandwiches? Are they discriminating against Jews if they refuse to sell a product that orthodox Jews rely on?

The answer is No.
posted by jsonic at 10:13 AM on July 11, 2009


Should my local deli be forced to sell kosher sandwiches?

If you cannot tell the difference between a deli and a pharmacy you are to stay the fuck away from my sandwiches.
posted by allen.spaulding at 10:16 AM on July 11, 2009 [35 favorites]


This isn't a law debate as much as its an ethical one. Yes, pharmacists are expected to comply with laws as well as doctors. Yes, Plan B isn't singled out in those laws. The issue is how it conflicts with Hippocratic Oath. The crux of the issue is how the laws conflict with what is concidered the ethical practice of medicine as its always been known. While contraceptives prevent fertilization, Plan B kills a cell organisim that is human. Its murder to some, a convenient way to get past a mistake for others...it all depends on where you draw that ethical line.

But while I'm saying this isn't as much of a law debate...for those pharmacists (and doctors) that can ethically deduce that the killing of a fertilized egg is akin to killing a human, and thus see it as murder....therein lies their dilemma. Sadly, as long as the courts set the rules on what is considered human and what is not, and as long as sex is fun, the debate will continue on.
posted by samsara at 10:17 AM on July 11, 2009 [1 favorite]


And answer the question instead of making an evasive hypothetical. Here is a list of diseases that predominantly or exclusive affect Jews. If a pharmacy declared it would not carry these because of religious beliefs, you would not have any problem whatsoever.
posted by allen.spaulding at 10:17 AM on July 11, 2009 [1 favorite]


(and I follow that up not even knowing how Plan B works..hah...disregard...it doesn't affect after-fertilization)
posted by samsara at 10:18 AM on July 11, 2009


It is PRIMARILY a state-sanctioned deliverer of medication.

If it was state owned and run, then this wouldn't be an issue. But its a private business. The issue here is how much a state can or should control what products a private business must sell. It's debatable, so let's try to not demonize those who aren't gung-ho about this.
posted by jsonic at 10:18 AM on July 11, 2009


Should my local deli be forced to sell kosher sandwiches?

This is getting to the level of deliberately ignoring what anyone else says. The difference between a pharmacy and other non-health critical businesses like a deli has been explained to you repeatedly above. At this point, pretending they are comparable in this issue is deeply disingenuous.
posted by lupus_yonderboy at 10:20 AM on July 11, 2009


The issue here is how much a state can or should control what products a private business must sell

You make it seem like this occurs in a vaccuum. The issue is whether or not a state can address a serious public health problem regarding issues of access to healthcare - a problem that has been created by certain elements of the healthcare infrastructure refusing to address the needs of this class of people on the basis of moral grounds. The answer is yes, yes the state can address public health through the enforcement of its own regulations - especially when there are issues of inequality involved.
posted by allen.spaulding at 10:22 AM on July 11, 2009


If it was state owned and run, then this wouldn't be an issue.

It is state-run. It runs under the charter and rules of the state. It's why you have to go to a pharmacy to get your prescriptions filled.

The private entity that runs the pharmacy chooses to be in that line of work. If the private entity doesn't want to follow the rules, they can open a deli.
posted by Benny Andajetz at 10:22 AM on July 11, 2009 [10 favorites]


But the difference, jsonic, is that the local deli doesn't have a government-granted monopoly on sandwiches. You can go anywhere and get them.

There are a lot of substances that the government, in either its wisdom or lack thereof, doesn't want people to have without supervision. It has appointed gatekeepers to these substances.

These gatekeepers, therefore, have unusual power in this relationship, because you can't get RU-486 from anyone but a licensed pharmacist. That license gives them power, and they're then using that government-granted power to promote personal agendas.

When you're a pharmacist, you're functioning as a monopoly. You enforce the social contract we have developed around the use of various chemicals. You're simply not allowed to inject additional restrictions into this social bargain. You're hijacking the law to force people to do what you want. Using that power as leverage in that way is unjust, and that is what the court has decided here.

If you think RU-486 should be illegal, then get the laws changed, don't abuse your license to force people to comply with your views. The law says they can have it, but you can wave your little license to say they can't.

That was not an intended power of licensure.
posted by Malor at 10:23 AM on July 11, 2009 [14 favorites]


The issue here is how much a state can or should control what products a private business must sell.

And in every civilized country in the world, we come to the same answer - the state decrees that it's important to heavily control exactly how pharmacies operate, exactly what services they can provide, what they must provide, what procedures they must go through to provide them, and all that.

Where's the issue here? If you don't want to work in a heavily regulated industry, either leave the pharmaceutical industry, or move to the third world.

And jsonic: what's your beef with Plan B?
posted by lupus_yonderboy at 10:24 AM on July 11, 2009 [1 favorite]


At this point, pretending they are comparable in this issue is deeply disingenuous.

I was using a example to make a point. Stop trying to demonize anyone who isn't in lock step with your view of morality.

If a pharmacist doesn't want to sell something, I don't think they should have to. Even for the intricately contrived issue of refusing to sell drugs that affect a specific subset of people.

There could be any number of non-hate-based reasons to do so. Maybe Sickle-Cell drugs are not profitable enough for a specific store to justify stocking them. Or maybe a pharmacy ONLY wants to sell sickle-cell related drugs.

It's their store, they should decide what products to sell. The state can restrict what they offer (i.e. no cocaine,etc) and regulate how the sell (labeled bottles, etc).
posted by jsonic at 10:28 AM on July 11, 2009


But requiring a business to sell a specific product seems a little weird.
posted by jsonic at 10:02 PM on July 10 [5 favorites +] [!]

I have issues with the state forcing a private company to sell a specific product. I would have this qualm regardless of my view of that product.
posted by jsonic at 12:13 AM on July 11 [1 favorite +] [!]

I think I see part of our disconnect. I'm saying a business itself shouldn't be forced to sell a product.
posted by jsonic at 12:25 AM on July 11 [+] [!]

Doesn't change the fact that it's a private business that I'd rather the state didn't force to sell a product
posted by jsonic at 12:46 AM on July 11 [+] [!]

I'm simply trying to get across the idea that I disagree with the state forcing a private company to sell a specific product.
posted by jsonic at 12:55 AM on July 11 [+] [!]

There's a difference between restricting what a business can sell and forcing it to sell a specific product.
posted by jsonic at 1:00 AM on July 11 [+] [!]

This case is about forcing the private company to sell a specific existing product.
posted by jsonic at 1:15 AM on July 11 [+] [!]

Regulating how a company sells products, and restricting what products they can sell, is different from forcing them to sell a specific product.
posted by jsonic at 1:25 AM on July 11 [+] [!]

There's a difference between regulating the products a company sells, and dictating that they sell a specific product.
posted by jsonic at 1:32 AM on July 11 [+] [!]



Keep telling yourself it's REALLY all about controlling women and punishing sluts. I've heard repetition make it true.
posted by jsonic at 9:03 AM on July 11 [1 favorite +] [!]
posted by Ndwright at 10:29 AM on July 11, 2009 [4 favorites]


Ndwright, if people keep asking me the same questions I'm going to give the same answer. Thanks for taking the time to cut & paste all my answers though.
posted by jsonic at 10:31 AM on July 11, 2009


jsonic, I don't understand what you are referring to when you suggest that the state could easily make Plan B available if they wanted to.

It's a disingenuous argument. Jsonic doesn't really want the state to dispense Plan B, because jsonic believes that the state should make Plan B illegal.
posted by dirigibleman at 10:32 AM on July 11, 2009


The biggest fallacy I keep seeing being repeated over and over is the idea that a pharmacy is a "private business," full stop. A general store is a private business that gets to choose the items for sale, barring those items that are regulated by government. A pharmacy is a business that works in conjunction with local, state and federal government and is bound by the rules set out by the agencies of government. That's the relationship you agree to when you decide to open a pharmacy, or become a pharmacist.
posted by xingcat at 10:32 AM on July 11, 2009 [2 favorites]


Actually, I like the Sickle-Cell example. According to you guys, if a local community organizer wanted to start a pharmacy to specifically help sickle-cell patients, then they wouldn't be allowed to unless they took on the expense and complication of offering all possible drugs.

How dare they try to pick and choose what drugs to offer!
posted by jsonic at 10:34 AM on July 11, 2009


if people keep asking me the same questions I'm going to give the same answer.

And if people rebut your answer by explaining to you why a pharmacist is a completely different business than almost any other, you're going to simply ignore them and post the same answer again and again.

and what do you have against Plan B, anyway? If you're against abortion, you should be extremely happy that Plan B prevents contraception without killing a fetus!
posted by lupus_yonderboy at 10:34 AM on July 11, 2009


Jsonic doesn't really want the state to dispense Plan B, because jsonic believes that the state should make Plan B illegal.

Hurray! Another person who REALLY knows my secret evil intentions. This conversation would be a lot more civil if you stopped treating me like the evil-religious stereotype you so desperately want me to be.
posted by jsonic at 10:36 AM on July 11, 2009


what do you have against Plan B, anyway?

None of my arguments in this thread have anything to do with if Plan B is good or not.
posted by jsonic at 10:38 AM on July 11, 2009


jsonic: What do you have against Plan B, anyway?
posted by lupus_yonderboy at 10:38 AM on July 11, 2009


Even for the intricately contrived issue of refusing to sell drugs that affect a specific subset of people.

It's not contrived. Plan B is only available for women. By refusing to stock it, pharmacists are refusing treatment to one class of people. In so doing, they are making them more unequal. Indeed it's worse than Sickle-Cell. While Black people have unequal health care and treatment, that's not a significant cause of racial inequality, but more of a symptom (although it's dynamic and certainly complicated). Denying women control over their reproductive health is certainly one of the reasons why women are unequal in society. So by refusing to carry Plan B, not only is a pharmacy denying a product to a specific social class, they are deepening societal inequality.

Of course they are also increasing the number of unwanted pregnancies and abortions.
posted by allen.spaulding at 10:38 AM on July 11, 2009 [3 favorites]


"A gas station that wants to sell gasoline to consumers but doesn't care for the state weights-and-measures standards and wants to dispense liters instead of gallons"

Is this actually illegal? I mean as long as the price is advertised in litres and the pumps are calibrated correctly. You all have some metric pop/soda bottles now right? The US is officially Metric.

em>"According to you, this is the state forcing a private business to carry and sell items they find morally objectionable. So. Really. It would be okay with you if they refused to carry and sell the items above?"

I should be legal even if it's stupid.

"Clearly St Alia and jsonic are actually against the Plan B drug. Can either of you tell me why that is? It certainly doesn't kill a fetus; it simply prevents conception. Is it that you don't believe in contraception under any circumstances?"

This is a derail at best. What difference does it make? I find it a bit weird that that the state is requiring certain stock and I've got no problem with on demand abortion; pre-martial sex; or birth control of any stripe.
posted by Mitheral at 10:38 AM on July 11, 2009


Then, jsonic, how do you propose the state make sure its citizens get ready access to necessary medications? Should we do away with privately run pharmacies in favor of government run pharmacies? Because the trade off for private businesses to become pharmacies is to provide a regulated service the government isn't providing. Its part of their agreement to become a pharmacy. The alternative is a state run pharmacy, and in all likelihood, reducing or eliminating private pharmacies. In your view, is that a better alternative? If not, how do you propose easy access to medications to all citizens?
posted by [insert clever name here] at 10:39 AM on July 11, 2009


jsonic: This conversation would be a lot more civil if you stopped treating me like the evil-religious stereotype you so desperately want me to be.

It's hard to really believe anything else, jsonic, when you keep harping on the one issue and refuse to really listen to what anyone is telling you. Did 'monopoly' even strike your consciousness? Are you ignoring the power-imbalance arguments because you can't deal with them?
posted by Malor at 10:39 AM on July 11, 2009


And if people rebut your answer by explaining to you why a pharmacist is a completely different business than almost any other

Oh, so I guess we can't even debate whether these regulations are correct or not. According to you, laws regarding pharmacies are 'different', and thus immune to debate or criticism.
posted by jsonic at 10:40 AM on July 11, 2009


if a local community organizer wanted to start a pharmacy

They would have to be a pharmacist. And they would have to follow state regulations. And nobody in this thread would be uncomfortable with that. And more likely than not, they would be the first person to offer help to those who are in a difficult situation and need emergency treatment.
posted by allen.spaulding at 10:41 AM on July 11, 2009


None of my arguments in this thread have anything to do with if Plan B is good or not.

Perhaps. But if you have the courage of your convictions, why don't you answer this simple question?
posted by lupus_yonderboy at 10:41 AM on July 11, 2009


According to you, laws regarding pharmacies are 'different',

According to me and to every other non-third world country in the world. And frankly, I don't believe that you think that pharmacies should have the same licensing as a deli, either.

and thus immune to debate or criticism.

No one - not one person on this thread - said anything remotely like that. In fact, we clearly think exactly the reverse - pharmacy rules should be subject to much more debate and criticism than, say, delis.
posted by lupus_yonderboy at 10:43 AM on July 11, 2009



Actually, I like the Sickle-Cell example. According to you guys, if a local community organizer wanted to start a pharmacy to specifically help sickle-cell patients, then they wouldn't be allowed to unless they took on the expense and complication of offering all possible drugs.


Only if they're doing so for religious reasons. Which would be a very screwed up religion indeed.

Also-Pharmacies don't work that way. Clinics, yes. Pharmacies? No. You don't have a diabetes pharmacy and a cancer pharmacy and a sickle cell pharmacy and a contraceptive pharmacy. You have a state-regulated pharmacy that is intended to meet the needs of the entire community.
posted by dinty_moore at 10:43 AM on July 11, 2009


But if you have the courage of your convictions, why don't you answer this simple question?

Because my arguments are not based on the pro/cons of any specific product and would be a derail into the morality of life-issues.
posted by jsonic at 10:44 AM on July 11, 2009


Ignoring the power-imbalance arguments makes you look very foolish, jsonic.
posted by Malor at 10:45 AM on July 11, 2009


I don't believe that you think that pharmacies should have the same licensing as a deli, either.

Get off the deli statement, already. I was using it as an example, not as the end-all argument for pharmacies in question.

You guys are simply parsing my statements looking for any minor item you can try to refute in order to give the impression my entire argument must therefore also be refuted. "jsonic thinks deli's are the same as pharmacies, what an idiot! Right guys?!"
posted by jsonic at 10:47 AM on July 11, 2009


Ok, I'll bite.

I like the regulations placed on pharmacies because the service they provide is too important to be left to the whims of any one person. Once a doctor decides that a person needs a given drug, it is crucial that said person gets the drug as quickly as possible. Pharmacies are there to facilitate this, since it isn't practical for doctors to keep all drugs on hand at all times.

The government has to regulate how pharmacies do business because the stakes are life and death. A patient's ability to get the drugs they need, and get them now outweighs the personal feelings of the pharmacists. Just as a defendant's right to a vigorous defense outweighs the public defender's personal feelings about his client. Just how the shanked child rapist's need for medical attention outweighs the prison medic's loathing for such a disgusting individual. I accept that the pharmacist's feelings are genuine and not based out of malice, and that the regulations are intrusive. I am willing to accept that trade off, indeed, I'm willing to place myself in a similar position because I believe the work they do is vastly more important.

You accept the job, you do the job.
posted by Doublewhiskeycokenoice at 10:49 AM on July 11, 2009 [5 favorites]


Morality vs. business. Aye, that's the rub.

This is the schizo underbelly of modern American life. Even jsonic says "Stop trying to demonize anyone who isn't in lock step with your view of morality" in one sentence, and "I'm saying a business itself shouldn't be forced to sell a product" in the next.

If you want a capitalist system, you have to give up the moralizing, to some extent. If you want a moral society, then give up the free-market and institute Sharia law. If you want to straddle the middle, there will be a degree of cognitive dissonance.

Seems to me most of the big issues of our day split along similar lines.
posted by Benny Andajetz at 10:49 AM on July 11, 2009 [4 favorites]


Sure. Maybe a pharmacist wants to run a pharmacy that deals with diabetic patients only. So they only stock and sell insulin. It's their business, they should be able to sell only the products they want to sell.

I appreciate you answering my question, even if it's among the top five dumbest things I've read recently.

"It's their business..." if they only want to supply insulin? Not if they want to be licensed as pharmacists. If they don't like the way the state regulates pharmacies and pharmacists, then the choices are: don't be a pharmacist, or lobby to change the state/federal regulations.

The state tells people - private citizens! - what to do all the time, in a huge range of circumstances, with various penalties brought to bear if they don't comply. Want to drive a car? You need a license. Want to open a bar? You need a license. Want to become a doctor? You need a license. The logical end of your argument is that the state shouldn't tell anybody what to do, or perhaps that people shouldn't have to follow the regulations if they don't want to. If you think a place with no state regulation is a good thing, I suggest you visit somewhere with no or very weak state control. I hear Mogadishu is awesome like that.
posted by rtha at 10:49 AM on July 11, 2009 [4 favorites]


Ignoring the power-imbalance arguments makes you look very foolish, jsonic.

Ok malor, which specific argument, of the many I'm trying to answer, am I insulting you by not addressing. I can't read and respond to every comment towards me when it's only me versus the mob.
posted by jsonic at 10:49 AM on July 11, 2009 [1 favorite]


Get off the deli statement, already. I was using it as an example, not as the end-all argument for pharmacies in question.

But I get the point. You value "freedom of conscience" above racial and gender equality. That's all I was asking. You think that a pharmacy should be able to use racial considerations in determining which pills to carry, so long as there is a faith-based reason to do. This is so obviously a violation of Title VII and so far outside the American Political mainstream that it is disingenuous for you to pretend that this is an "open question."
posted by allen.spaulding at 10:50 AM on July 11, 2009


You guys are simply parsing my statements looking for any minor item you can try to refute in order to give the impression my entire argument must therefore also be refuted. "jsonic thinks deli's are the same as pharmacies, what an idiot! Right guys?!"

But that is, in effect, what you are saying. You are saying that pharmacies are no different than any other private business (i.e. a deli). And if that is not what you are saying, then please explain how you think it differs from other privately run businesses. I think you might find the answer many people hear have been trying to explain.
posted by [insert clever name here] at 10:52 AM on July 11, 2009


"Pharmacies don't work that way. Clinics, yes. Pharmacies? No. You don't have a diabetes pharmacy and a cancer pharmacy and a sickle cell pharmacy and a contraceptive pharmacy"

This actually isn't wholly true. My mother goes to a pharmacy that specializes in diabetes. It's an independent and they have a much better stock for this disease than any of the borg pharmacies in town. She was referred there by the nearby pharmacy because they didn't want to stock a medication that required refrigeration for a single patient so she had to order it in advance each time.
posted by Mitheral at 10:52 AM on July 11, 2009 [1 favorite]


Want to drive a car? You need a license. Want to open a bar? You need a license.

I've never argued against the state licensing or regulating private businesses. But I'd be guilty of repeating myself if I tried to explain again what I am arguing. I guess people like battling strawmen instead.
posted by jsonic at 10:53 AM on July 11, 2009


jsonic: this one.

That, I think, explains very well why the state should be able to tell the pharmacists what to carry.
posted by Malor at 10:53 AM on July 11, 2009


You guys are simply parsing my statements looking for any minor item you can try to refute in order to give the impression my entire argument must therefore also be refuted. "jsonic thinks deli's are the same as pharmacies, what an idiot! Right guys?!"

You've used that analogy repeatedly. It seems fair to me to rebut it. Your argument is that "businesses in general should not be forced to sell a specific product" - we all agree with that, our claim is that pharmacies are a very, very specific business that are universally regulated throughout the "civilized world" and thus have very specific rules.

You are the one who keeps going to back to the "deli" metaphor. You are the one who refuses to address our polite arguments that a pharmacy is a very special business that cannot be compared to any other - particularly a deli.
posted by lupus_yonderboy at 10:54 AM on July 11, 2009


You value "freedom of conscience" above racial and gender equality.

Nope.

You think that a pharmacy should be able to use racial considerations in determining which pills to carry, so long as there is a faith-based reason to do.

False again. Thanks for projecting onto me all the evil stereotypes you have against those who don't agree with your worldview.
posted by jsonic at 10:55 AM on July 11, 2009


But I'd be guilty of repeating myself if I tried to explain again what I am arguing.

Can you then give us a link to one of your postings above that summarizes your argument?
posted by lupus_yonderboy at 10:56 AM on July 11, 2009


You are the one who refuses to address our polite arguments that a pharmacy is a very special business that cannot be compared to any other

False again. Take the diabetes only pharmacy above. Or the Sickle-cell only pharmacy. Call them clinics if you want to avoid the OMG-PHARMACIES-ARE-SPECIAL derail. Both are completely valid reasons for a private business to only sell specific drugs.
posted by jsonic at 10:58 AM on July 11, 2009


Malor, the monopoly issue would be pertinent if consumers did not have the choice to patronize whatever pharmacy they want. And the state could resolve the potential issue of a one-pharmacy town by making the drugs available themselves. Just like many states already do with hard liquor.
posted by jsonic at 11:01 AM on July 11, 2009


I haven't tried to order it (I'm male, my girlfriend is given a box every year by Planned Parenthood), but Plan B is available online from reputable online pharmacies such as drugstore.com. That said, pharmacists shouldn't be able to pick and choose what prescriptions they fill unless they have a valid health concern for the patient - and if they do I'm not even sure how that works but I'm sure there are established procedures. The argument isn't about state rights or religious freedom, it's about the imposition of one persons religious morals at the expense of another persons right to a medication.

Refusing to sell Plan B won't hurt a pharmacy financially, it's a relatively rarely used medication. It's considered by many of the anti-abortionists as a medication to induce abortion which is part of the reason which, coupled with the lack of financial impact, emboldens pharmacist's with the same views to deny Plan B contraceptives.
posted by substrate at 11:01 AM on July 11, 2009


False again

I asked you point-blank and it seems like you agreed. Do you think a pharmacy should be able to use racially-discriminatory religious beliefs to determine what medicines they stock? Should a pharmacy be able to refuse to carry any treatment for Sickle-Cell or Canavan disease? Yes or no. You said yes before. Are you changing your mind?
posted by allen.spaulding at 11:02 AM on July 11, 2009


Take the diabetes only pharmacy above. Or the Sickle-cell only pharmacy.

How are these "arguments"?! You propose something completely ridiculous - something completely uneconomic, something that's a very poor use of our public health dollar, something that no one has ever done or suggested doing or attempted to do - things that are forbidden under the current rules too. How is the supposed to convince me?

Call them clinics if you want to

Clinics have completely different rules. For example, STD clinics don't have to keep for example heart medicine. This is for obvious reasons.
posted by lupus_yonderboy at 11:03 AM on July 11, 2009


And the state could resolve the potential issue of a one-pharmacy town by making the drugs available themselves.

At the cost of billions - for no obvious social benefit over and above "not pissing off a few pharmacists".

Would you really support spending, say, $100 million of your tax dollars on creating a network of Plan B distribution pharmacies?
posted by lupus_yonderboy at 11:05 AM on July 11, 2009


I think the specialized pharmacy argument is kind of a red herring. I don't know for sure, but I'd imagine they're a fairly rare beast in the pharmacy world and serve a crucial enough function to probably be exempt from the rule. I would be surprised if the diabetic pharmacy was required to dispense Plan B. In fact, that might be the compromise we're looking for here. Want to be a pharmacist and not dispense Plan B? Find yourself a market that needs a specialized pharmacy and open up one of those! General pharmacies, however, need to stock all the drugs that are going to be needed by the people who are going to frequent it. One of those drugs is certain to be Plan B and the pharmacists have agreed to hand it over without any bullshit by signing up to be pharmacists.
posted by Doublewhiskeycokenoice at 11:05 AM on July 11, 2009


You said yes before. Are you changing your mind?

You're conflating not stocking sickle-cell drugs with doing so for racist reasons. There are many non-racist reasons for not stocking any specific drug. Maybe they're not profitable, maybe your pharmacy/clinic focuses on non-sickle-cell diseases like diabetes.

Your cunning attempt to paint me as a supporter of racists ain't workin. But it sure does raise the quality of our discussion.
posted by jsonic at 11:06 AM on July 11, 2009


You propose something completely ridiculous

NEWSFLASH, lupus, these 'ridiculous' drug-specific pharmacies ACTUALLY EXIST.
posted by jsonic at 11:08 AM on July 11, 2009


I would be surprised if the diabetic pharmacy was required to dispense Plan B.

I searched - I found no evidence of the existence of specialized pharmacies (as opposed to clinics, where a set of specialized doctors deal with specialized conditions). It seems wildly uneconomic to me. You'd still need a full-time pharmacist!

Moreover, a big function of pharmacists is preventing negative drug interactions. This whole function is lost if specific pharmacies existed. Which I don't believe they have ever done.
posted by lupus_yonderboy at 11:08 AM on July 11, 2009


NEWSFLASH, lupus, these 'ridiculous' drug-specific pharmacies ACTUALLY EXIST.

Link?
posted by lupus_yonderboy at 11:09 AM on July 11, 2009


NEWSFLASH, lupus, these 'ridiculous' drug-specific pharmacies ACTUALLY EXIST.

Ok, great. Sounds like the perfect place for someone who doesn't want to dispense Plan B.
posted by Doublewhiskeycokenoice at 11:10 AM on July 11, 2009


At the cost of billions

Lupus, many states have already setup state-run liquor stores without somehow falling into financial chaos.

Now are you going to actually have a discussion, or are you just planning on trying to contradict everything I say?
posted by jsonic at 11:10 AM on July 11, 2009


You still didn't answer the question. If a pharmacist has a religiously-motivated belief that was racially discriminatory, should he be exempt from generally applicable laws?

And the regulations do not require pharmacies to carry unprofitable drugs. The argument here was not that they were unprofitable or that this was a specialized clinic. The pharmacy in this specific case, as many do, argued that they had a religious belief that caused them to act the way they did. Stop weaseling. Should we defer to racially-discriminatory religious beliefs when there are no other reasons to explain the refusal to stock medicine?
posted by allen.spaulding at 11:10 AM on July 11, 2009 [1 favorite]


Link?

Enjoy
posted by jsonic at 11:11 AM on July 11, 2009


(and of course, there are tons of pharmacies that market to people with specific conditions - but all of them appear to be complete pharmacies that provide a range of treatments...)
posted by lupus_yonderboy at 11:12 AM on July 11, 2009


Malor, we're not talking about RU-486. We're talking about Plan B - two different pills. RU-486 is the "abortion pill." Plan B prevents implantation. Just want to make that clear.
posted by agregoli at 11:13 AM on July 11, 2009 [3 favorites]


You still didn't answer the question.

Actually I did. I just didn't answer it in a way that lets you paint me as a racist supporting fundamentalist stereotype. So I understand your disappointment.
posted by jsonic at 11:14 AM on July 11, 2009


So yes. The answer is yes. You believe that absent any other reason, a pharmacist should be able to discriminate on the basis of race because of a religiously-motivated belief.
posted by allen.spaulding at 11:15 AM on July 11, 2009


Link?

Enjoy


First, I'll ask you to be polite in this thread. I haven't been rude to you once, your sarcasm is not appreciated.

Second, "some guy's mother went to a pharmacist that specializes in diabetes" is hardly a rebuttal. Your claim is that pharmacies exist that only sell diabetic drugs and are exempt from the laws - I believe that this is not the case.

Please provide real evidence that this is the case.
posted by lupus_yonderboy at 11:16 AM on July 11, 2009


And if the answer is no, then you agree that maybe there might be a time and a place for limiting the "freedom of conscience" of pharmacists when there are significant interests involved, such as discrimination on the basis of race or sex.
posted by allen.spaulding at 11:16 AM on July 11, 2009


(And I'm really curious, jsonic. I still have no real idea what your argument is or could be. I believe I've read all your posts - can you point us to a link to one that sums up your argument?)
posted by lupus_yonderboy at 11:17 AM on July 11, 2009


Actually, I'm regretting getting off onto the sideline of specific pharmacists (though I haven't found one yet - National Diabetic Pharmacies seemed to be a match but they seem to be a supplier and not an outlet).

The law seems to perfectly allow for these by requiring pharmacists to stock drugs that they are requested to carry. If a diabetic pharmacy opened up in an area and started getting requests for birth control, the law would require them to carry it.
posted by lupus_yonderboy at 11:21 AM on July 11, 2009


You believe that absent any other reason, a pharmacist should be able to discriminate on the basis of race because of a religiously-motivated belief.

False. Again. I'm sorry I don't match the stereotype you wish I was.
posted by jsonic at 11:22 AM on July 11, 2009


I haven't been rude to you once

If you consider my 'Enjoy' to be rude, then feel free to re-read all your comments towards me. You've been plenty rude to me, far beyond a simple 'Enjoy'.
posted by jsonic at 11:24 AM on July 11, 2009 [2 favorites]


Ok, so if you don't believe that, then you agree that there are time when public policy concerns of equality demand that pharmacists carry pills that their religious beliefs oppose. I think we agree on this point. Now, how would you go about setting public policy in a democracy?
posted by allen.spaulding at 11:25 AM on July 11, 2009


jsonic, you'd really clear things up for us if you could either post your argument, or a pointer to a previous post that contains your argument.

You clearly believe we've all completely misunderstood your point. It could well be so. So help us out and point us to what you really believe!
posted by lupus_yonderboy at 11:25 AM on July 11, 2009


then you agree that there are time when public policy concerns of equality demand that pharmacists carry pills that their religious beliefs oppose

Where did I say that?
posted by jsonic at 11:28 AM on July 11, 2009


Or more specifically: a specific private pharmacy not stocking any specific drug is not a violation of someone's equal rights.
posted by jsonic at 11:30 AM on July 11, 2009


So now you're not making sense. Yes or No. You keep denying both
posted by allen.spaulding at 11:31 AM on July 11, 2009 [2 favorites]


You keep denying both

No, you keep conflating not stocking a drug with being racist.
posted by jsonic at 11:36 AM on July 11, 2009


I've never argued against the state licensing or regulating private businesses.

Which is what this most recent ruling says - part and parcel of the licensing and regulation requirements for pharmacies is that they must "maintain at all times a representative assortment of drugs in order to the meet the pharmaceutical needs of its patients." It is not a requirement to carry certain products. If a pharmacy is in an area with no black people, I don't imagine they'd be required to carry meds to treat sickle cell. But if a black family moved in, and one of them suffered from sickle cell, the licensing and regulation requirements say that the pharmacy would have to stock sickle cell meds. Not because they require stocking specific products, but because they require stocking items to meet the needs of its patients, which now includes people who suffer from sickle cell.
posted by rtha at 11:39 AM on July 11, 2009


Refusing to carry a drug that is only used by one racial group is a pretty good example of racial discrimination
posted by allen.spaulding at 11:41 AM on July 11, 2009


jsonic: "I'm suggesting that the state shouldn't force a private company to sell a specific product. The state can restrict what products a company can sell, and they can regulate how the sell it (health codes, etc). This really isn't a controversial statement."

Actually, it is controversial — it's quite obvious that a lot of people do favor forcing a private company to carry a specific product, at least in this particular circumstance.

I can see where your argument is coming from, provided you're arguing in good faith and not using the free-market argument as a cover for something else, and in a totally abstract sense I might even agree with you. But then again, in a totally abstract sense I think monarchy is a great form of government. It's surprising sometimes how greatly our world differs from an ideal case.

The argument over whether the state is right to force a business to carry specific products or do specific things is a purely academic one, because it's already been settled in the real world. The state forces private businesses to do very specific things all the time. We require bar owners to serve food — even though it clearly ought to be the responsibility of the drinker to control their own consumption and seek out food if they want it — because we've found through experience that it cuts down on drunk driving deaths and all other sorts of nastiness. We require businesses to have a certain number of handicapped parking spaces — even though there might not be any handicapped people in their community or customer base — because it's perceived as an acceptable tradeoff to ensure handicapped people can get around.

The real-world argument over whether the state ought to compel private businesses to do very particular things, which in many cases are a lot more bizarre than just selling (or not refusing to carry) a particular product, has been settled. The time to draw an absolutist line in the sand over state interference in private business, if there ever was one, occurred about a century or more ago. That ship has sailed.

So, given that we perform all sorts of regulation of private enterprise on a day-to-day basis, much of which involves compelling specific performance of various things if that enterprise wants to remain in business, the question is merely "is this particular regulation beneficial to the public?" And I think the answer is generally regarded as a 'yes.' There's a clear public benefit — increased access to emergency contraception, which is needed to be widely available within a very short timeframe to have any benefit — and very little downside risk. (At worst — and I don't even think this is likely — it might cause a few pharmacies owned by people who feel very strongly against contraception to close, but this seems like a long-term benefit: assuming those pharmacies are located in places that can support a pharmacy in general, it creates an opportunity for someone to open one who is willing to comply with the regulation.)

Regulation of private enterprise needs to be considered on a case-by-case basis, and the cost/benefit to the public weighed in each. In this case there is very little cost to the public (there's not even very much cost to the pharmacies; as it's been pointed out, the medication in question has a very long shelf life, and it's not even clear to me if they're required to carry it if there's no bona fide demand, or if they just can't refuse to stock it despite demand), and an obvious benefit. It's not exactly Sarbanes-Oxley.
posted by Kadin2048 at 11:41 AM on July 11, 2009 [17 favorites]


Ok, that's it for me today, guys. As a parting note, I'm probably not the stereotype you think I am, and I don't think it's that controversial to propose that I disagree with a certain state regulation concerning pharmacies. I recognize that others disagree and would rather hope we were capable of having a discussion that doesn't devolve into guessing how evil our opponents secret motivations really are.

Enjoy your saturday.
posted by jsonic at 11:42 AM on July 11, 2009


Or more specifically: a specific private pharmacy not stocking any specific drug is not a violation of someone's equal rights.

I agree.

The court case involved had nothing actually to do with "equal rights" - On Wednesday, a three-judge panel of the U.S. 9th Circuit Court of Appeals lifted the injunction, saying the district court was wrong in issuing it based on an erroneous finding that the rules violated the free exercise of religion clause of the U.S. Constitution.

This rule exists, not because of the equal rights clause of the Constitution, but because the United States decided that there was a strong benefit to the public by passing such a rule.

As many people have commented, this is similar to the laws requiring cars to have seat-belts - the overall benefit to all citizens trumps the car companies' right to sell whatever they want.

Again, I strongly urge you to post an actual argument - logical reasons why this policy should or should not be a matter of law.
posted by lupus_yonderboy at 11:42 AM on July 11, 2009


Refusing to carry a drug that is only used by one racial group is a pretty good example of racial discrimination

Only if you pre-suppose that their motivation for not stocking it was based on racism.
posted by jsonic at 11:44 AM on July 11, 2009


Ok, that's it for me today, guys.

What a shame you were not willing to ever tell us exactly what your argument was. I am always interested in discussions with people who might disagree with my beliefs. Sometimes my beliefs change dramatically as the result of such discussion.
posted by lupus_yonderboy at 11:44 AM on July 11, 2009 [1 favorite]


No, you keep conflating not stocking a drug with being racist.

You know, I've just been following along, glad I wasn't in the fray of this, but I can't imagine how you can fail to see how dispensing a drug to a customer--who would only use that drug if they were part of a specific racial group or gender--because you, for whatever reason, feel morally compelled (not, for example, because there are contraindications) not to prescribe that drug to that customer, while you're simultaneously dispensing similar or equivalent drugs (condoms) to other groups, is not somehow discriminatory. Because you don't have to be throwing around racial slurs for your actions to be racially discriminatory.

Also, everyone who's said "well, there's just no demand"--even if this isn't an oft-used drug, this wouldn't be an issue if there wasn't any demand. This article from the original FPP recounts how a woman tried to get Plan B from Ralph's and was turned away. How is a customer asking for an item any different from there being customer demand for that item?
posted by PhoBWanKenobi at 11:45 AM on July 11, 2009


Jesus.
posted by maxwelton at 11:57 AM on July 11, 2009


What a shame you were not willing to ever tell us exactly what your argument was.

I've put in hours last night, and hours this morning, explaining my position multiple times. People have even commented that I've explained it too many times. Some have agreed with me, most have not. So I really don't understand your claim here.

Also, the situation has basically devolved into random people popping up and either making comments I've already responded to multiple times. Or intentionally misreading my comments and trying to construct situations in an attempt to paint me as whatever their pet stereotype is for people they don't like.

It hasn't been a discussion for a long time, just me vs. the mob. Maybe the mob's right, maybe not. The current state of this conversation isn't going to advance the discussion, so I'm moving on.
posted by jsonic at 11:57 AM on July 11, 2009 [1 favorite]


And the state could resolve the potential issue of a one-pharmacy town by making the drugs available themselves.

Do you really want your tax dollars going towards dispensing Plan B?
posted by dirigibleman at 11:58 AM on July 11, 2009


Lupus, a good summary of my point is in the first post I made in this thread last night. I'm sure you'll be able to find an issue with that post since it's not a multi-chapter thesis handling all possible cases. And I'm sure I'll be able to show how your concern is mitigated in some way. Ad nausem for 300+ comments.
posted by jsonic at 12:08 PM on July 11, 2009


You really haven't explained your position much.

I, for one, don't comprehend why any pro-life idiot would be against contraception - surely they WANT to prevent abortions. And you're not going to stop people from fucking, no matter how hard you try.
posted by kldickson at 12:27 PM on July 11, 2009 [1 favorite]


Refusing to carry a drug that is only used by one racial group is a pretty good example of racial discrimination

I agree, and that's not what I said. (If your comment was addressed to me, that is.) If there is never a call for a sickle cell drug and the local pharmacy doesn't carry it, that's not discrimination. If there is a call for it, and the pharmacy refuses to stock it, then yes, discrimination. "Not carrying it because there is no demand for it" is not necessarily the same thing as refusing to stock it. I'm certain that there are towns in the U.S. where there are no black residents, or people with HIV, and that the pharmacies in those towns don't stock drugs to treat those diseases. If the licensing requirements for operating a pharmacy include the pharmacist carrying and dispensing drugs that meet the needs of his/her community, it does not follow that not carrying drugs that no one in the community is prescribed is discrimination.

I'm going to go get a bacon donut now.
posted by rtha at 12:32 PM on July 11, 2009


Move on then. You've been ignorantly and willfully trolling a thread since it started. We could have had a good discussion if you didn't have your ears closed. You've told us you are leaving several times.

Leave.
posted by lazaruslong at 12:33 PM on July 11, 2009 [1 favorite]


I note, jsonic, that you completely failed to respond to the power-inequity and monopoly arguments. Your single vaguely-related idea seems to be that 'the state should make it available', but that's what the state is DOING, through its government-granted monopoly.

You can't compare pharmacies to most other businesses, because most other businesses don't have exclusive power over a market by explicit government grant.

The license to dispense drugs is purely to dispense drugs according to the law. It is NOT a license to write your own opinion into the law!

I have little doubt that you will, once again, ignore this argument, because I don't think you have a counter.
posted by Malor at 12:33 PM on July 11, 2009 [1 favorite]


The court case involved had nothing actually to do with "equal rights"

I know that - this was a free exercise claim to a generally applicable statute. I was trying to draw attention to the justifications behind the regulation while at the same time getting some agreement on when "freedom of conscience" should be cabined.

I don't expect everyone to agree with me that refusing to stock Plan B violates principles of Sex Equality. I would hope to get people to agree that one cannot hide behind "freedom of conscience" when deciding to discriminate on the basis of race or sex. I asked jsonic what I thought was a simple question and he fought it at all points. Should we allow pharmacies to refuse to carry a drug only required by a minority racial group for the sole purpose of the pharmacist's religious beliefs. Finally he decided that this wasn't discrimination, which is just bizarre to me.
posted by allen.spaulding at 12:33 PM on July 11, 2009


If there is never a call for a sickle cell drug and the local pharmacy doesn't carry it, that's not discrimination.

That has never been the claim nor is that at play here or anywhere else where "freedom of conscience" is raised. The question I posed, and the question posed in this case, is whether one's religious motivation can be the sole reason to refuse to stock a drug.
posted by allen.spaulding at 12:36 PM on July 11, 2009


The only thing this thread has convinced me of is that jsonic's mother likely deserves the Congressional Medal of Freedom for what she had to go through to explain to him as a child why he couldn't have ice cream for dinner.
posted by XQUZYPHYR at 12:36 PM on July 11, 2009 [11 favorites]


I liked the part where he cited the existence of disease specific pharmacies that are in violation of state and federal law with a link to someone's anectode about their mom.


It's like theater, only more disingenuous!
posted by lazaruslong at 12:37 PM on July 11, 2009


Damn, y'all got trolled.
posted by hamida2242 at 12:41 PM on July 11, 2009 [7 favorites]


It hasn't been a discussion for a long time, just me vs. the mob.

**~tiny violins~**
posted by EatTheWeak at 12:45 PM on July 11, 2009


"This article from the original FPP recounts how a woman tried to get Plan B from Ralph's and was turned away. How is a customer asking for an item any different from there being customer demand for that item?"

Speaking hypothetically (IE: Not to say this is the situation): If only a single person over the course of four or five years comes into a pharmacy and asks for a drug it would be a stretch to say there is customer demand for that drug. While technically true the demand is so low as to approach non existent. And of course this becomes self fulfilling. Customers know Foo doesn't stock plan b so they no longer come to Foo to get plan b thereby reducing demand.

Even in the case where Foo might dispense say a dose annually it may not be remotely cost effective to stock the drug. I'm not a pharmacist but I'm guessing they can't order single doses from Paladin. So even though Foo'd dispense four doses before the expiry date the other 46/96/496? doses in the bottle would be wasted and have to be written off. Plus there is the continuous cost of shelf space, inventory, and inventory management. How often would those pills have to be counted? How much does Plan B cost? If it's costing the pharmacy $100 a dose (once you include all the overhead costs) to dispense this medicine are they allowed by this legislation to recover that expense?

It sounds like the regulations allow you to not stock a low demand drug as long as you are willing to order it in.

dirigibleman writes "Do you really want your tax dollars going towards dispensing Plan B?"

Be a lot cheaper to delist the drug.

Malor writes "You can't compare pharmacies to most other businesses, because most other businesses don't have exclusive power over a market by explicit government grant. "

Monopoly seems like kind of a sloppy term to use in this case. It's not like pharmacies are cable companies where someone living in at a specific area is required to go to a specific pharmacy. There may only be one pharmacy in town but that isn't because of goverment grant any more than if there is only one dentist or chiropractor in town.
posted by Mitheral at 12:53 PM on July 11, 2009


Since I didn't see where jsonic specifically explain why his handwaving statement that the EMT/ambulance refusing to dispense IVs for ethical reasons is "not analogous" to the pharmacist who refuses to dispense Plan B for ethical reasons, I'm assuming that he can't explain it.

I mention this hypothetical because it's far, far more analogous to the pharmacist than any analogy that includes delis, house inspectors, etc. A privately-owned health care provider, licensed by the state, responsible to provide a standard of care, refusing to dispense a particular medical treatment that had been ordered by a doctor, based on an ethical dilemma of the owner.

In fact, it seems patently obvious that an ambulance company wouldn't be allowed to keep its license if they refused to provide treatments that are considered part of the legally required standard of care (IVs or whateverr). I suspect neither jsonic nor anyone else in this thread would accept a situation where ambulances could arbitrarily decide, based on the ethical concerns of the owner, to refuse standard medical treatments ordered by a doctor, yet keep their license.

jsonic, it's clear that your argument based on a "rights of private business" basis is hosed. But the flailing around trying to shoehorn the issue into that kind of frame has been entertaining, if nothing else.
posted by darkstar at 1:06 PM on July 11, 2009 [1 favorite]


Darkstar.
posted by lazaruslong at 1:08 PM on July 11, 2009


That has never been the claim nor is that at play here or anywhere else where "freedom of conscience" is raised. The question I posed, and the question posed in this case, is whether one's religious motivation can be the sole reason to refuse to stock a drug.

I understand, and agree. I was attempting to address jsonic's specific point that, while he's says he's fine with the "state licensing or regulating private businesses", he also doesn't think the state should tell a business to stock a specific product. My point was that the licensing regulations for pharmacies don't do this - they say the pharmacy has to stock products used by the community it serves. Since the communities that Ralph's serves includes women, then they have to stock medications used by women, including legally prescribed birth control drugs.

(I feel like maybe I'm being really unclear, and I'm not sure how. I'm going to shut up for a bit and go back and reread your comments in particular, allen.spaulding, because I think I'm missing something. Apologies in advance if I've misconstrued you.)
posted by rtha at 1:10 PM on July 11, 2009


Heh, yeah, some hypotheticals are, indeed, traps. They trap you into coming face to face with the logical inconsistencies in your own argument. I guess it's why judges use them all the time to elucidate an attorney's argument, probe its soundness and illuminate its flaws.

Of course, it's quite understandable why someone with a weak argument would assiduously avoid having to address a closely analogous situation that shows the flaws in his argument.

Naturally, I'd love to hear a cogent explanation as to why the two situations are NOT analogous, as jsonic flatly asserted. But I don't think any of us are going to be holding our breath. And I suspect that jsonic knows that such an explanation can't be made without sounding like a fool.
posted by darkstar at 1:21 PM on July 11, 2009 [1 favorite]


Guys, you really have to stop engaging jsonic in this conversation, it's not going anywhere, and is taking away from the actually topic, I think. I'm amazed I've made it through 309 posts of all this bickering. Just leave him and his 'private business' be. That's all he really wants anyway!
posted by sunshinesky at 1:24 PM on July 11, 2009 [2 favorites]


"Not really. Some states, including Washington, only allow liquor to be sold from state run stores. So it's not weird at all for a state to distribute items themselves. They could do the same with controversial drugs and avoid this specific issue."
posted by jsonic at 9:22 AM on July 11 [+] [!]

This is ludicrous, considering your "free market" schilling in this thread. You're actually arguing for more "gummit" regulation of drugs? You would really want the state deciding which drugs are "controversial" and their sale restricted to state-owned, red-tape, bureaucra-pharmacies?
posted by diocletian at 1:28 PM on July 11, 2009


Darkstar: Of course. That's why it's a trap! We're being trolled. Like you said, it isn't about the rights of a private business to him. That argument has been made demonstrably false since the start of the thread. He's just repeating it to hide his intolerance of the product. We're fallen into the trap since comment number 6 or something. Fuck it, eh?
posted by lazaruslong at 1:39 PM on July 11, 2009 [2 favorites]


I think people here might be being just a tad nasty towards jsonic. I don't agree with him or even think that the argument he's advancing holds much water, but I'm glad that he's making a go of it, if only to force people to consider exactly why the regulation at issue is a good idea. The discussion would be a whole lot less interesting if it was just 300 people going "right on!!1!" So for that reason alone I think his arguments deserve to be taken at face value, rather than as a starting point for questions into ulterior motives. The latter seems like a borderline ad hominem and likely to turn this place into even more of an echo chamber than it already is.

With that out of the way, I think that the core of jsonic's objection from back upthread in his first comment, is a differing opinion as to the importance of contraception access. If someone truly and honestly believes that access to emergency contraception is equivalent to one's ability to get PBR instead of Bud (and I say this as a pretty big PBR fan), then I can see where the rest of the objection comes from.

However, I think it's fairly safe to say that the view that EC is trivial is a minority view at best, and that most people feel that it's Serious Business indeed. Hence while many people (myself included) would not support a state regulation that forced bar owners to carry an unpopular beer, many people do support a regulation to force pharmacies to carry — or at least not refuse to carry — EC. In the case of the bar, there's no compelling interest that overpowers the bar owner's right to not stock a particular beer, for whatever reason; in the case of the pharmacy, there's a pretty clearly a compelling interest which totally overrides any moral/ethical/religious/commercial objection on the part of the pharmacy owner. Bluntly (and with apologies to A1 steak sauce): yes, it's that important.

If that really is the objection — not believing that access to emergency contraception is really, really important — then I don't know if there's any real room for discussion. The best we can do is hope that the people who do think that EC is a big deal outnumber those who don't, and crush them via the democratic process, as is our right.
posted by Kadin2048 at 1:39 PM on July 11, 2009 [3 favorites]


If a product is a necessity you are not required to sell it if it is available at some other retailer in your area. If there are no other retailers in your area, than you must carry it. If no business voluntary agrees to carry it in your area, then the business that last came into existence must carry it (i.e. we'll respect seniority).

This has to be one of the most ridiculous ideas I've read (granted, I haven't read all the comments here). Just the "in your area" stipulation could be a fundie loophole. What does "in your area" mean? In one county? In one city? The definition of "area" alone could probably make it difficult enough for most women to get within the right time frame.

Plan B is not strictly an OTC medicine, so what about people who want to purchase it with prescription, covered by their insurance, and their insurance limits them to certain pharmacies. Your "area" plan isn't going to help them, is it?

Seniority? You've got to be kidding. What are you basing it on, age of the building? If someone buys their father's pharmacy, or a chain takes over an existing pharmacy, previously the oldest standing pharmacy in the area, will they then go to the lowest rank of the seniority order? How about once a new pharmacy comes into town, will the previous new pharm on the block get to hand over the Plan B torch?

The plan is just riddled with logistical issues and opportunity for the religious right to impede a woman's ability to get emergency contraceptive.

Nice try, though.
posted by necessitas at 1:52 PM on July 11, 2009


The discussion would be a whole lot less interesting if it was just 300 people going "right on!!1!" So for that reason alone I think his arguments deserve to be taken at face value, rather than as a starting point for questions into ulterior motives. The latter seems like a borderline ad hominem and likely to turn this place into even more of an echo chamber than it already is.

This is an incredibly facile reading of the cogent logical arguments presented by people in the thread. Myself and others took his arguments at face value, and offered rebuttals. They were ignored by jsonic, who then turned it into a Me vs The Mob martyr story.
posted by lazaruslong at 2:08 PM on July 11, 2009 [2 favorites]


Also, multiple cohesive logical arguments != echo chamber.

The term echo chamber is increasingly annoying. Do a quick MetaFilter search for the term if you feel like wasting a lifetime or two.
posted by lazaruslong at 2:14 PM on July 11, 2009 [2 favorites]


Yet somehow I'm the one with the histrionics. Also, thanks for hating on religion. At least I now know your real motivation.

As my Catholic step-father says, one-issue Catholics are hurting the Church and our political system.

Yes, he is pro-choice, but he also believes in dealing with the issues mentioned in the Beatitudes, which so many one-issue Catholics ignore.
posted by krinklyfig at 2:30 PM on July 11, 2009


Funny how violating someone else's right of conscience is a-okay if YOU don't agree with them.

Stop being a victim.

I am required to violate my conscience in my job every day, yet I don't claim that I'm a victim.

Are you a pharmacist required to violate your conscience, and you cannot stand it anymore? Quit. Don't impose your objections on others who are not responsible for your qualms and are just seeking health care.
posted by krinklyfig at 2:35 PM on July 11, 2009 [1 favorite]


I'm sad to see jsonic leave. That was getting really entertaining. Here is what his initial argument includes:

Some examples (which are obviously not as important as the Plan B case):

Pabst Blue Ribbon required at all bars
Apple Store now required to sell PCs, to "encourage competition"
Stores in the Bible belt must sell American flags to show 'patriotism'
Local radical bookstore required to sell Ann Coulter diatribes
Vegan restaurant required to sell chicken nuggets


One thing he never addressed and constantly dodged was the idea that a pharmacy is not a private business like any of his examples. Not to mention all the other plausible arguments he ignored.

An article I linked to upthread had a rundown of the story and how it got to this point. First the law is just re-instituting what was already in place up until a couple of years ago. Requiring to sell Plan B isn't something new. Not selling Plan B was a new law.

Article:

On June 1 (2006), (Seattle pharmacist Donna) Dockter (who is part of the Washington State Board of Pharmacy - WSBP) pushed through a substitute rule that will allow pharmacists to refuse to fill prescriptions for drugs like Plan B....
her proposal "had nothing to do with religion. There are business reasons, technical reasons, and expertise reasons," she said, that make it bad policy for a pharmacist to be required to fill every prescription...

...Judging from accounts of the April 21, May 2, and June 1 pharmacy board hearings where her proposals were debated, and after talking briefly with the young woman who works at Dockter's pharmacy, I have a good sense of Dockter's position. And it's true: Her proposal is not tied to moral objections.
She believes the "must-fill" mandate that was also under consideration by the board would interfere with a pharmacist's ability to practice his or her profession responsibly. What if a pharmacist feels they don't have the training or expertise to safely administer a new drug? What if they suspect that the customer has a fraudulent prescription? What if the customer's insurance doesn't cover the drug?
Dockter seems to believe that a must-fill order was an affront to her profession. "Their concern," says Steven Saxe, executive director of the pharmacy board, "was that a lot of professional judgment goes into what's best for the patient, and any 'shall-fill' proposal creates problems. They looked at other professions that have the right to make judgments."...

...Dockter's language, passed 5-0 at a June 1 WSBP hearing after the initial proposal for a must-fill rule was shot down 3-2, begins deceptively: "A pharmacist shall not obstruct a patient in obtaining a lawfully prescribed drug or device. If a pharmacist cannot dispense a prescribed drug or device, then the pharmacist must provide timely alternatives for the patient to obtain treatment."
Without defining the parameters that would justify when and why a pharmacist "cannot dispense," the open-ended rule goes on to nullify its assurances that pharmacists must try to fill those prescriptions. "These alternatives may include... return prescription to the patient... [and] if requested by patient, transfer the prescription" to another pharmacy.

posted by P.o.B. at 2:40 PM on July 11, 2009 [1 favorite]


I think we all know the real reason this thread grew as it did. Everyone saw jsonic's argument for the cover it was. As revealed previously, jsonic doesn't like "abortion" pills. Had he(she) just come out and said that, we could have discussed the actual issue and the merits of the argument. I fell into the trap, too, because the private business argument was such an obvious red herring that I couldn't understand anyone continuing to stand by it in the face of well explained reasoning as to why that wasn't the case.

Oh well.
posted by [insert clever name here] at 2:52 PM on July 11, 2009 [6 favorites]


I think we all know the real reason this thread grew as it did. Everyone saw jsonic's argument for the cover it was. As revealed previously, jsonic doesn't like "abortion" pills. Had he(she) just come out and said that, we could have discussed the actual issue and the merits of the argument. I fell into the trap, too, because the private business argument was such an obvious red herring that I couldn't understand anyone continuing to stand by it in the face of well explained reasoning as to why that wasn't the case.

Oh well.


Pretty much.

Alas, if we address the arguments, it's an echo chamber.

If we address the obvious motive and ignore the herring, then we're ad hominem.

This is why responding to trolling is a no win. Guilty here as well.

Oh well indeed.
posted by lazaruslong at 2:54 PM on July 11, 2009 [2 favorites]


I'm not a pharmacist but I'm guessing they can't order single doses from Paladin. So even though Foo'd dispense four doses before the expiry date the other 46/96/496? doses in the bottle would be wasted and have to be written off. Plus there is the continuous cost of shelf space, inventory, and inventory management...
posted by Mitheral at 12:53 PM on July 11 [+] [!]

Here's the thing...Plan B is not that uncommonly used. It's hideously expensive (I've seen it go for $50+ at pharmacies), yes, but it is not something that outside of extremely rural areas would just be sitting around for years on end. Plus, Plan B does not come in bottles of 46, 96, or 496 pills, it only comes in a single relatively small box containing two pills for one course of Plan B for one person at a time. It has a pretty long shelf life. It can sit next to the Claritin and Alavert with pseudoephedrine for years. It takes even less effort to sell Plan B OTC (just check ID) than it does to sell something containing pseudoephedrine in, well, California, at least where it sometimes feels like you're signing away everything.

So I really don't see the problem for many pharmacies to just keep a box around if they can also spare the space for "personal lubricants", "vibrating pleasure rings" (jeez, just call it a cock ring), penis pumps, drugs requiring refrigeration like my preferred hormonal contraceptive NuvaRing and more. Not to mention many common semi-OTC drugs are nowhere near as time sensitive as Plan B is, where the sooner you can get it the more effective it will be.
posted by janeylicious at 2:59 PM on July 11, 2009


Wow. Really, a paycheck is all that you need in order to surrender your status as a moral agent?

Your moral agency has to take a back seat to providing health care as your profession demands. You are not allowed to impose your morality on your patients. You are always obligated to act ethically, as the profession also demands. Note that professional ethics is not the equivalent of moral agency. You are not free to do whatever you wish as a licensed medical professional, no, sorry.
posted by krinklyfig at 3:00 PM on July 11, 2009


If a product is a necessity you are not required to sell it if it is available at some other retailer in your area. If there are no other retailers in your area, than you must carry it. If no business voluntary agrees to carry it in your area, then the business that last came into existence must carry it (i.e. we'll respect seniority).

That is ridiculously complicated, and it fails to address the central issue, namely that a licensed medical professional cannot deny care to someone due to religious/moral objections.
posted by krinklyfig at 3:04 PM on July 11, 2009


Nice strawman you got there. I, at least, mentioned numerous times that if the state wants this available, it could easily do it themselves. No need to force a private business to sell a specific product.

How would the state hire people for this job? Could the state require that the pharmacists they hire have no moral objections or ot put them aside for the job requirements? What if someone converted to Catholicism during the course of their employment and decided they couldn't dispense Plan B anymore? Wouldn't it just present the same problem in a different form?
posted by krinklyfig at 3:07 PM on July 11, 2009 [2 favorites]


Awesome.
posted by five fresh fish at 3:10 PM on July 11, 2009


Canadians should note that there is an activist movement in our pharmaceutical system that is trying to make it possible for pharmacists to deny prescriptions based on their personal moral stance.

I don't think they'd have a hope in hell of getting that past the Supreme Court, but it would make for an awkward few years while the case moved through the system.
posted by five fresh fish at 3:12 PM on July 11, 2009


I, at least, mentioned numerous times that if the state wants this available, it could easily do it themselves.

Besides the fact it's ridiculously prohibitive economically to have one store selling one specific product that doesn't have a constant line like a coffee shop? That was one of many arguments pushed forward that had no real merit it and was begining to actually make me smile, because of it being such an absurd notion.
posted by P.o.B. at 3:14 PM on July 11, 2009


"I think we all know the real reason this thread grew as it did. Everyone saw jsonic's argument for the cover it was. As revealed previously, jsonic doesn't like 'abortion' pills. Had he(she) just come out and said that, we could have discussed the actual issue and the merits of the argument. "

There's a fun discussion:
A) Abortion is murder.
b) Reproductive rights at all cost.
Rinse, lblather repeat.

I'd much rather a discussion on the actual issues (1st amendment aspects of the case, logistics, impact of the ruling, contrast to situation in other locations etc.) than yet another pro-choice/life merry go round via the motivations of the people who brought this before the court or LOLbabykillers. The general implications are much more interesting than abortion battle-royale part 289543787105.
posted by Mitheral at 3:19 PM on July 11, 2009 [1 favorite]


I recognize that others disagree and would rather hope we were capable of having a discussion that doesn't devolve into guessing how evil our opponents secret motivations really are.

You would deny medical care to people for moral objections, in what amounts to discriminatory behavior and a complete violation of medical ethics, yet you act like you're being persecuted for your views. A thousand violins are playing a sad song for you.

Grow up.
posted by krinklyfig at 3:21 PM on July 11, 2009


There is a difference between personal ethics and professional ethics. Can a jehovah's witness who works in the blood bank refuse to release blood because their personal beliefs make it a sin? Does a scientologist nurse have the right to refuse to administer anti-depressants or anti-psychotics ordered for their patient because their personal beliefs say that it is wrong? I have no right to impose my beliefs on someone else especially as it affects their health and well-being.

I only read half way through the comments because of the frustrating nature of the argument. If this has all been resolved by the end then never mind.

Life is complicated.
posted by whatever at 3:41 PM on July 11, 2009


Late to the party.

I just want to say, what bothers me about this whole thing is that the Board, or whoever decides what the regulations should be, didn't put forth a proposition to the effect of: all pharmacies must carry Plan B. No. It was automatically assumed that all pharmacies should carry it, and then when some pharmacies objected to that, their case was shut down because their reasoning was based on religion. Now it's a law. That doesn't seem like the right way to go about it. Forget the pharmacies who object; someone on the Board needs to grow a pair of balls and say "Henceforth, all pharmacies shall carry Plan B" yay or nay? They discuss it. They vote on it. They're the Board, right? They're supposed to make decisions. We're supposed to critique their reasoning.
posted by metastability at 3:42 PM on July 11, 2009


I just want to say, what bothers me about this whole thing is that the Board, or whoever decides what the regulations should be, didn't put forth a proposition to the effect of: all pharmacies must carry Plan B. No. It was automatically assumed that all pharmacies should carry it, and then when some pharmacies objected to that, their case was shut down because their reasoning was based on religion.

This isn't true. If you read pages 5-10 of the opinion, it discusses how the Board held hearings on the topic and solicit significant amounts of public opinion before deciding on these rules, which were driven largely by a focus on Plan B. The Board acted properly here.
posted by allen.spaulding at 4:11 PM on July 11, 2009


Also late to the party, but...

DON'T. FEED. THE TROLL.
posted by HumuloneRanger at 4:13 PM on July 11, 2009


Also late to the party, but...

DON'T. FEED. THE TROLL.



Wayyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyy too late for that.
posted by lazaruslong at 4:16 PM on July 11, 2009


Flashback a few decades, you know, back to the "good ole days" of back alley abortions. Abortions were, if my shaky grasp of history is correct, illegal in those days, unethical, etc. Rarely performed. Now, if we really want to stick with the "your took the job, you surrender your personal ethics at the door" stance, then those doctors should not have been performing abortions. Right?

Many in this thread would flinch from saying that, which is why I say the situation is more complex than "You took the job, you do the job." The shoe was on the other foot half a century back. Consider that. Imagine if abortions became illegal once more — would anyone here in this thread who wasn't pro-life say, "Well, professional ethics dictate that doctors not perform abortions any longer. I guess we're just S.O.L."

Right now, "we" (we, the liberals, etc) are ascendant, at least in some areas, and I think that's great, but let's not succumb to the kind of triumphant thinking that marks those who have gotten the upper hand, who have gotten lazy and soft because they're the "winners" right now. Part of it is the argument "hey, the laws are on our side, so those guys should just shut up and do what the law says," but remember that the law was not always on our side, and that the law might not always be on our side.

Keep sharp, because things just might change.
posted by adipocere at 4:22 PM on July 11, 2009 [1 favorite]


Metastability, I'm not sure I get your point.

Despite whether or not the board established that "henceforth, all pharmacies shall carry Plan B", it would still have ended up a matter decided by the courts, simply because religion is at the root of it. The board does not have the power to tell pharmacists to just "suck it up" when they are claiming that the practice infringes on their religious beliefs. Once the religious flag is waived, and it comes to drawing the line on that claim, the ruling has to come from the courts, and a law has to be created to be able to enforce that ruling.

It seems to me that the agreement to dispense medicine despite moral/religious objection should made when a pharmacist is licensed. If a pharmacist can not bring him/herself to dispense all medication as prescribed (and in the case of Plan B, that includes doctor's prescriptions and FDA's OTC guidelines), then pharmacist might not be the career for them.
posted by necessitas at 4:27 PM on July 11, 2009


jsonic, this is the second pro-life themed debate I've had with you. Your debating style is becoming oddly familiar with me. Quiet disagreement followed by increasingly loud histrionics, followed by question dodging, followed by putting words in non-existent people's mouths, followed by more histrionics, followed by intentional obtuseness, followed by enough strawmen to secure a thousand-acre cornfield against an airborne army of crows.

A great radical-right talking head in the making!
posted by oaf at 4:43 PM on July 11, 2009


Many in this thread would flinch from saying that, which is why I say the situation is more complex than "You took the job, you do the job." The shoe was on the other foot half a century back. Consider that. Imagine if abortions became illegal once more — would anyone here in this thread who wasn't pro-life say, "Well, professional ethics dictate that doctors not perform abortions any longer. I guess we're just S.O.L."

Huh? That's hardly logical. If abortions became illegal, there's no doctor who would say "it is against my religion to abstain from performing abortions, thus for moral and religious reasons I will continue to perform abortions." Eliminating the ability to perform procedures does not suddenly make a doctor unable to do his job. There's a big difference between that and a pharmacist's refusal to dispense Plan B.

I see a pharmacist's refusal to dispense EC to be exactly like a Jehova's Witness emergency room doctor refusing to perform a blood transfusion on a patient who desperately needs it. If someone can't perform all aspects of the job, and you can't tell me that the possibility that they'd have to do something against their religious beliefs never occurred to a devout christian pharmacist or a JW ER doctor, then they really shouldn't have chosen that profession to begin with.

An kosher jew should never be the chef at a BBQ joint. Similarly, a hardcore, militant vegetarian/animal-rights activist shouldn't be a chef or waitress at a steakhouse. A devout muslim male should never be a masseuse at a unisex spa. A fundamentalist Baptist should never own/work at a disco. It's common sense, right? So why isn't it common sense that a fundamentalist christian or devout catholic should not become a pharmacist (or remain a pharmacist if there are medicines on the market that they are unable to prescribe for religious reasons). None of these things have ANYTHING in common with a doctor no longer able to perform abortions. and I say this as a someone who is very pro-choice
posted by necessitas at 4:47 PM on July 11, 2009


There is a difference between personal ethics and professional ethics. Can a jehovah's witness who works in the blood bank refuse to release blood because their personal beliefs make it a sin? Does a scientologist nurse have the right to refuse to administer anti-depressants or anti-psychotics ordered for their patient because their personal beliefs say that it is wrong? I have no right to impose my beliefs on someone else especially as it affects their health and well-being.

Yeah but, you know, we can't have the government working to protect the rights of people from discrimination, particularly when it comes to their health, or rather reproductive health of course. I mean, they're there to protect the right for us to conduct business in any manner we please. Forcing a government regulated businesses employing government recognized and regulated professionals to provide a wide variety of medication that is needed in the community is just to much to ask of a government regulated business and a government regulated profession. We can even pretend that that doesn't even matter. Profit is what matters and after all, clearly, in each of these cases, profit was the motive for denying prescriptions, not morality or sadly deficient personal ethics that ignore the ethics of the profession these individuals chose to concentrate on when it's convenient for them. Profit I say!

We can look to private business for examples that make like total sense! Take a vegan restaurant for example. A consumer walks into the restaurant and demands meat. The restaurant shouldn't be forced to provide meat but hey, they should be allowed to deny the guy meat and thus jeopardize his appetite until he goes next door or down the block and finds a restaurant that serves meat (I know, it's hard in the United States to find such places). I mean, can't you see, it's just like, JUST LIKE, denying someone a drug, prescribed by their doctor, that may result in the patient preventing pregnancy. In one case a man might go without meat for a few minutes, in another, a woman may get pregnant. Totally like analogous!

Now, if we really want to stick with the "your took the job, you surrender your personal ethics at the door" stance, then those doctors should not have been performing abortions. Right?

If that was the stance, but it isn't. The stance is, person is prescribed a drug. Person is denied getting the prescription filled because the pharmacist feels that it's immoral that they can terminate a potential pregnancy. Should the pharmacist have the right to trump the rights of another based on their personal moral objections? If the answer is yes, then let's extend that across the board to business, education, and government, and cut science classes at whim, deny exposure to a variety of religions and beliefs, permit wide spread discrimination justified by but it's my religion arguments, and so forth.

In the case of illegal abortions, where is the person denying the patient what they want based on their beliefs? If the patient was being given an abortion because the doctor felt that that person shouldn't reproduce for moral reasons, whatever they may be, then that doctor would again, be violating the rights of the patient and terminating a baby they desired. Similarly, if you want to be a pharmacist, and the dispensing of certain medications is morally reprehensible to you, then don't be a pharmacist or lobby to create a for only profitable drugs or for only moral drugs pharmaceutical business and have a great time defining what moral drugs are.
posted by juiceCake at 4:55 PM on July 11, 2009 [3 favorites]


No idea there was so much controversy. Just prescribed this yesterday.
posted by gramcracker at 5:04 PM on July 11, 2009


Part of it is the argument "hey, the laws are on our side, so those guys should just shut up and do what the law says," but remember that the law was not always on our side, and that the law might not always be on our side.

My question is, are pharmacists who are ethically opposed to Plan B willing to commit to the consequences of their ethical opposition? The doctors who performed illegal abortions before Roe vs. Wade risked their professional licenses and their careers by performing procedures that were against the law (just as their colleagues/spiritual descendants, Drs. Slepian & Tiller, risked and lost their lives to ensure that women had access to those procedures now that they are legal).

People are saying the options anti-Plan B pharmacists have are to dispense Plan B or quit. I suggest that there's a third option: civil disobedience. Civil disobedience has consequences, though, and a lot of the whining is about not wanting to deal with the consequences of fully living your religion/morals in a society where the law doesn't support them.

Aside: I'm aware that civil disobedience in this case could have terrible consequences for the women seeking Plan B because of the time frames involved. I don't know what the consquences are for failure to dispense (any medication) but I'd like to think the pharmacy board would throw the book at pharmacists who deliberately didn't dispense prescriptions. My point is that pharmacists who are opposed to dispensing Plan B can refuse to do so even if the laws and regulations require them to; they just aren't willing to live with the results of following through on their beliefs.

Yes, this is a big complaint I have about anti-choice whiners across the board. These guys are no different.
posted by immlass at 5:05 PM on July 11, 2009 [5 favorites]


By the way, where's my male contraceptive pill?
posted by turgid dahlia at 5:08 PM on July 11, 2009 [1 favorite]


lazaruslong: "[This] is an incredibly facile reading of the cogent logical arguments presented by people in the thread. Myself and others took his arguments at face value, and offered rebuttals. They were ignored by jsonic, who then turned it into a Me vs The Mob martyr story."

Just to clarify, I wasn't saying that there hadn't been any good rebuttals, nor accusing you of anything, and in general I think the discussion has been pretty civil. I think that the best way to head off the inevitable ‘I'm being oppressssssed!’ claims is just to take each iteration of the argument as it is presented, crush it, and wait for the next one. Better sport that way, too.

"This is why responding to trolling is a no win. Guilty here as well."

Not completely; it's fine as a sort of pedagogical exercise. I don't think there was ever any chance of actually changing jsonic's mind, but that doesn't mean the discussion was devoid of merit. I think a lot of people made very good responses, and it's not impossible that someone else reading this thread might find one of them convincing.
posted by Kadin2048 at 5:50 PM on July 11, 2009 [1 favorite]


Canadians should note that there is an activist movement in our pharmaceutical system that is trying to make it possible for pharmacists to deny prescriptions based on their personal moral stance.

I don't think they'd have a hope in hell of getting that past the Supreme Court, but it would make for an awkward few years while the case moved through the system.


Wow, thanks for the heads-up, five fresh fish. As a Canadian of reproductive age, this concerns me, as much as I believe that this initiative won't get anywhere.

After reading this thread, I'm extremely thankful that I live in a country, where a condom can break and I can head to the nearest Sexual Health Center and pick up plan B for under 10$. No fuss, no muss. I'm just glad that the cost is negligible and any clinic who gives these things out would be willing to negotiate the price, based on need. You know, or I could just go pick it up at any pharmacy, OTC, for a similarly reasonable price.

Canada, I love you, even with Stephen Harper in office.

hey guys, do you think we could get our asses in gear next election and oust this doofus?
posted by sunshinesky at 6:36 PM on July 11, 2009


Clearly St Alia and jsonic are actually against the Plan B drug. Can either of you tell me why that is? It certainly doesn't kill a fetus; it simply prevents conception.

The conclusion that someone is against Plan B itself because they don't want drugstores to be forced to sell it is not a safe one. I agree with you that Plan B is essentially a contraceptive rather than an abortion pill. If I owned a drugstore, I would probably have it sold, along with other contraceptives.

But I find the idea that any business, including a drugstore, would be forced to stock and sell a product very troubling. I also believe that it's just fine to have a drugstore that not only doesn't carry plan B, but doesn't carry any contraceptives whatsoever. Not because I think there's anything wrong with contraception, in fact, I think not believing in them is weird. But freedom of conscience seems like a value as worthy of defense as the availability of contraception to me.

I'm not addressing the other arguments about whether or not it's valid to assume "Pharmacist just MEANS you must. sell. this. item." Just want to state at least one data point rebutting the idea that anyone against pharmacies being forced to sell it is also against the drug itself.
posted by weston at 6:39 PM on July 11, 2009 [1 favorite]


his isn't about moralizing or about the culture war. It's about holding people to the practices and standards as required by their medical or pharmaceutical license. Everyone is free to object, you are even free to object and perform objectionable actions anyway (like I do). The court is just saying that you are not free to have your pro-life cake and force your patients to eat it too.

This is incorrect. This is entirely about moralizing and the culture war. Did you read the opinion?

If it were merely about holding people to the practices and standards required by their medical license, and this were only about making necessary medication available to the community, then there would not be an exemption for the pharmacies that did not stock Plan B for economic reasons or low demand. That is, it would be mandatory in all instances, like fire extinguishers in restaurants.

That's not what's going on here. Instead, there are some people who own pharmacies and, for moral or religious reasons, do not want to dispense Plan B. According to the opinion itself, this offended civil rights groups in Washington, who lobbied for a law forcing those people to dispense Plan B. That is the culture war, dude. It sounds like your side won (this time, for now, pending certiorari review), but that doesn't make it any less part of the culture war.
posted by Slap Factory at 7:25 PM on July 11, 2009


But freedom of conscience seems like a value as worthy of defense as the availability of contraception to me.

But it's not just contraception we're talking about here, it's bodily integrity. When a woman needs Plan B, that's the difference between going on with her life or getting pregnant and either suffering pregnancy or having an abortion. Sorry if I think actual freedom to receive necessary healthcare trumps alleged freedom of conscience.
posted by hydropsyche at 7:28 PM on July 11, 2009 [1 favorite]


weston writes "The conclusion that someone is against Plan B itself because they don't want drugstores to be forced to sell it is not a safe one."

I didn't realise this is what people were thinking. If they were let me say I'm in agreement with weston. Birth control of all types should be handed out free on street corners IMO but this ruling is still worrisome. I know it's extremely polarizing in the the US and that is never a good place to be making law from.
posted by Mitheral at 7:34 PM on July 11, 2009


When I lived in Seattle, I had a friend who was a "cook" at a Pioneer Sq. Bar. I put the word in parentheses, because while there is a state law that says that places that serve hard liquor must sell food, there's no provision for the quality preparation of said food. So basically my friend was paid a few bucks to sit in the back and read, sometimes serving as emergency bar back on really crowded nights. About once a week some drunk businesman would order the jalapeno poppers and he'd get to exercise his culinary skill and expertise on a batch of microwaved, costco-bought appetizers. Any attempt at ordering anything that couldn't be microwaved was met with confusion and/or outright hostility.

Not sure how this is relevant, but I'm guessing it's at least as useful as some of the upthread arguments.

Sometimes willful ignorance brings out some good arguments. There are some comments in here that not only brilliantly illuminate this specific issue, but society's need for regulation in general.

It would also be cool if one of you smart people could convince me that I'm not a hypocrite for applauding this ruling yet continuing to consider the smoking ban in bars the highest form of state-sanctioned oppression.
posted by billyfleetwood at 8:00 PM on July 11, 2009 [1 favorite]


Birth control of all types should be handed out free on street corners IMO but this ruling is still worrisome.

I just don't see this. As the opinion noted, had the Board not ruled this way, the Pharmacy was almost certainly in violation of state and federal anti-discrimination rules. It's not that they were refusing to provide contraception to all people, they just refused one form of contraception that was only available to women.

There is a small number of pharmacists in this country who belong to a political movement that has targeted Plan B and RU-486 as problem drugs that ought not to be distributed. These actions are certainly discriminatory, insofar that they target only women (and as I said above, they not only target women but do so in a way that deepens inequality). If a pharmacy refused to carry any family planning devices and did not discriminate on the basis of sex, we'd have a very different situation that might not require government intervention in this form. If there was a need for intervention, it would likely be based in public health and privacy concerns and not anti-discrimination concerns. But that is not the case here - nor does anyone pretend that this is facially neutral in its application with regard to sex.

If there were a small number of pharmacists in any country that practiced discrimination in this manner, I would hope that the government would prohibit it. It's no different than refusing to fill prescriptions for disease that only affect Jews because you think they're going to hell. I'd hope people can agree that government should prohibit this behavior, just as they prohibit the same pharmacists from only hiring Christians.
posted by allen.spaulding at 8:19 PM on July 11, 2009 [2 favorites]


pineapple
Are those of you who think that the drugs that pharmacists dispense shouldn't have to be regulated by the state but by the free market, also okay with marijuana and other recreational drugs being decriminalized? Why should the state care, right? Let the pharmacists sell whatever they want, as long as it's good for business?

Sure, I don't particularly care if pot is legal.
In my state you can a prescription for it, but I'd object to a pharmacist being forced to carry it just as I object to a pharmacist being forced to carry any drug.
However, you don't have an accurate characterization of what I, at least, am saying. I am not suggesting that pharmacists not be regulated, only that this regulation is a poor one.

The doctor's job is to make medical diagnoses and prescribe medicine. The pharmacist's job is to dispense that medicine and advise on how it should be taken. The two roles are not equivalent. If a pharmacist has a medical concern with a prescription, he should take it up with the doctor, not force his issues onto the patient.


A valid stance, but one I disagree with. A pharmacist is supposed to look out for their clients. To be quite frank, a PharmD likely knows a lot more about the medication than an M.D. To suggest that they must fill a prescription under duress, even if it is not in the patient's best interest is misguided.
posted by madajb at 8:50 PM on July 11, 2009


"You can't legislate morality."

Which is one of the stupid phrases trotted out to support a point. Of course we legislate morality. We make murder illegal. We've changed our definition, in the West, of what consititutes rape so radically as to render it unrecognisable to people from thirty or forty years ago.

If you're going to argue that businesses shouldn't be controlled in how they do business by the legislature because their personal morality trumps our right to legislate their behaviour you should forget the injustices done to pharmiscists and start campaigning for the poor, victimised Gottis.

I do not, however, have the right to ignore, violate or otherwise neglect the laws and regulations of which I am professionally bound and still expect to keep my job or my state-issued license intact.

And, indeed, MLK made the point that he expected to be arrested for breaking the law, and that he expected his followers to be arrested, and he expected to recieve whatever punishments the courts handed down. His point was to break the law and convince people that said punishments were ridiculous. He did not expect to have a bob each way.

"Where not talking about denying a life saving medical procedure here."

No, because pregnancy carries no risks.

Funny how violating someone else's right of conscience is a-okay if YOU don't agree with them.

You seem pretty comfortable with the state denying gays the right to marry. Spare me your carping, you fucking hypocrite.


Since I didn't see where jsonic specifically explain why his handwaving statement that the EMT/ambulance refusing to dispense IVs for ethical reasons is "not analogous" to the pharmacist who refuses to dispense Plan B for ethical reasons, I'm assuming that he can't explain it.

I mention this hypothetical because it's far, far more analogous to the pharmacist than any analogy that includes delis, house inspectors, etc. A privately-owned health care provider, licensed by the state, responsible to provide a standard of care, refusing to dispense a particular medical treatment that had been ordered by a doctor, based on an ethical dilemma of the owner.


Even better, a little googling will turn up the shitstorm when EMTs were negligent in providing care for a trans person for those very reasons.
posted by rodgerd at 9:05 PM on July 11, 2009 [2 favorites]


A valid stance, but one I disagree with. A pharmacist is supposed to look out for their clients. To be quite frank, a PharmD likely knows a lot more about the medication than an M.D. To suggest that they must fill a prescription under duress, even if it is not in the patient's best interest is misguided.

When it comes to Plan B, and the pharmacist's issue is of a religious nature, and not a concern that combining two medicines is not in the patient's best interest because it could be dangerous for their health, it's it up to the patient to decide whether or not Plan B is in their best interest?

I think it is entirely misguided to suggest that a PharmD should be able to/responsible for determining what is in the best interest's of the patient's soul, or whatever other moral or religious conflict the pharmacist might have with Plan B.

If a pharmacist has an issue with Plan B and it's potential health risks, that pharmacist needs to take it up with the FDA, with the manufacturers, lobby for it to be taken off the market because of the potential HEALTH risks to the WOMAN taking the medication.

If moral or religious issues prevent a pharmacist from dispensing medication, be it plan B or medical marijuana, they need to not be in that profession. There is no room for subjective objections when it comes to dispensing medicine.
posted by necessitas at 9:05 PM on July 11, 2009 [1 favorite]


I guess what I'm getting at, and not phrasing very well, is that I am not particularly interested in the specific pharmacy case so much as I am the larger implications. I am more interested in the professional ethics trump personal ethics argument. "That's your job, do your job" fails two critical tests for me.

The first test is, how would we feel if the situations were reversed? Women have benefited from receiving abortions back when they were illegal and therefore professionally unethical. And if that went back into effect (something I would very much like not to see happen), most of the pro-choice people in here would drop the "well, it's the law, and professional ethics must be served" stance like a hot potato. We'd want that Plan B or RU-486, by hook or by crook, and you know somebody would be violating some professional standards getting it to you.

The second test it fails is, have we as a society ever benefited from people who decided that, no, "It's my job" doesn't cut it? Who was that guy who decided not to push the button and launch some missiles? If he had said "I accepted the job, I have to do the job" would we be happy about that? No. We benefited from that act of personal conscience. We benefit from whistleblowers.

It's easy to pick up as a debate tactic, but that's as far as it goes. I think the situation is more nuanced than "that's your job, do it." It's very attractive to bring up, because right now the pro-choice star is high in the sky, and it's fun to say "Suck it up, we're the winners," but that doesn't make it a very sound choice, especially when the worm could so easily turn.
posted by adipocere at 9:05 PM on July 11, 2009 [2 favorites]


madajb's reasoning leads to the conclusion that a pharmacist may decide, based on nothing more than personal morality, that pregnancy is "in the patient's best interest". That is misguided.
posted by casarkos at 9:07 PM on July 11, 2009


This is only controversial to fundie halfwits. Which is redundant.
posted by docpops at 9:14 PM on July 11, 2009 [3 favorites]


adipocere I think there is a danger in "reversing the situation" when there are hierarchical relationships and power imbalances involved. But that aside. If you read what some of us are saying, the point is not that "professional ethics trump personal ethics." What I have said is that professional services must be distributed in a non-discriminatory manner. A pharmacist claimed that acting in a non-discriminatory manner violated his right to exercise his religion. The court ruled that it did not.

I expect people to exercise all sorts of judgments when making important decisions, be they professional, personal, spiritual, scientific, utterly irrational, etc. That's fine. I want Pharmacists' judgment to be professionally component, which is why they are licensed. I also want them to make sure that their judgment is non-discriminatory.

This is pretty low-hanging fruit. The harder question is when there isn't facial discrimination. A tenured public school teacher who refuses to teach evolution is harder on these grounds. Should the state be able to force him/her to do so in violation of his/her freedom of conscience. I think most of us agree, but on public welfare grounds, which are often shakier than anti-discrimination grounds.
posted by allen.spaulding at 9:16 PM on July 11, 2009


madajb said: "A pharmacist is supposed to look out for their clients. To be quite frank, a PharmD likely knows a lot more about the medication than an M.D."

Is this an speculative "sounds reasonable so I'll say it aloud" anecdote intended to win an online debate? Or do you have some sort of medical experience that will add credibility here? I'm not trying to be an ass... I'm being serious. This sounds like one of those things that sounds good on the face but is wholly untrue.

"To suggest that they must fill a prescription under duress, even if it is not in the patient's best interest is misguided."

Not what I suggested. What I said was:

"If a pharmacist has a medical concern with a prescription, he should take it up with the doctor, not force his issues onto the patient.

If a situation of "duress" is created (and truly, I'd love to have some sort of number about how often this kind of thing actually happens, where it is not an issue of morality such as with Plan B), then the pharmacist needs to pick up the phone and call the prescribing doctor. That's why the phone number is printed right on the piece of Rx paper.

What is or is not in the "patient's best interest" should be decided first by the doctor -- the one who actually did the medical examination. I love the guy at Target who dispenses my scrips... and sure, I'm his "client", technically... but actually I have more "service relationship" with the lady who sells me cleanser at the Lancome counter. Let's not overinflate the pharmacist's role in my life, or suggest he is on the same level as an actual, licensed medical doctor.
posted by pineapple at 9:33 PM on July 11, 2009


The first test is, how would we feel if the situations were reversed? Women have benefited from receiving abortions back when they were illegal and therefore professionally unethical. And if that went back into effect (something I would very much like not to see happen), most of the pro-choice people in here would drop the "well, it's the law, and professional ethics must be served" stance like a hot potato. We'd want that Plan B or RU-486, by hook or by crook, and you know somebody would be violating some professional standards getting it to you.

This test completely fails. First of all, Plan B is NOT the abortion pill and it isn't a pro-choice/pro-life issue any more than the birth control pill is a pro-choice/pro-life issue. Contraception, emergency or otherwise, is not abortion, and if you confuse one with the other, you are already starting out with points that appear less valid.

About your actual argument, you're not comparing apples to apples. What you have proposed is not the reverse of the situation. Plan B is legal. a pharmacist, in this case, is bound by the law, and also bound by professional ethics, but refuses to dispense it because of his PERSONAL beliefs. The opposite of this situation is where Plan B is NOT legal, and a pharmacist is bound by law and professional ethics to NOT dispense it, but because he does not believe in the law for PERSONAL reasons, he dispenses it anyway. That would be illegal and professional unethical, and distributing an illegal medication for personal reasons is as reprehensible as refusing to distribute a legal medication for personal reasons.

Pharmacists who use personal/religious valuse determine which legal drugs they will and will not dispense are no different than pharmacists who use personal/religious values to determine which illegal drugs they will and will not dispense. A pharmacist who acts on personal, religious values, rather than the professional obligations to which they are bound, is nothing more than an in-store drug dealer. There is no more science, law, or professional standards guiding their actions, subjective dispensing is as lawless as drug dealing, and that goes equally for pharmacists who refuse to dispense legal medications, and those who refuse to abstain from dispensing illegal medications.

The second test it fails is, have we as a society ever benefited from people who decided that, no, "It's my job" doesn't cut it? Who was that guy who decided not to push the button and launch some missiles? If he had said "I accepted the job, I have to do the job" would we be happy about that? No. We benefited from that act of personal conscience. We benefit from whistleblowers.

And a second argument that fails the logic test. These pharmacists are not whistle blowers. I had started to type a response to point out the flaws in your logic, but I've got to believe that you KNOW how ridiculous this is and there's no reason for me to point it out to you. If you can not see how ridiculous it is, that would be quite a shame, but there's nothing I can say to even get you to understand the difference between logic and whatever word there is to describe your second argument.
posted by necessitas at 9:43 PM on July 11, 2009


Oh, I forgot to address something:

Women have benefited from receiving abortions back when they were illegal and therefore professionally unethical.

This is so irrelevant. Those abortions were, mostly, back alley abortions done with rudimentary implements. They were not professional caliber, there was no professional ethics, they were not done by professionals. Sure, some women benefited, but many died or suffered horrible consequences as a result. NOBODY is championing the cause of back alley abortions or any procedure done by non-professionals, or in a non-regulated environment, that will be almost more likely to harm the woman than it would be to help the woman.

The abortions that were performed by MDs were not done during office hours, as a service advertised, they were done in secret. There was no professional ethics involved there, either. These doctors were either motivated by money or motivated by the cause.

The big difference in both these cases is that women had a choice, not an ideal choice (which would be legal abortion), but a choice nonetheless. They could either go to a coat-hanger service, or an undercover doctor if they could find one, or they could not risk it and just suffer the pregnancy. Nobody was forcing their values on the woman (ignoring the obvious one that abortion was illegal). When a woman has unprotected sex, or their primary contraceptive fails, and they go to the pharmacy but the pharmacist refuses to dispense the morning after pill, the pharmacist is forcing her to submit to his values, and removes her choices (if it is a one-pharmacy town).

This IS a professional ethics issue and one that can't be easily reversed to a tables-turned scenario.
posted by necessitas at 9:59 PM on July 11, 2009 [1 favorite]


But freedom of conscience seems like a value as worthy of defense as the availability of contraception to me.

"Freedom of conscience" doesn't mean a licensed medical professional can hang his/her moral objections over my head and fail to do his or her duty to provide the legal services as obligated by professional ethics and mandated by medical licensing and the courts. You don't get to become an OB/GYN and then refuse to look at a vagina because it is a violation of your religious beliefs or offends you morally, or at least if you want to keep working as an OB/GYN. Similarly, as a pharmacist, you cannot decide which drugs to dispense and which you will not because of moral objections. Doing so puts people's health and potentially their lives at risk and removes the ethical obligation, which is a much larger consideration than someone's personal qualms.
posted by krinklyfig at 11:37 PM on July 11, 2009


But I find the idea that any business, including a drugstore, would be forced to stock and sell a product very troubling.

It's horrible that car companies are forced to sell cars with seat belts, isn't it.
posted by Blazecock Pileon at 11:41 PM on July 11, 2009


1. One of the deals we make as members of a pluralistic society is that we get to choose our own beliefs and how we carry them out but we don't get to enforce them on other people.

That's one reason institutions of power tend to have restrictions put on them, and this rule and ruling seem consistent with that.

2. One quirk of something like this is everyone feels very uncomfortable about it. Until the exact moment they need it (and even then, probably).

It's really, really easy to look down with disdain on people who need emergency contraceptives at those (many) moments in your life when you yourself don't need one.

So in a sense, policies like this protect us against our own (worst) selves.
posted by flug at 11:48 PM on July 11, 2009


In my state you can a prescription for it, but I'd object to a pharmacist being forced to carry it just as I object to a pharmacist being forced to carry any drug.

I can't be sure, but I think your feelings would be different if it were a drug you were prescribed, and the pharmacist refused to dispense it for personal reasons, particularly if you had to travel long distances to get to another pharmacy, and your prescription's effectiveness was extremely time-dependent.

Of course, I can't be sure, but self-interest is a powerful motivator.
posted by krinklyfig at 11:50 PM on July 11, 2009


Is this an speculative "sounds reasonable so I'll say it aloud" anecdote intended to win an online debate? Or do you have some sort of medical experience that will add credibility here? I'm not trying to be an ass... I'm being serious. This sounds like one of those things that sounds good on the face but is wholly untrue.
pineapple
Debate? No, just continuing the discussion. I'm not attempting to win anyone over to my point of view nor do I think that is likely on either end.

I am certainly not a PharmD, but I've spent a lot of time in the same building as PharmD students and have seen their labs/courses.
It doesn't seem unreasonable that someone who spends 6 years(2 years pre-pharmacy and 4 years in the Pharmacy program) studying the subject of Pharmacology would be a more knowledgeable than someone who hasn't specialized.

but actually I have more "service relationship" with the lady who sells me cleanser at the Lancome counter. Let's not overinflate the pharmacist's role in my life, or suggest he is on the same level as an actual, licensed medical doctor.

For a lot of people (most?) that's probably the way it is, you go, you get your medication, you go home.
But a good pharmacist can take an interest in you and perhaps suggest alternate medications that you could take to your doctor, point out side effects you may not notice, etc.
posted by madajb at 12:19 AM on July 12, 2009


I can't be sure, but I think your feelings would be different if it were a drug you were prescribed, and the pharmacist refused to dispense it for personal reasons, particularly if you had to travel long distances to get to another pharmacy, and your prescription's effectiveness was extremely time-dependent.

Certainly possible. My health plan does have mail-delivery prescriptions, though as noted above, that's not much help in a Plan B situation.

I don't know. I hear what people are saying about pharmacies needing to provide impartial care, and I am sympathetic to the idea.
But fundamentally, I think pharmacists should be able to make up their own mind about what they will sell or not.
posted by madajb at 12:32 AM on July 12, 2009


I find it hard to believe that someone could have so much trouble understanding how pharmacies operate. Pharmacies have to agree to fill any order that a licensed physician gives. No questions asked. That is what a pharmacy is.

But then again I'm sure that jsonic has no idea how natural monopolies work or why power companies have to agree with whatever the public commission decides.

Since it's a "private" company though I guess it means they don't have to follow any laws.
posted by Allan Gordon at 12:35 AM on July 12, 2009


Pharmacies have to agree to fill any order that a licensed physician gives. No questions asked. That is what a pharmacy is.

Do you have a cite on this? It doesn't seem to me that this would be true. At the very least, if a pharmacist knows, for example, that a combination of drugs from two different physicians for the same customer would be lethal I would think that they can refuse to fill the orders.
posted by XMLicious at 12:44 AM on July 12, 2009


Another aspect of it is that a physician really does not need to know what they're doing at all to write a particular prescription. I know someone who was getting prescribed fluoxetine (generic Prozac) by her podiatrist, and not for anything having to do with her feet - just because she happened to mention feeling depressed when she was in to see him. So that's another reason why I have difficulty believing the "any physician's instruction automatically trumps the pharmacist's judgment" story.
posted by XMLicious at 12:54 AM on July 12, 2009


They can contact the physician if they think there is an error, which does happen, but if there is no error then they must fill the prescription.

I'm not sure how it works when someone is getting multiple prescriptions from different doctors, but I think even then they would have to fulfill the prescription.

I have nothing to cite since this is just what I have heard from a friend I work out with who is going to school to be a pharmacist.

Obviously our system is not perfect shown by the example you gave of a podiatrist prescribing Prozac. But it's not like specialists are somehow not doctors anymore. They learned about the entire human body when they went to school, so it's the best we have.
posted by Allan Gordon at 1:08 AM on July 12, 2009


Another aspect of it is that a physician really does not need to know what they're doing at all to write a particular prescription. I know someone who was getting prescribed fluoxetine (generic Prozac) by her podiatrist, and not for anything having to do with her feet - just because she happened to mention feeling depressed when she was in to see him.

You are absolutely correct. A podiatrist can not prescribe anti-depressants that have nothing to do with treatment of the foot. They are restricted to prescribing medication related to treatment of that part of the body only. Here's an example from NY.

So, yes, that point is valid, but the point in general has NOTHING to do with the topic at hand. A pharmacist is not qualified to make non-health related judgments about whether or not Plan B is in the patient's best interests. Short of interaction with other medications, there is no reason that a pharmacist's objections would benefit the patient in any way. That is not a claim that can be used to justify the support of pharmacists refusing to dispense contraceptives that they personally find morally objectionable.
posted by necessitas at 1:10 AM on July 12, 2009


So, yes, that point is valid, but the point in general has NOTHING to do with the topic at hand. A pharmacist is not qualified to make non-health related judgments about whether or not Plan B is in the patient's best interests.

It was basically asserted that a pharmacist is compelled to do anything that a physician's instructions written on a prescription notepad and handed to him ask of him or her. Along with some gnashing of teeth that people are having "so much trouble understanding how pharmacies operate".

If that statement is relevant to the topic at hand then it sure as hell is relevant whether it's true or not.
posted by XMLicious at 1:48 AM on July 12, 2009


jsonic--

What I think you may not be understanding is that this particular business is a direct beneficiary of the state: In a fully free market, any store would be able to sell Plan B. Literally, it could be available right there next to the Condoms or the Advil.

And it's not just Plan B. Every medication could be fully available, which would increase the supply, thus decreasing profit margins for the pharmacy significantly. The state is literally out there, banning products from being sold by potentially willing vendors.

With such a regulated market, the state is creating the situation by which a small number of players can have a significant impact on the availability of a good. That's what you're not understanding: If it wasn't for the state's limits, it wouldn't matter that one particular vendor refused to carry the good, as there'd be many others competing for the business.

The state wasn't out to allow non-medical override of physician care by creating this system. The goal of the restrictions was to prevent people from incorrectly medicating themselves. There's organizations that are seeking to define "incorrectly" as "not in line with my ethical beliefs". They are free to do this, but then the state is free to constrain its oligopoly a little more.

That's what you're missing, jsonic. In a fully free market, there wouldn't be supply chain issues. Since we don't want a fully free market, since in fact we want to invest heavily in last-mile correctness for pharmaceutical dispensation -- a demand that dramatically limits the availability of medicines -- we need to manage the side effects of such market constraints. We do in fact need to demand that the vendor not use the oligopoly they've received for medical reasons, to push a political agenda.
posted by effugas at 2:15 AM on July 12, 2009 [9 favorites]


Pharmacists can and do exercise professional judgment in filling prescriptions, particularly when they have reservations with regard to dosing, drug interactions, or forgery.

But, fortunately, most pharmacists don't conflate their professional judgment with their personal religious convictions.
posted by timeo danaos at 5:27 AM on July 12, 2009


agregoli: Malor, we're not talking about RU-486. We're talking about Plan B - two different pills. RU-486 is the "abortion pill." Plan B prevents implantation. Just want to make that clear.

Oops! I didn't realize they were different things. From seeing the description of Plan B, it was pretty obvious that it wasn't about abortions at all, but I figured it had just gotten spun that way in the media by conservatives. Thanks for the clue.
posted by Malor at 6:31 AM on July 12, 2009


Oh, also, that link up there explains Plan B as ovulation prevention, not implantation prevention. I don't know if it's fully correct, but that's what it claims.
posted by Malor at 6:34 AM on July 12, 2009


Pharmacies have to agree to fill any order that a licensed physician gives. No questions asked.

OMFG THIS IS INCORRECT

Hi, I'm a pharmacist. Each time I fill and dispense a prescription, I check that the dose is both safe and effective and that the drug is appropriate for its intended use. I look for interactions with the patient's other medications and concomitant disease states. I check for cross sensitivities with allergies. I compare it with what I've dispensed for that patient previously, to make sure there aren't any weird discrepancies in maintenance meds, or to see if, perhaps, they got a similar antibiotic recently and if they aren't feeling better it might be time to try something different. For controlled substances, I check to make sure that it is, in fact, a real prescription and has not been altered.

There are LOTS AND LOTS OF REASONS not to fill a prescription. Physicians aren't infallible. Sometimes they simply write the wrong thing. Sometimes they make errors calculating weight based dosing. Or they are unaware that the dose needs to be adjusted for, say, a patient's renal function. Not uncommonly they prescribe a medication that will interact with a medication someone else prescribed. Sometimes they hear about some new drug, but they don't realize that the patient will have to pay hundreds of dollars for it, but there's another drug that will work just as well that the patient's insurance will cover. Maybe there's some new and significant study or warning related to the drug, and what would have been an appropriate prescription a couple of months ago carries more risk than we realized previously, but they haven't read about it yet. Let's not forget the patient who takes that prescription for 20 Vicodin and add a 1 in front of the quantity or gives themselves 5 refills the physician didn't intend.

If I unquestioningly dispensed every damn thing just the way it was written, my god do you know how many people I would have injured or killed by now? And I haven't even been at this that long. You can damn well bet I am questioning every aspect of every prescription, because that is the whole fucking point of what I do. They are my patients, they are not my customers, and I do have an ethical responsibility to them.

Fortunately, nearly all of these problems can be resolved by contacting the physician. Rarely have I had to refuse to fill a prescription without being able to tell the patient "Call me later/tomorrow/Monday, we should have it fixed for you by then." But there are occasions when for very good reason I have had to simply refuse to fill a prescription because I could not legally, ethically, and safely provide the drug as prescribed. (Note--nothing about morals in this list.)

On to the specifics of this situation--hypothetically, it is possible that sometimes one of the mechanisms of action of Plan B is to block implantation of a fertilized egg. This is not something for which I have a cite. I learned it in pharmacy school, and it is part of the vast fuzzy area of things we're only guessing about how drugs work. It is impossible to know all the biochemical implications of putting exogenous molecules in the human body. HOWEVER, this is also true of Lo/Ovral, and Yaz, and NuvaRing, and every other goddamn hormonal contraceptive that I'd be willing to bet these jackasses dispense all the time. IF YOU ARE OKAY WITH DISPENSING BIRTH CONTROL PILLS, THERE IS NO GOOD REASON TO HAVE A PROBLEM DISPENSING PLAN B. And if you have a problem dispensing birth control pills, you need to go work at a hospital, or nursing home, or an outpatient pharmacy busy enough to be staffed by more than one pharmacist so that you can let your colleagues handle the prescriptions you find morally objectionable.

THIS IS IMPORTANT: If you are ever in a situation where you need emergency contraception and are having difficulty finding a pharmacy that stocks it, several types of common birth control pills can be used as emergency contraception. This doesn't help if you're trying to get it over the counter, but a physician can prescribe it as "(whatever brand of BCP) #1 pack, take as directed", and then tell you how many of the pills to take for it and how to take them, and you can sneak one right by those suckass pharmacists. In my experience most physicians aren't aware that they can do this, so, uh, if anybody wants the chart with which brands and how many pills, I've got it around here somewhere, send me a message.
posted by little e at 7:36 AM on July 12, 2009 [34 favorites]


little e, thanks SO much for weighing in here. You have been absolutely needed in this thread for a long time. I hope I didn't come across sounding diminutive about pharmacists, who I respect fully; I just feel that the equating of pharmacists and doctors (who perform different roles in my health and medical treatment) has been mostly disingenuous in this particular political conversation.

Your comment renders pretty moot my point to XMLicious but I'll make it anyway:

XMLicious said: "It was basically asserted that a pharmacist is compelled to do anything that a physician's instructions written on a prescription notepad and handed to him ask of him or her. Along with some gnashing of teeth that people are having "so much trouble understanding how pharmacies operate".

If that statement is relevant to the topic at hand...
"

I don't agree it's relevant, at least not for my point (and I'm the one who mentioned the notepad)... which has always been that if a pharmacist has a problem, he or she should take it up with the doctor. Plan B opponents are arguing in this thread that since the pharmacist is allowed to refuse to dispense medication for medical/health reasons, therefore s/he is also entitled to refuse to dispense medication for moral reasons -- which is logically false.

And as our own resident pharmacist has just pointed out, even when the pharmacist refuses to dispense for health reasons, s/he takes it up with the doctor, instead of just sending the patient away empty-handed, "too bad, you're out of luck, goodbye."
posted by pineapple at 8:57 AM on July 12, 2009 [1 favorite]


little e - well said. Where were you 300 comments ago? :)

Reading this thread back, I saw that, while commenting with my blood up, I said that a pharmacist wasn't qualified to determine how badly a woman might need to purchase Plan B. That was a stupid point that I need to retract or at least modify - your point as to how a pharmacist who distributes birth control shouldn't have any moral qualms with distributing Plan B is a lot more coherent and a lot less rude, so let me add my voice in support of that argument, if I may.
posted by EatTheWeak at 9:11 AM on July 12, 2009 [1 favorite]


pineapple said: " I hope I didn't come across sounding diminutive about pharmacists, who I respect fully"

Diminutive, OR, you know, "dismissive." The one where I'm being derogatory, and not a Little Person.
posted by pineapple at 9:25 AM on July 12, 2009 [1 favorite]


Here is one of the tables little e mentioned that gives the brand name of a large number of birth control pills and tells the dosing for emergency contraception. Considering how many people didn't know the difference between Plan B and RU486 before this thread, at least there's been some educating going on.
posted by hydropsyche at 9:55 AM on July 12, 2009


"And as our own resident pharmacist has just pointed out, even when the pharmacist refuses to dispense for health reasons, s/he takes it up with the doctor, instead of just sending the patient away empty-handed, 'too bad, you're out of luck, goodbye.'"

They also said "But there are occasions when for very good reason I have had to simply refuse to fill a prescription because I could not legally, ethically, and safely provide the drug as prescribed. (Note--nothing about morals in this list.)" so sometimes the customer does walk away empty handed.
posted by Mitheral at 10:46 AM on July 12, 2009


Okay, this part here, "I am not particularly interested in the specific pharmacy case so much as I am the larger implications. I am more interested in the professional ethics trump personal ethics argument. 'That's your job, do your job' fails two critical tests for me." do I have to make it blink for people to read that?

Overall, I am saying that the argument "That's your job, do your job" is a very, very broad brush. I do not care how it applies to the pharmacist situation. Not a bit. Seriously, I will make that text blink if that is what it takes for someone to read that.

We really, really do not want "that's your job, do your job, no matter what" to become some kind of broad standard. In this particular case, who knows? Overall, that's a pretty frightening thing to want to bring into society. I, for one, do not wish to become a conscienceless cog in a machine defined solely by my job description and what the most recent batch of managers thinks is "okay."

You're letting your love for this one particular micro-issue blind you to the broader implications if you cannot see the consequences of "that's your job, do your job, no matter what" as being a Good Way to Live.
posted by adipocere at 12:29 PM on July 12, 2009


From this site: Plan B works like other birth control pills to prevent pregnancy. Plan B acts primarily by stopping the release of an egg from the ovary (ovulation). It may prevent the union of sperm and egg (fertilization). If fertilization does occur, Plan B may prevent a fertilized egg from attaching to the womb (implantation). If a fertilized egg is implanted prior to taking Plan B, Plan B will not work.

So we're both right!
posted by agregoli at 12:47 PM on July 12, 2009


adipocere - I've given you a series of reasons why it might be a good idea for the government to mandate specific tasks for various professionals. This falls pretty clearly into one of the easier categories. Here's a list of "people doing their jobs" that I want the government to regulate.

I am a teacher and I don't want to teach evolution - sorry, there is a public policy interest in teaching students the basics of modern scientific understanding and we're going to override your personal feelings.

I am a small business owner and I don't want to hire black people - sorry, there is a strong government interest in fighting discrimination on the basis of race.

I am an arms manufacturer and I want to sell weapons to North Korea - sorry, there is a strong national security interest in restricting your ability to do so.

I am a car salesman and I want to sell cars without seat belts - sorry, there is a strong public health reason against this.

I am a payday loans officer and I want to extract interest rates of 400% on my most vulnerable clients by using a post-dated check as leverage with the threat of criminal prosecution to extract continuing rents - POLICY COMING SOON to a country near you.

The point is that there are multiple ways we restrict businesses and tell them "sorry about your personal feelings on the matter, you have no choice." In this case, refusing to sell Plan B is a clear violation of sex-discrimination laws. If a state licensed pharmacy wanted to refuse to sell any contraception at all, and there was no law requiring it to do so, it might violate the 9th Amendment privacy right described in Griswold, depending on the level of state involvement and alternative means of access. That's a tougher case on a constitutional level, but an easier one on a policy level, if a state wanted to mandate it.

There is a strong public health and autonomy interest in making sure that contraceptives are available at state-licensed pharmacies. Legislation to this extent seems no less objectionable than the ones I listed above.
posted by allen.spaulding at 12:55 PM on July 12, 2009 [4 favorites]


adipocere, in most jobs, I would probably agree with you. But in this specific case, by misusing their gatekeeper authority, pharmacists can make their opinions into law without the consent of the legislature. That's not what the gatekeeping license was intended for.
posted by Malor at 2:46 PM on July 12, 2009


I know there are laws. That's great. I do not automatically retire personal judgment in the face of law. I do this for small things, like inappropriately placed traffic signs — if a line is too far back such that it is a dangerous place to stop, I stop where I think is best because I am not an automaton.. I do this for other, larger things, too. I think that stating that professional ethics automatically overrule personal conscience is too broad of a statement to adopt as a universal principle.

When Mark Felt became "Deep Throat" and revealed information that would alert us all to Watergate, he violated professional ethics in doing so. (Interestingly, Felt used the "just following orders" defense later and was anyway convicted for "extralegal" searches involving relatives of the Weathermen.) Roll back four years and recall the right-wingers suggesting that Felt was guilty of treason. We benefit from Mark Felt's decision.

When Jeffrey Wigand, head of R&D for a Big Tobacco company, blew the whistle and revealed that corporate executives knew that their additives were carcinogenic, and that they were intentionally increasing the levels of nicotine for additional addictive punch, he violated professional ethics, which dictate that he should have kept quiet. We benefit from Jeffrey Wigan's decision.

When Stanislav Petrov deliberately failed to report what appeared to be incoming American missiles, he overrode the training and his instructions in favor of personal choice. We benefit from Petrov's decision.

Remember in 2003, when John Ashcroft began subpoenaing medical records looking for late-term abortions, which would be edited to remove the identifying information of the patient? The "correct" thing to do is to hand over the records. If you were a secretary in a doctor's office, would you roll over or fight the decision? If your stance is "you took the job, you do the job," you must roll over. (Fortunately, it was fought, but I could not figure out the legal wrangling which kept it from going through)

Look, it's a great argument to make because it "wins" your particular situation. It's like being in a vicious fight and suddenly you've got a tire iron appear at your feet. It's the easiest thing in the world to pick it up and win that particular fight. Unfortunately, it means that afterwards, everyone gets the tire iron, too. The Republicans, who were pretty big on "He's the President, the President can do whatever he wants!" five years ago, are now more than a little fearful now that all of the power they've handed over to the hands of the executive branch is in the hands of Obama. It was a short-term strategy that worked very, very well for them, but they must now reap what they have sown.

I would not be so casual about taking away personal conscience as some kind of worldwide statement; it's an easy way to go because, right now, it's on your side, but it's a stance liable to come bite you in the butt later on. Now, I have no idea how to comfortably resolve the problem, but I think that mere regulation is probably not going to entirely cover it. For the specific case of the pharmacist, it's solvable, I hope, but I'd be very, very careful about what we take away from this little adventure. I actually agree that this is a jerk move by Jesusheads, but I think that this is not a good way to win.
posted by adipocere at 4:17 PM on July 12, 2009 [1 favorite]


Thanks for enlightening us on the way it really works, little e - I was pretty sure that pharmacists have an important professional role and aren't just a cog in the machine or something.

I agree that the scientific basis for the moral reasoning here is probably faulty. I just think that if this is the operative principle, court rulings should say so rather than saying "a pharmacist must always provide any legal medication, even if he or she believes it's going to be used to kill someone."
posted by XMLicious at 4:49 PM on July 12, 2009


I just think that if this is the operative principle, court rulings should say so rather than saying "a pharmacist must always provide any legal medication, even if he or she believes it's going to be used to kill someone."

This is a gross misunderstanding of this ruling. Here's what happened.

1) A number of pharmacists in Washington state refuse to carry Plan B and there is significant enough protest that the state regulatory agency decides to hold hearings. Among the concerns raised is that the refusal to carry Plan B is discriminatory in nature, something that the state's own anti-discrimination agency asserts.

2) After a lengthy set of hearings and meetings, the state decides to issue a set of rulings that require all pharmacies to carry drugs according to basic guidelines, which are sensitive to many economic, practical, practical, and reasonable exceptions, but do not allow for pharmacists to employ solely faith-based reasons in choosing which medicines to stock.

3) One pharmacy owner decides that these policies are unconstitutional because they interfere with his right to refuse to carry Plan B on the basis of his religion.

4) The 9th circuit overrides a lower court and says that the regulation itself is not unconstitutional. The policies are neutral and generally applicable to all pharmacists and due not interfere with his ability to practice his religion under 1st Amendment jurisprudence.

The courts never said "a pharmacist must do anything." What the courts said was simple. The rules are not violative of his right to Free Exercise.

Now you can disagree with the motivations behind passing such a law - believing that it is preferable for a state to allow pharmacists to assert faith-based reasons for choosing what prescriptions to honor. All this ruling did was say that if the state disagrees, and thinks that it is better to deny pharmacists the right to make faith-based decisions in this manner, it is constitutionally permitted to make such a regulation.
posted by allen.spaulding at 5:01 PM on July 12, 2009 [2 favorites]


It's so practical it repeats itself!
posted by allen.spaulding at 5:02 PM on July 12, 2009


All this ruling did was say that if the state disagrees, and thinks that it is better to deny pharmacists the right to make faith-based decisions in this manner, it is constitutionally permitted to make such a regulation.

I may just be being thick here, but what's the distinction you're drawing? Isn't the faith-based decision they're making, which the court is saying it's okay to declare verboten, "I must not provide this because I believe it may kill someone"?

Also, speaking of "gross misunderstandings" what you said there about what the court was stating - that The courts never said "a pharmacist must do anything." - doesn't really appear to be in line with this quote from the last link in the OP:
"Any refusal to dispense -- regardless of whether it is motivated by religion, morals, conscience, ethics, discriminatory prejudices, or personal distaste for a patient -- violates the rules," the panel said.
I've gotta say that the repeated "you're obviously incapable of understanding anything" that keeps getting advanced as the reason why anyone would think this is bad is pretty silly and insulting.

Possibly I have a subtle misunderstanding because the phrases "any refusal to dispense" or "violates" or "the rules" don't mean what I think they mean, but seriously, pretending that we must have no clue at all to hold the position we do? I didn't even make a statement about the 9th circuit or even any court in particular, simply a general statement about what I don't think courts should be prohibiting - but you couldn't pass up the chance to assert I'm misunderstand something, could ya?

Just the fact that this tactic has been trotted out so repeatedly during this thread makes it look like people are flailing around desperately in trying to find counter-arguments. And for me that lends credence that a substantial part of the opposition to pharmacists making their own choices here is really simply "your beliefs are WRONG". (Which, as I said above is okay but this ought to be stated openly, not cloaked in some pretense of a general principle that people must always "just do their jobs" without ethical or moral considerations.)
posted by XMLicious at 5:58 PM on July 12, 2009


Heh, 300 comments ago I think I was busy having a conversation with an inexperienced MD about No, Srsly, You Don't Want to Use These Antiobiotics Together Unless You Like Giving People Seizures.

I really wish I had more time right now to elaborate on why I have had to send people away empty handed. I'll be back in the morning with stories!
posted by little e at 6:05 PM on July 12, 2009


1) Isn't the faith-based decision they're making, which the court is saying it's okay to declare verboten, "I must not provide this because I believe it may kill someone"?

No. The faith-based decision is "my belief system considers this to be immoral independent of any medical or scientific judgment." Nobody is even asserting a belief that Plan B kills anyone. The belief is that contraceptives are immoral. It's not about saving lives, it's about saving souls. That's not the job of a pharmacist.

2) I have a subtle misunderstanding because the phrases "any refusal to dispense" or "violates" or "the rules"

I think this is where this is where you're getting tripped up. The word "panel" in the pull quote refers to the 3-judge panel that decided the case. The word "rules" refers to the rules promulgated by the State of Washington. This panel did not create those rules. It is merely stating the obvious: pharmacists cannot use a faith-based rationale for denying medicine that is independent from all technical, scientific, professional, and medical understanding. That is exactly what the state regulators said. No court imposed these rules on any pharmacist. They merely upheld them as constitutional against a First Amendment challenge. The decision is pretty straightforward and I just summarized the case history in the last post.

The denial of faith-based decision-making that is imposed on pharmacists was done through state regulatory channels. That's not a trivial distinction. This was reflective of a democratic process which was only then sanctioned by the 9th Circuit. You can't say that the court is imposing something on pharmacists. The court is upholding a state regulation that was challenged.

And you seem to be willfully ignoring what is targeted here. The only restriction placed on these pharmacists is they cannot replace legal, medical, and scientific reasoning with their own faith-based belief that is not grounded in anything but religious sentiment (or discriminatory sentiment, or personal ethics independent of medical and scientific reasoning).

If there is a reason to believe that the drugs will cause an adverse reaction, if there is a medical concern for the patient's well-being, then they can act as they wish. But the law now requires more than "because the Bible told me so." The litany of verboten prejudices you repeated are all non-scientific and non-medical. They are faith-based, disjoint from modern medical practice. The democratic organs of the state of Washington decided that pharmacists need more than just faith to deny someone a prescription. The 9th Circuit says that such a regulation is constitutional.
posted by allen.spaulding at 6:33 PM on July 12, 2009 [3 favorites]


sorry, I mistyped above. This section should read:

It is merely stating the obvious: under the regulations promulgated by the state of Washington, pharmacists cannot use a faith-based rationale for denying medicine that is independent from all technical, scientific, professional, and medical understanding.
posted by allen.spaulding at 6:35 PM on July 12, 2009


Well, XML and adipocere, I think I understand what worries you here, but remember that pharmacists are in an unusual position, where refusal to dispense amounts to a law that someone can't get something. Particularly with Plan B, which is very time-sensitive, if a given pharmacist says 'no', then the patient may simply be denied care she's legally entitled to, and has a prescription for.

This means that pharmacists are, on the fly, creating law because of their opinion. Instead of convincing society as a whole that they're correct, and getting the laws changed, they're short-circuiting that process, and abusing their position as gatekeeper to write new law. And that's not why we created the concept of pharmacists. They're not there to protect anyone's ethics, particularly not their own. They're there to make sure that doctors aren't making mistakes. They're supposed to be an extra layer of safety net, not a conscience.

If we declare assisted suicide legal, which will probably someday happen, it will be wrong for pharmacists to inject themselves into that decision, too. Their job is to enforce the law and prevent medical mistakes. They're guardians, not arbiters.
posted by Malor at 6:38 PM on July 12, 2009 [3 favorites]


"We really, really do not want "that's your job, do your job, no matter what" to become some kind of broad standard. "

I think you're muddying what professional ethics are. You're arguing as if professional ethics is "just follow orders", when a better example is the Hippocratic oath - something higher than whatever your job orders or the day happen to be, something that can and does override your orders of the day, but which is a professional code of conduct, and to which you cannot add your own private peccadilloes, affiliations, or agendas.

I cannot come up with a non-laughable code of conduct for pharmacists that allows a personal prejudice to override someone's legal need for treatment.

So I don't see your (legitimate) concern as pertinent to the pharmacy issue - I agree with you that people should not blindly follow orders, but I do not agree that it would follow from this that people can then ignore legitimate orders because they feel like it - ie for personal reasons - and expect to keep the job.
posted by -harlequin- at 6:40 PM on July 12, 2009 [1 favorite]


their primary contraceptive fails, and they go to the pharmacy but the pharmacist refuses to dispense the morning after pill, the pharmacist is forcing her to submit to his values, and removes her choices (if it is a one-pharmacy town).

A one-pharmacy town? In the greater Seattle area, with a population of over 3 million people, it was impossible to get Plan-B.
A condom broke on the eve of a 3-day weekend a couple of years ago. You didn't need a doctor's prescription to get Plan-B, but you did need a full pharmacist, not an assistant, to get it. It turns out that a lot of pharmacists go on vacation on a 3-day weekend.

3-5 hours on the phone EVERY DAY for three days, going through all medical listings, trying to find a place that had both the drug and the pharmacist at the same place at the same time and were open. Driving countless miles all around town, every day, due to all the red herrings from pharmacies that SAID they could dispense the drug (jump in the car and go!) then when you actually arrive in person, discover that they cannot.

In a metropolis of over 3 million people...
Hours spent every day on the phone and in the car...
It took three days before anyone could/would dispense the drug.

Healthcare in this country is a joke. WA State pharmacies particularly so from my data-point of one. The more stuff that is OTC, the better, because pharmacies here sure as hell can't cope with dispensing time-sensitive drugs. I don't care if they manage to get their shit together nine out of ten times if I happen to be the unlucky tenth.

Which also means that it is a Big Deal if you let just a few little pharmacists to fail to act professionally and refuse to dispense - because even in a city of 3 million, you can be up against a wall to get time-sensitive drugs. We should aim to ensure that no pharmacist is sub-standard, because there is no reason to think that any other outlet will be open or reachable.
posted by -harlequin- at 7:13 PM on July 12, 2009 [2 favorites]


That is pretty screwed up -harlequin- and a shocking failure of the system. I've got three pharmacies within a few blocks of my house (Pop:80K) and I just called the two that are open 16 hours a day and they'd both be able to dispense, in theory anyways and it's not a long weekend. It's easier to get Plan B in this neighbourhood than beer. I imagine it would be a bit trickier on a Sunday Christmas eve.
posted by Mitheral at 8:22 PM on July 12, 2009


Did any of you know that in Seattle a pharmacist can dispense birth control pills without a doctor's prescription? It's part of a pilot study with the UW School of Pharmacy.

So on the one hand, you have the fight over Plan B. On the other hand, you have pharmacies dispensing birth control without needing a doctor's OK. Again, we see Washington at its most self-contradictory.
posted by dw at 10:04 PM on July 12, 2009


Most incidents where I have had to flat out refuse to fill a prescription were because I suspected the script was fake or had been altered and I was unable to contact the ostensible prescriber. (Well, and a whole lot of other controlled substance shenanigans that aren't worth getting into here. I really dislike acting as gatekeeper for the controlled substances. FYI kids, pain pills may fuck up your life!) I tend to work odd hours, and it's difficult to reach physicians outside of their normal office hours or who work at hospitals. If I'm pretty sure it's not legit, I'm not going out of my way to prove it.

(Of course sometimes you are able to reach the physician, and it is a fake. And the physician happens to be a deputy sheriff, who calls all his law enforcement friends, and you get to have a drug bust right there in the drive through!!! And it turns out they've been calling in fake prescriptions all over town! And they're drinking beer while they drive around picking up their fake scripts, so they get them on the open containers too! Why am I always on vacation when the excitement happens??)

You know how occasionally on the news you see a physician leaving his or her office in handcuffs? That's never a surprise in the local health care community. And right up until the DEA agents knocked on the door, those guys were writing all kinds of scripts that pharmacists had to choose to fill or not fill.

Sometimes it's more difficult. It's 9 pm on a Sunday when a patient who has never been to the pharmacy before shows up with a script for a BIG whomping dose and huge quantity of...Oxycontin? MS Contin? I can't remember. Generally, there is no set maximum dose for opiates. Patients treated for pain over a long period of time, especially oncology patients, develop tolerance and can safely end up on doses that would cause fatal respiratory depression in me or you. I have absolutely no problem filling these prescriptions when I can look at what the patient got last month, and the months before, and see that the dose has been gradually and appropriately increased. Or if I can discuss it with the prescriber. I really, really hate to turn down someone in this situation, but if I don't have documentation that reflects the dose will be safe for the patient, and I can't reach the MD, I cannot dispense a potentially fatal dose. I think I ended up telling this lady to go to her regular pharmacy when they opened in the morning.

Here are a couple of good stories. The stickiest ethical situations I've encountered were along those lines--should I follow black letter law and send the patient away empty handed, or violate it and give them what they need? And I say "stickiest" in the most flippant way possible, because that is an easy choice. Yeah, you don't have any refills left, but you're standing at my counter wheezing. Here is an inhaler and I hope you feel better.
posted by little e at 6:36 AM on July 13, 2009 [3 favorites]


I don't really think all this personal vs. professional ethics talk is meaningful in this particular area of healthcare. We aren't choosing when to turn off ventilators. We aren't pronouncing brain death for organ donors. There's little to debate. Be patient, kind and decent.
posted by little e at 6:54 AM on July 13, 2009 [2 favorites]


little e - thank you. I've been that wheezing patient at the counter with no refills. Otherwise, it's the emergency room. And next time I will leave those damn kittens alone, no matter how cute they are.
posted by shoesietart at 7:46 AM on July 13, 2009


Using your example, it would be like forcing a Ford dealership to sell a Prius since they're so great for the environment. You mean like the way california requires a certain percentage of vehicle sales be low/zero-emissions?

Mostly, I'm curious how the state plan-B dispensary would work in jsonic land, since drugs still have to be dispensed by a trained pharmacist, so they would just work for the state, instead of some private pharmacy. The state pharmacy board would still have to force objecting pharmacists to fill the scripts, under threat of de-licensing the individual who refuses, et al.
posted by nomisxid at 2:44 PM on July 13, 2009 [1 favorite]


Nobody is even asserting a belief that Plan B kills anyone. The belief is that contraceptives are immoral.

allen.spaulding, it's pretty clear at this point that you simply make up straw men and whatever else you feel you need, completely off the cuff; whatever you can cobble together to make it look like other people are deluded or misinformed or maniacally religious. From the Seattle Post-Intelligencer link in the OP:
In the mind of pharmacist Jim Ramseth, there is a moral hierarchy when it comes to preventing pregnancy: Selling condoms and birth control pills is OK. But the emergency contraception known as Plan B is not, and Ramseth refuses to provide it.

...

"Everybody draws their own lines," Ramseth said. "And if a person's purpose is to kill a fertilized egg, then I disagree with that. Regardless of where the practitioner draws that line, they should have the right."
Malor: If we declare assisted suicide legal, which will probably someday happen, it will be wrong for pharmacists to inject themselves into that decision, too. Their job is to enforce the law and prevent medical mistakes. They're guardians, not arbiters.

If a pharmacist or a physician assists in an illegal suicide right now they can be held responsible for the death. A government changing its policies isn't going to alter that; a government changing its perception of morality doesn't make everyone else's moral judgment and sense of personal responsibility disappear.

It seems absolutely insane to me that you think it would be just fine and dandy if the government could compel physicians and pharmacists to be party to someone's death in that way - to force them into a position where they would feel they'd been responsible for the death of another human being.
posted by XMLicious at 7:57 PM on July 13, 2009


XMLicious - What you quoted directly supports what I said. The Pharmacist is claiming that he is drawing a line based on morality. Not science. Plan B is not designed to terminate a fertilized egg and it is unclear whether it even can - but that's never the intent. It's designed to prevent conception. It seems like the person quoted does not distinguish between Plan B and RU-486 and ifso, between intent and side affect.

More importantly, the concern isn't over the life of the patient, which the Pharmacist is legally allowed to do. He can't try to save souls. How is this a strawman. Everyone who is fighting this is claiming religious or moral grounds, not medical or scientific. Where am I creating a strawman?
posted by allen.spaulding at 8:34 PM on July 13, 2009 [1 favorite]


XMLicious said: "Nobody is even asserting a belief that Plan B kills anyone. The belief is that contraceptives are immoral.

Morality regarding this kind of prescription medicine is not one that a medical professional is allowed to bring to the workplace. It's that simple.
From the Seattle Post-Intelligencer link in the OP: In the mind of pharmacist Jim Ramseth, there is a moral hierarchy when it comes to preventing pregnancy: Selling condoms and birth control pills is OK. But the emergency contraception known as Plan B is not, and Ramseth refuses to provide it.

"Everybody draws their own lines," Ramseth said. "And if a person's purpose is to kill a fertilized egg, then I disagree with that. Regardless of where the practitioner draws that line, they should have the right."
Then Jim Ramseth is in the wrong line of work. I simply do not understand what you, XMLicious, and others refuse to get about this.

Your flavor of morality is not one that has been ruled acceptable or standard by the government. You have to just take your lumps. Fight for it with letters to your Congressman, fight for it in protests on the street; fight to change the legislation wherever you like. But the laws of this country say that you don't get to foist your morality on everyone else.

A government changing its perception of morality doesn't make everyone else's moral judgment and sense of personal responsibility disappear.

Well, I guess that depends on your definition of government, doesn't it? In the U.S., the government is designed to represent the will of people.

But ultimately, you are correct; you are absolutely entitled to your moral judgment. And I am entitled to mine.

But most importantly, yours doesn't trump mine, according to the government.
posted by pineapple at 8:55 PM on July 13, 2009 [4 favorites]


I favorited the shit out of that one pineapple.
posted by lazaruslong at 8:59 PM on July 13, 2009 [1 favorite]


allen.spaulding: What you quoted directly supports what I said. The Pharmacist is claiming that he is drawing a line based on morality. Not science.

Uh, no, that's not what you said at all and I don't think hand-waving is going to let you get away with retconning what you said. You said a bunch of stuff about religion (when I'd already pointed out that the court ruling is much broader than that) and then claimed Nobody is even asserting a belief that Plan B kills anyone which is unquestionably a false statement.

Where are you creating straw men? Come on, how dumb do you think I am? "I must not assist in killing someone" versus "I must prevent my patients from using contraceptives because it's immoral."

By now shifting to emphasizing, "it's moral or religious, not scientific or medical!" you're demonstrating my point: this has nothing to do with some general principle that pharmacists or other professionals must not be allowed to act on their morals, it's that specific principles they hold are WRONG.

If the idea is that Jim Ramseth's belief that Plan B can destroy a fertilized egg is wrong that is what should be stated, or if it's that Jim Ramseth cannot be allowed to act towards a fertilized egg the way the he would towards an infant (because it's "unscientific" to do so I guess?) that should be stated - it shouldn't be cloaked in some ridiculous faux-egalitarian principle that "professionals can never act upon their morals" or the other ones that have been put forward.

pineapple: Then Jim Ramseth is in the wrong line of work. I simply do not understand what you, XMLicious, and others refuse to get about this.

No one is refusing to get anything - that's just another example of you guys trying to pretend that anyone who disagrees with you has to be clueless or ignorant.

People have refrained until now from saying what you just said:

Your flavor of morality is not one that has been ruled acceptable or standard by the government.

"Their morality is wrong, my morality is right." I don't understand why anyone's been trying to pretend that the motivation is anything other than forcing these pharmacies and pharmacists to follow someone else's moral code.

(And I would point out that as I said above, I have absolutely no problem with Plan B myself. It's just another element of self-deception on your part that only a certain stereotypical person could fail to agree with you on this.)

There isn't any general principle here; the government is specifically saying to these pharmacists, "You are not allowed to regard this as killing someone."

Well, I guess that depends on your definition of government, doesn't it?

If you are saying that you surrender your moral judgment and personal responsibility to the government and simply say, "Whatever the government says is right!" I call bullshit - you do not have a definition of government that says this. Like allen.spaulding you're just saying anything you can come up with.

But most importantly, yours doesn't trump mine, according to the government.

Au contraire, that's exactly what the government is saying here. If you are a pharmacist then you can be compelled even to the point of doing something that constitutes assisting in killing someone in your eyes. And the only reason you're acceeding to the government being able to do so is because you're expecting that you'll never be put in the same position, that the government in the future is going to agree with your moral code. (And you're probably betting that the ability of the government to do this isn't going to spread too far beyond the pro-life / pro-choice debate.)
posted by XMLicious at 10:20 PM on July 13, 2009


And how is your argument any different than that in support of slavery, or repression of women, or any of a multitude of moral codes, XMLicious?
posted by five fresh fish at 10:36 PM on July 13, 2009


It seems absolutely insane to me that you think it would be just fine and dandy if the government could compel physicians and pharmacists to be party to someone's death in that way - to force them into a position where they would feel they'd been responsible for the death of another human being.

Not physicians, since they're in the judgment business. But pharmacists? Absolutely. If the patient and his or her doctor decide that it's time for life to end, it's not the pharmacist's job to interfere. It's his job to prevent accidental interactions, and to make sure the patient understands what the drugs will do. As long as the patient understands, it's the pharmacist's job to dispense them. His opinion is irrelevant.

His unique gatekeeper status gives him no right to force others to comply with his moral views, and in fact it takes away from his own autonomy. That's the deal with being a gatekeeper. If you're guarding the gate, and you see someone you absolutely despise and know will cause trouble, but you're under orders to let that person through, then you open the gate. Gatekeepers have some latitude, but they fundamentally must follow orders or stop being gatekeepers. They do not own the gates, the city does.

If that person is going through the gates to suffer the death penalty, and you're a decent human being, you'll warn them and make sure they know stepping through the gate will kill them. But if they want to come through anyway, you open the gate, because you don't own it. It's not your gate.

Pharmacists are not arbiters. Doctors are the conscience. Pharmacists are there to prevent accidents.
posted by Malor at 12:02 AM on July 14, 2009 [1 favorite]


anytime, shoesietart :)
In the mind of pharmacist Jim Ramseth, there is a moral hierarchy when it comes to preventing pregnancy: Selling condoms and birth control pills is OK. But the emergency contraception known as Plan B is not, and Ramseth refuses to provide it.

"Everybody draws their own lines," Ramseth said. "And if a person's purpose is to kill a fertilized egg, then I disagree with that. Regardless of where the practitioner draws that line, they should have the right."
Good god, I didn't even catch that bullshit before. Here. Science. This is the first thing I found with a half-assed 30 second PubMed search. (Note: Don't believe everything you read on PubMed, but AJOG appears to be a reputable publication.)
Am J Obstet Gynecol. 1999 Nov;181(5 Pt 1):1263-9.
The mechanism of action of hormonal contraceptives and intrauterine contraceptive devices.Rivera R, Yacobson I, Grimes D.

Modern hormonal contraceptives and intrauterine contraceptive devices have multiple biologic effects. Some of them may be the primary mechanism of contraceptive action, whereas others are secondary. For combined oral contraceptives and progestin-only methods, the main mechanisms are ovulation inhibition and changes in the cervical mucus that inhibit sperm penetration. The hormonal methods, particularly the low-dose progestin-only products and emergency contraceptive pills, have effects on the endometrium that, theoretically, could affect implantation. However, no scientific evidence indicates that prevention of implantation actually results from the use of these methods. Once pregnancy begins, none of these methods has an abortifacient action. The precise mechanism of intrauterine contraceptive devices is unclear. Current evidence indicates they exert their primary effect before fertilization, reducing the opportunity of sperm to fertilize an ovum.

PIP: The mechanism of action of contraceptive method is essential for the development of new methods. It also influences cultural and individual acceptability of a contraceptive method. Modern hormonal contraceptives and intrauterine contraceptive devices have multiple biologic effects. Some of them may be the primary mechanism of contraceptive action, whereas others are secondary. For the combined oral contraceptives and progestin-only methods, the main mechanism of action are the inhibition of follicular development, ovulation, and as consequence, corpus luteum formation. Further, it is also involved in the alteration of the cervical mucus that inhibit sperm penetration. For hormonal methods, particularly the low-dose progestin-only products and emergency contraceptive pills have effects on the endometrium that, theoretically, could affect implantation. However, no scientific evidence will indicate that prevention of implantation actually results from the use of these methods. Once implantation has taken place, none of these methods are effective and pregnancy proceeds normally. The precise mechanism of IUDs remains unclear because of difficulties in carrying out relevant investigations in humans and the limitations of extrapolating findings from animal studies. However, several studies evidenced that IUDs exert their primary effect before fertilization, by impeding the ascent of sperm to the fallopian tubes or by reducing the ability of sperm to fertilize an ovum.
That article's old, but there haven't been any recent mindblowing advances in our understanding of how contraceptives work. THE LINE HE IS DRAWING DOES NOT MAKE SENSE. If he refused to dispense any hormonal contraceptives, I would still disagree with him but at least he would be logically consistent. Either Jim Ramseth is full of shit, or he could have saved himself a lot of trouble with a half-assed 30 second PubMed search.
posted by little e at 12:57 AM on July 14, 2009 [1 favorite]


little e, that's because he's really one of the 'punish sluts' crowd, not the principled objector he tries to paint himself as. Regular birth control can be rationalized away as being okay for married couples and so forth, but Plan B, despite being the same thing at higher dose, is something that only women "of loose morals" use.

He's a pharmacist; he's responsible to know what you just posted. Punishing sluts is the only reasonable explanation that still presumes basic competence on his part.
posted by Malor at 1:42 AM on July 14, 2009


Aw, yeah, I know. That comment was much ruder when I first wrote it, and I think when I edited out most of the profanity I also removed the obviousness of my sarcasm.
posted by little e at 2:19 AM on July 14, 2009


It's just such horrible, stupid, obvious bullshit.
posted by little e at 2:22 AM on July 14, 2009


Ah, okay -- I read your post as being frustrated with his stupidity, rather than being sarcastic about obvious untruths. Sorry for the too-obvious observation. :-)
posted by Malor at 5:34 AM on July 14, 2009


"Their morality is wrong, my morality is right." I don't understand why anyone's been trying to pretend that the motivation is anything other than forcing these pharmacies and pharmacists to follow someone else's moral code.

It's pretty clear that you haven't read the ruling. The point isn't that their moral code is wrong, but that the State of Washington is allowed to cabin its ability to interfere with medical and scientific judgment.

There is a political movement that is trying to stop the use of this drug by interfering with the doctor-patient relationship. This is not based out of medical or scientific concern for patients, but out of moral and religious sentiment. There were public meetings held by the state regulatory agency and a code drafted to prevent this from happening. The court upheld the regulations. Nobody is substituting one moral judgment for another. They are merely saying that the Pharmacist must focus on saving lives and not saving souls.

If a high school biology teacher refuses to teach evolution because she believes it's immoral, should she have freedom of conscience? If the state wanted to mandate its teaching, should she be able to opt out? Is the state saying her morality is wrong? How is this any different?

Again, nobody is saying Plan B kills patients. Some might believe that preventing an egg from being fertilized is murder, sure. There are lots of crazy people out there. But contraception is no more murder than sneezing is. Some believe that Plan B may cause an abortion of an already-fertilized egg, something which is not medically indicated and if true would be at best a side effect. If you want to call this murder, I hope you don't mind me calling Kleenex a genocidal company. Plan B is not an abortifacent. There is no medical reason to think it kills anyone.
posted by allen.spaulding at 6:28 AM on July 14, 2009


XMLicious said:
"But most importantly, yours doesn't trump mine, according to the government."

Au contraire, that's exactly what the government is saying here. If you are a pharmacist then you can be compelled even to the point of doing something that constitutes assisting in killing someone in your eyes."
I no longer have faith in your reading comprehension skills on this topic.

Yes, if you are a pharmacist you can be compelled to give medicine that a board of licensed medical experts have decided is safe and standard; if you can't take the heat, get out of the kitchen. This argument has been made to you and your side in a million logical ways throughout this thread, and you are just blindly refusing to acknowledge it.
There isn't any general principle here; the government is specifically saying to these pharmacists, "You are not allowed to regard this as killing someone."
No. The government is specifically saying to these pharmacists, "Regard this as whatever you want, but dispense it when the scrip comes in because that's the job for which we licensed you. Don't want to play by our rules? Then you don't get our license."
"People have refrained until now from saying what you just said: 'Your flavor of morality is not one that has been ruled acceptable or standard by the government.' = 'Their morality is wrong, my morality is right.'

Well, I guess that depends on your definition of government, doesn't it? = If you are saying that you surrender your moral judgment and personal responsibility to the government and simply say, "Whatever the government says is right!" I call bullshit - you do not have a definition of government that says this. Like allen.spaulding you're just saying anything you can come up with."
These are two very egregious and silly twistings of my words. At this point, I've dismissed you as a valid participant in this discussion. You are trying so hard to make the factual observations and opinions of other people fit into your preconceived boxes about how this argument will advance that it's not worth my time. Someone with less to do today can continue to rebut your intentionally obtuse position.

By the way, for any of you polarized and partisan readers out there who might be playing the home game, please understand that it's this exact sort of hands-over-ears, wildly interpretive reframing of reasoned positions that make the other side abhor engaging with you. It's like Brer Rabbit and the tar baby.
posted by pineapple at 7:03 AM on July 14, 2009


Also, as long as I'm ranting --

The irony that we get to spend weeks watching GOP Senators attack Sonia Sotomayor for what they fear will be her tendency as a liberal to interpret the law to fit her politics,

and meanwhile the nutbags and anti-choicers and Moral Minority are over here arguing that, in fact, an anti-choice pharmacist DESERVES -- nay, is morally obligated -- to interpret the law to fit his politics...

would be delicious if it weren't so bloody schizophrenic and sad.

Here's the death of your party, Republicans. Go ahead and keep rocking this big tent where the libertarians and the homophobes and the Nixon Republicans and Big Business and the religious wingnuts and the Palin lovers and the sexists are all to live together in one big happy. Good luck with that.
posted by pineapple at 7:10 AM on July 14, 2009 [2 favorites]


There isn't any general principle here; the government is specifically saying to these pharmacists, "You are not allowed to regard this as killing someone."

Also, what's wrong with this? Can anyone opt-out of any legal obligation by making up some nonsensical belief that to do so would be to commit murder? Your honor, I didn't stop at the red light because I believe that brakepads are people too.

Perhaps more on point:

Your honor, you can't send me to jail for rape. I believe menstruation is murder because every egg is sacred. I had to inseminate her otherwise I'd have killed someone.

Why can't a state decide that this is an invalid argument when we're talking about a heavily regulated industry performing a public service that is essential to the doctor-patient privilege?
posted by allen.spaulding at 8:36 AM on July 14, 2009


There is a difference between the state compelling you to take an action and the state compelling you not to. A better example than an over the top rape analogy might be paying taxes.

It's a good discussion though. Why do we allow any side stepping of rules, regulations and law because of religion? Sikhs are allowed to wear their kirpans to university and to school in places where zero tolerance can get you suspended for a paring knife. OSHA has exempted Amish and Sikh workers from hard hat requirements.

"the nutbags and anti-choicers and Moral Minority are over here arguing that, in fact, an anti-choice pharmacist DESERVES -- nay, is morally obligated -- to interpret the law to fit his politics."

Are you lumping everyone who doesn't agree 100% with your point of view into the "nutbags and anti-choicers and Moral Minority" category? Because I'm none of those things.
posted by Mitheral at 10:41 AM on July 14, 2009


Mitheral said: "Are you lumping everyone who doesn't agree 100% with your point of view into the 'nutbags and anti-choicers and Moral Minority' category? Because I'm none of those things."

Depends. Do you believe that "an anti-choice pharmacist DESERVES -- nay, is morally obligated -- to interpret the law to fit his politics"?
posted by pineapple at 1:05 PM on July 14, 2009


If a pharmacist is confused enough to think that Plan B somehow causes an abortion...then I don't want him as my pharmacist.
posted by miyabo at 6:10 PM on July 14, 2009 [2 favorites]


It's a good discussion though. Why do we allow any side stepping of rules, regulations and law because of religion?

This is the substantive question posed by the Free Exercise clause. Modern First Amendment jurisprudence asks whether a certain restriction is a neutral law of general applicability, a test first formulated in Employment Division v. Smith. You can read some of it in this 9th Circuit opinion. (Things are a little more complicated when it comes to federal statutes and RFRA, which was congress' moderately-failed attempt to overturn this standard. Before 1990, there was a strict scrutiny standard that protected a lot more religious conduct.)

Anyway, this is how the law looks to answer that question. If a state passed a law saying "You can't sell Halal meat" it'd certainly fail the test. If a state passed an animal cruelty law that outlawed a certain form of inhumane slaughter that happened to be used in the preparation of some Halal meat, that'd likely be ok.

As you can imagine, this is an extremely complicated and bizarre area of the law, with little consistency from case to case and over time. Many of the big-name legal scholars have dedicated their careers to studying/explicating these rulings and proposing superior standards and tests.
posted by allen.spaulding at 7:17 PM on July 14, 2009 [1 favorite]


fff: And how is your argument any different than that in support of slavery, or repression of women, or any of a multitude of moral codes, XMLicious?

I usually find your viewpoint salient and insightful fff but this doesn't jive with me - an implication from the language used seems to be that since a pro-choice stance is right it "doesn't count" as a moral code to be included in this analysis. Not so at all. Someone who is saying "how dare anyone be allowed to act the way these pharmacists are!" is moralizing just as certainly as anyone with a more antique moral code.

It also seems like a rather ostentatious conflation to say that instead of slavery or repression of women being most similar to "we're right so we can force anyone to do anything even to the point of forcing people to participate in an act they believe is killing someone", no, it's saying "it shouldn't be possible for the government to force someone to do that" which is like slavery. The former reasoning seems like it would be much more easily employed in supporting any moral code at all rather than the latter, though I wouldn't expect either of them to stand alone anyways.

Since fff decided to bring in an analogy to slavery I'll make a point I've refrained from making before now. What this reminds me of the most is the Fugitive Slave Laws, where pro-slavery advocates tried to rig it so that everyone, even abolitionists, was forced by law to participate in slavery and in maintaining slavery. (And before anyone starts screaming, of course my analogy isn't that pro-choice or pro-life beliefs are like slavery, it's to the tactic of forcing one's ideological opponents to participate in the activity or institution they disagree with.)

Malor: If that person is going through the gates to suffer the death penalty, and you're a decent human being, you'll warn them and make sure they know stepping through the gate will kill them. But if they want to come through anyway, you open the gate, because you don't own it. It's not your gate.

Malor, it's really great that if as you say you owned a licensed business operation and someone offered to pay for your assistance in an execution, rather than declining the business and directing them to another vendor you'd say, "well I don't believe in killing people, but step right on up and I'll help!" - but not everyone would, for some people their conscientiousness in regards to being a party to killing someone would take precedence over their conscientiousness in fulfilling a role in society implied by their licensure.

If somehow I'd come into possession of being the sole provider of some necessary factor in euthanasia, even if I'd become so unwillingly it would give me pause. But the scenario you're talking about is where people devoted their lives to being pharmacists perhaps decades before euthanasia was legalized and they aren't going to be the exclusive vendors of it. It still seems insane to me that you'd simply go to every pharmacist and say "Sorry, now that the law has changed, you have to help kill people."

allen.spaulding: It's pretty clear that you haven't read the ruling.
pineapple: I no longer have faith in your reading comprehension skills on this topic.

It's pretty ridiculous that, on top of all of the other attempts to paint anyone who disagrees with you as clueless or ignoramuses or something, you're going to claim that I can't read. It says alot about your position that you feel you can't refrain from advancing this pretense.

Yes, if you are a pharmacist you can be compelled to give medicine that a board of licensed medical experts have decided is safe and standard; if you can't take the heat, get out of the kitchen. This argument has been made to you and your side in a million logical ways throughout this thread, and you are just blindly refusing to acknowledge it.

Nope, this "blind refusal to acknowledge" something I've explicitly agreed with is another straw man on your part. As I said above, if the idea is simply that they can't be allowed to think what they think scientifically (which may be true, I'm content to trust little e on this) then that could be straightforwardly stated there should be no need to try to invalidate things like, "Any refusal to dispense -- regardless of whether it is motivated by religion, morals, conscience, ethics...".

As I have said repeatedly, it would be just fine to simply say that these people are wrong scientifically and medically. But people in this thread and the ones who are opposed to anyone refusing to dispense Plan B (who are the ones I'm talking about, nice bit of legerdemain trying to spin what I'm saying as a misinterpretation or inability to read one specific court ruling) want a "home run" against their ideological opponents.

Also, pineapple, if indeed my response to your "That depends on your definition of government" quip was just a twisting of your words I really would like to hear you give your definition of government where "A government changing its perception of morality [makes] everyone else's moral judgment and sense of personal responsibility disappear" or what you meant by implying that such a definition would have bearing. Nothing having to do with me making you "fit into ... preconceived boxes", it's just pretty obvious that you were bullshitting in insinuating that we just need to use the right definition of government so that individual morality is non-existent or irrelevant. So yeah, I'm pretty sure you do think that at least your moral judgment and personal sense of responsibility exist and should be acknowledged by the government.

Or, y'know, you could just continue to pretend that I'm not eligible to be a "valid participant in this discussion" by your indisputable standards. Let's see... I can't read, I'm the sort of person who wants to force my morality on you, I can't validly be allowed to discuss this topic... but it's me who's so unacceptably guilty of putting you in "preconceived boxes" that my participation in this discussion is invalid.

allen.spaulding: If a state passed a law saying "You can't sell Halal meat" it'd certainly fail the test. If a state passed an animal cruelty law that outlawed a certain form of inhumane slaughter that happened to be used in the preparation of some Halal meat, that'd likely be ok.

That doesn't seem like a great parallel - so out of curiosity, what if a state passed a law that required a Halal deli or a Kosher deli to sell non-Halal / non-Kosher meats? Although I don't think it's quite parallel to requiring someone to participate in what they perceive as helping to kill someone.



Just to reiterate an important point - as I said above several times, if anyone wants to assert that the scientific or medical notions that would underlie these particular pharmacists' particular moral decisions in this particular case are invalid, and that's why they need to be overridden, that's okay with me. (And indeed this thread's resident pharmicist, little e, is saying so, and that's good enough for me.) It's the general principle that ethics or morals or conscience can't be allowed for pharmacists or others, at least not allowed so far that pharmacist would refrain from taking an action that would help to kill someone - a principle which has definitely been advanced, if only in this thread - that I disagree with. And which I furthermore think is being advanced because those proposing it are simply seeing their own ethics and morals and conscience as indisputably right and something which goes without saying.
posted by XMLicious at 1:44 AM on July 15, 2009


For fuck's sake. I gave an example to describe the workings of the Free Exercise clause with no intention to relate back to the underlying question here and you can't see this. You get pissy when people note you aren't talking about the underlying case and then you once again refuse to acknowledge anything that resembles a fact here. You're clearly hung up on the idea of moral in a way that it is not used in the Washington statute and by responding to some of the tangential points here instead of the actual history or law in question, you're not really engaging in any meaningful substantive debate. Furthermore, you're ignoring all issues of power dynamics and of discrimination, which makes the fugitive slace analogy just remarkably inapt.

So I will ask you one final time. Do you believe that a high school biology teacher should be able to refuse to teach children evolution because he thinks it's immoral?

If I think that serving black customers in my restaurant will kill a magical fairy in my head, can I refuse to serve them?
posted by allen.spaulding at 3:12 AM on July 15, 2009


...you just declared that I'm not engaging in meaningful substantive debate and that I'm making remarkably inept analogies, then asked about whether racially discriminating between restaurant customers would kill magic fairies. I hope I don't need to get too in-depth in explaining why this is another example of you having a severe double standards problem and a need to strike a pretense that those who disagree with you are inherently inferior somehow.

I think that a school system should be able to have say over the curriculum taught in it. So I think that a private evangelical Christian school system should be able to require its teaching staff to teach Creationism or Intelligent Design or whatever and the public school system and others should be able to require its staff to teach evolution.

I think that public schools should teach evolutionary biology but not because Creationism is WRONG or "False" and because evolution is right or "Truth" but because the objective is to prepare the students for further studies and it's evolution that is integral to the biology they would study in college or would be background to what they'd read in books or newspapers or magazines. The important thing is the utility of what's being taught, not because the school authorities have Truth and they need to Teach What's Right. I would oppose making Creationism a major component of public school biology for the same reason I'd oppose making Twistor theory a major component of public school physics... because true or not those things aren't going to be very useful in learning more biology or learning more physics.
posted by XMLicious at 6:07 AM on July 15, 2009


So if you think that a law requiring teachers to teach something even if it violates their moral code is ok - what's the problem here? The law does not say that Plan B is right or that those who believe that birth control is murder is wrong. It just limits the ability of a pharmacist to completely substitute their religious views for scientific responsibility - just like a religious public school teacher couldn't refuse to teach evolution.

And the magical fairies quip isn't that far off. You realize that the assertion that an unfertilized egg is a human being is just nuts. This makes menstruation manslaughter. The courts have acknowledged the complexities around abortion. Med students and doctors never have to perform one and nearly all states refuse to fund them at all - but are allowed to fund programs to talk women out of them. But to extend this to contraception is really pushing it. Especially when it is enforced in a discriminatory manner. And again, there is a very specific power dynamic in play here that makes context very important.
posted by allen.spaulding at 7:33 AM on July 15, 2009


XMLicious:
But ultimately, you are correct; you are absolutely entitled to your moral judgment. And I am entitled to mine. But most importantly, yours doesn't trump mine, according to the government.
Au contraire, that's exactly what the government is saying here. If you are a pharmacist then you can be compelled even to the point of doing something that constitutes assisting in killing someone in your eyes. And the only reason you're acceeding to the government being able to do so is because you're expecting that you'll never be put in the same position, that the government in the future is going to agree with your moral code.
And how is your argument any different than that in support of slavery, or repression of women, or any of a multitude of moral codes, XMLicious?
I usually find your viewpoint salient and insightful fff but this doesn't jive with me - an implication from the language used seems to be that since a pro-choice stance is right it "doesn't count" as a moral code to be included in this analysis.


Your argument does not seem to me to be any different than one which would state that considerations of a pro-slavery, pro-women-as-chattel, pro-etcetera stances should be considered valid arguments against the involvement of government in defining what is and is not allowed.

There are myriad aspects of our social and business lives that are dictated by law. I assume you have no beef with racial discrimination being barred from decisions as to who may and may not shop at your local 7-11. I assume you have no beef with sex discrimination being barred from decisions as to who may or may not be employed, or vote, or drive a car.

That you have a beef with laws determining that a privileged business operation providing sole-source medical products is not allowed to discriminate in its provision of legal medicines is at odds with the support you presumably offer toward laws that affect non-privileged businesses that are providing non-essential products in a highly competitive market.

If it is okay to require a 7-11 to allow any race to shop in the store, when the highly competitive market in which 7-11s operate provide endless alternatives for those against whom it would discriminate,
then surely it is okay to require pharmacy, which operates in an oligopoly market protected by government fiat, not discriminate in the delivery of legal medications.
posted by five fresh fish at 9:17 AM on July 15, 2009 [1 favorite]


Also, you have your slavery analogy bass-ackwards. It is not a case of forcing people to have slaves; it is a case of forcing people to not have slaves despite their desire to have slaves. It is a case of forcing pharmacists to not have the ability to make a woman stay pregnant despite their desire to make women stay pregnant. (And in this case, it's not even that: the woman isn't even pregnant yet!)
posted by five fresh fish at 9:22 AM on July 15, 2009


Malor, it's really great that if as you say you owned a licensed business operation and someone offered to pay for your assistance in an execution, rather than declining the business and directing them to another vendor you'd say, "well I don't believe in killing people, but step right on up and I'll help!" - but not everyone would, for some people their conscientiousness in regards to being a party to killing someone would take precedence over their conscientiousness in fulfilling a role in society implied by their licensure.

You are a gatekeeper, and you do not own the gate. It is society's gate. If you don't want to run the gate by society's rules, then you need to find another job.
posted by Malor at 10:57 AM on July 17, 2009


I want to be an executioner. You know, the well-paid guys who throw the switch or inject the lethal dose. And then I want to refuse to do my job on conscientious grounds. But they can keep paying me, of course. I don't want to give up the job, I just don't want to do it!
posted by five fresh fish at 4:33 PM on July 17, 2009 [2 favorites]


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