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Monday, June 25, 2018

Miscarriage of Duty

I have so many problems with this situation. Having been on both sides of the counter for this, I can sympathize with the mother and how poorly it was handled.

1. You're a pharmacist. You understand how these medications work. The woman was carrying a lifeless fetus in her womb. Whatever your personal beliefs about abortion, this is not killing a baby. She is inducing delivery of a deceased fetus. You are no more responsible for its death than the hotelier who gave a couple a room is responsible for them getting pregnant on one of his beds.

2. I know it's a "he said, she said" sort of situation but did the pharmacist really stand at the counter, prescription in hand, and refrain from giving it to her? If so, he's no colleague of mine and I'd be ashamed to call him one. Take her aside to explain it. Allow someone else to sell it to her. Under no circumstances should you explain it's for your own ethical reasons that you are denying the sale. I won't push my beliefs on you, you don't push them on me. That's how this played out in front of other patients. Yes. You are allowed to possess them. Yes. You, in Arizona, are allowed to deny the sale for this reason. However, your lack of empathy is uncalled for and galling. Call a pharmacy down the road and transfer it.

3. I do not agree with these "ethical, moral, religious" exemptions. If I believed the world was flat, I'd not take a job in a globe factory or store. (Is this the best analogy? No. It's lame, but it'll make people think a little about the inanity.) If you don't like vaginas, don't become a gynecologist. You don't get to pick and choose which medications you're going to dispense. An addict is dying in the street. Do you hand a box of Narcan over the counter to help save her and say "come back and we'll bill it later"? Do you hand a bottle of Nitroglycerin over to the wife of a man who is having chest pains out front? Definitely. Do you allow your beliefs to get in the way of saving someone's life? You cannot if you have any ethics at all.

4. When I was in my Ethics class in school, we had to watch these cheesy vignettes and determine if they were ethical responses from the pharmacist. The only one I remember was a man filling Estrogen for himself on his way to becoming a woman. The pharmacist looked at him and went "WHOA! NO way!" and handed it back. At the time, I remembered the Stone Temple Pilots song, Creep, and I said "It's not our decision. We have to let him become half the man he used to be". It's a legitimate prescription for a legitimate reason. While we may not agree with the intended use, there is nothing ethically wrong with it.

which leads me to. . .

5. "Arteaga filed a complaint with the Arizona State Board of Pharmacy. And, she wants a law in place that would require pharmacies to fill prescriptions approved by doctors." 
Whole buncha NOPE NOPE NOPE on this one. (If anyone wants to know why this is a bad idea, see "Opioid Crisis in America" and you'll learn what happens in these cases.) We are professionals. We are trained to use professional judgement. While I sympathize with her in this ordeal, there is no way in hell I am going to be a prescribers' bitch and fill whatever they write. That is not the job of the pharmacist. I can see it now:
"Sorry ma'am. Your prescriber is trying to kill you with this drug interaction but the law says I have to give it you and not question his almighty-ness."

To me this means she, like most of the general public, does not understand a damn thing about what our job is. We are more than just "pouring pills from big bottles into little bottles, label slapping, mindless automatons". When the social media outrage over this subsides, we will back in the shadows, doing our jobs of making sure your prescribers don't kill you. That you take the correct medications correctly.

Now that I think about it, I'm Batman.


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