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Ob/gyns misrepresent pharmacy practice,
misconstrue conscience rights
Pharmacist organizations, led by APhA, respond to
commentary in Obstetrics & Gynecology that claims pharmacy professionals
do not have same ethical and moral discretion as physicians.
“A policy that allows pharmacists to dispense or not
dispense medications to patients on the basis of their personal values
and opinions is inimical to the public welfare and should not be
permitted.” So argue L. Lewis Wall, MD, and Douglas Brown, PhD, in
a commentary published in the May issue of Obstetrics &
Gynecology that focuses on one actual and one hypothetical instance
of a pharmacist refusing to dispense emergency contraception (EC).
Upon learning of this attack on pharmacists’ rights of
professional conscience, APhA prepared a response and, with the
collaboration of the American College of Clinical Pharmacy, the Academy
of Managed Care Pharmacy, and the American Society of Health-System
Pharmacists, submitted a letter to the editor of the lead journal of the
American College of Obstetrics and Gynecology (ACOG).
Wall and Brown’s objection to making it possible for pharmacists
to have the same opportunity as physicians and nurses to step away from
professional activities they find personally objectionable is based on
equal parts misunderstanding of what pharmacists do and an inapplicable
“slippery slope” argument, according to the pharmacists
group. In their letter, APhA and colleagues note the commentators’
critique rests on “intentional blurring of pharmacist refusals
with unethical obstruction of patient access to medications, …
ignorance of contemporary pharmacy practice, and … lack of
citation to the positions of health care professional
organizations.”
The full letter can be accessed by clicking on the second Web Link
below, but two of the ob/gyns’ claims and the pharmacists’
corrections bear highlighting.
To bolster their argument that “unlike physicians, pharmacists do
not exercise full autonomous control and authority over their area of
expertise,” Wall and Brown state, “Pharmacists can dispense
but not prescribe.” The commentators also claim that a person
presenting a prescription at a pharmacy is the pharmacist’s
“customer” while remaining the physician’s
“patient” and that “pharmacists do not take
comprehensive medical histories, perform physical examinations, or
evaluate laboratory results when they fill prescriptions.”
APhA and its colleagues debunk each of these claims, pointing out that
more than 40 states authorize pharmacists and physicians to enter into
collaborative practice agreements under which pharmacists can prescribe
or modify drug therapy and monitor patients’ response to
treatment. In Alaska, California, Hawaii, Maine, Massachusetts, New
Hampshire, New Mexico, Vermont, and Washington, in fact, pharmacists
working under a protocol are able to prescribe and dispense EC. Wall and
Brown also failed to note that ACOG has recently launched a campaign
called Ask Me, which promotes expanded access to emergency contraception
(EC) by either ensuring that women have advance prescriptions for the
therapy or that more states allow pharmacists to prescribe and dispense
EC.
The other significant point Wall and Brown miss, according to the
pharmacist groups, is that allowing pharmacists to follow their personal
conscience in professional matters does not and should not mean that
patients are denied legal, safe, and necessary drugs. APhA and its
colleagues each have stated policies that “support the ability of
the pharmacist to opt out of dispensing those prescriptions where the
pharmacist has an objection to the intended use of the medication while
concurrently supporting the establishment of systems to assure patient
access to legally prescribed, clinically safe therapy,” the
response letter states. In practical terms, these policies, which are
echoed by statements of the American Medical Association, encourage the
development of procedures that permit pharmacy professionals to step
away without stepping in the way of patients getting appropriate
medications.
When such policies are followed, pharmacies can put procedures in place
to have certain prescriptions filled by personnel who do not have
objections, understandings can be developed between prescribers and
pharmacists, and alternate dispensing systems can be established. APhA
and other pharmacist organizations also encourage practitioners to
choose practice sites with an eye toward whether they will be forced to
confront situations where they will be presented with prescriptions that
pose ethical or moral difficulties for them.
Web links
Related resources on www.pharmacist.com
Contact the writer: Ed Lamb, Pharmacy Today
Posted May 24, 2006, 4:45 pm EDT
| Pharmacist organizations, led by APhA, respond to commentary in Obstetrics & Gynecology that claims pharmacy professionals do not have same ethical and moral discretion as physicians. |
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