aziz
-
01:28:15 pm on July 17, 2008 | # | |
Thursday thread topic: Do pharmacists have a right to refuse to dispense medication on moral grounds?
I addressed this topic a few years ago, arguing that pharmacists do have such a right, as long as they do not violate their professional ethics (wihch demand that the patient not be denied care deemed medically necessary by a doctor).
However, given that a large fraction of the american muslim community are both 1. socially conservative and 2. health professionals, I think this is a salient issue worth revisiting.
-
Tag this post
Comments
Leave a Comment
razib 1:36 pm on July 17, 2008 | #
u know what you’re going to get (or NOT get) if you go to a catholic hospital. people should figure out a way to advertise themselves well enough that others don’t waste time and make really bad decisions cuz they didn’t know about issue X with doctor/pharmacist Y. i mean, stuff like morning after pill hours might matter….
Muse 2:01 pm on July 17, 2008 | #
short answer: no. to me this is akin to the case of the somali muslim taxicab drivers refusing to take seeing-eye dogs in their cabs. i dont have sympathy for either case.
Willow 2:37 pm on July 17, 2008 | #
Personally I think you shouldn’t be in healthcare if you don’t care about health. If it matters more to you to conceal your forearms than it does to sanitize them for surgery, you’re probably in the wrong profession. Muse’s point about the seeing-eye dog is a good one–what if it’s not just morning-after pills a pharmacist feels “morally” obligated to withhold? How long before it’s cough syrup? (Which is about half alcohol.) Hormone replacement drugs? (Derived from animal urine.) Pain killers? (Derived from half a dozen different kinds of khumr.)
razib 3:05 pm on July 17, 2008 | #
i think GP’s are diff. from ER dox and pharmacists. in the latter cases a decision on their part in keeping with their own values may simply decide your own choices by default.
thabet 4:50 am on July 18, 2008 | #
The question should be: “If a pharmacist refuses medication on the grounds of religious freedom, does the patient have a choice to go elsewhere?”
Ironically, those railing against consumerism may have to end up promoting ‘choice’ in healthcare to bypass these sorts of controversial issues.
Those in state-funded systems, however, have more limited choices.
aziz 6:03 am on July 18, 2008 | #
Muse, Willow, I am sympathetic to the hardline position since I am very liberal. However, willow your point in a way illustrates the dilemma - there is no neat and tidy line between “health” and “faith”. It’s equally unfair - and harmful to medicine as a professsion - if conservative muslims were discouraged from entering the field because they might encounter situations where the lines are blurred. Frankly theres no reason to believe that Islam and modern health are incompatible - my own wife is now a dermatology resident, and she has worn hijab from med school onwards, even to her interviews. To suggest that muslims make a stark choice instead of actively trying to find ways to reconcile faith and professional ethics is to surrender.
Invoking cough syrup, pain killers, etc is a slippery slope argument, but for the most part that is not an issue (and there are plenty of non-alcohol alternatives.) The flash point is really abortion.
As far as cabbie drivers and whatnot, these are not medical professionals, so the issue of professional ethics is nonexistent. A cabbie has a right to refuse service to an abusive oaf, to a drunk, to someone who makes them feel unsafe. Why not someone with a dog? Especially if theres fear involved as well. OK, the dog may be a seeing eye dog, which is considered different from a dog who is “just” a pet (though in my opinion this is rather dismissive of pets). But the cabbie is not under a professional obligation to take every customer. there is no cabdriver version of the Hippocratic Oath.
to clarify my position, I think that in the specific case of a muslim (or other faith) pharmacist, refusing to personally dispense an abortion medication is morally acceptable, as long as they make arrangements for the patient’s medical needs to be met by another pharmacist who does not have the same moral qualms. That is what I mean by professional ethics - not imposing the religious morality on the patient. But by dispensing that specific medication (which is by its nature very different from cough syrup, etc bec the outcome of the medication, not the formulation of the ingredients, is the morally objectional part), the pharmacist also is having different religious morality imposed on them. Both the pharmacist and the patient have equal right in this regard.
The case in Madison was an outrage because the pharmacist did not make alternative arrangements for the patient. Note that the American association of pharmacists does permit its members to refuse to dispense meds, as long as they do make the arrangement for the patient to get them from someone else.
aziz 6:05 am on July 18, 2008 | #
thabet, I cant speak to that example since I am not well informed about the way the healthcare system i the UK works (or doesnt, as the case may be). However from my understanding of the push for national health care here in the US, patients would retain their choice of providers. The liberal movement for healthcare here is really towards government subsidy of patients’ insurance premiums (”single-payer”).
Willow 9:09 am on July 18, 2008 | #
Aziz, Thabet just sent me something from a conservative website werein a brother announces that flu vaccine is derived from pigs, and asks whether anyone else has heard this.
Slippery slope is not a fallacy, it is a fact.
Willow 9:11 am on July 18, 2008 | #
(More relevantly, he was informed of this by a Muslim doctor.)
aziz 9:59 am on July 18, 2008 | #
I wouldnt call a slippery slope argument a fallacy, but my usual approach to such things is to take it case-by-case. I suppose the specific scenario we are worried about here is as follows:
A patient sees a (muslim) doctor, and requires medical treatment A. muslim doctor believes (rightly or wrongly - irrelevant) that A is haram for reasons X Y Z. The issues are:
1. should the doctor inform patient that A is available? (YES - professional ethics)
2. is the doctor obligated to provide A to the patient? (NO - moral standards)
3. does the doctor have any right to prevent patient from obtaining A? (NO - professional ethics AND moral standards).
My point is that the doctor has a professional obligation to inform the patient of the availability of A, irrespective of the doctor’s belief. However the doctor him/herself is under no moral or professional obligation to actually deliver the treatment. As long as the medical professional (doctor, pharmacist, whatever) ensures that the patient is transferred to teh care of another doctor for whom A is not a moral issue, then the doctor is doing their job. Anything less is a violation of the ethics of the profession.
If a muslim has moral standards which are in confli ct with certain treatments A, then that should not be a reason for them to forgo medicine as a profession.
However, if a muslim doctor cannot in conscience uphold the ethics of the medical field - which are a separate issue from morals! - then they should not practice medicine. We must keep the distinction between morals and ethics clear here.
Willow 11:27 am on July 18, 2008 | #
But at some point, doesn’t ritual law become extremely arbitrary when applied to practical medicine? If a Muslim doctor can refuse to dispense flu vaccine because a single one of its components was derived from a pig, is it really Islamic morals that are being protected? Or is it simple arrogance?
Let’s think about this on an emotional level here, because in day-to-day reality this counts for far more than an abstracted conversation about morals vs. ethics: even if said doctor provided the patient in question with a reference to someone who would dispense flu vaccine, imagine how shocking it would be for the patient to be turned away for religious reasons. For something that simple.
Let’s not forget that driving people away from Islam is a sin, too.
I’m willing to make this a one-issue thing: if what we’re really talking about is abortion and only abortion (ie RU486; the ‘abortion pill’), okay. That’s a fundamental argument about when life starts that crosses religious and cultural boundaries. But I don’t think it’s going to stay a one-issue thing because we’ve already got med students refusing to scrub up and fundies vilifying flu vaccine.
aziz 12:41 pm on July 18, 2008 | #
well, ultimately since we cant (and shouldnt) legislate religion or morality, it doesnt matter. All that matters is whether the patients of that doctor are geting their care.
razib 7:24 pm on July 18, 2008 | #
But the cabbie is not under a professional obligation to take every customer.
cabs are licensed. so yeah, they are under obligation.
thabet 9:30 pm on July 18, 2008 | #
The Muslim medical student story in the UK turned out to be a complete misunderstanding, which was then exaggerated by the right-wing press. One female student had enquired about the rules; no one had actually refused to roll up their sleeves and wash properly.
Not to say this issue isn’t a problem; morning after pills have been refused by some Muslim and Christian pharmacists (the rules of the RPSGB allow them to do so, so long as they ensure an alternative can be found for the patient). And then there is this enquiry about flu vaccine which I saw on a Muslim website (this is a new one to me).
razib 10:19 pm on July 18, 2008 | #
professions like pharmacy and medicine are meant to serve the public, the fact that they provide careers and fulfillment for individuals is totally secondary socially (though individually very important). no one has a “right” to practice these professions which are regulated by governments which confer cartel power on the practitioners.
on things like abortion there will be latitude and accommodation because a substantial proportion of the public agrees with this moral view. OTOH, if very few of the public see the moral dilemma of something then you’re screwed. i think the birth control pills are the borderline issue here in the USA, only a tiny minority of americans really oppose these on principle (though larger minorities might worry about unmarried or teens having access), so pharmacists will get little sympathy.
razib 10:21 pm on July 18, 2008 | #
and btw, i do want to emphasize the regulatory aspect of the government here. if everything was ‘over the counter’ then we wouldn’t have issues with pharmacists. if the abortion pill didn’t need a prescription doctors wouldn’t be needed. as it is, we don’t live in that world, so the public gets to decide what is, and isn’t, acceptable behavior for professionals whose practice is sanctioned and given the imprimatur of legitimacy by government fiat.