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March 28, 2005


Not everyone lives in a big city or town where there are multiple choices for pharmacists. And pharmacists take a risk by not adhering to professional standards:

Judge’s Decision a Victory for Patient Health and Rights

Madison, WI – The pharmacist who refused to refill or transfer a Menomonie woman’s prescription for oral contraceptives was reprimanded today in a strongly worded decision issued by Administrative Law Judge Colleen M. Baird.

Judge Baird found that Neil Noesen, R.Ph., "engaged in practice that constitute[d] a danger to the health, welfare, or safety of a patient,” and “substantially depart[ed] from the standard of care," potentially harming the patient and violating Wisconsin’s Administrative Code.

Judge Baird rejected every excuse offered by Noesen for his unprofessional conduct, saying, “the patient should not be required to abide by the pharmacist’s personal, moral decision,” and that Noesen “clearly needs training in the ethics of his profession.”

“This decision unequivocally states that it violates the law for pharmacists to put their personal beliefs above their patients’ health care needs,” said Kelda Helen Roys, Executive Director of NARAL Pro-Choice Wisconsin. “We hope this disciplinary action will ensure that Wisconsin patients receive the health care they need and are legally entitled to receive. The recommended sanctions provide the minimum acceptable punishment, given the very serious nature of Noesen’s behavior and the potential harm to patients.”

However, this is likely a state-by-state issue.

same case from a local paper:

Reprimand advised for pharmacist
Beliefs, duties clash; he refused to fill birth control order

In a case that highlights the clash of religious beliefs and legal responsibilities for medical professionals, a judge recommended Monday that the state reprimand and limit the license of a pharmacist who refused to refill a young woman's prescription for oral contraceptives.

Pharmacist Neil T. Noesen, 30, also refused to refer the young woman to another pharmacy where she could get her prescription filled.

The case has attracted the attention of both abortion opponents and supporters, who are waging a war in Wisconsin and across the nation over "conscience clause" legislation that would allow medical professionals to refuse to participate in abortion and other procedures they say conflict with their religious beliefs.

In this case, the state Department of Regulation and Licensing investigated whether Noesen had put the patient in harm's way by refusing to fill or transfer her prescription for birth control pills.

Again, this one guy might lose his license, but what happens in MS and MO?

Glad to see some reprimands coming down on these clowns. I guess they take a morally relativistic stance on how they should behave.

Principles Nos. III & IV from the Code of Ethics adopted by the American Pharmacists Association:

III. A pharmacist respects the autonomy and dignity of each patient.

A pharmacist promotes the right of self-determination and recognizes individual self-worth by encouraging patients to participate in decisions about their health. A pharmacist communicates with patients in terms that are understandable. In all cases, a pharmacist respects personal and cultural differences among patients.

IV. A pharmacist acts with honesty and integrity in professional relationships.

A pharmacist has a duty to tell the truth and to act with conviction of conscience. A pharmacist avoids discriminatory practices, behavior or work conditions that impair professional judgment, and actions that compromise dedication to the best interests of patients.

And Principle Two from the Ontario College Code of Ethics:

The pharmacist actively promotes the well-being of every patient in a caring, compassionate manner. The patient's well-being is at the centre of the pharmacist's professional and business practices. This principle ensures that no patient shall be deprived of pharmaceutical services because of the personal convictions or religious beliefs of a pharmacist. Where such circumstances occur, the pharmacist refers the patient to another pharmacist who can meet the patient's needs. The pharmacist exercises his or her professional judgement to ensure that patients' needs are met in situations where emergency services or care may be required.

but what happens in MS and MO?

According to a sidebar in the Post article, MO is actually considering a law that would require pharmacists to fill prescriptions. Some good news in a depressing piece.

It seems to me this raises the possibility of defensible cases of religious discrimination in hiring. If I'm the owner of "Tolerant Pharmacy" and I want to ensure that I will be able to provide my customers with certain drugs, I almost HAVE to ask my potential pharmacists if they are religious (or at least if they believe there are some drugs that shouldn't be filled). This violates EEOC laws. But if that is true, you're saying pharmacies have lost control of their product.

Why would anyone train for a profession when they did not wish to carry out the tenants of such profession. Are they just too stupid, or do they demand a world in their religious imagine. This is important because it always boils down to the pro-choice versus pro-life difference in attitudes toward other's beliefs! Any pro-choice individial can be as extremely religious as anyone on earth and hold life so dear as to never take any step to kill even an ant themselves. However, they realize that the world is complex in these areas, and in the interest of harmony and fairness, they leave this decision to the individual. The pro-life movement has come to represent the "Liberals" in this country who demand that government action make it their way for themselves and everyone else period! This has to lead to a return of the dark ages eventually and must be stopped.

In the case of pharmacists, any pharmacist who does not wish to deal in a certain area should engineer his/her life to not have to deal with those areas, such as working in a nursing home. Otherwise, harse disciplinary actions by state Boards are strongly and quickly needed TO NIP THIS CRAP IN THE BUD!

"Why would anyone train for a profession when they did not wish to carry out the tenants of such profession."

If the FDA approved a hypothetical "hetero-pill" that worried parents could give to their children who they feared might turn out gay and doctors prescribed the pills, would you consider declining filling those prescriptions if you were a pharmacist?

What if someone became a pharmacist before the invention or widespread use of birth control pills? What if that person had a religion conversion experience after becoming a pharmacist?

I'm not opposed to a conscience clause. Neither would I oppose observant Jews becoming college professors even though holy days might cause them to cancel or reschedule classes. And neither would I oppose conscientious observers being given an exemption from a military draft.

Let's be clear about something here, though. The ethical problem is not he refusal to fill the prescription, it's the failure to transfer the prescription after the refusal. Sure, it's a bit inconvenient for the customer, but transferring the prescription provides a work-around for the problem. If you want the law to require customers be given the smoothest possible service, then you should allow employers to descriminate against the handicapped if it costs customers even a second of lost time.

Finally, I know that some will raise the objection of a rural patient needing a prescription filled and having the only pharmacist in the area refuse to provide the pills. This can be a false dichotomy. The options are not necessarily between a pharmacist who will fill a birth control pill prescription and one who won't. Sometimes, the options are a pharmacist who will fill 99.9% of prescriptions and no pharmacist at all. Some rural areas are underserved medically to the point that they allow underqualified personnel to serve as doctors rather than have no health care at all.

Let's be clear about something here, though. The ethical problem is not he refusal to fill the prescription, it's the failure to transfer the prescription after the refusal. Sure, it's a bit inconvenient for the customer, but transferring the prescription provides a work-around for the problem. If you want the law to require customers be given the smoothest possible service, then you should allow employers to descriminate against the handicapped if it costs customers even a second of lost time.

Look, in most states, doctors can dispense meds right from their office, but pharmacist cannot dispense Rx meds in most states without orders from a licensed doctor. That tells you something about the system. If a pharmacist wants to be a medical doctor, then let them go to medical school, and patients can choose to go to them or not based on what others say or previous experience. Either that or they can go to clergy school and change their life's work.

How many people think that when they go to a pharmacy, their wishes and their doctor's wishes are going to be overturned by the religious beliefs of the pharmacist? Do you really believe such freedom in that profession of pharmacy will allow society to keep that profession intact. Why bother?

Three states (South Dakota, Arkansas, Mississippi--with significant rural populations with limited access to providers) have laws on the books granting pharmacists the right of refusal to sell any birth control. Eleven more are considering similar legislation (as of last November, when I wrote this). Twelve states, including these three, have a right of refusal for any health care provider to prescribe or provide any contraceptive. We're not just talking Plan B, but all also plain old birth control pills, and in some the language is loose enough that a pharmacist would probably be included. And it's a growing movement. Prevention had a very good write up on the movement, New Birth Control Ban last fall. All of it based on the tenuous medical assumption that birth control pills can work as abortifacients. Which is bull shit, but since when has science or medicine ever trumped ideology with these people?

FDA approval of Plan B is critical, but FDA approval alone isn't going to be able to trump state laws that allow the right of refusal.

Anthony, read the Wisconsin case again. The pharmacist, as should happen, puts his license at risk. Want to take the conscience clause to its logical conclusion? Find another profession.

By the way, one angle on this not discussed: both the Internet and the availability through medical plans of 'send-away' pharmacies for 3 month supplies make this les of a problem than it might otherwise be, but it's still an issue. Not everything can wait a few days for the mail to come.

Trapper and posters, thanks for this fine article and discussion.

I don't think this is a question of religious freedom at all. I think it's a question of your right to swing your fist ending where my nose begins.

It's easy to think of potential "relgious freedoms" which would be against the law because they violate a public good ... the "freedom" for instance to allow drug use as a sacrament, or to practice polygamy, or to take an extreme case, the potential "freedom" to practice some religion which involves human sacrifice. And in these cases, our society has decided that that right to religious freedom or potential freedom is not as great as the harm that it would cause to society, and thus religious freedom is curtailed.

And in the case where somebody's religious freedom conflicts with my freedom to bring a child into the world, or not, at the time of my own choosing, when I am able to be a mature, financially responsible, and stable parent, I'd say that my freedom represents the greater social good.

I was prescribed contraceptives to control bleeding and instead I developed severe blood clots. I was 52 yrs. old when this happened last year and will have to be on kumadin the rest of my life. I recentlY saw a show about a group of pharmacists against prescribing such blind medication. CoOLd you get further details to me on this group or offer me further options to pursue.
Sincerely yours
Nelida Reynolds R.N.

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