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How Would You Manage This Ethical Question?

A pharmacist refused to fill a valid prescription because he had an ethical question about it. The customer called him out on social media. What would you do?

Imagine you go to your local pharmacy, like so many people do every day. You hand your prescription to a pharmacy staff member, wait a period of time, and leave with your prescription in hand. This happens hundreds of thousands, maybe millions, of times a day. It’s something most of us take for granted and do not think twice about. 

You certainly don’t imagine that the pharmacist would have an ethical question about filling your prescription.

For Nicole Arteaga of Peoria, Arizona, this everyday seamless interaction did not happen. In a post that immediately went viral on social media (https://www.nytimes.com/2018/06/25/us/walgreens-pharmacist-pregnancy-miscarriage.html), she explained her experience in detail. After suffering a miscarriage, her OB/GYN prescribed her a medication, misoprostol, to help end the pregnancy (important to note, the baby had already passed away in utero).

The Pharmacist Refused to Fill Her Prescription:

At her local Walgreens, with her small child accompanying her, she spoke with Brian Hreniuc, a pharmacist who refused to fill her prescription on his own moral beliefs. He presented it as an ethical question. She was forced to explain the scenario in front of her young child, and Hreniuc still would not fill this prescription. 

Eventually, Arteaga was able to obtain her prescription from another Walgreens location, but, as she says, felt “ashamed and humiliated” by the pharmacist in her time of grieving. She posted a picture of his business card along with her post.

Readers Disagreed with Pharmacists’s Refusal:

The power of social media was deafening. As a pharmacist, I followed this closely. Just reading a percent of the thousands of comments on her post, many customers demanded Walgreens fire the pharmacist, and pledged to boycott the chain. Some even threatened the pharmacist, and posted personal information.

Walgreens responded with a statement,

“To respect the sincerely held beliefs of our pharmacists while at the same time meeting the needs of our patients, our policy allows pharmacists to step away from filling a prescription for which they have a moral objection.”

This statement was also found as a reply to many angry comments on the original Facebook post.

How Should a Pharmacist Handle an Ethical Question?

Six states, including Arizona, have a “Conscience Clause,” which permits pharmacists to refuse to fill an emergency contraceptive prescription based on personal beliefs or values. (http://www.ncsl.org/research/health/pharmacist-conscience-clauses-laws-and-information.aspx). Although this prescription was NOT for an emergency contraceptive, it seems as if the law protected the pharmacist in this case.

As pharmacists, we make sure that each prescription is issued for a legitimate medical purpose, where the doctor acts in the usual scope of professional practice. For example, a dentist should not prescribe birth control pills because that is not in the scope of the dentist’s practice. An OB/GYN should not prescribe medications for attention deficit disorder, because that is not in the scope of practice, and so on. For these examples, although the medication may be appropriate for the patient, the issuing of the prescription is not in the scope of the doctor’s practice. 

In real life, this rarely occurs and when it does it is often for a family member, putting the pharmacist in an uncomfortable situation.

Pharmacists Are Not Robots:

Very important to note, many people out there seem to think pharmacists should fill any prescription from any doctor, no matter what, like a robot. Those people do not understand that pharmacists have caught many drug interactions.

 To me personally, anything that an OB/GYN prescribes that is in the scope of their practice is legitimate. Now, that’s not to say that a pharmacist should fill everything without question, from an OB/GYN or from any type of doctor. 

Again, there may be coexisting conditions to look out for or drug interactions that may require an alternative of medication.

I think it is important for people to understand that pharmacists must evaluate prescriptions and not fill anything and everything like robots. That to me is important, but on a medical basis, not a moral basis. I personally have no moral objection to any kind of birth control pills, emergency contraception, misoprostol, etc. That, to me, is not my business. Obviously, though, some pharmacists do feel that it is an ethical question.

Was This Situation Handled Properly?

Was the situation handled properly? Due to HIPAA, we will never know the full story. There are always three sides to every story. From Arteaga’s perspective, she was humiliated by the pharmacist who told her that he would not fill her prescriptions based on his moral beliefs. Again, I would have no problem filling this prescription. HOWEVER, if I were in his shoes, I would have tried to handle this in a different way with more sensitivity.

There was no need for an opinion to be shared with the patient–she needed to get her medication and go home with her child. He could have just as easily said, “I’m sorry, we don’t have this in stock, I’ll send this over to the Walgreens down the street.” This way, he does not have to fill the prescription and he does not have to impose his beliefs and opinion on the patient. (Although I personally do not see the point of this, if a pharmacist is going to send the patient to another store and ensure she gets the medication, why not fill it in the first place and save her a trip?)

Do unto others as you would have them do unto you is an appropriate way to handle this situation. Patients should always be treated with care and respect, even if a pharmacist is exercising the right not to fill a prescription.

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