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April 03, 2007

Time for Pharmacy Board -- and Governor -- to Get it Right

The P.I. printed a Sunday editorial that called on the Washington State Board of Pharmacy to quit dilly-dallying with patients' rights and approve rules that direct pharmacists to fill prescriptions, regardless of personal moral and religious views.

We've heard, time and time again, that this sort of change would remove pharmacists' authority and force them to act in a way that contradicts their personal beliefs.

We certainly don't advocate turning pharmacists into automatic drug-dispensing machines. But pharmacists aren't valued for their religious beliefs -- we have spiritual advisers for that. It's their useful, in-depth knowledge of pharmaceuticals that makes them indispensable to us.

That summarizes the debate in a way that makes total sense. It is a pharmacist's responsibility to not dispense a medication that might contra-indicate with something you are already taking. For example, you would want your pharmacist to alert you against a medication that could cause bleeding when you are already on a blood-thinner like Coumadin. However, it is not part of the pharmacists' job to use the prescription counter as their personal pulpit, and it's about damned time someone in a position of power said so. How about the governor? Gregoire has spent the better part of a year trying to find a "compromise" on this issue when a "compromise" is not appropriate. And it sets a very dangerous precedent when political leaders are so squeamish about offending the religious moralists among us that good medical policy is thrown to the curb. The prescription my pharmacist is required to fill comes from my doctor, and no amount of priggishness wafting from behind the counter should be able to circumvent the authority of the agreement between me and my doctor. Period.

This whole fiasco began last year when the pharmacy board passed a ruling in June that gave the moralizers and religious zealots the right to refuse medication to pharmacy customers. It was brought to the fore because some pharmacists freaked out over Plan B, the emergency contraceptive that prevents fertilization of an egg if taken within 72 hours of unprotected sex. The moralizers pushed the false theory that Plan B is an abortion pill -- which it is NOT -- and therefore, those who are opposed to choice should have the right to deny women the medication. Lynn Allen wrote an excellent, comprehensive post about the issue at that time:

The right-wing war on contraception is now being waged here in Washington State. Yesterday, the Board of Pharmacy endorsed a vaguely worded proposal that allows pharmacists the "right" to decline to fill prescriptions that are in conflict with their personal beliefs.

Although we could make a mockery of their intentions and mull over what pharmacists might choose to decline -- unmarried men with prescriptions for Viagra? People too undisciplined to excercise who take appetite supressants? Teenagers with skin disorders desperate to rid themselves of acne? It's clear that this, like other attempts around the country, is designed to decrease a woman's right to get emergency contraceptive medication.

Instead of settling the issue, it only fueled further debate when thousands of outraged Washingtonians weighed in to oppose any moralistic power grabs at the expense of their rights to medication prescribed by their own doctors. So, on Thursday, July 20, the pharmacy board voted to reconsider the earlier ruling. Then the governor worked her wiles for a "compromise" by last August 31, whereby pharmacists would be required to fill prescriptions, but she still left a loophole for the moralizers to not comply if there was another pharmacist on hand who would fill it. And of course, this did not settle the basic question of what to do with pharmacists who have personal issues with their customers' medical needs. That compromise only served to please self-appointed prescription preachers like Jim Ramseth, from Covington, who decided long ago it was up to him to draw the line on which prescriptions he would consent to fill. In fact, Ramseth left the August 31 meeting feeling very satisfied:

Jim Ramseth, a South King County pharmacist who has been outspoken about his right to make medical and business decisions based on his own moral code, left the meeting almost gleeful. The board, as he saw it, had done nothing to hinder him -- or his refusal to sell Plan B.

Because Ramseth refuses to stock Plan B at his pharmacy, the possibility of having another pharmacist on hand to dispense it is rendered moot. Women needing the medication are made to visit pharmacy after pharmacy, hoping that one will do its job in time. Remember, Plan B only works within a 72-hour time frame. So if you happen to live in a town populated by moralizing pharmacists, you'd best pack a bag and gas up the car, because you're going to be traveling some to get what you need. The ironic -- and truly sick -- part of that scenario is that not being able to find a willing pharmacist within the 72 hours makes it all the more likely that the woman will end up having an abortion, which is what the moralizers claim they are trying to prevent in the first place.

It's really a shame that the governor has allowed this to happen. She could have shown real leadership and done what Rod Blagojevich, Illinois' governor, did in 2005 when the zealots tried the same tactic there. He wrote up an executive order mandating that all pharmacists comply -- regardless of personal beliefs.  And our legislature could have acted by now to take care if this. Last summer, after the June ruling, legislators Jeanne Kohl-Wells and Karen Keiser promised thay would draft a bill. But so far, nothing. The pharmacy board is slated to make a final decision on April 12. What happens if the ruling allows pharmacists to opt out? Will we be hearing from the governor or the legislators? Since the legislative session is about to come to a close, let's hope that our elected officials won't wimp out. We need leadership on this issue. We need resolution about our rights. We need for them to finally stand up and do the right thing.

Posted by shoephone on April 3, 2007 at 09:51 AM in Policy | Permalink


I think the perfect solution to a pharmacist's moral dilemma would be to QUIT. If you were in the temperance league, would you work in a liquor store?

Posted by: op99 | Apr 3, 2007 3:00:48 PM

Oh, I think that someone who went to pharmacy school should be permitted to deny drugs to anyone - in the privacy of their own home. Once they are licensed by the State, they have a duty to serve all Citizens in an evenhanded manner. If the State allows them to do otherwise, then the State is violating the Constitution.

However, I know that logic has no place in the World of Religious Dementia.

Posted by: Brenda Helverson | Apr 3, 2007 4:40:35 PM

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