Words fail me

[lamzee.]

I agree in the principle of signposting, but surely in this case there is not much of a necessity since most towns have several pharmacies and finding another is hardly a major geographical exercise.

[roper]

In what way did she fail to signpsot? She offerred 2 options: 1) Go to another pharmacy (I think we can safely assume that the patient was aware of the locations of the other local pharmacies and that the paharmacists working in them would be prepared to make the supply.) 2) Come back tomorrow when a different pharmacist will be prepared to supply.
The case is unusual because there are few pharmacists opposed to the use of the regular contraceptive pill (many catholics are not really with the pope on that one) but I see no grounds for the RPSGB to act on and I don't find th Daily Mail a good source of a balanced view.

[Suki Lalla]

Has anyone actually read the daily smell story properly ??

It does actually say that the pharmacist signposted to other pharmacies or to come back the following day as he/she would not be on duty .. so did EXACTLY what was required for the purposes of the CoE (code of ethics that is !)

Think about this .. this pharmacist presumably has been qualified for a few months at least ... presumably doing the same thing elsewhere ... these patients accepted the pharmacists right to have a consceince objection ... and they acted in a fair and neutral way.

What the person quoted in the daily smell did was escalate this for her own reasons .... think about this type of individual .. many of us will have come across this type before ... "you do as I say or I will report you etc etc "!! ... many of us in community pharmacy see patients even worse shouting the odds ... see my thread about bullying and fear in pharmacy http://www.locumvoice.com/viewtopic.php?f=2&t=2865&p=32364&hilit=violence#p32364

There is more that is unsaid about the identity of the pharmacist but I presume many will have drawn (and presumably quartered from their high horses) their own conclusion as to the faith that this particular pharmacist practises.

Give the readership demographic profile of the daily smell and reading the comments following the story I think we are being suckered into a wider anti ******* sentiment (even though the identity of the pharmacist is not revealed I suspect many daily smell readers will have come to a quick fire decision)

You fill in the ******** according to your own prejudices ...

I repeat .. WE MUST stand by OUR RIGHT as pharmacists to refuse to dispense ANY product that is objectionable to our SINCERELY held FAITH or RELIGION providing we signpost appropriately.

Always look at the bigger picture.

[Defblade]

I see no ethical difference in providing a product, and telling someone where it can be obtained.

Which kinda makes a mockery of the whole thing.

Anyhow, I don't like the conscience clause. We don't dispense all scripts issued by Godlike beings with a bow and doffing of the cap, but we should only refuse on scientific/clinical grounds, not because of random ungrounded beliefs the patient does not share.

[Titch]

I have no problem with any pharmacist choosing to not dispense a script for OC on religious grounds provided that this is explained to the patient and they are signposted.

This story is (as already pointed out) slightly more gray and what may need discussing amongst the pharmacy profession is that refusing to supply a drug because of what it can be used for when it has more than one use is not fair to a patient.

If the script had been for dianette for acne and the patient readily paid for it, no contraceptive symbol on it etc. would that have still been refused?

What I'm trying to say is that refusing OC supply when it is to be used to prevent conception is a commonly understood religious choice. I'm concerned that pharmacists exercising that choice class all OC drugs as if they are to be used for contraceptive purposes, or do their beliefs mean that they cannot supply a OC because it might prevent a pregnancy just because a patient is taking it? Perhaps because I do not have that religious belief I do not understand the decision process but to me it would depend on how the drug was to be used before I would decide if supply was appropriate or not within my religious views.
Given how Rxs are written and the lack of access to records, this is very difficult to do practically.

On the subject of euthanisa Rxs, I had a Rx last week for diamorphine 600mg - luckily I had enough background knowledge of the patient to know that meds had been titrated up so that that was the equivalent diamorphine dose but if I'd not had that info, I'm not sure I would have been happy to supply.

[Bishop Ryder]

The Daily Heil's at it again, I see. Just a couple of weeks since their similarly inaccurate "Sick trade in NHS medicines: Profiteering chemists cash in by selling life-saving drugs to European clinics" vituperation. We've obviously resurfaced on their radar for an overdue dose of their trademark reactionary extremism, and I find telling the jingoistic manner in which they have selectively misrepresented the patient's comment as to not knowing the religion of the pharmacist in order in my view to 'press buttons' within their readership.

I support the right to conscientious objection including when I do not agree with the underlying beliefs as long as the patient is 'signposted' accordingly. It appears possible that in the case in question, the access to more detailed patient medical information may have facilitated the pharmacist's decision-making process — we cannot say whether or not this pharmacist would have made a different decision if she had known that the prescription was not for contraceptive purposes, but I can imagine that at the very least it may not always be straightforward to determine this. Likewise I'm of the view that informed consent is essential, particularly e.g. in explaining the modes of action of EHC to patients to allow them the opportunity to object to 'contra-implantation' if their views differ to mine. There are aspects of community pharmacy practice today that I disagree with (e.g. some of the products and services associated with us, and commercial branding taking precedence over factors such as safety, efficacy and appropriateness with many OTC medicines) but unfortunately given the climate in which we operate there often isn't much an individual pharmacist can do about such matters. However, for each of us there will be a line to be drawn over which our conscience will not allow us to step. We may not be aware of or able to foresee on what issue this situation may arise, but for myself I am prepared to be in a minority of one if necessary in the eventuality that somehow we find ourselves going down the road of assisting suicide. I for one would object to participating in such a 'service' in any way at all, and would not wish personally to get involved to the point of having to 'signpost' — I would rather take my disciplinary chances if necessary. In such a scenario, I think that Krystal's breaking down of 'conscience' to "a case of faith vs science" may be overly simplistic. We cannot guess what the state and/or large corporations may ask of us at some point in the future, and so while we have a 'conscience clause' we must defend it to the hilt. Without it, we already know that even if we are prepared to live with the consequences of our actions, the Nuremberg defence will no longer wash if we are ever held to account.

"Hey I will stand my ground, and I won't back down."

[johnep]

Beat me to a comment on Dianette. However, if actually being used for acne and the pt signs for OC use to avoid paying the charge. What should the pharmacist do then?
johnep

[LocumLuke]

The problem the pharmacist in question faces, is that after 13 long years, the public have repeatedly been told they can have everything they want, for free, right now! And more fool you if you try to stand in the way! See also; co-cod.sales, sudafed sales, etc etc.
I think a lot of the public would have sympathy if it were a fatal barbit. dose to end life, but in the 21st century, refusing a pill script?!
Does this lady get much work?

[cartrefeira]

We cannot guess what the state and/or large corporations may ask of us at some point in the future, and so while we have a 'conscience clause' we must defend it to the hilt. Without it, we already know that even if we are prepared to live with the consequences of our actions, the Nuremberg defence will no longer wash if we are ever held to account.

"Hey I will stand my ground, and I won't back down."

My point exactly.

Bob Gartside

[roper]

At risk of repeating myself (and several others) this lady did nothing wrong under our current code of ethics and I don't see why it is controversial on a forum frequented by experienced pharmacists. I understand that it is scandalous to the Daily Mail but if the facts they present are true then there is no case against her.

[Lindsey]

The facts of the case as far as they appear however is that this is the use of a hormone preparation for a medically diagnosed condition. If the pharmacists had known that, would they have had an issue with supply? Did they just assume it was for a purpose which they objected to? Is it the correct thing to actually ask and surely in this day and age a simple sign could be placed at the reception point to explain that on that day the following items can not be supplied...

Did the contractor know - and if so, why don't they back their pharmacist- although I suppose an investigation gets them off the hook.

I would have been annoyed and embarrassed too to be told I could not have my meds, and generally I support the exemption clause. Perhaps we just need to handle this better.

Lindsey

[cailleach]

Analgesic (Probably NSAID) + OCP + Age of patient = secondary dysmenorrhea or endometriosis or similar pathological condition.

Sussing this out would be acting clinically not jumping to conclusions.
I have mixed views on the conscience clause. Where I practice there are usually no convenient pharmacies to signpost to regularly and the very patients who would be disadvantaged by failing to supply are those who are on the margins already.

A pharmacist with a "faith" based objection to supply should opt not to work where their beliefs could compromise the patient. This would be the ethical course of action and I would defend their choice of not supplying in this scenario. However if they take any position offered without considering the effect of their choice on patients I would not support their action.

Catherine

[VeteranLocum]

I see that someone purporting to be a Pharmacist replied to this article. What was, preumably intended to be "...pharmacist on duties discretion" was spelled "...pharmacist on dutites descection". This was noticed and commented on by another poster who enquired whether someone whose spelling was that bad was fit to dispense CD's. I must admit I could see where the second poster was coming from. With "colleagues" like this do we really need enemies?. The entire thing strikes me as another clause in the argument to replace us with slot machines.

[farmergiles]

I would support a pharmacists right to refuse to dispense a product on religious grounds, however I also support my right not to engage/employ someone who holds these beliefs.

[Suki Lalla]

I would support a pharmacists right to refuse to dispense a product on religious grounds, however I also support my right not to engage/employ someone who holds these beliefs.

Which is why a contractor should NOT be allowed to own more than ONE contract ?