PHARMACIST'S RIGHT TO CHOOSE?

Recent news stories have focused on whether pharmacists should have the right not to fill a valid prescription for certain products. This issue is emotionally and politically charged, as demonstrated by the reactions of the public, government, and employers to pharmacists who feel obligated to follow their beliefs and moral ideals and not dispense a particular product.

In 1998, the American Pharmacists Association (APhA) developed a policy on this issue, which states: "APhA recognizes the individual pharmacist's right to exercise conscientious refusal and supports the establishment of systems to ensure patients' access to legally prescribed therapy without compromising the pharmacist's right of conscientious refusal." A recent Pharmacy Times survey, which is available at www.pharmacytimes.com/article.cfm?ID=2138, suggests that many practicing pharmacists support this position. Our survey results showed the following:

1. Pharmacists should be allowed to step away from dispensing the morning-after pill.

Agree 62%

Disagree 33%

Undecided 5%

2. Pharmacists who refuse to dispense this pill should find a way for the patient to receive the prescription.

Agree 68%

Disagree 25%

Undecided 7%

Although those who disagree are a minority, they still represent a potentially large number of pharmacists. Therefore, the possibility of disagreement between pharmacists in a given workplace exists.

Although the focus of public attention is on the morning- after pill, the potential to extend moral concerns to other products exists. As a minimum, pharmacists and employers should agree on how to handle such situations before they arise. Pharmacists should be proactive in informing their colleagues and employers if they have moral objections to handling certain products. If your pharmacy does not have a policy, developing one before a problem occurs seems prudent.

Because state statutes, Board of Pharmacy rules, or employers' policies may vary, pharmacists need to become acquainted with how this situation is covered in the state where they practice or by the policies of their employer before they decide to exercise their conscience. In this way, they will be prepared for handling the consequences of their action. Sometimes negative consequences arise when one follows his or her moral convictions. At least by knowing the rules, one can be better prepared for that possibility.

If pharmacists are forced to fill all legal prescriptions, one unintended consequence may be the loss of the important role they play in double-checking the appropriateness of a prescription. As patients visit multiple prescribers, that pharmacist role becomes more important. The pharmacist judgment on the appropriateness of any prescription serves to protect the patient. In the desire to ensure patient access to a particular type of therapy, that important professional role of the pharmacist could be compromised.

Simple solutions to complex issues do not exist. Handling the pharmacist's right to exercise his or her conscience does not lend itself to a simple solution.

Mr. Eckel is professor and director of the Office of Practice Development and Education at the School of Pharmacy, University of North Carolina at Chapel Hill.