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Ronald A. Lindsay - Future Bioethics
Posted: 06 September 2008 05:39 AM   [ Ignore ]   [ # 16 ]
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adamruth - 06 September 2008 05:18 AM
asanta - 06 September 2008 04:48 AM

If I remember correctly, and I’m sure I do, the pharmacist WOULD NOT RETURN THE SCRIPT SO THE PATIENT COULD GO ELSEWHERE. What ‘ethical’ frame work would this be????

Now that’s a valid complaint, because that’s theft. But that’s also a shift in argument.

The argument was that the pharmacist does not have the right to not fill the prescription. Do you agree that the pharmacist has no such right?

Sorry, you are correct. it was a shift in argument. If the pharmacist could not/ would not fill the prescription, he should refer the person to another pharmacist who will. Including a coworker in the pharmacy. If you have a limited amount of time for the medication to be effective, if you are not given the information, you could spend hours and hours searching for a pharmacist willing to fill your prescription. Imagine that the young lady may have been raped. Why should she go through the trauma of going from pharmacy to pharmacy to beg some one to help her. It’s like adding more assaults upon the original violation.

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Posted: 06 September 2008 02:55 PM   [ Ignore ]   [ # 17 ]
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asanta - 06 September 2008 05:39 AM

If the pharmacist could not/ would not fill the prescription, he should refer the person to another pharmacist who will.

We absolutely agree on this, the pharmacist should do it, and any pharmacist who doesn’t is a bad pharmacist. Indeed, any pharmacist refusing to fill a prescription is already a bad pharmacist.

My question is, what should the consequence be for the pharmacist?

Personally, I think they should be fired. If the pharmacy won’t do that, then it should be boycotted and protested. But even with all that, I still acknowledge the right of the pharmacist to do it, since they didn’t use force on anyone. In other words, the consequences for voluntary actions should themselves be voluntary. The podcast, however, took the tack that the pharmacist has no right to refuse service. That can only mean that potential customers have a right to force the pharmacist to perform work for their benefit; that is what I cannot agree with.

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Posted: 06 September 2008 04:05 PM   [ Ignore ]   [ # 18 ]
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adamruth - 06 September 2008 02:55 PM

Personally, I think they should be fired. If the pharmacy won’t do that, then it should be boycotted and protested. But even with all that, I still acknowledge the right of the pharmacist to do it, since they didn’t use force on anyone. In other words, the consequences for voluntary actions should themselves be voluntary. The podcast, however, took the tack that the pharmacist has no right to refuse service. That can only mean that potential customers have a right to force the pharmacist to perform work for their benefit; that is what I cannot agree with.

I agree. A person who owns a pharmacy should be able to run it however they like, within reason. As abhorrent as the example is… I find it a lesser evil the poor moral choice made freely by an American as compared to forced morality from the government.
I have had discussions with feminist groups on this subject. I am astounded just how fiercely feminists have often fought for their own freedom and self determination only to turn around and cheer when someone else’s freedom and self determination is taken away.

Much happens.. but we learn nothing from it.

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Posted: 06 September 2008 04:52 PM   [ Ignore ]   [ # 19 ]
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adamruth - 06 September 2008 02:55 PM

Personally, I think they should be fired. If the pharmacy won’t do that, then it should be boycotted and protested. But even with all that, I still acknowledge the right of the pharmacist to do it, since they didn’t use force on anyone. In other words, the consequences for voluntary actions should themselves be voluntary. The podcast, however, took the tack that the pharmacist has no right to refuse service. That can only mean that potential customers have a right to force the pharmacist to perform work for their benefit; that is what I cannot agree with.

Agree wholeheartedly. AND the pharmacist should have been charged with the theft, which would have impacted his license, just as if he’d stolen some pills from his pharmacy.

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Posted: 06 September 2008 05:59 PM   [ Ignore ]   [ # 20 ]
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asanta - 06 September 2008 04:52 PM

Agree wholeheartedly. AND the pharmacist should have been charged with the theft, which would have impacted his license, just as if he’d stolen some pills from his pharmacy.

Even worse, it’s the same as stealing pills from a patient. I think it’s worse, anyway, at least the pharmacy can replace the pills without anyone being harmed.

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Posted: 06 September 2008 06:30 PM   [ Ignore ]   [ # 21 ]
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adamruth - 06 September 2008 05:59 PM
asanta - 06 September 2008 04:52 PM

Agree wholeheartedly. AND the pharmacist should have been charged with the theft, which would have impacted his license, just as if he’d stolen some pills from his pharmacy.

Even worse, it’s the same as stealing pills from a patient. I think it’s worse, anyway, at least the pharmacy can replace the pills without anyone being harmed.

Stealing prescription meds would get MY license yanked very quickly!

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Posted: 07 September 2008 06:16 PM   [ Ignore ]   [ # 22 ]
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Voorlon - 02 September 2008 03:48 AM

Sounds like my kind of book.

I thought it was a good interview—I think the book would be interesting and thought-provoking….

(1) the term “bioethics” is relatively uncommon and this might get in the way of book sales
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(2) I thought I understood the interview to say that in the original Hippocratic Oath the doctor would not charge for services. I didn’t find this in the Wikipedia version http://en.wikipedia.org/wiki/Hippocratic_Oath and will do more digging.  So far it seems to me that it says not to charge for the teaching of medicine, nothing about charging the patient.  Would appreciate any info here….
(2a) I wasn’t aware of this either—but there are a some interpretations of the original Hippocratic Oath [ SUCH AS THIS ONE] which call attention to its apparent proscription of both abortion and euthansia.  Maybe Ronald Lindsay could comment.
(3) in the podcast Lindsay makes an argument in favor of stem cell research which suggests the point that in concept an embryo is no different than a stem cell (or something like that) and that our body is made up of millions of cells which could in principle become individual living entities.  I’m not sure I understood this argument, but it seems to me that embryos formed by the fertilization of egg & sperm represent a new and unique individual with DNA different from either parent, and that this is fundamentally different from a"clone” which one could in principle get from one’s own stem cells.  I am in favor of stem cell research and am only questioning whether this particular argument as stated isn’t sufficiently strong.  I think the related argument that our medical technology will eventually be up to the task of generating trillions of truly independent human beings and the earth just doesn’t have the resources to sustain them all—we don’t have an obligation to generate these trillions of distinct people etc etc.
(3b) I was wondering if Lindsay’s book or Lindsay himself considers the ethics of aborting embryos which do not have desired characteristics—to pick an extreme example, a Henry VIII wants a son and his wives keep aborting embryos until the doctor says he’s got a boy.  Or—will the baby have the blue eyes of his/her siblings.  And if this is okay, does the book or Lindsay himself consider whether “fetus-cide” or “infantcide” is also ethical for such selfish reasons.  Although I fully support abortion rights, I’m sort of assuming/hoping that the mother would never do choose it for such reasons—except medical progress may make this a minor choice {one can access the info from the mother & father’s DNA and actually make choices—whose decision should it be whether the child has blue eyes or a musical prodigy like Aunt Maizie}

Anyway, these are my thoughts on listening to it once—I recommend the podcast….

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Posted: 15 September 2008 12:22 PM   [ Ignore ]   [ # 23 ]
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Let me comment first on the discussions between adamruth and asanta. Adamruth in particular seemed troubled by what he thought was my contention that health care professionals, in particular pharmacists and physicians, do not have a right to refuse service. Sense slavery has been abolished, it is obviously true that no one in this country can be forced to perform any work that she or he chooses not to perform. However, with respect to pharmacists and nurses who refuse to perform certain services, in almost every instance what they want to do is to be able to keep their employment while selecting which tasks are to their liking. I do not see why they should be able to refuse to perform certain services without any penalty and while retaining their job, especially as this has often interfered with the health care decisions of patients. Unlike their selection of a physician, patients do not typically choose their pharmacist or nurse. They have dealings with whichever pharmacist or nurse the drugstore or hospital happens to assign to them. Accordingly, they typically will not know before their dealings with the pharmacist or nurse which services these health care workers may refuse to provide. No one is forced to become a pharmacist or nurse. (This, among other factors, distinguishes their situation form the draftee who conscientiously objects to military service.) If one chooses to become a professional in these occupations, then one should expect to be required to perform all legal duties that their employer asks them to perform. And, typically these days, both nurses and pharmacists are employees. (There is a not insignificant number of pharmacists who run their own businesses, but overall they are a small minority.) In any case, as the book points out, persons who run their own business are in a different position than employees, and provided they do not mislead the public about the scope of their services, they can justifiably decline to provide certain services. However with respect to employees, why should we treat pharmacists and nurses, and other health care workers, any differently than other employees. Other employees cannot refuse to do certain tasks based on their religious or moral views if that refusal materially interferes in some way with their employer’s services to customers or patrons. There was a controversy not long ago involving Muslim taxicab drivers at the Minneapolis airport who refused to convey passengers who were transporting alcohol. Would asanta claim that these cab drivers had the right to refuse to convey customers based on their objection to alcohol? Can a librarian refuse to stock certain books because of her objections to their content? Can a male truck driver refuse to be partnered with a female truck driver because he finds this objectionable to his religious beliefs? Can a server in a restaurant refuse to wait on tables that order meat products because the server is a vegetarian? Once we start allowing all employees to refuse to provide services in a job that they have freely chosen, and to do so without penalty, we will have chaos. Regarding physicians, as my book points out, they are in a somewhat different position, because in our health care system they are the ones who decide, in consultation with the patient, what health care will be provided. Moreover, although this is increasingly not the case, patients still have more choice over their physician than they do over the choice of their nurse or pharmacist. Provided the physician makes clear to the patient at the beginning of their relationship what services he or she will not provide, then I am not especially concerned about the physician’s refusal to perform an abortion, carry out a sterilization, etc. But the patient should be informed about the limitations on the physician’s services upfront.

Let me turn now to some comments made by Jackson, beginning with comments on the Hippocratic Oath. Jackson is right that I misspoke about not charging for services to patients. That was too broad a statement. The oath required those who took it to provide free services (especially teaching services) to fellow physicians and to their children. But the key point I was making was that the Hippocratic oath contains provisions that have not been followed by physicians for some time. Among other things physicians nowadays typically do not swear by “Apollo.” In addition, one thing that many do not realize is that the Hippocratic oath did not even reflect accepted medical practice in most of the ancient Greek city-states, where many physicians would provide a lethal drug for a suffering patient that could not be cured. In other words, the Hippocratic oath represented a minority view even in ancient times. Finally, and perhaps most importantly, the Hippocratic oath has not been administered in most United States medical schools for decades. Currently, only 6 of the 122 medical schools in the US administer an oath that would prohibit physician assistance in hastening death. Regarding the argument on stem cell research, my point here was to undercut the claim that because the embryo supposedly has the potential to be an adult human individual, we cannot do anything that might harm the embryo. Based on recent developments in biomedical technology, it appears that each of the cells in our body could in principle become an embryo and therefore, might develop into an adult human individual. If the underlying moral claim of opponents of embryonic stem cell research is that we should not do anything to harm cells that have the potential to become adult human individuals, then logically this implies we cannot do anything to harm any of the cells in our body, which of course is an absurd conclusion. Unlike Jackson, I do not see any fundamental difference between an individual created through cloning and an individual created through the fertilization of an ovum by sperm. (Identical twins have the same DNA.)

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Posted: 15 September 2008 12:42 PM   [ Ignore ]   [ # 24 ]
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ronaldlindsay - 15 September 2008 12:22 PM

Regarding the argument on stem cell research, my point here was to undercut the claim that because the embryo supposedly has the potential to be an adult human individual, we cannot do anything that might harm the embryo. Based on recent developments in biomedical technology, it appears that each of the cells in our body could in principle become an embryo and therefore, might develop into an adult human individual. If the underlying moral claim of opponents of embryonic stem cell research is that we should not do anything to harm cells that have the potential to become adult human individuals, then logically this implies we cannot do anything to harm any of the cells in our body, which of course is an absurd conclusion. Unlike Jackson, I do not see any fundamental difference between an individual created through cloning and an individual created through the fertilization of an ovum by sperm. (Identical twins have the same DNA.)

Yes, I raised this same point in a thread awhile back in a thread HERE, re. a new procedure which apparently allows scientists to turn ordinary skin cells into embryonic stem cells. Doing this sort of manipulation will only become easier as time goes on.

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Posted: 15 September 2008 02:12 PM   [ Ignore ]   [ # 25 ]
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Mr. Lindsay, thank you for clarifying your viewpoint. I think, perhaps, it can get a bit confusing when the concept of “rights” comes up, particularly when discussing rights and private arrangements. So, it seems then that this “conscientious objector” status is intended to be between a pharmacist and their employer, not between a pharmacist and a customer. That’s a world of difference, and the idea that a pharmacy would be forced to retain a disobedient pharmacist is just as antithetical to freedom as the idea of a pharmacist being forced to fill a prescription they do not want to.

ronaldlindsay - 15 September 2008 12:22 PM

Would [adamruth] claim that these cab drivers had the right to refuse to convey customers based on their objection to alcohol? Can a librarian refuse to stock certain books because of her objections to their content? Can a male truck driver refuse to be partnered with a female truck driver because he finds this objectionable to his religious beliefs? Can a server in a restaurant refuse to wait on tables that order meat products because the server is a vegetarian?

Absolutely they have the right to, but I’m using a more narrow definition of “right” than I believe you are. You seem to be saying that they don’t have the right to refuse service *and* retain their job if their employer objects. Since no one has a right to a job, then obviously their own rights don’t override the rights of their employer to fire them. If, in any of these cases, the employer didn’t have an objection then they could do these things without consequence (the consequence of losing their job anyway).

What would your opinion be if the pharmacy owner agreed with the pharmacist in not filling the prescription? What should the consequences to the pharmacy be?

ronaldlindsay - 15 September 2008 12:22 PM

Once we start allowing all employees to refuse to provide services in a job that they have freely chosen, and to do so without penalty, we will have chaos.

You’re right because *we* don’t have any say in the matter. That’s strictly an issue between the employer and employee. We don’t have the right to interfere and tell the employer they must either fire or retain their employee, it’s a private contractual matter.

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Posted: 15 September 2008 03:31 PM   [ Ignore ]   [ # 26 ]
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To respond to your question re the consequences to the pharmacy, if the pharmacy is entirely privately owned, receives no tax breaks/subsidies from the federal, state or local government, and the pharamacy makes its policy known to customers, then there should not be any consquences to the pharamacy. There are actually some pharmacies that have been established that style themselves as pro-life pharmacies and refuse to carry many contraceptives.
I think alerting customers is important, becase the reasonable default assumption is that a pharamacy will not refuse to carry a range of legal medications for religious reasons.

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Posted: 15 September 2008 03:57 PM   [ Ignore ]   [ # 27 ]
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Mr. Lindsay, thanks again for your response. It looks like we’re on the same page. I take back all of the mean things I considered saying about you but was too lazy to grin

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Posted: 15 September 2008 04:04 PM   [ Ignore ]   [ # 28 ]
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ronaldlindsay - 15 September 2008 03:31 PM

To respond to your question re the consequences to the pharmacy, if the pharmacy is entirely privately owned, receives no tax breaks/subsidies from the federal, state or local government, and the pharamacy makes its policy known to customers, then there should not be any consquences to the pharamacy. There are actually some pharmacies that have been established that style themselves as pro-life pharmacies and refuse to carry many contraceptives.
I think alerting customers is important, becase the reasonable default assumption is that a pharamacy will not refuse to carry a range of legal medications for religious reasons.

Thank you for clarifying your position, I see nothing I do not agree with. I had not thought about the fact that people do not usually pick their nurses. I have had people refuse a nurses services on the basis of personality conflict, but I can’t see that a patient would be allowed to refuse a nurse on the bases of the nurse’s race or religion these days. While I have seen it happen and enforced in the 1990s, I believe it is now considered illegal discrimination. I have had patients refuse a nurse based on their own religion (a male is not allowed to care of a female muslim patient for example) and we usually try to respect this, but I find that even muslims apply this inconsistently, and the ones who try to enforce it across the board are compromising the care of their loved one so thoroughly, we can’t morally, legally or ethically follow their wishes.

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Posted: 15 September 2008 07:19 PM   [ Ignore ]   [ # 29 ]
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ronaldlindsay - 15 September 2008 12:22 PM

If the underlying moral claim of opponents of embryonic stem cell research is that we should not do anything to harm cells that have the potential to become adult human individuals, then logically this implies we cannot do anything to harm any of the cells in our body, which of course is an absurd conclusion. Unlike Jackson, I do not see any fundamental difference between an individual created through cloning and an individual created through the fertilization of an ovum by sperm. (Identical twins have the same DNA.)

Thanks for responding to the comments—it does sound like an interesting book.

As I noted, I’m in favor of stem cell research, but I personally don’t get this “all cells are equal” argument.  The podcast emphasized other contradictions which I found compelling, such are requiring the extra stem cells or embryoes (after an infertile couple successfully has a child)  to be destroyed rather than used for medical research.  The general population now supports contraception as well as the treatment of infertility, and I’m hopeful the use of stem cells will be part of normal medicine in time.

Thanks again for bringing up many thoughtful points in the interview.

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Posted: 15 September 2008 07:55 PM   [ Ignore ]   [ # 30 ]
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One of the things I really like about this forum is that so often we are able to hear from authors who will participate in discussions here.
Thanks again smile

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