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Ronald A. Lindsay - Future Bioethics
Posted: 16 September 2008 08:55 AM   [ Ignore ]   [ # 31 ]
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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

I have to disagree with this, since it overlooks the fact that pharmacies and pharmacists are licensed by the state. This is because they are acknowledged to offer services and products which can potentially be harmful if improperly provided, so government oversight and establishment of standards that ensure public safety is justified. If a pharmacy can pick and choose which services and medications to offer, or allow its employees to do the same, then it becomes nearly impossible for the consumer to trust that whatever pharmacy they go to will meet consistent, appropriate standards for their services.

As an example in a different context, the British public health service sent investigators to a number of homeopathic pharmacies posing as travellers to areas where malaria is endemic and asking for anti-malrial prophylactics. In all cases, they were discouraged by the pharmacists from using these proven drugs and encouraged to use homeopathic preparations with no real efficacy. Following this advice from a licensed, and so supposedly trustworthy, professional would expose the customer to unecessary medical risk based solely on the pharmacists idiosyncratic beliefs about medicine.

The case seems much the same to me if someone goes to a pharmacy requesting emergency contraception, regular contraception, AIDS medications, or any other legitimate medical product the pharmacist may have personal objections to. Being denied the service, and perhaps being given inappropriate or inaccurate information about the condition or the medications, potentially exposes the customer to harm based on the individual preferences of the pharmacist. I don’t believe this is acceptable, especially for a profession licensed by the government for the purpose of ensuring accurate and trustworthy information and service for the customer. The only reason the issue comes up at all is because the views in question are more widespread and generally based on religious belief, unlike the homeopathy example. This is a pragmatic political reason for exempting pharmacists from the general standards of licensed medical professionals, but it is not I think a strong reason based on principle.

Allowing pharmaicsts and pharmacies to choose their own exemptions from the standard services they are licensed to provide creates what I believe is an unacceptable burden on the pateint. Should a rape victim be expected to survey local phramacies to determine which will or will not humiliate her by denying her a prescription contraceptive? I hardly think that’s reasonable. Part of the burden of being granted a state license to practice, and profit from, pharmacy is to serve patients according to pre-established and uniform standards set for the sake of public welfare, and if that is unacceptable then there are other careers available. You’ve made this same point regarding individual pharmacists, so I don’t see why it should not apply to the institutions they work for.

[ Edited: 16 September 2008 01:24 PM by mckenzievmd ]
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Posted: 16 September 2008 01:03 PM   [ Ignore ]   [ # 32 ]
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Excellent post.

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Posted: 04 November 2008 02:36 PM   [ Ignore ]   [ # 33 ]
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mckenzievmd - 16 September 2008 08:55 AM

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

I have to disagree with this, since it overlooks the fact that pharmacies and pharmacists are licensed by the state. This is because they are acknowledged to offer services and products which can potentially be harmful if improperly provided, so government oversight and establishment of standards that ensure public safety is justified. If a pharmacy can pick and choose which services and medications to offer, or allow its employees to do the same, then it becomes nearly impossible for the consumer to trust that whatever pharmacy they go to will meet consistent, appropriate standards for their services.

mckenzie, so basically what you’re hedging at is that healthcare should be fully socialised/nationalised. This seems like a fine idea until you get a fully conservative government as we so recently had. Maybe the gov’t in its wisdom would decide RU486 and the like don’t need to be legal. In this case there is nothing for the goodly pharmacist or victim to do other than vote. My government has actively worked to rollback EPA standards, to halt science and medical funding, to hand millions in free money to churches and these people are going to say what pills the pharmacy is allowed/forced to sell? You argue the gov’t already has the power but you’d be handing them a whole lot more. The HPV vaccine comes to mind…strongly opposed by American conservatives supposedly for “health” reasons.

The problem in your homeopathic remedy hypothetical is that “homeopathic” would be permitted the status of “medicine” which of course it is not and thus should not be sold in anything resembling a pharmacy nor marketed as or claimed to be medicinal.

In practice, lots of pharmacies will carry just about anything that makes them money. If anything, the issue with any sort of drugs and medicine in a market economy is that it will be made too readily available. Add to the mix the rise of the internet-based (legit) pharmacy and the whole issue seems a bit irrelevant. There are some examples that are potentially problematic however, as in the case of the rape victim but then shouldn’t ERs and state clinics have those suppies on hand as they are “emergency care” type items? Or at least they ought to be. Concievably, a person in a small town with only WalMart for a pharmacy could find themselves in a pickle and I find this a weakness of my position.

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