of Pharmacists and Fundamentalists, or, the War on Science

[Irvine511]

[q]Health Workers' Choice Debated
Proposals Back Right Not to Treat

By Rob Stein
Washington Post Staff Writer
Monday, January 30, 2006; Page A01

More than a dozen states are considering new laws to protect health workers who do not want to provide care that conflicts with their personal beliefs, a surge of legislation that reflects the intensifying tension between asserting individual religious values and defending patients' rights.

About half of the proposals would shield pharmacists who refuse to fill prescriptions for birth control and "morning-after" pills because they believe the drugs cause abortions. But many are far broader measures that would shelter a doctor, nurse, aide, technician or other employee who objects to any therapy. That might include in-vitro fertilization, physician-assisted suicide, embryonic stem cells and perhaps even providing treatment to gays and lesbians.

Because many legislatures have just convened, advocates on both sides are predicting that the number debating such proposals will increase. At least 18 states are already considering 36 bills.

"It's already a very hot issue," said Edward R. Martin Jr. of the Americans United for Life, who is advising legislators around the country pushing such bills. "I think it's going to get even hotter, for lots of reasons and in lots of places."

The flurry of political activity is being welcomed by conservative groups that consider it crucial to prevent health workers from being coerced into participating in care they find morally repugnant -- protecting their "right of conscience" or "right of refusal."

"This goes to the core of what it means to be an American," said David Stevens, executive director of the Christian Medical & Dental Associations. "Conscience is the most sacred of all property. Doctors, dentists, nurses and other health care workers should not be forced to violate their consciences."

The swell of propositions is raising alarm among advocates for abortion rights, family planning, AIDS prevention, the right to die, gays and lesbians, and others who see the push as the latest manifestation of the growing political power of social conservatives.

"This is a very significant threat to patients' rights in the United States," said Lois Uttley of the MergerWatch project, who is helping organize a conference in New York to plot a counterstrategy. "We need to protect the patient's right to use their own religious or ethical values to make medical decisions."

Both sides agree that the struggle between personal beliefs and professional medical responsibilities is likely to escalate as more states consider approving physician-assisted suicide, as embryonic stem cell research speeds forward and as other advances open more ethical fault lines.

"We are moving into a brave new world of cloning, cyborgs, sex selection, genetic testing of embryos," Stevens said. "The list of difficult ethical issues involving nurses, physicians, research scientists, pharmacists and other health care workers is just continuing to increase."

Most states have long had laws to protect doctors and nurses who do not want to perform abortions from being fired, disciplined or sued, or from facing other legal action. Conflicts over other health care workers emerged after the morning-after pill was approved and pharmacists began refusing to fill prescriptions for it. As a result, some lost their jobs, were reprimanded or were sanctioned by state licensing boards.

That prompted a number of states to consider laws last year that would explicitly protect pharmacists or, alternately, require them to fill such prescriptions.

The issue is gaining new prominence this year because of a confluence of factors. They include the heightened attention to pharmacists amid a host of controversial medical issues, such as the possible over-the-counter sale of the Plan B morning-after pill, embryonic research and testing, and debates over physician-assisted suicide and end-of-life care after the Terri Schiavo right-to-die case.

"There's an awful lot of dry kindling in the room," Martin said.

At least seven states are considering laws that would specifically protect pharmacists or pharmacies.

"Every other day, I hear from pharmacists who are being threatened or told they have to sign something that says they are willing to go along with government mandates," said Francis J. Manion of the American Center for Law & Justice, which is fighting an Illinois regulation implemented last year requiring pharmacies to fill all prescriptions, which led to a number of pharmacists being fired. "The right to not be required to do something that violates your core beliefs is fundamental in our society."

Opponents say such laws endanger patients by denying them access to legal drugs, particularly morning-after pills, which must be taken quickly. They say women often must go from pharmacy to pharmacy to get those prescriptions filled.

"Women all over the country are being turned away from obtaining valid and legal prescriptions," said Jackie Payne of the Planned Parenthood Federation of America. "These kinds of laws would only make the situation worse. It's shameful." Planned Parenthood is supporting efforts in at least six states to pass laws requiring pharmacists to fill all prescriptions.

At least nine states are considering "right of refusal" bills that are far broader. Some would protect virtually any worker involved in health care; others would extend protection to hospitals, clinics and other health care facilities. Some would protect only workers who refuse to provide certain health services, but many would be far more expansive.

http://www.washingtonpost.com/wp-dyn/content/article/2006/01/29/AR2006012900869.html
[/q]



so what could this mean? could an Opus Dei member legally refuse to prescribe brith control? could Tom Cruise refuse to prescribe prozac? could Sen. Brownback refuse to sell me condoms? could the Concerned Women for America be too overcome with concern to sell Viagra to a single person, hetero or homo?

have people of strong religious faith lost their respect for the neutrality of the public sphere? has faith morphed into something that's all about ME and MY FAITH and MY RIGHT NOT TO BE OFFENDED and not about respect for others and their health care needs? are we seeing lines drawn between those of faith and those of any sort of faith (or non-faith) that deviates from that individual's strict understanding of what is and what isn't acceptable? are we seeing the government enable individuals to submit all parts of their lives, even the jobs they were hired to do, to their particular dogma? do we now think that the freedom of religion enables now the freedom to deny life and health to others? are we seeing the acceptance of a new breed of doctors and pharmacists, people who are able to reject modern and mainstream drugs and treatments at the expense of their patients (and who might be more accurately labled "faith healers")?

 

[Irvine511]

double post.

 

[deep]

if people do not want to sell birth control

they should not work where it is sold


If a Muslim or a Mormon's religious beliefs forbid alcohol use,
they should not be allowed to refuse to sell it
if they work at a place where it is sold.

 

[deep]

have people of strong religious faith lost their respect for the neutrality of the public sphere? has faith morphed into something that's all about ME and MY FAITH and MY RIGHT NOT TO BE OFFENDED and not about respect for others and their health care needs?

"There is no God, but my God."

American Taliban

 

[randhail]

While I disagree with the majority of this "shielding law," I do think some of it has validity regarding physician assisted suicide. I don't see this issue being an example of faith intruding, but more of a physicians desire not to compromise his own medical ethics. A physician ought to have the right not actively play a role in a patient's death.

 

[Irvine511]

While I disagree with the majority of this "shielding law," I do think some of it has validity regarding physician assisted suicide. I don't see this issue being an example of faith intruding, but more of a physicians desire not to compromise his own medical ethics. A physician ought to have the right not actively play a role in a patient's death.

on this issue i agree with you.

however, PAS is only legal (sort of) in Oregon, and is clearly not considered mainstream medicine in the way that Prozac, Viagra, and contraception are.

 

[deep]

While I disagree with the majority of this "shielding law," I do think some of it has validity regarding physician assisted suicide. I don't see this issue being an example of faith intruding, but more of a physicians desire not to compromise his own medical ethics. A physician ought to have the right not actively play a role in a patient's death.

have you really looked into this ?
or are you just letting your "beliefs" lead you to a conclusion



these end of life situations are hardly killing someone

they are reserved for patients that 3? different doctors have determined are at the end of their life, terminal, they also get psych counseling, and have less than six? months to live in chronic, debilitating pain

all people die, do you want doctors to abandon them
once they have no chance of recovery?
any further assistance is just easing their way to death, is it not?

 

[Se7en]

i don't know irvine. jesus healed a blind guy AND resurrected a dude that was DEAD without so much as even using an acetomeniphine gelcap. far be it from me to go against god's will.

 

[deep]

from the article

Doctors opposed to fetal tissue research, for example, could refuse to notify parents that their child was due for a chicken pox inoculation because the vaccine was originally produced using fetal tissue cell cultures, said R. Alto Charo, a bioethicist at the University of Wisconsin.

"That physician would be immunized from medical malpractice claims and state disciplinary action," Charo said.

Advocates for end-of-life care are alarmed that the laws would allow health care workers and institutions to disregard terminally ill patients' decisions to refuse resuscitation, feeding tubes and other invasive measures.

"Patients have a right to say no to CPR, to being put on a ventilator, to getting feeding tubes," said Kathryn Tucker of Compassion and Choice, which advocates better end-of-life care and physician-assisted suicide.

Others worry that health care workers could refuse to provide sex education because they believe in abstinence instead, or deny care to gays and lesbians.

 

[Se7en]

it's disturbing, deep. there's no two ways around it.

 

[randhail]

all people die, do you want doctors to abandon them
once they have no chance of recovery?
any further assistance is just easing their way to death, is it not?

I have no problems with DNR orders, comfort measures only, etc. I'm not at all suggesting that physicians abandon their patients during these times. In contrast, this is when the most time needs to be spent with them. It is only when a phyisician actively plays a role in the death of the patient that it becomes unethical. It inherently goes against the oath physicians take "to do no harm."

 

[deep]

I had one opinion before I actually did some research on this and listened to people involved with the program.

Based on your posts I believe you do not understand how the Patient Assisted Suicide program works.

 

[BonosSaint]

I cannot imagine a law in the world that would REQUIRE a doctor to participate in PAS (or for that matter perform an abortion), which I understand would be an active participation as opposed to a passive participation of allowing the patient to refuse care.
I cannot imagine any physician being liable in not performing PAS. His/her only requirement would be to step aside and let another physician take over if the patient so desires it. No compromise of personal medical ethics.

 

[deep]

I cannot imagine a law in the world that would REQUIRE a doctor to participate in PAS (or for that matter perform an abortion),

they are red herrings- false arguments

this is about a Pharmacist refusing to fill a prescription.

 

[randhail]

I had one opinion before I actually did some research on this and listened to people involved with the program.

Based on your posts I believe you do not understand how the Patient Assisted Suicide program works.

My idea is a physician actively providing means to a patient to commit suicide whether it be a lethal dose of medication or by saying, if you do such and such a thing, you will die. Active being the key portion. I am a few years removed from Biomedical ethics class, so things could have changed.

I'm interested in knowing more about it though.

 

[Irvine511]

My idea is a physician actively providing means to a patient to commit suicide whether it be a lethal dose of medication or by saying, if you do such and such a thing, you will die. Active being the key portion. I am a few years removed from Biomedical ethics class, so things could have changed.

while i have no interest in digging up (ha) the Teri Schiavo debate, you are absolutely correct in the distinction between a doctor allowing nature to take its course -- which does include the removing of a feeding tube -- versus the injection you mentioned. my father is a physician and feels very strongly about this -- he would have no problem if, say, an elderly patient with cancer and in pain chose to let a pneumonia end their life (while making her comfortable with morphine), however he would not ever inject someone with a tranquilizer that might, say, stop her heart.

but, as Deep noted, this is a red herring. this is not about PAS, or abortion -- this is about your right to refuse someone a valid, legal, mainstream medication or perscription on the basis of YOUR religious beliefs.

and it also speaks to the contempt, as evidenced in this article, that many people of faith have for the mainstream. respect is demanded, but none is accorded in return.

it's little more than me-first narcissism.

 

[randhail]

but, as Deep noted, this is a red herring. this is not about PAS, or abortion -- this is about your right to refuse someone a valid, legal, mainstream medication or perscription on the basis of YOUR religious beliefs.

Ah, my bad then. I saw Physician assisted suicide in the article and gravitated towards that, but as I said disagree with all of the protection measures.

The whole idea of protecting pharmacists is a little absurd. They do not prescribe the medication, they dispense pills not morality lessons. It would be way out of line for one to step in and say I can't get a certain drug. Birth control is mentioned now, but where else could it go? AIDS patients being denied medication because they have AIDS?

 

[BonosSaint]

I agree with you entirely. I think the argument that a physician would be forced to participate in PAS is purely a straw argument.
I am horrified that a physician would deny medical treatment (or perhaps even more important--information) and would be following any other agenda than the medical interests of his/her patient and it is unconsciencable that a health worker could interfere in the medical decisions made by a physician and patient.

 

[Irvine511]

Ah, my bad then. I saw Physician assisted suicide in the article and gravitated towards that, but as I said disagree with all of the protection measures.

The whole idea of protecting pharmacists is a little absurd. They do not prescribe the medication, they count out the pills, and no offense to them, do very little at my local CVS. It would be way out of line for one to step in and say I can't get a certain drug.

i think there's an effort to link a doctor's right to refuse PAS or abortion and the desired right for a pharmacist to deny someone birth control.

 

[BonosSaint]

I forgot, Irvine. You're a doctor's kid, too.

 

[verte76]

Some of this is disturbing. Denying health care to gays and lesbians? I don't like this.

 

[yolland]

Does anyone know if pharmacists have to take anything resembling the Hippocratic Oath?

While I personally am vehemently opposed to pharamacists having the right to deny filling prescriptions for contraceptives or RU486, I am not sure deep's analogy to a Mormon not selling alcohol fully holds up. If your religious beliefs hold that these drugs are abortifacients and abortion is murder, than that makes it all a bit more complicated than whether you might be supporting an "indecent" lifestyle. Like it or not, I am afraid this issue cannot really be resolved without venturing into the larger issue of whether women have the right to control what goes on inside their bodies. I do not think we can really cordon these debates off from one another.

 

[anitram]

It is not the pharmacist's job to determine your course of treatment. This is the job of your physician and once you have been given a prescription by an MD, I don't give a rat's ass about the religious sensibilities of the pharmacist. They knew what their job would consist of and chose to pursue a career in this field. So, tough.

Furthermore, many of these medications, specifically the birth control pill, have uses beyond the obvious contraception. They are used to treat hormonal imbalances, acne and other dermatological issues, migraines, even depression. It is not within the scope of the pharmacist's job to refuse service based on what he thinks you are using it for. For all he knows you're a fundamentalist virgin with low estrogen and need the pill.

I'm so sick of the society catering to a small segment of people who have blatant disregard for 99% of us. We are expected to bend over backwards and ask them, "Sir, would you like some more?" while they shit all over us. Enough is enough.

 

[deep]

I'm interested in knowing more about it though.

here is some information

Limited Cases

A limited number of people have actually used the Death with Dignity law to end their lives. According to a report released in March by Oregon's Department of Human Services, about one of every 800 deaths in Oregon last year resulted from physician-assisted suicide, and 208 people had used the law overall through the end of last year.

Oregon residents 18 or older with terminal illnesses must voluntarily request physician-assisted suicide. The person must state his intentions — once in writing and twice verbally — and must be determined to be fully competent and be certified by two physicians to have six months or less to live. He or she also must be made aware of other treatment options.

Doctors must report all prescriptions for the medications to the Department of Human Services. They and their patients are protected from prosecution, and the decision does not affect patients' health or life insurance policies. Doctors can prescribe the drugs but cannot administer them.

According to the report, 37 people in 2004 ingested medications prescribed under provisions of the law — five fewer than in 2003, though the numbers have increased since legalization.

In addition, the report found that 40 physicians wrote a total of 60 prescriptions for lethal doses last year, the first decrease in the annual total of prescriptions written under the law. Thirty-five of the prescription recipients died after ingesting the medication, and of the 25 who did not ingest it, 13 died from their illnesses and 12 were alive at the end of the year. The other two people who died had received prescriptions in 2003.

Rasmussen said "a small number of people" ask him about assisted suicide — 150 of his patients have seriously inquired over the years, and he estimates more than a dozen have carried out their suicides.

 

[deep]

If your religious beliefs hold that these drugs are abortifacients and abortion is murder, than that makes it all a bit more complicated than whether you might be supporting an "indecent" lifestyle.

Religions do not have the right to call birth control or even abortion murder.


Murder is a legal term.
It is always a crime.
and punishable by law enforcement.

When they misapply this legal term
they are contributing to the Planned Parenthood Bombers and Doctor murderers.

Meat is Murder to PETA

 

[shrmn8rpoptart]

Murder is a legal term.
It is always a crime.
and punishable by law enforcement.

When they misapply this legal term
they are contributing to the Planned Parenthood Bombers and Doctor murderers.

Meat is Murder to PETA

i'm not going to get into the argument, but i would just like a further definition.

murder is a legal term, but what does that legal term refer to?

my dictionary (webster's new world) defines it as "the unlawful and malicious or premeditated killing of a person"

that causes me to think a few things:
1)the definition does in fact include "unlawful", in this country, abortion is not unlawful, so the definition does not fit.
2)i'm not trying to make any judgements, just wondering, but if we were to make the killing of any person legal, then would that killing cease to be murder?
3)finally, even if abortion was made illegal, it would seem that the debate over the point at which an embryo becomes a person would still have to be decided prior to being able to correctly apply the term murder.
4)you are correct, according to the definition, PETA can never accurately apply the word murder to the slaughter of animals for human consumption.

my english and greek classes are really making me into a word nerd.

i do find it interesting though, that the same people who are usually making arguments about the fluidity of language, and the relativity of meaning behind words suddenly asking for strict definitions and correct usage.

anyhow, sorry for the interruption. carry on.

 

[yolland]

Religions do not have the right to call birth control or even abortion murder.

I like this idea in principle, but I'm not sure how realistic it is in practice. While my own thinking on this topic is informed by a variety of perspectives, I would be being dishonest to say it was not in part influenced by Jewish doctrine, which says these things are not murder. (Which by your same logic isn't valid either.) And that means this ultimately informs my voting habits too, just as religious-derived perspectives (along with, hopefully, a multitude of others) inform the thinking of judges and doctors.

Now if religious doctrine is being presented as a wholly adequate and legitimate basis for secular lawmaking or policy in its own right, without perceived need for the due consulting and evaluation of other rational (*see last paragraph below) perspectives, then yes that is veering into "theocracy" territory and is something else entirely. Freedom of conscience does not mean you get to ignore the premises behind separation of church and state, and pretend that religious activists are just another lobbying group innocently seeking representation of their interests (a nod to Irvine's me-first narcissism allegation: to a point all lobbying is "me-first," but most of it does not entail intrinsic challenges to fundamental principles of secular democracy).

Still, I think it is dangerously unrealistic to expect that religious people can or will fully block out the influence of religious doctrine on their thinking. Better to insist on balanced discourse instead, and for that matter, to support alternative religious dialogue which argues for a reconsidering of the interpretations of various doctrinal principles.

And comparing PETA to the Vatican is a bit of a stretch--you're talking about a 1500-year-old intellectual tradition versus a contemporary bunch of media assassins with relatively little substantial ethical discourse underlying their convictions. As far as it goes, one need not believe in God at all to accept the idea that life begins at conception, and therefore fetal life warrants protection. The two ideas are not inherently dependent on each other. Don't you know any nonreligious pro-lifers? I certainly do.

 

[BonosSaint]

Well, perhaps if these shield laws go into effect, they should require a sign informing the patient that the providers use other criteria than objective medical requirements of the patient. For example, "I provide my service based on my personal beliefs which may supercede your medical needs." The conscience of the provider is taken care of and the patient can be steered elsewhere where his health decisions are not deemed a moral issue.

 

[najeena]

I'm a doctor's kid, too. An old-fashioned small town Family Practioner (at seventy-two, he just passed his boards yet again), my Dad has seen the sea-change in the medical field over the last twenty-five years, and he's glad that he won't be involved in it too much longer. "It's about politics and money- it used to be about patients and what they needed"

 

[BonosSaint]

Old time small town GPs