I really had zero intention of blogging today.  Unfortunately Avitable had to start some shit about drugs that was carried over from the Clearly Your Retarded show where he is the co-gladiator with Miss Britt.  The topic of the show was Should a pharmacist or physician be able to deny you medication or treatment based on their personal moral or religious beliefs? Pretty hot topic right?  While I’m not looking to make it any hotter… I do want to clarify my views and better explain my reasoning without leaving a post in comments as I was tempted to do.

Also please understand that in this case I am referencing those pharmacists who work for a corporate pharmacy such as CVS, Duane Reade, Walgreens, or whichever one you choose.  I do not feel that an independent pharmacy owned by the pharmacist must distribute something they feel is contrary to their personal beliefs and morals, unless it is mandated by their regulating agency.

I believe that a pharmacist or a physician who denies you medication or treatment based on their personal moral or religious beliefs should be de-certified/ have their license revoked and face the repercussions that their state law allows. Why do I feel this way?

I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.
-The Hippocratic Oath

Physicians

Physicians today still take the Hippocratic Oath before beginning medical school.  The truth is, while medicine is still considered an art there have been a number of advances including both examination and treatment protocols for the vast varieties and ailments that have been identified.  It is in fact possible for a doctor to refuse to become a patient’s physician.  However, what must occur for that to happen is the doctor must find another physician within a certain geographic location who is willing to take the patient.  Then, once that physician has been found, there is a 3 month period of consultations and exams done jointly between the two doctors before the first doctor is relieved of his obligation. 

Additionally, in regards to patients without the ability to pay, hospitals with emergency rooms and the doctors that operate in them are under the Federal Emergency Medical Treatment And Labor Act (EMTALA).  Basically what EMTALA does is say that they MUST treat you, you and your unborn, and stabilize you.  Additionally, EMTALA regulates ambulances and prevents us from picking a “stabilized” patient up from one hospital and bring them to another without having a pre-arrangement for a bed and a receiving doctor.  Unfortunately, before the regulations, ambulances routinely did this type of “patient dumping” from facility to facility of uninsured patients which only added to our ill repute as meat wagons.

EMTs

The reason I am bringing EMTs into the mix is, because, well I am one.  Surprisingly or not, EMTs and Pharmacists have A LOT of things in common.  EMTs are certified/licensed by regulating agencies in the states that they work.  EMTs operate under the license of a physician.  EMTs are held to regulations and standards that vary state by state, including what is called Duty To Act (DTA).  DTA basically states that when an EMT is on duty, it is his responsibility to act either to a call assigned by the dispatcher or to people injured on the street.  DTA applies to BOTH paid and volunteer EMTs.

If an EMT refuses to act, by either refusing a call or driving by a scene where people may be hurt, injured, or are “flagging you down” (even if you already have a patient onboard), that EMT is in a heap of trouble.  The penalties can include suspension or revocation of their license, fines, and criminal charges that can result in jail time.  These same penalties can be applied by the regulating agency for Failure to Act, Patient Abandonment, and Gross Negligence.  Then there are the lawsuits.  Usually they’re small because we get lumped in with hospitals, doctors, nurses, and the police… but every agency needs malpractice insurance because of it.

Pharmacists

Pharmacists are certified/licensed by regulating agencies in the states that they work.  A Pharmacists job is to provide federally approved and regulated narcotics to people based on the prescription of their doctors.  A Pharmacist operates under the direction of the physician (through the prescription).  A Pharmacist however, does not operate under a DTA.  I think that’s what part of the problem is… and what part of the legislation is aiming to do.

If a Pharmacist refuses to fill a prescription because of his personal moral, I honestly don’t know what happens to him.  What SHOULD happen is his license should be subject to suspension or revocation, he should be subject to fines, and he should be eligible for criminal charges.  The Pharmacist has a job to do and if he refuses to do it, just as if an EMT refuses to do his job, he should be subject to the consequences.

But the issue is bigger than Pharmacists.  The issue is about morality vs. duty, and when they conflict which one should be adhered to without repercussions.

American Morality

One of the contributing factors to the dilemma is the very nature of American Morality… or more specifically the lack of cohesiveness to it.  We pride ourselves on being founded with religious freedoms and the separation of church and state as a cornerstone building block.  Yet American laws, symbols, and traditions smack of the popular religions at the time of the country’s birth.  Religion has been intertwined into our lives, and the morals it carries with it has been interwoven with the very laws we live by.  Utah having previously been a state of legal polygamy, Nevada being a state with legal prostitution, and California being a state with legal marriage of same sex couples all go to show the variety of moral values and how states change based on the majority.

For a country with a cornerstone being the separation of church and state, we’ve surely clung our government to the very thing of persecution that inspired the founding of this country.  Personally, I am against state sanctioned same sex marriage.  Shocked?  You really shouldn’t be because in fact, I am against state sanctioned opposite sex marriage.  I am against the use of the word marriage in any law, proclamation, or license.  I believe that marriage is a word originating from religion to define the joining of a man and a woman in the eyes of God.  This is what my religious education taught me… and that same education uses that argument against same sex marriage.  I do not believe the word has purpose anywhere in government.  I am for governmental benefits to those who join in a civil state sanctioned union, whether it be same sex or opposite sex, and I think that once you disassociate the religious word from the governmental status it suddenly becomes a non-issue.

I do not believe a Bible should be used in court for an oath to be sworn upon… in fact I think it should be the penal code for that state, or in the case of the President of the United States, he should take his oath with his hand on THE Constitution.  A little tidbit: there is no mention or requirement for the use of a book of religious text or for the incoming President to end the oath with, “So help me God.” That has been added in time and time again… because people don’t really want to separate their Church from their State as much as they claim.

What does this do for American Morality?  It makes it a murky watered beast with more shades of gray than Crayola crayons has colors.

American Duty

As a human being I have obligations to both society and myself.  Failure to fulfill those obligations are not without consequences on either side.  The obligations I have to society, my American Duty, I find commonality with alot of people.  They are the same people who chose the same type of career path that I have… doctors… nurses… other EMTs… nurse aides… pharmay techs… pharmacists… those who serve under the Rod of Asclepius.

As an EMT I have an obligation to serve those around me in the capacity of an EMT.  As I mentioned in a previous post, I am a proponent of euthanasia.  I believe in quality over quantity when it comes to life.  So when I go to a nursing home, to find a vegetative and contracted husk of a body in cardiac arrest, do I refuse to do CPR because it is against my moral belief of quality over quantity?  No.  In that moment, my sense of duty overcomes my moral sensitivities.  This is the career I consciously chose, and this is the job I agreed with my employer that I would do.  I will do my best to bring this poor person back to life… for however long they are kept alive on machinery until a family member can take the time to come and relieve them of their painful existence.

My obligation to society, as someone who chose to work in an aspect of healthcare and therefore be a contributor to the art of medicine, is to fulfill that role as best I can.  It is indeed a service role, but unlike a waiter or a cab driver (other service roles), I am directly contributing to both your quality and quantity of life.  It is what I chose to do… there is no question about who is right and who is wrong… it is my duty and it is clear cut black and white.  Most importantly it is the same for me as it is for every other EMT in the state.

Moral Duty

Of course there is also Moral Duty.  This is the sense of obligation you feel based on your personal moral values.  This can be a tougher thing to act upon in society, because not everyone around you will understand or agree with your sense of duty or the morals it is based upon.  There is no shared commonality, and if it conflicts with your duty to your role in society then it will obviously cause friction. 

Following your sense of duty to society may cause you internal strife and grief.  Maintaining your sense of Moral Duty when in conflict with your duty to society can, and usually is, viewed as a selfish and discriminatory act.  Moral Duty is individually based, and therefore not necessarily in the best interest of the whole. 

Of course there will be those who will say I am advocating communism or socialism.  I’m not advocating that in the slightest, but considering that we are essentially talking about businesses and people who are paid through Federal programs funded with your tax dollars such as Medicare and Medicaid, there should be accountability and regulation.  That regulation should include the assurance that there be no product discrimination or favoritism.

In Conclusion

As an EMT, I have chosen to perform this job.  I have chosen this career and have chosen to fulfill the obligation I have to those around me as best as I can.  If your sense of Moral Duty to yourself outweighs that of your sense of American Duty to society around you, then the only honorable and ethical thing to do is to remove yourself from a service career and role in society that is compensated by tax dollars.  That is why I ultimately think a pharmacist or a physician who denies you medication or treatment based on their personal moral or religious beliefs should be de-certified/ have their license revoked and face the repercussions that their state law allows.