Thursday, April 21, 2005

Pharmacists and conscience clauses: Straight from the horse's mouth.

Yes, yes, I know I've beaten this topic to death lately but I just ran across an enlightening letter to the editor that shows pretty clearly how difficult it is to strike a balance between religious nutbar, "pro-life" pharmacists and customers who just want their damned prescription filled and no, they don't need a patronizing lecture with those pills, thanks very much.

The main issue here is whether it's possible to accommodate both sides, so it's worth seeing how the people at the top -- the very top -- propose to handle this. To wit, this 2004 letter to the editor from American Pharmacists Association (APhA) VP, Policy and Communications and Staff Counsel Susan C. Winckler, RPh, Esq, to "Prevention" magazine. Because if Susan Winckler, RPh, Esq., can't explain it, you get the feeling no one else is going to have much luck either.

So let's work our way through Winckler's letter slowly and methodically, and see how she abuses logic in new and exciting ways (all emphasis added to maximize the embarrassment potential).

July 1, 2004

To the Editor:

I am responding to your story, “Access Denied: Find out why growing numbers of doctors and pharmacists across the U.S. are refusing to prescribe or dispense birth control pills.”

Your detailed story was informative, but it is missing the balanced perspective of the first-established and largest professional organization of pharmacists in the United States – the American Pharmacists Association (APhA).

OK, so Winckler is just establishing her street creds here. Big whoop. Let's get to the good part:

The APhA absolutely supports patients’ right to access their legally prescribed medications.

Hot damn. It doesn't really get any less ambiguous than that, does it? No dodging, weaving, tap dancing, shucking and jiving or acting like Weasel Boy. "Absolute" support. End of discussion. Case closed.

But wait. What's this in the very next sentence?

APhA also supports the pharmacist’s right of conscience.

OK, I'm confused. Just how do you reconcile these two statements? Customer wants birth control pills, pharmacist doesn't want to give customer said pills. How exactly are you supposed to keep both sides happy? And what just happened to that "absolute" support? As the old saying goes, something's gotta give. Continues Winckler, making less and less sense by the word:

That right of conscience comes with responsibility to assure patient access to the legally prescribed therapy.

Still confused. Apparently, that right of conscience is still trumped by the customer's right to have her prescription filled. I'm pretty sure someone is going to end up unhappy here, it's just not clear who. Continues Winckler, in a futile effort to clarify the situation:

In contrast to the impression created by your story, these two objectives are not mutually exclusive.

They're not? That would be a major development, wouldn't it? So just how does this work, this magical policy that allegedly satisfies everyone?

When the profession’s policy is implemented correctly--and proactively--it is seamless to the patient, and the patient is not aware that the pharmacist is stepping away from the situation.

Aha! So we're finally going to get to the details of this "policy," and note how Winckler assures us -- yes, she does -- that the policy is "seamless" to the customer, and that the customer should not even be aware of what's happening.

Put another way, Winckler assures us that dealing with a pro-life wingnut should be completely, totally transparent, and the customer should be utterly oblivious to the pharmacist's moral strictures. So is that how it really works?

Whether another pharmacist on duty completes the prescription ...

Whoa, whoa, whoa ... stop right there, we have our first problem. Is that Winckler's first attempt at a "seamless" solution? Because it fails pretty spectacularly.

Assume, for the sake of argument, there there even is another pharmacist on duty willing to do the dirty work. If that pharmacist is available, then no problem. But what if he or she is tied up with another customer, maybe on the phone and can't take over at the moment? It's not hard to imagine the pro-life pharmacist handing off the job, then stepping back with nothing to do and kind of just hanging around, humming show tunes or something while the customer is starting to wonder why she's waiting for that guy when this guy clearly has nothing to do.

This is Winckler's idea of "seamless"? Of the customer not being "aware"? And note that Winckler doesn't even address the possibility of there being only one pharmacist on duty. As a "seamless" policy, this obviously fails miserably. But it just gets sillier as Winckler continues in that same sentence with other possibilities:

Whether another pharmacist on duty completes the prescription or patients are proactively directed to pharmacies where certain therapy is available ...

Ah, directing patients elsewhere. Yeah, that's "seamless," isn't it? (Apparently, there's nothing about being a RPh, Esq. that prevents one from being jaw-droppingly stupid and illogical.) But Winckler isn't done making a fool of herself, still in the same sentence:

Whether another pharmacist on duty completes the prescription or patients are proactively directed to pharmacies where certain therapy is available, or even different systems are set up, the patient gets the medication, and the pharmacist steps away from that activity--with no intersection between the two.

"Or even different systems are set up"? What can that mean? From various readings, I take this to mean that the prescription can be mailed to the patient. And, once again, this is "seamless" and transparent to the customer, who might need that prescription filled right now? And yet, given the overwhelming evidence that what she describes is just idiocy, Winckler has the nerve to write:

This policy works.

No. No, it doesn't. It works neither theoretically nor practically, despite Winckler's ludicrous delusions. But none of this stops Winckler from concluding with a passage that is absolutely breathtaking in its sheer stupidity:

It is only if the policy is not implemented properly that the needs of a patient or the right of conscience of the pharmacist would not both be properly acknowledged. It is because such instances of improper implementation are rare – rather than frequent -- that they inspire widespread media coverage. Although rare, such situations are extremely unfortunate, and we are working to ensure they will not occur.

And yet, as we've already seen, there is no conceivable way to keep both sides happy, and nothing that Winckler describes even proposes such a workable policy. And if Susan C. Winckler, RPh, Esq., can't come up with anything more relevant and meaningful than the above gibberish, I think it's safe to say that what we have is an impasse. And all of Winckler's hoping and wishing and deluded fantasies of keeping everyone happy isn't going to solve it.

BY THE WAY: In the midst of all of Winckler's gibberish, did you see any details of an actual "policy" anywhere?

1 comment:

Mark Richard Francis said...

A lot pf pharmacies are owned by pharmacists. You see where I'm going with this, right? Heck, should it even matter if the owner is a pharmacist? Nope. 'No pharmacist working for me is going to dispense birth control!'

Since they want to be able to decide for patients what prescriptions they can or can't have, I think that we should relieve them of the responsibility. Keeping in mind that pharmacists' position as society's gatekeeper to prescribed drugs is legislated, why not allow certain prescriptions to be filled by non-pharmacists? Doctors write the script, and why not fill them? Why not allow public health nurses the ability to fill birth control pill scripts? The pharmacist is really just a technicality here anyway. The pills are pre-packaged. The pharmacists' fee here is a rip off.

If pharmacists want to be able to determine based on their misguided conscience what's good for people, then they should be prepared to lose some of their monopoly.