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Old 04-05-2005, 10:46 PM   #1 (permalink)
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When pharmacists refuse, market is best medicine

I just read a wonderfull OP/ED regarding the witholding of Birth Control by pharmacists.

A segment I thought worthy of discussion follows:
Quote:
No business should be obligated to employ people who chase customers away and refuse to follow its policies. Last year, when three pharmacists at an Eckerd store in Denton, Texas, wouldn't give a morning-after pill to a rape victim, they were fired. The "conscience" law proposed in Austin would protect their jobs. That would be a mistake. Pharmacists who insist on imposing their views on others don't deserve state-enforced job protection. They may have to pay a price for their principles by finding another line of work.
http://news.yahoo.com/news?tmpl=stor...e&sid=84439559

Now, it is fair to point out the OP/ED defends a pharmacists right to conscience refusal. It simply makes the point that in a free market, a pharmacist who does this may find themselves out of a job. A company that supports conscience actions by pharmacists may find it loses customers to competition. According to the American Pharmacists Association, a pharmacist is expected to either refer the customer to a Pharmacy that will fill their prescription, or hand the slip of to a pharmacist that will fill it.

So in a small area with only one drug store with one or two druggists, how can a woman expect that her legal rights be met if there are no other pharmacy's?

More to the point of why I'm posting, I have seen quite a few people on this board arguee that the free market is a good thing. The free market does no always go hand in hand with any political attitudes however. A store does have the right to fire an employee that does not do as the company requires or expects. In other words, in the free market Walgreens can fire every conscience objecting pharmacist, and it's perfectly legal, within the right of the company even. And I like that just fine.

What are your thoughts?
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Old 04-05-2005, 10:53 PM   #2 (permalink)
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I agree with you completely. If the situation were a Rand McNally salesman who refused to sell maps that showed the world was flat because he believed it wasn't, he'd be fired and no-one would complain. I don't mean to suggest that these pharmacists' beliefs are fictitious, but that someone who refuses to do their job shouldn't work there anymore.
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Old 04-06-2005, 04:09 AM   #3 (permalink)
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Quote:
=arch13]So in a small area with only one drug store with one or two druggists, how can a woman expect that her legal rights be met if there are no other pharmacy's?
The same way a women in a town with no pharmacies, she goes to another town. I lived in a town with no grocery store, yet people didn't starve, and there weren't many farmers either. People went to a grocery store in the city. Likewise, many small towns that have stores have limited selection, should people complain because their legal right to goods not sold there isn't being met? No, you go where what you want is being sold.


Quote:
Originally Posted by arch13
More to the point of why I'm posting, I have seen quite a few people on this board arguee that the free market is a good thing. The free market does no always go hand in hand with any political attitudes however. A store does have the right to fire an employee that does not do as the company requires or expects. In other words, in the free market Walgreens can fire every conscience objecting pharmacist, and it's perfectly legal, within the right of the company even. And I like that just fine.

What are your thoughts?
Would you say that a company could fire a openly gay man if it felt that his homosexuality lead to a loss of business? Or what about the company in Michigan that recently fired employees for smoking at home, do you agree with that business as well? Or what about a business that requires a woman to wear makeup?

I don't think a business should be able to force people to unreasonably go against their beliefs. Most likely, the pharmacists in question felt that by giving out the morning after pill they would be participating in murder. I don't think people should be punished for having principles, and I hope they get either their jobs back or a large settlement.
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Old 04-06-2005, 04:45 AM   #4 (permalink)
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I believe that the following are the protected attributes: gender, national origin, race, religion, sexual orientation, pregnancy, or disability.
So the situation with a company firing people for smoking should be rectified, and so should anyone being fired based on sexual orientation.
Other than that, it seems to be fair game, which would include pharmacists going against company policy as long as the policy is legal and non-discriminatory. (in this case, company policy is legal).
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Old 04-06-2005, 04:49 AM   #5 (permalink)
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Quote:
Originally Posted by JustJess
I believe that the following are the protected attributes: gender, national origin, race, religion, sexual orientation, pregnancy, or disability.
That's a little overly simplistic. Some of those things are protected in certain situations, but not others. To my knowledge, in most places sexual orientation is NOT protected. As for disability, it depends on what disability. There's also different legal tests for discrimination on the different categories. IIRC, race discrimination has the most stringent tests for being allowed, followed by gender then nat'l origin.
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Old 04-06-2005, 05:29 AM   #6 (permalink)
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Quote:
Originally Posted by alansmithee
That's a little overly simplistic. Some of those things are protected in certain situations, but not others. To my knowledge, in most places sexual orientation is NOT protected. As for disability, it depends on what disability. There's also different legal tests for discrimination on the different categories. IIRC, race discrimination has the most stringent tests for being allowed, followed by gender then nat'l origin.
alansmithee... you are correct, sexual orientation is NOT protected... look at the last election, most the issues on ballot didn't only address gay marriage, but ANY "special treatment" for sexual orientation.

sorry to thread hijack.

as far as pharamists refusing to dispense drugs? they should be fired plain and simple. a pharmacists job description does not included dictating morality.
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Old 04-06-2005, 06:12 AM   #7 (permalink)
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slightly continuing the thread hijack... actually, I was referring to the example of employment. And as far as employment goes, you cannot discriminate based on sexual orientation, even if "it makes the customers uncomfortable".

And agreed - if I want someone to tell me how to live... well, I wouldn't go to a pharmacist.
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Old 04-06-2005, 06:33 AM   #8 (permalink)
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I agree with the drugstore here. When a pharmacist won't fill a perscription because its against his beliefs, well, he's probably in the wrong job.
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Old 04-06-2005, 06:48 AM   #9 (permalink)
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Yep, the stores should be able to fire the pharmacists. No different than a video store clerk refusing to rent R or X rated movies or a grocery store clerk refusing to sell cigarettes or booze. This seems so obvious.
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Old 04-06-2005, 07:01 AM   #10 (permalink)
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This article came from Tennessee, but I beleive Illinois already has this law on the books...

Bill Would Give Pharmacists Right To Refuse Prescriptions


There's a move in the legislature to give state pharmacists the right to morally object to filling some prescriptions.

The bill would include any drug a pharmacist morally or religiously objects to.

Some critics say pharmacists could refuse to fill birth control medication or especially the morning after pill.

But the Republican legislator who introduced the bill says it's meant to give pharmacists the same rights as other health care professionals to refuse to fill a prescription for any medicines they feel violate their moral principles.

“Doctors and nurses have the same right. It seems right that as a health care professional, there are certain things that if they violate your conscience, you shouldn't have to do it. It’s the fair and right thing to do,” said Representative Glen Casada (R) of College Grove.

It's being called the Pharmacists Freedom of Conscience Act and it would protect pharmacists from liability or disciplinary measures if they refuse to fill a prescription for religious or moral reasons.

The bill faces an uphill fight on Capitol Hill, where many legislators think moral questions should be decided by a patient and their doctor.

A last minute glitch threatened to derail the bill because of a question of where the money to enforce it would come from, but legislators took care of the money problem by dropping TennCare enrollees from the measure.
~~~~~~~~~~~~~~~~~~~~
Frankly I really don't care what an individual pharmacy decides to do, however, if their policy is to not dispense birth control or morning after pills, then that sign should be clearly posted at the front door. I have read incidents of the prescriptions of women being taken and not given back.

But it makes me wonder, if these same pharacists that don't dispence birth control, also will dispence Viagra to unmarried men...
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Old 04-06-2005, 07:12 AM   #11 (permalink)
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Old 04-06-2005, 07:17 AM   #12 (permalink)
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maleficent, the next time I have a root canal and the drugstore refuses to fill my pain reliever prescription, they are going to have a fight on their hands.
Maybe it will go something like this. "I'm sorry, but it is against my religion to give out pain relievers, perhaps one of the other pharmacists can help you".
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Old 04-06-2005, 07:25 AM   #13 (permalink)
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I completely agree with Tecoyah, on this one, but i anticipate that there with be numerous people attempting to point out that his refusal to give the morning after pill was not necessarily based on his religious beliefs. That being said, however, we are talking about what the Religious Right believes is an "abortion pill" and the state of Texas here, it would be a stretch to say he did it for any other reason.
as a side note, the "morning-after pill" is a notoriously misunderstood medication, purposefuly made all the more so by some fundamentalists who attemptto decieve people.
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Old 04-06-2005, 07:32 AM   #14 (permalink)
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Quote:
Originally Posted by arch13
A store does have the right to fire an employee that does not do as the company requires or expects. In other words, in the free market Walgreens can fire every conscience objecting pharmacist, and it's perfectly legal, within the right of the company even. And I like that just fine.

What are your thoughts?
depends on what is explicitly written in the contract that the pharmacist signed in the first place.

wal-mart for example, does not stock the "morning after pill". regardless of the pharmacist's beliefs about contraception, it is impossible for the wal-mart pharmacist to fill the prescription.

on the flip side, there are pharmacies that do stock the "morning after pill". according to the oath (oath of maimonides) :

Quote:
The eternal providence has appointed me to watch over the life and health of Thy creatures. May the love for my art actuate me at all time; may neither avarice nor miserliness, nor thirst for glory or for a great reputation engage my mind; for the enemies of truth and philanthropy could easily decieve me and make me forgetful of my lofty aim of doing good to Thy children.

May I never see in the patient anything but a fellow creature in pain.

Grant me the strength, time and opportunity always to correct what I have aquired, always to extendits domain; for knowledge is immense and the spirit of man can extend indefintely to enrich itself daily with new requirements.

Today he can discover his errors of yesterday and tomorrow he can obtain a new light on what he thinks himself sure of today. Oh, God, Thou has appointed me to watch over the life and death of Thy creatures; here am I ready for my vocation and now I turn unto my calling.
that pharmacists ascribe to upon graduation, they are not required to fill every prescription, but rather to "watch over the health and life of they creatures".

the physical act of filling a prescription is the job of a pharmacy technician. making the decision as to whether or not a particular prescription is appropriate by drug or schedule of taking the drug is appropriate is that of the pharmacist.


Quote:
Originally Posted by stevo
I agree with the drugstore here. When a pharmacist won't fill a perscription because its against his beliefs, well, he's probably in the wrong job.
i would disagre. adding to my comments above, there is also evidence based medicine. say a patient is newly diagnosed with hypertension (high blood pressure), and the physician writes an order for a beta blocker. the pharmacist could refuse the prescription, and say that a beta blocker is not the first line treatment for newly diagnosed hypertension. that's what the pharmacist "believes", and he/she is not in the wrong.

last year in the icu, my team wanted a patient to have propofol. however, an unwritten rule of the pharmacists is that only patients with head injuries get propofol. so, the patient didn't get it. the pharmacist should not be obligated to do whatever the physician says. if that was the case, there would be no need for pharmacists, and we should just have pharmacy technicians.










back to what i think was the original point at hand... pharmacists who refuse to fill the "morning after pill".

1. to cut it off from the jump, the physican should fill out a script for the "morning after pill", and another for regular birth control pills. if the pharamcist won't fill the "morning after pill", just turn in the script for the birth control pills. after all, birth control pills taken at certain doses have the same effect.

2. as long as the pharmacist who refuses the "morning after pill" follows the apa guidelines/recommendations of referring the customer to a pharmacy or pharmacist willing to fill the prescription, it should be fine. it should be just the same as a ob/gyn who doesn't perform abortions, or a surgeon who won't perform a particular surgery.

in the end, i think if the pharmacist chooses not to fill the prescription, and does not provide a route for the patient to get the script filled, then he/she should be fired. but if he/she does refer the patient, nothing should happen to the pharmacist.
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Old 04-06-2005, 07:45 AM   #15 (permalink)
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I don't like the oath of maimonides, it mentions god it in. Surely this country is doomed to fall.
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Old 04-06-2005, 10:42 AM   #16 (permalink)
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I don't think this issue has the earmarks of a major legislative issue. The solution will likely be something like CVS pharmacies do -- pharmacists can refuse to fill, but they are obligated to refer to a pharmacist and pharmacy that will fill the prescription. Oftentimes, this might even be a referral to another pharmacist in the same office.
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Old 04-06-2005, 11:08 AM   #17 (permalink)
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If they can't be fired, then where does one draw the line? What proportion of prescriptions does one allow them not to fill before firing them? 1%, 5%, 10%, 50%, 90%?

Clearly this is your job, and not filling prescriptions is not doing your job.
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Old 04-06-2005, 11:15 AM   #18 (permalink)
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raveneye, I agree, but I'm realistic about what will actually happen. How about the doctors that won't prescribe it?

It ought to be OTC medicine
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Old 04-06-2005, 11:18 AM   #19 (permalink)
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I wonder what our resident Pharmacist, Baron Opal thinks of this.
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Old 04-06-2005, 11:45 AM   #20 (permalink)
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meembo, yep. I'm just thinking that there has to be a balance of rights. The business can't be expected to absorb whatever losses the employee's ethics dictate, no matter how much they are. The same applies to privately employed doctors in my view.

If it's OTC, then still a stocking person might refuse to put it on the shelf
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Old 04-06-2005, 06:25 PM   #21 (permalink)
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So under these "conscious laws" if a Christian Scientologist, a religion that forbids the use of medicine, somehow gets a job as a pharmacist or pharm. tech. then he or she wouldn't have to fill any prescriptions and couldn't be fired? Sounds like an ingenious scheme to get paid without having to work.

It would be against my conscious to serve most of what is on the McDonald's menu. Maybe I should look into a McD's position in Texas...
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Old 04-06-2005, 06:31 PM   #22 (permalink)
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People don't have a problem with OB-Gyns who don't perform abortions why should this be any different?
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Old 04-06-2005, 07:27 PM   #23 (permalink)
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The difference with OB-Gyns is that they are usually not expected to do every single procedure. Usually, you will have a large number of them working in a clinic or hospital and so you don't have to have everyone performing abortions. The clinic can hire people specifically to perform abortions and others who they know will not perform abortions but will do just about every other procedure.
Pharmacies, on the other hand, can usually only hire one pharmacist to be on duty at a time. The pharmacist is therefore expected to fill out every prescription whether he likes it or not. That's the job description and if the pharmacist decides he's not going to do his job, the pharmacy should have the right to fire him IMO.
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Old 04-07-2005, 09:52 PM   #24 (permalink)
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Quote:
Originally Posted by maleficent
People don't have a problem with OB-Gyns who don't perform abortions why should this be any different?
I'm not sure but don't OB-Gyns specialize like other doctors? I recently had a problem and went to a dentist who sent me to a gum specialist who then sent me to a root canal specialist.

I don't think we should have to go to multiple pharmacies to get prescriptions filled. Who knows, as screwed up as the medical industry is maybe they will start specializing too.
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Old 04-08-2005, 03:53 AM   #25 (permalink)
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People don't have a problem with OB-Gyns who don't perform abortions why should this be any different?
If an OB-Gyn is hired specifically by a clinic to perform abortions (among other things), then has a change of ethics and refuses, then I think the clinic should have some legal recourse.
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Old 04-08-2005, 08:22 AM   #26 (permalink)
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When pharmacists refuse, you either find a new one, or bypass the whole system altogether and order from an online pharmacy (the govt sees this as a threat, however)
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Old 04-08-2005, 08:42 AM   #27 (permalink)
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Morality and religion trying to dictate state law again, wonderful.

Just to preface my post with a bit of info- my post is largely not opinion. I worked in a pharmacy (walgreens) for two years, so take that as you will.

The only time a pharmacist should refuse a script is if he/she believes it is in the best interest of the patient to not take the drug due to possible health risks. The law allows them that. If the REASON, however, is because they feel it's "morally" wrong, not wrong in a way that might cause health issues, then that is not in keeping with their purpose and obligation as a pharmacist, and **should not be protected**. **is my my opinion.

If they refuse to fill a prescription, they are required by law and their Pharmacist's license to give the script back and tell the patient where another pharmacy is, or, give it to a pharmacist on staff that will fill it. Instances where it is rejected based on direct threat of health issues are a separate story, but we're not discussing those right now.

Both fortunately AND unfortunately, there is no law that says a pharmacist HAS to fill a prescription.

I say fortunate because there are many cases where a pharmacist will refuse the script based on usage of the drug, and that he/she feels there is a chemical dependency that the patient's doctor needs to evaluate. Also, where the patient demands the medicine where it would pose an immediate health risk- i.e., giving viagra to a person on lithium, or steroid inhalers for asthma sufferers already taking MAOI's. Deadly combinations, both of them.

I say UNfortunate because there are backwater places where too many pharmacists hold the same "moral" issue with certain medications (birth control being a big issue as well) and there is simply no nearby place to get the medicine. Sure, you may "live in a small town" and have to go to "the city" to get some things, but what happens when you live in the "heartland of moral america" where every pharmacist within an hour's drive radius of you are all on the same moral agenda? These places very much exist, and it is a big issue in these places.

And I love analogies, but not every analogy you can reasonably come up with can possibly have anything to do with such a highly specialized field of medicine in such a controlled working environment. They are hired to do one job, one area of specialty, which is highly regulated and scrutinized to the "nth" degree.

Last edited by analog; 04-08-2005 at 08:48 AM..
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Old 04-12-2005, 07:33 PM   #28 (permalink)
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Personal anecdote that may be relevant.

Just after she turned 18, my sister was able to get a prescription for her hormones. She went through the system properly, had a letter of recommendation from a psychologist and a prescription from a doctor. At the first place we went to, Grace's regular pharmacy, the pharmacist took one look at the prescriptions, and refused to fill them. I took down the name of the Pharmacist, left the store and went to a different pharmacy from a different chain, where they were happy to have an ongoing cash customer, and even send us a notice in the mail reminding us when Sissy's prescriptions are about to run out.

The next day, we went back asked for the store manager, and told her that her store, which happened to stock all of the medications Sissy needed, had lost a $200 a month cash customer, my entire family would be taking all future prescriptions to another store (including my SO's monthly prescription, $80 a month), and when I had advised a diabetic friend of Sissy's treatment, she decided to switch to a mail order provider for her testing supplies and a different local pharmacy for her insulin and pills. I gave the manager the name of the Pharmacist who refused to fill the prescription and left.

I also called customer service for the chain, found out the name of the district manager, and wrote her a letter explaining what happened, emphasizing that her employee had cost the store, by my estimate, somewhere in the area of $4000 to $5000 a year in prescriptions and incidentals bought there, not to mention any future prescriptions we might have, and that we would be actively avoiding the entire chain in the future.

I have no idea what happened to the jerk who refused to fill the prescriptions, but I certainly hope he was fired. And I believe it should be the company's right to fire an employee who costs his employer thousands of dollars of business without good reason.
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Old 04-12-2005, 09:20 PM   #29 (permalink)
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Quote:
Originally Posted by uncle_el
i would disagre. adding to my comments above, there is also evidence based medicine. say a patient is newly diagnosed with hypertension (high blood pressure), and the physician writes an order for a beta blocker. the pharmacist could refuse the prescription, and say that a beta blocker is not the first line treatment for newly diagnosed hypertension. that's what the pharmacist "believes", and he/she is not in the wrong.
Then what would be the point of going to the doctor? I mean, if all we need is a pharmacist to tell us what drugs to take, why bother going to see the doctor at all? Instead of getting rid of pharmacists, let's just do away with doctors. After all, what do doctors really know anyway when compared to like....a pharmacist.

I don't mean that to be an insult to pharmacists. Well, not all pharmacists. I mean to make the point that there is also an unspoken chain of command, for lack of a better term. Doctors are higher up on the chain. Doctors prescribe things because that's what doctors do. That's their job. To diagnose and treat, but above all, do no harm. Pharmacists fill prescriptions and make sure my Viagra isn't going to react bad with my lithium. That's their job. Not to pawn off counterside righteousness. I have no problem with a pharmacist refusing to fill a prescription because of a conflict in medication, but to refuse because he's having a little crisis of conscious?

Total idiocy.

I mean, If you start allowing everyone and their mother to refuse treatment based on, of all things, moral reservations, where does it stop?

Let's take it to the farthest reaches of extremism.
Joe thinks Jan is a slut. She dresses like a slut, she acts like a slut and is probably on her way to the bar to corrupt some poor virtuous man with promises of raunchy, dirty sex. Joe refuses to allow his taxi be used for such things and tells Jan to find another way to get to her danceclub of sin.
It'll never get that far, but once you open the door to allow denial of service based on subjective morality for the pharmacists, it'll be pretty hard to put it back in Pandora's little box.

The pharmacist has got a job. If they cannot fulfill the requirements of that job, then they should be terminated. They have a job to do. They should shut the fuck up, collect their paychecks and protest on their own time like everybody else.
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Old 04-13-2005, 10:33 PM   #30 (permalink)
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I'm going to pick another issue and ask the same question. I am asking this same question because opinions on this issue are moderately likely to be polar opposites of the one at hand, and because many people feel just as strongly about it.

A man walks into a local Walmart. Let's say, for the sake of argument, that this Walmart is the only one within quite a long distance that sells the product in question. He walks to the sporting goods department and asks the clerk there (a department manager,) for a box of .38 JHP ammunition (I picked this because it is rarely used in rifles.) The department manager is the only one in the department with the computer security permission to handle ammunition transactions. He is a vocal advocate of gun control, and does not believe that anyone aside from law enforcement and military personnel should be allowed to own guns. Conssitent with his beliefs, he refuses to sell the customer the ammunition.

Does the store manager have the (ethical, not legal) right to fire the sporting goods manager for failing to provide complete customer service? Or should the department head's beliefs be protected by a law that provides him immunity from being fired as long as he processes transactions involving all other merchandise in the store that the computer permits him to sell?



Quote:
Originally Posted by Locobot
So under these "conscious laws" if a Christian Scientologist, a religion that forbids the use of medicine, somehow gets a job as a pharmacist or pharm. tech. then he or she wouldn't have to fill any prescriptions and couldn't be fired?
Christian Scientist. There'a s big difference between The Church of Christ, Scientist, and the Church of Scientology.
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Old 04-13-2005, 11:01 PM   #31 (permalink)
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Quote:
Originally Posted by MrSelfDestruct
Does the store manager have the (ethical, not legal) right to fire the sporting goods manager for failing to provide complete customer service?
First for reference, I'm in favor of reasonable gun control measuers such as handgun registration and waiting periods.

That said, absolutely, the store maganger should be allowed to fire the sporting goods manager for not selling a product offered in that department. If he's not willing to sell every legal product available for sale, he shouldn't be working there, let alone manager.
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Old 04-14-2005, 05:48 AM   #32 (permalink)
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Quote:
Originally Posted by Gilda
First for reference, I'm in favor of reasonable gun control measuers such as handgun registration and waiting periods.

That said, absolutely, the store maganger should be allowed to fire the sporting goods manager for not selling a product offered in that department. If he's not willing to sell every legal product available for sale, he shouldn't be working there, let alone manager.
I concur. Just as there are extremists that want to ban all gun sales, and ammunition sales, there are those trying to ban contrceptive sales. In both cases, the appropriate response is their firing.

Someone gets to have an "ethical" descision such as this when they own the store and choose whether to stock that product. Before that, they answer to their boss for their actions, and should be fired if they don't do their job.
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