Patient’s rights vs. religious beliefs
A friend of mine, a woman in her 40s, was having problems with her periods. They were getting way too heavy, and her doctor did the necessary tests to make sure she didn’t have uterine cancer (she didn’t). So her doctor decided to do a hysteroscopy, a procedure in which the doctor inserts a skinny telescope through the uterine cervix to look at the uterine cavity. She’d be looking for any abnormalities that could cause my friend’s problems, like a fibroid tumor or a polyp, benign conditions that can lead to heavy bleeding. Her doctor gave her a prescription for misoprostol.
Misoprostol is approved by the FDA for the prevention of the stomach ulcers that can occur with the chronic use of nonsteroidal anti-inflammatory drugs like Advil and Aleve. But we doctors can use FDA-approved drugs “off-label” if there are studies to support their use. In the case of misoprostol, the properties of this drug are quite useful in the field of obstetrics and gynecology.
Misoprostol causes the uterus to contract, and so the drug can be used to persuade a lazy uterus to contract after childbirth and thus stop postpartum bleeding. Misoprostol has another very useful property. It softens the cervix, and that can be quite helpful as preparation for inducing labor. Or, as in my friend’s case, it can soften the cervix enough so that a hysteroscope can go in without major discomfort.
My friend’s doctor gave her a prescription for one misoprostol pill to insert in her vagina the night before the procedure. So she trotted off to her local pharmacist, where the pharmacist promptly refused to fill the prescription. As Dave Barry would say, I am not making this up. He told her she’d have to buy 60 pills (I guess that’s how the pharmacy buys them), or none at all.
“Are you using this for an abortion?” he demanded. Because one of the other uses for misoprostol is as a companion to mifepristone for a medication abortion.
“That’s none of your business!” she retorted, and flustered and upset, she left to figure out what to do next.
Maybe the reason the pharmacist wouldn’t fill the prescription was because he’d be opening a bottle of 60 to dispense just one. Or maybe he, like the pharmacists and pharmacies who refuse to dispense or even carry emergency contraception, had a moral objection to what he thought was going on.
We are hearing, more and more, about pharmacists who refuse to dispense emergency contraception, about pharmacies that refuse to stock it, and about pharmacists who even refuse to dispense birth-control pills.
I admit this is the first time I’ve heard about a refusal to dispense misoprostol.
Where, I wonder, is the moral objection to dispensing Viagra to single men? Or to selling the proven killers known as cigarettes?
Although it’s hard to prove it these days, we live in a country that does not mandate our religious beliefs, or even that we have any. It is, as we often said when we were kids, a free country.
The pharmacist has a right to his moral beliefs. But does he have a right to act on them in this case? What about the rights of the patient and her doctor?
According to the Code of Ethics for Pharmacists, “a pharmacist promotes the good of every patient in a caring, compassionate and confidential manner.” I think my friend’s pharmacist dropped the ball on that one.
The code goes on to say, “a pharmacist avoids discriminatory practices, …and actions that compromise dedication to the best interests of the patient.”
It seems to me that the patient and her doctor are the most qualified to assess those interests.
We cannot tell a pharmacist what to believe, but we can require that he or she act a certain way if it is within the law. In the case of emergency contraception, birth-control pills, and even misoprostol the law is clear. Pharmacies must dispense FDA-approved drugs.