PZ Myers. 2004 Jul 07. Access Denied. <http://pharyngula.org/index/weblog/access_denied/>. Accessed 2008 Dec 04.
Posted on M00o93H7pQ09L8X1t49cHY01Z5j4TT91fGfr on Wednesday, July 07, 2004
Access Denied
Doctors and pharmacists denying best-practice medication on the basis of their religious derangements...what next?Here is a troubling article from Prevention magazine.
In April, Julee Lacey, 33, a Fort Worth, TX, mother of two, went to her local CVS drugstore for a last-minute Pill refill. She had been getting her prescription filled there for a year, so she was astonished when the pharmacist told her, "I personally don't believe in birth control and therefore I'm not going to fill your prescription." Lacey, an elementary school teacher, was shocked. "The pharmacist had no idea why I was even taking the Pill. I might have needed it for a medical condition."
Melissa Kelley, 35, was just as stunned when her gynecologist told her she would not renew her prescription for birth control pills last fall.
"She told me she couldn't in good faith prescribe the Pill anymore," says Kelley, who lives with her husband and son in Allentown, PA. Then the gynecologist told Kelley she wouldn't be able to get a new prescription from her family doctor, either. "She said my primary care physician was the one who helped her make the decision."
Lacey's pharmacist and Kelley's doctors are among hundreds, perhaps thousands, of physicians and pharmacists who now adhere to a controversial belief that birth control pills and other forms of hormonal contraception--including the skin patch, the vaginal ring, and progesterone injections--cause tens of thousands of "silent" abortions every year. Consequently, they are refusing to prescribe or dispense them.
Scenarios like these--virtually unheard of 10 years ago--are happening with increasing frequency. However, until this spring, the issue received little attention outside the antiabortion community. It wasn't high on the agendas of reproductive rights advocates, who have been preoccupied with defending abortion rights and emergency contraception. But when Lacey's story was picked up by a Texas TV station and later made the national news, Planned Parenthood Federation of America and others took notice.
Limiting access to the Pill, these groups now say, threatens a basic aspect of women's health care. An estimated 12 million American women use hormonal contraceptives, the most popular form of birth control in the United States after sterilization. The Pill is also widely prescribed by gynecologists and family doctors for other uses, such as clearing up acne, shrinking fibroids, reducing ovarian cancer risk, and controlling endometriosis.
"Where will this all stop?" asks Lacey. "And what if these pharmacists decide they suddenly don't believe in a new lifesaving medicine? I don't think pharmacists should be in a position to decide these things."
This is just nuts. I can imagine the day I have a heart attack, I'm rushed to the hospital with sirens wailing and lights flashing, and am taken to the doctor who tells me, "I'm a Christian Scientist. It's against my religion to treat you. Please close your eyes and pray—your symptoms are entirely imaginary."
It's the same thing, after all: doctors who are trained and commissioned to treat our material, physical ills, yet allow their superstitions about immaterial, unevidenced supernatural forces to compromise the job they are supposed to do.
What I find particularly worrisome about this situation is that this isn't the product of a small number of reactionary nutcases who have acquired power and are trying to dictate their will to those below them. It's sewage, bubbling up from below; the product of a culture that accepts and encourages religious buffoonery. Given the legacy factor in med school admissions, it's also a problem that can perpetuate itself.
The one gleam of hope, though, is that these deluded doctors are still a minority, and now is the time to fight against them.
But what will you do if, like Kelley, Williams, and Lacey, you encounter a doctor who tells you no or a pharmacist who won't honor your prescription? "If your gynecologist won't prescribe the Pill, find a new doctor--and tell all your friends what has occurred," says Vanessa Cullins, vice president for medical affairs at Planned Parenthood Federation of America in New York City. The same goes for pharmacists who refuse to fill your prescription. The best defense against this grassroots movement, Cullins notes, is another one--in opposition.
Personally, I haven't had to ask a doctor for a prescription to the Pill...but I think it's a good idea for us guys to ask our doctors about their policies on such things, and if they are believers in such crap, to change providers. Their work may not affect us directly, but they sure do harm to the women in our families and communities.
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Dr. Myers, I agree with you 100% - this is nuts. There is absolutely no scientific and, in my opinion, no moral rationale for this nonsense. Even if someone holds the position that human life begins at conception, he or she would have a real stretch in explaining how preventing conception constitutes an abortion. Pharmacists and doctors have had enough scientific training that they should know better.
This belief isn't universal among Christians, and I'm curious why it would be spreading now. There is nothing in the Bible about contraception - how could there be? Who cooks this stuff up?#: Posted by on 07/07 at 08:29 AM -
I can imagine the day I have a heart attack, I'm rushed to the hospital with sirens wailing and lights flashing, and am taken to the doctor who tells me, "I'm a Christian Scientist. It's against my religion to treat you. Please close your eyes and pray—your symptoms are entirely imaginary."
Well, this is a fairly tenuous comparison. Both scenarios are equally dumb, but ethically they're poles apart. And any hospital with a devout Christian Scientist in the ER might as well have a banner over the door reading "Please Sue Us". -
Even if someone holds the position that human life begins at conception, he or she would have a real stretch in explaining how preventing conception constitutes an abortion.
Some may be simply opposed to contraception, full stop. But those claiming the pill etc. can be in effect a (very) early-term abortion aren't referring to the prevention of conception, but of implantation. As I understand it, there are a couple of ways the pill can work. Most prevent conception, but one prevents implantation of the fertilised egg. The IUD, SFAIK, has no contraceptive effect but merely prevents implantation. Although I think these people plainly wrong in their position, the position isn't based on a fantasy. (Indeed, if one is really consistent and absolute in opposing abortion rights, it's the position one should take. Perhaps consistency is the hobgoblin of small minds; but the fact that even most anti-choice politicians don't go so far may indicate that the position is politically unpalatable even on the far Right.)
There is nothing in the Bible about contraception - how could there be?
Ah. I see that you are not familiar with Gen. 38:8-10. Mind you, it wasn't the (primitive) method of birth control that landed Onan in trouble with the Lord, but his refusal to give his dead brother a kin-selection helping hand.
As for physicians refusing to prescribe the pill and pharmacists refusing to dispense it: well, I am a liberal through and through, so I'd say they're within their rights. Just as their customers are within their rights to take their business elsewhere, and make sure everybody knows why; and just as the relevant professional bodies should be within their rights to expel these people.#: Posted by Mrs Tilton on 07/07 at 09:12 AM -
They are not within their rights. The privilege of being licensed to practice in those fields requires indiscriminate treatment. Doctors make judgment calls, and might have more room. Pharmacists have no such right. Imagine if this were the only pharmacist in that town, or county. They can decide not to carry cigarettes, not to carry candy. They cannot decide which medicines do or don't conflict with what their magic pixies in the sky require of them. Want to force your beliefs and yourself on everyone else? Become a priest, not a pharmacist.
#: Posted by on 07/07 at 10:13 AM
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I asked a few of my doctor and pharmicist clients about this.
The gist, at least here in FLorida, was that most OBY's and PCP's (And Docs in general) are self employed or work for a small partnership. If that self employed Doc or their partnership has decided to not prescribe a substance for whatever reason, or if they leave it up to each Doc, that's their call.
The potential consequences both to their practice and their exposure to law suits is their responsibility.
(BTW, to get at them, you need to get to the HMO's and PPO's that make up a large portion of revenues to the Docs practice. Health Orgs like that are tough to reason with, but if your doc is not prescribing routine HRT for example because of ideological reasons, there is a good chance you could get the HO to drop them if enough people bitch. And that will their attention)
The Pharmicist working for CVS is less clear. According to one Pharmicist I spoke with, a Pharmicist can deny filling a legit prescription for any reason he wants, but he'll have to answer to the owner(s) of the store. If his reason runs counter to company policy, then he'll quickly get canned if he keeps it up.#: Posted by on 07/07 at 10:15 AM -
Is there any kind of "atheist yellow pages" out there? It's about time for me to support clear thought with my purchasing habits. Ethnic and sexual minorities have had great success supporting their own communities. Rationalists might want to do the same.
#: Posted by on 07/07 at 10:16 AM
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As far as pharmacists go, I can not imagine the owner of a pharmacy wanting an employee to turn away paying cusotmers. Nor can I imagine the same owner wanting the negative publicity that results. So the advice is right on the mark ... publicize! (And check to see what local laws are on the subject as well).
Regarding the hospital heart attack analogy ... I think the larger likelihood is that some doctor refuses to treat you for a medical condition because he doesn't like something about you ... your "Gay Pride" or "Dump Bush" t-shirt, or the fact that you look like an Arab, or whatever. I linked to an article in which a proposed Michigan law would allow health care workers to refuse services if it violated their personal conscience. In other words, if this law passed, then a health care worker could refuse to treat gays, or Arabs, or blacks, or women on the pill, or whatever. -
One addition: One Doc I spoke with, a pretty good friend, pointed out that Docs (And Pharmicists) have more lattitude with drug scripts that other treatments because of drug hysteria. I.e. The War on Drugs.
The Docs are under incredible scrutiny by the DEA and have to attend Continuing Eed where they're sometimes told to 'just say no' whenever they feel like it. The DEA is talking mostly about narcotic painkillers, benzodiazipine sedatives, or barbiturates/hypnotics, but the refusal can be extended to other substances.#: Posted by on 07/07 at 10:25 AM -
As for physicians refusing to prescribe the pill and pharmacists refusing to dispense it: well, I am a liberal through and through, so I'd say they're within their rights. Just as their customers are within their rights to take their business elsewhere, and make sure everybody knows why; and just as the relevant professional bodies should be within their rights to expel these people.
Covington's correct, the only right health professionals have is to fulfil their duty of care to the letter. Patients rely on physicians to provide informed, objective, scientifically-driven diagnoses and treatment, and any personal convictions which undermine this trust is ethically deficient. As for pharmacists, well, and no offense to any pharmacists out there, but she's a bloody pharmacist. Who died and gave her the right to make moral decisions regarding the distribution on prescription medications? What's next, refusing to supply HIV inhibitors to an infected gay patient because you disagree with homosexuality? It's a slippery, slippery slope, and it needs to be weeded out, because such attitudes can manifest themselves in less overt ways than a pharmacist coming straight out and saying that she doesn't believe in contraception. What if, for example, instead of flat-out refusing to prescribe HIV inhibitors, the doctor prescribes placebos without the patient's knowledge? -
This is a problem I've commented on before - and it's quite troubling. In very few cases does another person's beliefs directly affect another in day-to-day business. This is probably the most insidious. I do like your solution and plan to employ it with every doctor and pharmacist I deal with. Further, I will make sure that the local news outlets are aware of any problems I uncover.
Zealots are not people to be dealt with lightly or to ignore. These cretins are no exception. -
Mrs. Tilton, from what I've read, the copper IUD is spermicidal, and therefore strictly contraceptive. The progesterone IUD may prevent implantation.
I'm an atheist who is pro-life (boo! hiss! went the crowd) but not anti-Pill, for a couple of reasons. First of all, I'm undecided on the subject of whether an individual human organism can be said to exist at a time when twinning and chimerism are still possible. Second, and more to the point in this case, the anti-implantation effect of the Pill is theoretical. Nobody really knows if it even occurs. Some researchers have inferred from indirect evidence that it does, and others differ. Certainly the primary effect is to prevent conception. There is a possible side effect of preventing implantation if the contraceptive mechanisms fail, but you know, there are probably lots of things that I eat, drink or am exposed to in the environment that could theoretically prevent implantation if I happen to conceive. You can't protect against everything. -
Is the next step refusing to do tubal ligation (SP?) because their Deity says so?
Thought Experiment.
Imagine an adoption couselor saying, 'We're sorry. If God meant for you to have children, He would have made you fertile.'#: Posted by on 07/07 at 02:53 PM -
Ben writes:
>Covington's correct, the only right health professionals
>have is to fulfil their duty of care to the letter.
Err... technically, that would not then be a right but a 'duty', n'est-ce pas?
I'm not sure 'duty of care' is the concept you're looking for, anyway. Health care professionals certainly have a duty of care. Failing to fulfil it (as with any duty of care) is negligence. Leaving a retractor inside a patient is a breach of the duty of care. Refusing to prescribe the pill for contraceptive use isn't.
Must a physician prescribe the pill to a woman who wants it for contraception (and does not have have any contraindications that mean she should not use it - prescribing it in those circumstances could violate the duty of care)? In an every-day ethical sense (i.e., as opposed to professional ethics, which do not entirely overlap with the common-sense use of the word), I should say, Yes. But then, some physicians might disagree with me.
Whether they are free to put their disagreement into practice depends on the law and the professional ethical standards of the licensing body to which they belong. The law may impose liability if a qualified medical professional fails to treat a patient in an emergency situation (it does where I live, anyway). Don't know much about US civil rights law, but I'd imagine it may also forbid physicians to refuse to treat a patient on the basis of race or another 'suspect class' (this would certainly be the case if the physician were receiving government money). And the AMA could rule that doctors may not refuse to treat patients - though it seems they have not done so, given that there is no suggestion the physicians in the story above face disciplinary action. Absent an obligation from one of these sources, a physician may refuse to prescribe the pill. I'm not aware of any such general obligation. If you think there should be one, lobby your congressperson.
I don't think there should be one, though. I very much dislike the idea of a physician refusing to prescribe the pill for any other than a valid medical reason. But I also very much dislike the idea of forcing the conscience of another. Would you (for example) force a devout Roman Catholic OB-GYN to choose between performing abortions and losing his licence?
>As for pharmacists, well, and no offense to any pharmacists
>out there, but she's a bloody pharmacist. Who died and gave
>her the right to make moral decisions regarding the
>distribution on prescription medications?
Well, who died and gave you the right to tell her how to run her business? If she owns her shop, and there is no legal or professional rule requiring her to dispense all prescriptions as written, she can do pretty much what she damn well pleases. If she is an employee, she can do pretty much what her employer damn well pleases (or seek employment elsewhere). If the shop refuses to sell the pill - or refuses to sell beta blockers or antacids, for that matter - that's its owner's affair (for all that it may be a stupid and offensive decision, not least from a business perspective). The remedy, as I said before, is to take one's custom elsewhere, and make sure everybody knows why.
Obeah,
>I'm an atheist who is pro-life (boo! hiss! went the
>crowd)
And I'm a Christian (boo! hiss! went the crowd) who is pro-choice. So between the two of us, the cosmic balance is maintained.#: Posted by Mrs Tilton on 07/07 at 05:02 PM -
The cosmic balance may be slightly upset, as I am another pro-choice Christian. But on to my actual comment ...
Ironically, pharmacists used to be the most trusted profession in this society (though the Robert Courtney case couldn't have helped that any). In this instance, I see a slightly different set of problems than most of the previous commenters:
Failure to set expectations. Any pharmacist who will not provide a widely expected service for any reason should prominently post a sign that says so. Someone who thinks they're nobly engaged in preserving the sanctity of life ought to be able to devote a little extra effort to clear communication (not to mention politeness).
Loss of market share by drugstores tolerating such behavior. I expect this will lead to prompt termination of pharmacists indulging in same, unless of course the store owner is equally, er, motivated. In which case the sign needs to be out in front of the store, not at the pharmacy counter.
Reaction from large employers. I know what mine would do if it found out that its female employees were being denied contraceptives. Entire drugstore chains would be informed that they would lose our business in short order unless corrective action were taken. And since I work for the biggest company (and a self-insured one, I might add) in a metro area of nearly 2 million people, I expect we'd get results.#: Posted by Jay Manifold on 07/07 at 06:06 PM -
I guess it´s probably too trite to point out that the pharmacist and doctor, and others like them, are probably using their deep concern for the unborn as a cover for their dislike of a womans sexuality. The same people probably would have no problem facilitating an american soldiers activities in Iraq where he/she could quite easily be responsible for the termination of many an Iraqi fetus in varying stages of develpment. Of course we all know that Jesus wasn`t really much concerned with killing, his main concern was prayer in school and sex.
I too am an athiest who finds abortion to be PERSONALLY morally questionable, but I have no great problem with women making their own personal moral choices, I´m sure it`s a tough one for most and probaly is none of my business. I find the amount of already born people who we destroy too be a much more serious & pressing moral & actual problem.
I´m not sure the owner of a business should be forced to provide services that violate their moral values but I do agree that such a serious omission in normal and legal health care should be clearly advertised so that, at the very least, a poential customer need not be humiliated unnecessarily and can financially support a business which provides the services which they expect and require.
Imagine a pharmacy that didn´t sell aspirin because they´re against alcohol or anti-depressants because mental sickness is caused by demons.#: Posted by on 07/08 at 12:28 AM -
Yes, I do think it all boils down to controlling women, and one reason the abortion/birth control debate is so fierce is that it taps into a deep concern of our evolutionary heritage, as Sarah Blaffer Hrdy suggests in this description of Rick Santorum's emotional response to abortion.
Like all humans, and indeed as is typical of the entire Primate order, the senator [Santorum] exhibited an intense, even obsessive, interest in the reproductive condition of other group members. Like other high-status male primates before him, he was intent on controlling when, where, and how other females belonging to his group reproduced.
You just have to picture these people as small, furious monkeys, constantly prodding and sniffing at the butts of females in their troop. Puts 'em in perspective. -
jc writes:
I too am an athiest who finds abortion to be PERSONALLY morally questionable,...
That's you and Obeah set against Jay Manifold and me, then, with excellent results for the Cosmic Balance.
...but I have no great problem with women making their own personal moral choices, I´m sure it`s a tough one for most and probaly is none of my business.
Very well put. When I wrote that I am pro-choice, I did not mean that I find abortion morally untroubling. (Really, can there be many pro-choice people who do?) Indeed, at a personal level I find the very thought of it extremely distressing. My position on the issue comes down to what I believe the state should, and should not, tell people they can or cannot do. Like you, I'm sure the decision to abort is a very tough one for most. But even for those who could make the decision without a second thought, that decision is theirs, not mine or thine.
I've seen pro-choice bumper-stickers in America reading, 'Don't like abortion? Don't have one'. That's rather flippant, but on another level it's profoundly correct.#: Posted by Mrs Tilton on 07/08 at 07:51 AM -
Would you (for example) force a devout Roman Catholic OB-GYN to choose between performing abortions and losing his licence?
Again, a rather tenuous comparison. No physician can be forced to perform any procedure, but signing for a repeat of a birth control prescription is hardly a procedure.
Well, who died and gave you the right to tell her how to run her business?
Not me. Medical codes of ethics. Pharmacies can't and shouldn't exactly be paragons of laissez-faire capitalism because, as members of the health-care sector, their primary concern should be the interests of patients, not their profit margins. Call me idealistic if you must.
I've seen pro-choice bumper-stickers in America reading, 'Don't like abortion? Don't have one'. That's rather flippant, but on another level it's profoundly correct.
Another profoundly correct bumper sticker pertinent to this issue would be: "Don't like birth control? Don't use it.". -
"It wasn't high on the agendas of reproductive rights advocates, who have been preoccupied with defending abortion rights and emergency contraception."
Why do a "few cells, relatively undifferentiated", require "emergency contraception"?
Choices have consequences.
http://www.opinionjournal.com/extra/?id=110005277
The Empty Cradle Will Rock
How abortion is costing the Democrats voters--literally
There were 12,274,368 in the Voting Age Population of 205,815,000 missing from the 2000 presidential election, because of abortions from 1973-82.
In this year's election, there will be 18,336,576 in the Voting Age Population missing because of abortions between 1972 and 1986.
In the 2008 election, 24,408,960 in the Voting Age Population will be missing because of abortions between 1973-90.
These numbers will not change. They are based on individual choices made--aggregated nationally--as long as 30 years ago. Look inside these numbers at where the political impact is felt most. Do Democrats realize that millions of Missing Voters--due to the abortion policies they advocate--gave George W. Bush the margin of victory in 2000?#: Posted by on 07/08 at 10:20 AM -
It's isn't the few undifferentiated cells that require emergency contraception—it's the zillions of differentiated cells organized into a thinking, feeling, responsive woman that require it.
And that article is one of the silliest, dumbest things I've read in ages. - w-wow... well, I don't want to know what you've been reading, Dr Myers, because that easily tops my all-time list. Daylight second.
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Not me. Medical codes of ethics. Pharmacies can't and shouldn't exactly be paragons of laissez-faire capitalism because, as members of the health-care sector, their primary concern should be the interests of patients, not their profit margins. Call me idealistic if you must.
I'm afraid I must. So far as I can tell, no law and no professional code, whether of physicians or pharmacists, would require a physician to prescribe, or a pharmacist to dispense, the pill. (At the very least, the quoted article contains no suggestion that the erring representatives of either profession face sanctions.) As I said, one can argue over whether there should be such laws or codes. But if you think there should be, by all means agitate for them.
BTW, I don't think the example of the RC OB-GYN is as tenuous as you do. I am assuming the physician or pharmacist who refuses a patient the pill does so because he or she thinks it can result in a very early abortion. If it is merely an objection to contraception as such, then my example is indeed stretched.
However, I think the principle still holds. I would disagree with a doctor's or pharmacist's refusal to provide contraception (again, for any other than sound medical reasons). But it's his or her choice. That the reasons for the choice strike you as wrong or silly or mystical is irrelevant. Absent law or professional rules, a health professional is not required to provide any particular service (though might be by terms of employment - a different matter altogether). A plastic surgeon is free to limit his practice to reconstructive (as opposed to cosmetic) surgery, or vice versa. A dentist is free to limit her practice to (say) orthodontics. At least where I live, any medical practice may choose to accept only patients with private insurance. These professionals' reasons for their choices aren't relevant to their right so to choose. (And, at least in the last example, those reasons are likely to be quite rational, if not admirable.) Anybody who disagrees with these choices may (and doubtless should) find a different plastic surgeon or dentist - or physician or pharmacist.
In any case, I suspect you have more important things to worry about than getting laws and professional codes fixed to require doctors to give out the pill and orthodontists to drill out cavities. As things stand now, a company like CVS may, I believe, sack an employee pharmacist who refuses to dispense the pill on religious grounds. Much likelier than a mandatory-pill-dispensing law in America is, I should think, a law protecting such employees from being fired. Indeed I seem to recall having heard of such suggestions. (And I imagine you and I would be in complete agreement that a law like that would be undesirable.) No doubt the big pharmacy chains would fight like cats to prevent such a law's passage, and money often wins such fights. But not always; and until the US electorate manages to significantly reduce the raving lunatic contingent in Congress, it's not beyond imagining that this sort of thing could become law.#: Posted by Mrs Tilton on 07/08 at 11:22 AM -
And that article is one of the silliest, dumbest things I've read in ages.
Oh, I don't know. After all, haven't scientists recently located the Gene for Party Affiliation?#: Posted by Mrs Tilton on 07/08 at 11:25 AM -
I know for certain that if my pharmacist refused to fill a prescription, I'd ring up the licensing board and make a lot of rumblings about suing. Every time.
Case law in the HMO refusal-to-pay cases indicates that physicians have an obligation to explain available procedures to patients, even if the physician does not offer it. I think, again, that if my physician explained a better procedure and then refused to offer it, I would talk with the disciplinary committee. If the physician didn't explain it, I'd talk to a lawyer fast.
People who work in jobs that require them to do things they consider immoral should get out of those jobs. That's why I don't work for Republicans.#: Posted by on 07/08 at 12:43 PM -
As I have pointed out elsewhere (it's the last of 60[!] comments), the OpinionJournal article linked above makes several falsifiable predictions. We'll know soon enough whether or not it's any good as a predictive model. I note only that arguments proclaiming the historical inevitability of this or that have a way of running afoul of reality.
#: Posted by Jay Manifold on 07/08 at 01:42 PM
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My advice: Only take a position if you will discharge the standard duties involved. Anything else is negligence.
Applying to be a tour guide at the ICR museum? Be ready to lie to spread the meme. Take a Playboy gig? You must strip for the camera. Refusing to do either is negligence of duty, making it ethically wrong.
Likewise, taking the position of ob-gyn or pharmacist in a mainstream hospital or pharmacy requires you to provide standard, legal reproductive care. If you cannot accept the responsibility, move to a conservative Roman Catholic hospital.#: Posted by on 07/11 at 08:13 PM -
Do yourselves a favor people - from now on carry a coat hanger, I promise it's less expensive than birth control pills, and no one can take away your right to a coat hanger. And hey, you'll also help keep population down! Score one for the pro-choice team huh?
#: Posted by on 08/12 at 08:00 PM