tag:blogger.com,1999:blog-20406961.post6373469683364853896..comments2023-06-07T09:13:41.693-05:00Comments on Episcopal Chaplain On the High Ground: Considering Provider Autonomy and Conscientious ObjectionMarshall Scotthttp://www.blogger.com/profile/02807749717320495495noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-20406961.post-22182169780951868192009-10-07T09:58:56.021-05:002009-10-07T09:58:56.021-05:00Actually, Jack, while not the specific issues that...Actually, Jack, while not the specific issues that brought about this presentation, these are certainly appropriate. In fact it was issues of pharmacists and birth control and distance that became the presenting issue, leading both an executive order in Illinois requiring pharmacists to distribute birth control pills regardless of personal beliefs, and to the executive order of the Bush Administration that not only consolidated existing protections for professionals but also seemed to extend them to all employees regardless of job description.<br /><br />Note that this is really acute in areas where professional care is, as it were, "few and far between," and particularly to the independent pracititioner. A pharmacist in a chain drug store functions under a contract for employment. So, he or she would have little control over stock, and rights of conscientious objection would be delimited in the contract. Independent pharmacies with competition in town, or with more than one pharmacist on staff, have some opportunity to refer to another if there is individual objection; and professional codes of ethics all seem to expect (if not explicitly require) referral when the individual professional objects. (I can't speak to whether individual states might also have referral requirements in their licensure requirements.)<br /><br />So, if you're the only pharmacist in the only pharmacy in a county in southwestern Kansas or the panhandle of Oklahoma, working in a pharmacy that you own as a small business, what is the requirement? The principle of fiduciary responsibility would seem to call for some provision, even in the face of conscientious objection. Do we make a distinction in that between condoms (which don't require a prescription), birth control pills or diaphragms (which require a prescription, but aren't so time sensitive), and "morning-after" medications (which both require a prescription and are time sensitive)? Is this an emergency," and who decides that(again, particularly important for "morning-after" medications)?Are there other resources at all (an emergency room, or a physician with samples)? If no other resources, what are the requirements under the rubric of "public health," for, again, licensure allow restriction of trade to professionals in exchange for some public benefit. (And, of course, this doesn't address how this might affect the relationships between the pharmacist and referring physicians.)<br /><br />Again, professional standards seem to require some provisions, and other circumstances (contracts, state regs, etc.) might make requirements more explicit.<br /><br />As to the physician, the AMA Code is more explicit; and once again state public health regulations might be more explicit, since an std is a public health issue (we saw this over the past generation as we discovered what AIDS was, and what living with it meant). That physician, having agreed to care for the patient, is expected to make the recommendation, and perhaps say where they might be obtained. Now, I don't know that requires actually supplying the condoms (but, then, all that really requires is quarters and a local truck stop). However, the AMA Code is clearer than some.Marshall Scotthttps://www.blogger.com/profile/02807749717320495495noreply@blogger.comtag:blogger.com,1999:blog-20406961.post-66030358834963154772009-10-06T20:50:47.221-05:002009-10-06T20:50:47.221-05:00I find this a fascinating discussion, but way over...I find this a fascinating discussion, but way over my head. A couple of hypotheticals.<br /><br />What if a person has a std, should the doctor be required to recommend condoms? The nearest doctor is 40 miles away.<br /><br />Can a pharacist refuse to stock any birth control medicines or devices because the pharamists is Catholic?<br /><br />These questions are way below the level of your post, but here they are:)<br /><br />BTW, at 76 the questions are kind of theoretically, but what would I say if asked by a 20 year old. No one has ask me. JackAnonymousnoreply@blogger.com