Wednesday, March 26, 2008

Score One For The Good Guys

I've said many times before that freedom of religion does not give someone the right to impose their religion upon others, especially not in a context where medical treatment is involved.

In recent years, there have been a spate of Pharmacists refusing to fill prescriptions because of their religious beliefs. In one case in 2005, a pharmacist at a Wal Mart refused to fill prescriptions for birth control pills. When he was disciplined by his employer, he turned the whole business into a religous discrimination case. Finally, in Wisconsin's courts ruled against the man.

I did some more digging on the matter, and found this article which states the facts of the case much more clearly:

Before working at this store, the pharmacist provided a written statement to the acting pharmacy supervisor for Wal-Mart, explaining his religious convictions and stating that he would "decline to perform the provision of, or any activity related to the provision of, contraceptive articles," including "complete or partial cooperation with patient care situations which involve the provision of or counsel on contraceptive articles."3

The pharmacy supervisor understood these limitations to mean that the temporary pharmacist would not fill prescriptions for birth control. To accommodate this limitation, the supervisor relieved the pharmacist from "filling prescriptions for birth control, taking orders for birth control from customers or physicians, handing customer's birth control medication, and performing checks on birth control orders." The supervisor also arranged for birth control prescriptions to be sorted into a separate basket so that the pharmacist would not have to touch the items and ensured that someone would be available to fill orders and respond to customer inquiries concerning birth control.

Within a few days, the supervisor realized that these accommodations still did not satisfy the pharmacist because he refused to do anything related to patient care duties if it even remotely involved birth control. For example, when the pharmacist answered the telephone and the caller asked for a refill on a contraceptive prescription, he would put the caller on hold and not tell any other pharmacy personnel that there was a call waiting. When a patient came to the pharmacy counter and asked for a birth control prescription refill or asked for advice about anything related to the use of birth control products, the pharmacist would just walk away and again not inform the other staff that someone was waiting for assistance. He rationalized this behavior, stating that if he had to talk to anyone asking about birth control, he would always counsel against using contraception.

The supervisor then attempted to mollify the pharmacist further by offering to have him assist only individuals who came to the counter who were males or women not of childbearing age. Due to the high volume of telephone traffic, the pharmacist would still have to answer the phone. The pharmacist refused these further attempts of accommodation unless walk-in patients and phone calls were first prescreened by someone else to assure him that he would not have to deal with any birth control inquiries. The supervisor tried to placate the pharmacist by agreeing he would not have to talk to any walk-in patients but he would still have to take phone calls and refer the objectionable ones to someone else.

On the fifth day of employment at this pharmacy, it became clear that the pharmacist would not accept the accommodations proposed by the supervisor. Therefore, the supervisor terminated the pharmacist's employment. But the pharmacist refused to leave the store, and he began to vocally preach to customers in the pharmacy area that Wal-Mart was discriminating against him for his religious beliefs. The police were summoned, and he was physically carried out of the building. Remember the article published in the prior edition of this column? This gentleman was quite familiar with this treatment because he had done the same thing just a few months earlier in a pharmacy in Minnesota where he had worked as a pharmacy intern. In that case, he was charged with (and convicted of) criminal trespass and interference with legal process.



As is so often the case in these matters, it is often portrayed by the person claiming persecution as a singular incident. The reality is that we are often talking about a pattern of behaviour repeated in numerous different ways (a similar example is the case of Chris Kempling in Canada, who found himself on the receiving end of disciplinary actions after a series of events).

However, when we are talking about professions where one's position in the community puts a practitioner into situations where their personal values are at odds with what they are being asked to do, there is a moral and ethical responsibility to ensure that the client is in fact looked after whether by the individual practitioner or another practitioner. Outright denial of service, or worse, providing undesired treatment (e.g. substituting a placebo for the desired drug) is plain wrong.

As pharmacists, we have an obligation to provide professional service to our patients and others involved with their care. Walking away from the counter or putting phone callers on hold without asking someone else to provide service or answers is simply not acceptable. It is easy to understand that a conscientious objector might think that helping somebody to find others willing to help them is just as bad as doing the acts they object to. But individual pharmacists cannot pick and choose who they want to assist. The law will protect people who object to certain practices, but if the objectors demand too many concessions from their employers, they should not be surprised when the law will not step in to mandate unreasonable accommodations. Indentured servitude no longer exists in this country, and no one is forced to accept employment where practices they object to go on. The better alternative is to find employment or conditions where you will not be expected to do something unconscionable.

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