Senate The U.S. Politics thread

Discussion in 'Community' started by Ghost, Dec 6, 2012.

  1. Jabba-wocky Chosen One

    Member Since:
    May 4, 2003
    star 8
    44, healthcare professionals are licensed by the government to practice healthcare. They are involved because they are involved from the very outset. The real question is why it would make sense for them to be completely unconcerned about people that theycertify to the public as safe, effective, conscientious practitioners in a particular field?
  2. anakinfansince1983 Chosen One

    Member Since:
    Mar 4, 2011
    star 7
    I don't know that anyone is suggesting that the doctor or pharmacist should be arrested.

    Vaderize would need to cover medical licensure because I don't know anything about it. I would assume that such a pharmacist could lose his or her license to practice based on refusal to fill a medication that a patient is given by her doctor. If the pharmacist then tries to practice without a license, this is where the law steps in.

    A doctor who refuses medical care based on personal beliefs could probably be sued for malpractice if the patient then has a life-threatening emergency.

    As far as the example I gave about religious books: I am certified as a public and school librarian in the state of North Carolina and if I did such a thing, I probably would and should lose both certifications.
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  3. Mr44 VIP

    Member Since:
    May 21, 2002
    star 6
    Wocky, Because there are different ways to fulfill that aspect?

    The main question that has never been answered is why if one single pharmacist doesn't carry something like Viagra or Yaz pills, it's being equated to having the option completely taken away. I get what you just asked about why someone would choose to do that, and the answer is that humans have free will? I don't know.

    This is the crux of what Fatburt asked when my reply was chopped. Why is it an "either/or" situation? If someone had a prescription for Viagra and the pharmacist they went to first didn't carry it, what happens? They just walk around the store bumping into walls? They crumple it up and throw it in the trash because it's worthless? Or they just go to the next drug store down the road? How is the fact that one pharmacist chooses not to stock something being characterized as removing all options from the person with the prescription? (In fact, realistically, in all likelihood, no one walks into a pharmacy "blind" anymore. Typically, you get a list of approved pharmacists, so you'll already know going in, but I appreciate the discussion aspect of this) There's a bit of "chicken little/sky is falling" reaction here. "Oh, no an individual pharmacist doesn't carry X, Y, or Z...Everyone is going to run around pregnant now!!!!"

    I still say a pharmacist can choose not to carry something and fulfill the requirements of being a pharmacist, no different than the other examples brought up here. Is there a risky drug that maybe a pharmacist chooses not to carry? Let's say a cholesterol pill causes excess bleeding. I could see a pharmacist not stocking that drug, and if anyone came in with a prescription for it, simply referring them on to a pharmacist that does carry it. Businesses do this all the time. That pharmacist is not taking away whatever rationale the doctor had for writing the prescription. That's between the doctor and the patient. They just aren't carrying that specific drug.
    Last edited by Mr44, Aug 8, 2014
  4. anakinfansince1983 Chosen One

    Member Since:
    Mar 4, 2011
    star 7
    IIRC you and I both live in cities with multiple pharmacists. So let's say I were the one needing a Pill prescription and one pharmacist refused to fill it for me. You would be correct; in a city of two million people, I could go to another one. In the town where my father grew up, which only has 500 people and one pharmacy, a woman has that pharmacy as an option, other than the mail-order ones, and again, what is stopping them from doing the same?

    But that doesn't really address the ethics issue of allowing one's personal feelings to interfere with one's work, in any profession, or attempting to interfere in personal decisions made by a customer.

    And using your cholesterol meds example, I would say that a pharmacist is obligated to stock a drug that doctors in an area are prescribing. If the pharmacist has such an issue with the drug, opening a conversation with the doctors prescribing it would be a better idea than taking the stance that "I know better than you do what is best for your patients."
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  5. Vaderize03 Manager Emeritus

    Member Since:
    Oct 25, 1999
    star 5
    This. It's easy, 44, to accuse one of hyperbole, but I'm referring to personal experience, not all experience, and that clearly colors my perception of the situation.

    Look, in healthcare, it's considered unethical to put one's personal beliefs above what's best for the patient. It's never black-and-white, but what you're proposing is very much a slippery-slope. Viagra is not a valid example, because it's not something that's considered politically controversial...yet birth control is.

    Why is that? Why are women having sex subjected to a higher level of scrutiny then men? Why does that scrutiny, on the political level, almost always come from men? Why did the House hold a hearing on this very subject and staff their committee with white males only?

    You see the issue here? Women's health has become highly politicized, and it shouldn't be. Religion, in this instance, is being used to justify enforcing a code of behavior that a majority of Americans no longer wish to follow. The Viagra example is a violation of Equal Protection, yet America allows this if we quote the Bible.

    Why? Why are we the only industrialized country that's still having these debates, and every election cycle, no less?

    Peace,

    V-03
  6. VanishingReality Jedi Grand Master

    Member Since:
    Apr 21, 2013
    star 3
    The performance of a health care system is judged by access, quality and cost. Having fewer sites carry medication is an example of restricted access. The whole "go to the next drug store down the road" thing should be avoided in an ideal health care system, because it is a delay in the time treatment can be delivered to a patient.
  7. Mr44 VIP

    Member Since:
    May 21, 2002
    star 6
    Yeah, and this is what you've never answered. Why are they obligated? Why would a specific pharmacist not be able to give a referral if they personally don't stock something? This is what happens. The pharmacist says "sorry, I don't carry that. You'll have to go to Bob's drug store 2 blocks over to get that filled...." How is that negating the original doctor's decision? This is exactly what I mentioned above. You seem to suggest that if a single pharmacist doesn't carry every single item in existence, then the person with the prescription has no other option. They should just toss out the script because they will never be able to get it again after asking for it at one drug store.

    For a probability puzzle, what if the first pharmacy that the person goes to is the one that stocks their prescription? They would never know if the second pharmacist ever carried it at all. And then there's Schrödinger's Drug Store and Quick Stop, which half carries the item and half doesn't carry it.... :p

    So, according to your view, a lawyer should have to take DUI clients and they don't have a choice. A pacifist book store owner should have to sell books on war if a customer wants to buy them. A vegetarian restaurant owner should have to sell meat if a single customer asks for some, instead of just sending them to the hamburger shop down the road. That just doesn't make sense to me.
    Last edited by Mr44, Aug 8, 2014
  8. anakinfansince1983 Chosen One

    Member Since:
    Mar 4, 2011
    star 7
    You're completely missing the point. How is it in any way ethical to allow one's personal feelings to interfere with one's work?

    Whether the patient can go to another pharmacy is not the issue.

    Lawyers usually specialize in particular areas of law. If a lawyer chooses not to take DUI cases and instead chooses to take corporate tax cases, that's not unethical. If a lawyer refuses to take a particular DUI case because he doesn't like the color of the client's skin, that's unethical.

    Anyone who goes into a vegetarian restaurant and orders a hamburger is an idiot. The name "vegetarian restaurant" indicates no meat is served.

    I'm going to repeat the question that no one answered earlier: if a Hindu buys a McDonald's restaurant, should he/she be allowed to refuse to serve hamburgers?

    That is the equivalent you are looking for here, not a customer going to a vegetarian restaurant and ordering a hamburger.

    A woman who goes into a pharmacy and asks to have a birth control prescription filled, should expect to have it filled. The definition of the word "pharmacy" indicates that prescriptions are filled there. Unless, of course, there is a sign on the window that says "Sexually active women not served here", in which case, good luck with that.

    Just so nothing gets lost here, repeating the question that is the crux of the matter:

    How is it ethical to let one's personal feelings interfere with one's job in such a matter?
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  9. Jedi Merkurian Episode VII Thread-Reaper and Rumor Naysayer

    Manager
    Member Since:
    May 25, 2000
    star 6
    44, I guess the counter - question would be that if one pharmacist refused to carry a product, what's to stop all pharmacists in a given area from doing the same? One can't just go elsewhere in that case.
    Last edited by Jedi Merkurian, Aug 8, 2014
  10. anakinfansince1983 Chosen One

    Member Since:
    Mar 4, 2011
    star 7
    Yeah, I've asked that several times, they're all pretending that couldn't possibly happen.
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  11. VanishingReality Jedi Grand Master

    Member Since:
    Apr 21, 2013
    star 3
    I don't think that denying medical treatment can be compared to other industries denying services. Birth control pills dramatically effect the quality of life for people suffering from endometriosis, for use in cancer prevention and anemia relief, not to mention for contraceptive purposes for young people and people in poverty who cannot afford children. Having a medical need isn't a choice like salad vs burger.
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  12. Rogue_Ten Chosen One

    Member Since:
    Aug 18, 2002
    star 7

    i addressed your examples quite handily by pointing out how laughably out of step they were with the realities of the professional disciplines they purported to represent, with the added bonus of delving into why discrimination based on someone's choice of profession is -- in many if not all cases -- quite different from both discrimination based on ascribed status and delivering substandard care by dint of one's religious identity

    indeed, wocky thanked me in PM for pointing these things out. apparently he felt they were pretty important points to make, but was wrestling with how to bring them up without bruising your ego, since they're so glaringly obvious

    despite this, i dont see any rebuttal from you, though i must admit to a tendency to skim your hypergraphic spasms, due to their rather predictable, cyclical nature
    Last edited by Rogue_Ten, Aug 8, 2014
  13. Jedi Merkurian Episode VII Thread-Reaper and Rumor Naysayer

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    star 6
    Also, kudos to V03 and wocky for making the point far more eloquently than I could.
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  14. FatBurt Force Ghost

    Member Since:
    Jul 21, 2003
    star 5
    Can I give a UK example here.


    Private pharmacies are very rare, on the main we have Boots, Lloyds and Tesco's

    Where I grew up we had Boots and that was it, if the corporation decided against providing birth control we would have had a 30 mile drive to get to a Tesco or Lloyds. If you didn't drive you were screwed.

    Now this was back in the 80's and granted things are different now, the UK has a delivery service and various other options but I am not aware of one pharmacy that has refused to provide a prescription given by a doctor because that is not their place.

    I am aware of one person who runs the local Boots pharmacy who won't hand out the morning after pill but as there always has to be a minimum of two pharmacists the company gets round that by ensuring he is paired with someone who will provide the prescription. If on the rare occasion he is on his own he will however dispense as there is no other option.


    We have recently had occasions where Muslims in supermarkets have refused to sell pork produce or alcohol when on till duty, these individuals are normally relocated to back office functions or dismissed from their role if their employment restrictions cannot be accommodated.

    Providing the morning after pill or similar is a time sensitive issue, mail order is not feasible here and in some cases you kind of need it NOW. If you live in a city, being told no is less of an issue than if you live in a rural area with crappy public transport and no car. Eitherway it is not (IMO) the pharmacist's call to say no to a patient if they come in with a prescription.


    BTW a pharmacy has an expectation of providing medicines, expecting them to do this is an understandable position to hold. Expecting a vegetarian restaurant to provide you with a steak is stupidity.
  15. Mr44 VIP

    Member Since:
    May 21, 2002
    star 6
    Well, you just summed up exactly my point. Exactly why the government shouldn't get involved.

    The easy answer is that what you described is the interference that happens in countless areas in everyday situations. It's called life. V was the most academically honest when he used his own personal feelings to rank the topics here, but he still used his personal feelings to create that ranking. You're over-simplifying the issues, and then cherry picking your conclusions.

    Let me offer you a different example. What if a restaurant is simply called "Anakinfan's cafe?" I walk into it expecting, as you said, to get a hamburger...The owner says "I'm sorry, I serve only vegetarian food here. It's excellent, so you can try it, or you can go to Big Boy's hamburgers on the other side of the shopping center." What options do you suggest I undertake?

    1)Throw myself on the floor and start yelling that it's not fair and I want a hamburger right now?
    2)Start filming with my I-phone, call the press, and declare that the owner's feelings are discriminating my wishes?
    3)Lament in the fact that I will never be able to buy a hamburger again because the one cafe I went to doesn't sell them?
    4)Thank the owner and just go get my hamburger at Big Boys?

    Unfortunately, I think the first two are all too common. #3 is strange. And #4 is what should happen.

    So again, I'll continue your example. If a customer walks into a drug store expecting to fill a prescription, why does the expectation in itself trump the drug store owner simply saying " I'm sorry, I don't carry that item, but you can go to ____ and get it filled?" Every other profession/store owner who you indicated gets to use discretion, but the pharmacist has none, and the "none" is based solely on the "politicalness" of the topic. So a pharmacist could choose not to carry viagra, and that would be no big deal because there is no controversy there. But a pharmacist who doesn't carry every birth control option that exists is unethical and is one step away from professional anarchy.

    To me, the drug store owner has an equal right to choose what to sell and what not to sell. Because when you start picking aspects, you end up with bad law.
    Last edited by Mr44, Aug 8, 2014
  16. Rogue_Ten Chosen One

    Member Since:
    Aug 18, 2002
    star 7
    @Mr44 it has been explained to you over and over again that healthcare is different and there are professional standards that pharmacists, licensed by the state, are expected to meet. i dont know how many different ways we can explain that to you. in the case of pharmacists (and someone correct me if im being harsh, but i think this pretty much hits the mark) the job is, if someone brings you a perscription for something, you either fill it from your stock on hand or you offer to order it. this is how it works

    if there might be a dangerous drug interaction or something that you think the prescribing professional missed, you can bring that up with the prescribing professional, but other than that, you pretty much fill what you're given. you are a dispensory. you dont get to say "we dont serve WHORES here" if you dont like what's on the perscription.

    if you dont like that you can go into a less standardized professon. one example might be opening up a homeopathic store, which there is certainly a growing demand for

    in fact, to address your lastest hilariously inadequate "example" (and honestly im already looking forward to the next hastily-assembled crop), if someone believed in naturopathic cures and refused to dispense certain allopathic medicines, on the grounds that they believe they are harmful to people, (much like a vegetarian restaurant owner who doesnt dispense meat... i guess... ignoring like 30 other flaws in your example, for simplicity), they would not be able to practice as mainstream pharmacists. they might then go into business as a naturopathic store owner, but the licensing organizations should not be expected to license them to be pharmacists.

    i imagine someone who believes birth control is murder could find plenty of career options in alternative medicine without running into licensing issues, but allopathy (that's mainstream medicine, for our intents and purposes) runs off of accreditation and standardization. its evidence based. if you have a problem with that, you dont go into the field
    Last edited by Rogue_Ten, Aug 8, 2014
  17. FatBurt Force Ghost

    Member Since:
    Jul 21, 2003
    star 5
    Again I go back to the rural concern.

    What if the nearest drug store to you refuses to provide you with what you have been prescribed but advises you that you can get it from the next town 30miles away. Is that acceptable.

    If you go into a food outlet and they advise you that they don't serve a hamburger you are able to get something else from there or go down the road as food outlets are quite frequently found in towns


    In some cases you only get one pharmacy



    An individual who provides healthcare or the means to facilitate healthcare should not be allowed to decide who does and doesn't get what based on their own perceptions of it's icky to me. If an individuals own physician has decided that X is the medicine for them or the birth control for them then that's what they should provide. The best course of action is to work with local physicians to ensure that the prescriptions being written are ones that can be accommodated.

    Please also note that birth control is not only issued for birth control it has other medicinal properties as well (Menstrual issues etc...) and sometimes a specific type has to be issued
  18. anakinfansince1983 Chosen One

    Member Since:
    Mar 4, 2011
    star 7
    A restaurant called "anakinfan's cafe" would have a menu posted outside so that customers would know what to expect. That is good marketing, as I would not enter a restaurant without knowing what type of food the restaurant served.

    The equivalent of your example is opening a restaurant called "anakinfan's burgers" and then telling potential customers that, oh, sorry, I'm trying to save the cows now. This place doesn't really serve burgers.

    Or maybe a better example would be refusing to allow customers to have mayonnaise on their burgers because I don't like the way it smells (which is true, both the sight and smell of it make me gag) or even better, because the fat customer does not need it.

    But you didn't answer my question about whether it is ethical to allow personal feelings to dictate job performance, or Merk's about the pharmacies.

    BTW, I think if many doctors in the area are prescribing Viagra, pharmacies are obligated to stock it, not refuse because "old men don't need boners."
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  19. Mr44 VIP

    Member Since:
    May 21, 2002
    star 6
    Well R10, if that is the case, the last time this issue came up, here is the official statement from the The American Pharmacists Association (APhA):

    The APhA is inclined to recognize pharmacists' right not to fill a prescription as long as the patient's needs can be met by others. The APhA suggests that in addition to referring patients to another pharmacist or drugstore, concerned pharmacist in a rural community, for example, might let physicians know what prescriptions he will not fill and suggest that they dispense the drugs themselves. Or, they could refer patients to another pharmacist.

    So, according to the governing body that sets ethical behavior for pharmacists, it's perfectly ethical to decide not to carry something, and it is suggested (not even required) to refer to a different pharmacist. Unless that position has changed, your entire post is moot. There used to be a regular who was a pharmacist who posted here. I forget his name for the moment, which he'd probably kill me, but he had insight from inside the field.

    Of course, Rogue, we're having a discussion, of which there are differing opinions. For me, mostly focusing on the role of the government forcing a choice. But if the government followed the APhA's guidelines, this isn't even an issue. But it certainly isn't as final as you think, eh?
    Last edited by Mr44, Aug 8, 2014
  20. Rogue_Ten Chosen One

    Member Since:
    Aug 18, 2002
    star 7
    you really dont understand the difference between is and ought, do you? grown-ass man and you just cant grasp it. fascinating

    i fixed it for you, made it a little clearer. i mean, we've been doing that writ large for probably at least a decade now, but you know, one more try
    Last edited by Rogue_Ten, Aug 8, 2014
  21. Mr44 VIP

    Member Since:
    May 21, 2002
    star 6
    I know. I know. You can come over an punch me in the face if you want and get rid of all that stress you must carry worrying about it.
  22. Jedi_Dajuan Admin: FanForce and Games

    Administrator
    Member Since:
    Dec 30, 2002
    star 6
    The difference between a restaurant and a pharmacy in your example is the restaurant isn't the only type of place that sells food. You can go to a grocery store and buy it, grow your own, find a farmer or farmers market, etc. Pharmacies are one of the only places to get drugs.

    Sent from my SPH-L720 using Tapatalk
  23. Vaderize03 Manager Emeritus

    Member Since:
    Oct 25, 1999
    star 5
    Not to step into this, but the governing bodies that sets not only the standards of ethics for physicians (AMA/ACP/IOM), but the standards of training for OB-GYN's (American College of Obstetricians/Gynecologists) have come out strongly against every major piece of legislation that's attempted to restrict access to abortion, including (but not limited to): the ban on late-term procedures (substantial testimony offered in scientific defense of when the procedure was medically necessary, despite a "legislative finding" to the contrary, which was ignored by both Congress and an all-male majority of the Supreme Court), laws that claim a fetus can experience claim at 20 weeks (it can't), claiming there's a link between abortion and breast cancer (there isn't), and most recently, laws forcing clinics that perform any abortion (including non-surgical ones) to conform to the standards of an ambulatory surgery center under the guise that it improves patient safety (there is not a shred of evidence to support this or any findings to the contrary).

    Evidence from experts the country over, offered again and again, yet it gets ignored in favor of "legislative findings."

    How is that different from passing a law insisting the Earth is flat? Tell me, please. We have satellite images to the contrary, but I guess one can always claim that the pictures were faked. Seems easier for some than facing the truth.

    Anyhoo....

    Peace,

    V-03
    Last edited by Vaderize03, Aug 8, 2014
  24. Mr44 VIP

    Member Since:
    May 21, 2002
    star 6
    Uh, I'm sorry, was that directed at me, V? I don't think I've said anything about abortion other than to say that if a doctor doesn't want to do one, that doctor just sends the patient to one who does. Are you drawing a parallel between the two?

    But you're hitting on the issue that hasn't been answered for me yet. Yeah, if there was some birth control pill version of Roe v Wade and it was being repealed, I'd understand your argument. If there was some sort of magical law which was legislating a Seinfield episode, and all birth control pills were being banned from the market. I'm right with you in the protest march. All I am saying is that if one drug store doesn't carry something, just go to a drug store that does. It's not rocket science. What's doubly puzzling is that you seem to accept such decisions in all other cases, except when birth control is involved. If the owner of a specific store chooses not to carry something, what makes birth control unique in your mind that it's akin to 1)denying life saving emergency medical aid, or 2) restricting access to all birth control forever? Because up until now, the sum total of the argument has been:

    A customer walks into a drug store and asks for birth control. The owner says "sorry, we don't carry that here, you'll have to go down the street." And I guess the customer just curls up in the fetal position on the floor, because heaven forbid they go someone else, so they have no choice but to get pregnant. That sounds more like the set up to a joke than it does any sustainable argument. The punchline is "And the kids all looked like the mailman." When in fact, there are probably a half dozen pharmacies/drug stores that carry what they want that just aren't the store they're standing in at the moment.

    And to go back to a prior question. Yes, if a Hindu opened a McDonalds and didn't sell beef, that's their choice. Their McDonalds would specialize in mcnuggets and Filet o'Fishes. (assuming franchising restrictions and such) Who cares? Don't like it, don't go there. If someone else believed in a religion that didn't touch pork, and they opened a McDonalds, it's their decision not to sell the Ribwich. (Although it could be debated how much pork is in a Ribwich) The argument that a potential customer who walks into a McDonalds has an expectation of a pork sandwich is the least relevant one in the owner's decision on how to run their business.
  25. Rogue_Ten Chosen One

    Member Since:
    Aug 18, 2002
    star 7