Senate The US Politics discussion

44, part of this seems to be your fundamental misunderstandings of medical ethics. It's not just about the "life-threatening" criteria. People who work on in healthcare have a special privilege, as Vaderize noted. There's no detail of life they can't pry into. They can ask a patient to strip for them on demand, and it's done without question. They may well be more familiar with the patient's body than the patient themselves. Mental, physical and social conditions are all to be laid completely bare. Within the doctor-patient relationship, there is little to no expectation that the patient will be able to keep anything to themselves at all. In terms of interpersonal interactions, that's virtually unparalleled in its level of invasiveness.

But people only agree to this arrangement for a few reasons. The last, and most recent to be legally codified, is the idea of patient privacy. There are hard restrictions on spreading this information around. One of the first is the idea of disinterest. The healthcare provider is exercising this incredible access to a person and their life only to make the person more healthy. That's the only reason the patient comes, and that's the only reason the nurse, doctor, or pharmacist treats. The fact that one has this access does not transform one into some sort of god that can arbitrate over what is right and wrong for the person, or what they should and should not be doing in life. They confine themselves to speaking about what promotes or harms health.

So let's take your example: someone has a prescription for Viagra. It doesn't matter if he intends to use it when he visits an illegal prostitute on the street corner, or if he's looking to physically reconnect with a dearly beloved wife after life circumstances kept them apart from one another for 18 months. Nor does it matter if the pharmacist is a free-love polyandrous libertine that thinks bonobos model the ideal form of human interaction, or if he or she is Shaker that finds all sexual activity sinful and worth abstaining from. What matters is that the person has a real, treatable medical condition. Do I, personally, think a Viagra prescription is a very worthwhile or hugely important thing? Not at all.

But that's just it. I'm not the one with the Viagra prescription. Neither is the patient. It is absolutely outrageous for me to tell him that something he has chosen to value in life is actually not important. That is, it's not anyone's place to deny treatment to another person just because their view of the world is not the provider's own. Do you know why physicians just can't unilaterally pull the plug on patients in the hospital? Because it's not their place to say when a life is or is not worth living. It is the patient's, or by substitution the patient's designated decision-maker. They are the one that determines what's important in their life. Violating that understanding and substituting your own is unfathomably arrogant, narcissistic, and thankfully illegal. But the same principle about denial of care works for administration of care, too. Maybe we don't think that it makes a big difference in life whether someone gets Viagra, or birth control, or is able to keep playing golf on Friday afternoons. Regardless, for the particular patient each one of those things is important. Going to school for a few years more than average doesn't give healthcare providers the right to force that patient to reject their own values and substitute someone else's.

To KK and others who spend their time spewing libertarian clap-trap, what about this most fundamental point of freedom? Shouldn't patients be able to decide for themselves what is and isn't meaningful in life? Should they really be at the mercy of healthcare providers that arbitrarily refuse to treat them just because they disagree with the patient's decisions? Are you alright with a police force that would decline to help someone in trouble just because they think the person made bad decisions to end up that way? Personally, I don't believe that's how our system should ever work.

 

I'm sure the nurse getting in trouble would be a real comfort to the patient who was coding and then died. Oh wait...

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Yeah, that's weird. I was supposed to quote you on your second question. My final reply was to Fatburt. The board chopped my post.

Anyway, I had a longer answer for you, but basically, the nurse should still be subject to the decisions made, but I also think that specific example was so limited it goes into the "unlikely to happen, so it applies only to its own circumstance file."

However, yes! Now we're getting somewhere:

Yes, exactly. Perfect example. What do you think should happen to you if you removed all books with Bible stories from your library? It's not a "life threatening" action. You should be fired based on your employment requirements. But should you be arrested? Should you be personally sued? Should you pay a fine? If you did that, it would be between you and your library (or whoever has ultimately authority over the library-School Board, etc..) Why would the government need to get involved at all through laws and legal ramifications? That's what I'm asking.

 

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?

 

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.

 

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

 

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.

 

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....

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.

 

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.

 

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

 

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.

 

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.

 

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

 

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

 

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?

 

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

 

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.

 

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.

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