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Tuesday Aug 28, 2018

Conflicting Beliefs Shouldn't Hinder Patient Care

Kim came to my office for a followup regarding hormone replacement therapy, but when I asked how she was tolerating the medication, Kim -- a transgender female -- said she had been unable to fill her prescription. A pharmacist told her he could not do so, but did not explain why and did not refer her elsewhere.

[pharmacy logo on building corner]

Kim's story sounded familiar because there have been other, high-profile stories of patients being refused prescribed medications this summer.

In June, Nicole Arteaga was given two options by her physician for her unviable pregnancy -- dilation and curettage or a misoprostol prescription. Arteaga, who had suffered a previous miscarriage, opted for the prescription.

Unfortunately, a pharmacist at a Peoria, Ariz., Walgreens refused to fill her prescription. Arteaga said in a Facebook post(www.facebook.com) that she tried to explain her situation -- she wanted the child but it had stopped developing -- while standing in line with several other customers. The pharmacist still declined, citing his ethical beliefs.

Walgreens apologized for the incident(news.walgreens.com) and filled the woman's prescription at another location.

A month later, Hilde Hall, a transgender woman in Fountain Hills, Ariz., made news by sharing her account of a CVS pharmacist's refusal to fill a hormone prescription.(www.aclu.org)  

As a family physician and former pharmacist, I understand that all health care professionals are entitled to their own religious and moral beliefs. The question is, what happens when our beliefs conflict with those of a patient?

AAFP policy developed by our members states, in part, "If a family physician's moral or ethical beliefs conflict with the ability to provide the requested resources or education, the family physician should ask a colleague to provide this information in a timely fashion rather than omit it."

The same standard should be applied to pharmacists. In fact, American Pharmacists Association policy(www.pharmacist.com) "recognizes the individual pharmacist's right to exercise conscientious refusal and supports the establishment of systems to ensure patient's access to legally prescribed therapy without compromising the pharmacist's right of conscientious refusal."

Unfortunately, how the issue is actually handled varies widely from state to state.(nwlc.org) Arizona, where both recent examples above took place, is one of six states that allow pharmacists to refuse to provide medications for religious or moral reasons.

Seven states have laws that require pharmacists to transfer prescriptions or refer a patient elsewhere if a prescription is not filled. (Such protection, however, may be of little help to patients in rural or underserved areas if the next nearest pharmacy is far away.)

Meanwhile, at least eight states have laws prohibiting refusals to fill prescriptions.

I never learned why Kim was unable to initially fill her prescription, but she finally did at the pharmacy in my building -- three months after I wrote the prescription.

There are lessons to be learned from this. We need to know the laws regarding pharmacist refusal in our own states. Patients should follow up with their physicians immediately if they are refused service. And those who have been trusted to provide patient care should remember that when they are unable to provide a medication or service, it doesn't mean they have the right to impede a patient's legal right to receive it.

Ada Stewart, M.D., is a member of the AAFP Board of Directors.

Posted at 12:20PM Aug 28, 2018 by Ada Stewart, M.D.

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