Pharmacist Robin Block won’t sell cigarettes.
“I tell [customers] they have to go up front to buy them because I can’t see selling them their stroke medicine and cigarettes at the same time.”
But Block, who works at Walgreens on East Capitol Drive, doesn’t think pharmacists should “impose [their] own moral values on other people.”
And she doesn’t think pharmacist Neil Noesen did the right thing in refusing to transfer an oral contraceptive prescription that he had declined to refill for University of Wisconsin-Stout student Amanda Phiede in July 2002.
Last week the state Pharmacy Examining Board agreed and reprimanded Noesen, 31, for the incident, which occurred in Menomonie, Wis.
The only pharmacist on duty in the store that Saturday, he refused to either refill or transfer Phiede’s prescription to another pharmacy on the grounds that either action would violate his religious Roman Catholic convictions.
The four Jewish pharmacists interviewed for this story were unanimous in thinking that Noesen was out of bounds in refusing to transfer Phiede’s prescription.
“I don’t think he had the right to [refuse her service], whatever his reason — economic, practical, religious. Everyone has a moral framework, but you have to be reasonable.
The person on the other side of the counter also has beliefs,” said pharmacist Mike Pistiner, of Thiensville, co-owner of Fitzgerald’s Pharmacy in Whitefish Bay.
“You are a health professional first, and if you can’t do that without violating your religious beliefs, maybe you should be in a different job,” said Sheldon Bernstein, a pharmacist since 1973, who is now unable to work because of a difficult back surgery last year.
“I am more concerned about filling the prescription the doctor wrote than I am with my own religious beliefs,” he said.
Bernstein said that since pharmacists are not licensed to prescribe, it is not up to them to make moral judgments. “If I were [licensed to prescribe] I would have to justify in my own mind, by virtue of the tests that are given, whether [the patient] really needs the medicine.”
Even in cases where they might suspect suicidal intentions, the pharmacists interviewed mostly did not feel justified in intervening. Block, however, said, “What you can do is give them a small amount [of the drug].”
Pistiner, however, does not think that he would alter the prescription at all. “I honestly don’t think I would impose my beliefs on someone else.”
“I think a person has a right to decide for himself when enough is enough. The only way I would intercede would be if I felt an order had been altered in order to obtain an illegal amount, ” said Norm Malmon, of Brown Deer, an in-patient pharmacist at the Columbia campus of Columbia St. Mary’s Hospital.
The pharmacists who spoke with The Chronicle emphasized that they have many professional and ethical responsibilities, including familiarity with state and federal laws pertaining to pharmaceuticals, consideration of possible drug interactions, examination of prescriptions for correct dosages, mistakes or intentional pampering, to name a few.
“A pharmacist not only has a right, but also an obligation, if he or she has a question about a prescription, they have an absolute duty to question the doctor. Then if the doctor asserts that this is what he or she wants, you document it, no matter whether it’s a possible abuse or allergy,” said Bernstein.
And they do sometimes observe practices that they don’t feel comfortable with. “I deal with oncology and hospice patients and my feeling is that their care sometimes goes beyond what I think is reasonable treatment; but I go along with it because it is not my decision to make,” said Malmon.
Bernstein said he is bothered by “the indiscriminant use of the ‘morning-after’ pill” and has questioned doctors when he has received perscriptions for multiple doses for the pill. “It has been turned into a maintenance drug [and] that is a wrong use for it. It is promoting unsafe, unprotected sexual behavior and that changes its use [from what was intended].”
In the Noesen case, the board decided that he will have to provide advance written notice to employers about what pharmacy practices he will refuse to perform and what steps he will take to ensure that his clients will have access to necessary medications.
Although Wisconsin is one of 47 states with a law that allows physicians, hospitals and hospital workers to refuse treatment on moral grounds, the 1970s laws do not provide pharmacists with those protections, according to the National Abortion and Reproductive Rights Action League.
The Noesen case has spurred Republican legislators in Wisconsin, and elsewhere, to introduce a “conscience clause” — a bill to shield pharmacists from prosecution for refusing to perform services that they say go against their beliefs.
Neither Bernstein, Block, Pistiner nor Malmon expect a conscience clause to pass in Wisconsin. And if it did, Bernstein added, “I think it would be wrong.”
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