Based on many years of professional training, a licensed physician prescribes an FDA approved pain medication to a patient. The patient, who suffers from chronic pain related to a serious medical condition, brings the prescription to a local pharmacy to be filled. The pharmacist refuses to fill the prescription and then refuses to return the prescription to the patient so that it can be filled at another pharmacy. The patient returns home in pain.

If you think this can’t happen, think again. This rather improbable sounding scenario is happening every day in pharmacies across the country with respect to a growing number of important medications like painkillers, Emergency Contraceptive (EC) pills, psychotropic drugs, and birth control pills.

Pharmacists (and the American Pharmacists Association) call it conscience-based refusal; the American Medical Association (AMA) sees it as a wrongful denial of a patient’s access to legally prescribed therapy and medical care.

At its annual meeting on Monday, the AMA voted to use its influence to see that such “conscientious refusals” do not deny patients’ of  needed medical treatment by supporting legislation that would require pharmacists to fill any valid prescription or to refer such patients to another pharmacy that will. The AMA will also press for amendments to existing state laws to allow physicians to dispense medications when there is “no willing pharmacist available within a 30 mile radius.”  

While the American Pharmacists Association recognizes what it sees as a right of individual pharmacists to refuse to fill certain prescriptions, it “supports the establishment of systems to ensure a patient’s access to legally prescribed therapy without compromising the pharmacist’s right of conscientious refusal.” The organization also opposes any confrontation wherein a pharmacist berates, belittles, or lectures a patient.   

Medpage Today reports fourteen states have either passed or are considering legislation protecting pharmacists who refuse to fill prescriptions based on moral, religious, or personal grounds while nine additional states are in the process of enacting laws that would permit pharmacists to refuse prescriptions “for any reason.”

Conscientious refusal first became an issue when some pharmacists refused to fill prescriptions for EC pills viewing them as a form of abortion. The refusals soon spread to birth control pills.

Now, however, many pharmacists have extended their objections to include painkillers and psychotropic drugs. In some situations pharmacists are also refusing to return the prescriptions thereby preventing patients from turning to other pharmacists.

This problem is magnified in areas where the local pharmacist is the only pharmacist or where the nearest alternative pharmacy may be several miles away.

A coalition of medical specialty groups and individual physicians want the AMA to press pharmacists to follow ethical guidelines for the delivery of healthcare. They see this as no different than the ethical duty of doctors to refer patients they are unwilling to treat to another physician.

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