Transcript The Morning After Pill

The Morning After Pill?
Carly Sharp
Janine Vance
Ashley Walker
Kalee Ankrum
Wendy Cumberbatch
What is the Ethical Question?
Should pharmacists have
the right to refuse to
dispense the morning
after pill?
What are the Facts?
 The morning after pill is a pill taken by a woman to avoid
fertilization of an egg after having unprotected sex.
 The first prescription-only combined estrogen-progestin
dedicated product, Schering PC4 (ethinylestradiol and
norgestrel), was approved in the UK in January 1984 and first
marketed in October 1984.
 It wasn’t until July 28, 1999, that the FDA approved the
prescription progestin-only Plan B (two 750 µg levonorgestrel
pills) emergency contraceptive in the U.S.A.
What are the Facts? (cont’d)
 Pharmacists do have a moral right to
refuse to dispense the morning after
pill.
 Although this moral right is given, they
must still adhere to what is written in
their job descriptions.
Perspective of Stakeholders
 Patient
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Increased inconvenience
Potential for embarrassment and humiliation
Right of access to care
Question of abortion
Impact on future
 During and after pregnancy
 Life changes, job, finances
 Their partner
• Impact on future
 Marriage?, child support
 Both families
Stakeholders (cont’d)
 Pharmacists
• Dispensing violates personal code of ethics
• Can refuse and refer to another pharmacist
• Reputation
 Pharmacies
• Reputation, customer satisfaction
 General public
• Welfare, adoption agencies, increased cost to
society
What Options do Pharmacists
Have?
 Direct customers to another pharmacy.
 Step away and allow another
pharmacist to dispense meds to
patient; therefore, maintaining the
woman’s rights.
 Refuse to dispense based on personal
beliefs.
Pharmacists’ Options (cont’d)
 Direct customers to another pharmacy
• Acting against beliefs, yet still protecting a woman’s rights.
• Board of Pharmacy allows refusals but obligates
pharmacists to direct customer where to get prescription
filled.
 Step away and allow another pharmacist
to dispense meds to patient;
• Not getting involved, yet still allowing the dispense to occur.
Refusal to Dispense
 Can be based on:
• Morales
• Ethics
• Religion
 Pharmacist are protected by Refusal Laws
and conscience clauses endorsed by the
APA.
 Georgia, Arkansas, Mississippi, S. Dakota
are the only states that allow refusal.
What Should I Do?
BEST COURSE OF ACTION:
 Pharmacists should not be able to refuse to
dispense the morning after pill based on
personal, moral, or religious judgments.
• Refusal to dispense should be based on
professional or medical concerns: potentially
harmful contraindications, interactions with other
drugs, improper dosage, or suspected drug
abuse.
What Should I Do? (cont’d)
 The pharmacist ultimately has the responsibility
to ensure timely patient access to legally
prescribed medications.
• Either by filling the prescription or transferring prescription
to another pharmacist.
 Pharmacists knowingly enter a profession where they
serve the public, subject to regulation.
 The objection to contraception is rooted in personal
religious belief, not professional training, science,
medicine, or the law.
What Should I Do? (cont’d)
 Women rely on prescription contraceptives
for a range of medical purposes in addition
to birth control, such as regulation of cycles
and endometriosis.
 Refusals to dispense contraceptives or
transfer prescription to another pharmacist
can have devastating consequences for a
woman’s health
Justifying Our Choice
 Two theories that help justify this decision:
1) Utilitarian

Actions are right to the extent that they tend to
promote happiness and wrong to the extent that they
tend to promote the reverse of happiness.
•
Refusing to dispense emergency contraceptives
does not promote happiness.
•
According to this theory, it is wrong to refuse
access to EC’s because happiness is the most
important thing, and that is not being considered.
Justifications (cont’d)
2) Deontological
• Considers whether it is one’s duty to perform or
not perform an action.
 It is the pharmacist’s duty to ensure timely patient access to
legally prescribed medications.
 “Can I, as a rational person, consistently will that everyone in
a similar situation should act in the same way?” –Immanuel
Kant
 The proposed action is morally acceptable because all
pharmacists should act in the same professional way, which is
to fill medical prescriptions, regardless of personal belief.
Justifications (cont’d)
 Ethical Approach that applies to this
situation:
 Analysis of Rights
• Based on the consideration of whether an
action affirms or violates human rights
 A right is an especially powerful moral claim that
others are obligated to respect.
 Pharmacists have both rights and responsibilities.
 Is their right to refuse disbursement of the morning
after pill ethical?
How Could this Ethical Problem have Been
Prevented?
 More specific laws pertaining to the dispense
of the product be established before the
arrival of the product.
 The pharmacist should respect the patients
request to purchase the “morning after pill”.
 Early strict expectations of pharmacists in
their job descriptions.
NAPRA Statement
 National Association of Pharmacy
Regulatory Authorities (NAPRA) places the
onus on the pharmacist who declines to
provide emergency contraceptives to
prearrange access to an alternate source, either
another pharmacist or a physician who has a
supply of the drug.
 NAPRA states that pharmacists “shall hold
the health and safety of the public to be their
first consideration.”