Wall L Lewis, Brown Douglas
Department of Obstetrics-Gynecology, Washington University, St. Louis, Missouri 63110, USA.
Obstet Gynecol. 2006 May;107(5):1148-51. doi: 10.1097/01.AOG.0000214951.46283.40.
Over the past several months, numerous instances have been reported in the United States media of pharmacists refusing to fill prescriptions written for emergency postcoital contraceptives. These pharmacists have asserted a "professional right of conscience" not to participate in what they interpret as an immoral act. In this commentary, we examine this assertion and conclude that it is not justifiable, for the following reasons: 1) postcoital contraception does not interfere with an implanted pregnancy and, therefore, does not cause an abortion; 2) because pharmacists do not control the therapeutic decision to prescribe medication but only exercise supervisory control over its dispensation, they do not possess the "professional right" to refuse to fill a legitimate prescription; 3) even if one were to grant pharmacists the "professional right" not to dispense prescriptions based on their own personal values and opinions, pharmacists "at the counter" lack the fundamental prerequisites necessary for making clinically sound ethical decisions, that is, they do not have access to the patient's complete medical background or the patient's own ethical preferences, have not discussed relevant quality-of-life issues with the patient, and do not understand the context in which the patient's clinical problem is occurring. We conclude that a policy that allows pharmacists to dispense or not dispense medications to patients on the basis of their personal values and opinions is inimical to the public welfare and should not be permitted.
在过去几个月里，美国媒体报道了多起药剂师拒绝为紧急事后避孕药开具的处方配药的事件。这些药剂师主张拥有“职业良心权利”，不参与他们认为不道德的行为。在本评论中，我们审视了这一主张，并得出结论认为其不合理，原因如下：1）事后避孕不会干扰已着床的妊娠，因此不会导致堕胎；2）由于药剂师并不控制开处方的治疗决定，而只是对药物配给行使监督控制权，他们不拥有拒绝为合法处方配药的“职业权利”；3）即使给予药剂师基于自身个人价值观和观点而不配发处方的“职业权利”，“柜台前”的药剂师也缺乏做出临床合理伦理决策所需的基本前提条件，即他们无法获取患者完整的医疗背景或患者自身的伦理偏好，未与患者讨论相关的生活质量问题，也不了解患者临床问题发生的背景情况。我们得出结论，允许药剂师根据个人价值观和观点决定是否为患者配药的政策不利于公众福祉，不应被允许。
