(by guest blogger Douglas Anderson, PharmD, and Dennis Sullivan, MD)
Out of Arizona comes a tragic case where a woman who had suffered a miscarriage was denied a drug for treatment, on the basis of the “conscience rights” of a pharmacist. Nicole Arteaga was nine weeks pregnant when her pregnancy came to an abrupt end. Fetal development had ceased and the heartbeat had stopped. In order to avoid the need for a surgical procedure, her doctor prescribed misoprostol, a medication designed to cause the uterus to contract and deliver the now-dead fetus. But when Nicole arrived in the Walgreen’s pharmacy in Peoria, Arizona, the pharmacist involved refused to fill the prescription, citing ethical concerns. This caused the patient considerable pain and embarrassment. She later said,
I left Walgreens in tears, ashamed and feeling humiliated by a man who knows nothing of my struggles . . .
From an ethics standpoint, this outcome was altogether avoidable.
The basic conflict here is between patient autonomy and the conscience rights of the pharmacist. However, as is often the case in community pharmacies, the pharmacist did not understand the full clinical scenario. Had he known that a miscarriage had already occurred and that the medication was not being used to induce abortion, then his response might have been different. But pharmacists need to be aware that just because they know what a medication could be used for, they do not necessarily all of the nuances of every case.
Sometimes pharmacists must investigate such clinical nuances when it is in the best interests of the patient, such as the case of a medication allergy or a harmful drug interaction. But this is not the case in asserting conscience rights, which protects the pharmacist’s interests.
A better option would have been to simply hand the prescription to another pharmacist, or to refer the patient to another pharmacy (which ultimately happened in this case). It would have avoided the painful situation of the patient having to explain to the pharmacist that she had miscarried, and would help her get the therapy that she needed.
Professional conscience rights are important, but they must be handled with care and diplomacy. Only then can pharmacists, nurses, physicians, and others avoid becoming easy targets for overly harsh legislation or even lawsuits. The professionalism of healthcare is at stake.