Mass. to Walmart: Stock morning-after pill

[cocoa_femme]

:D :D :D

WASHINGTON, Feb. 15 (UPI) -- Wal-Mart pharmacies are required to stock emergency contraception in Massachusetts, a state regulatory body ruled Tuesday.

The retail giant has until Thursday to comply with the Massachusetts Pharmacy Board ruling, and a company spokesman earlier said that the company would comply with any state decision on the matter.

The board's unanimous decision makes Massachusetts the second state in the country, after Illinois, requiring pharmacies to carry the controversial medication.

Two weeks ago three women filed a lawsuit in state court alleging that by not stocking emergency contraception, Wal-Mart was in violation of a state law requiring pharmacies to carry all "commonly prescribed medications in accordance with the usual needs of the community."

At the same time, they filed a complaint with the Pharmacy Board, resulting in Tuesday's ruling. The lawsuit is still pending in Suffolk Superior Court.

The rest of the article can be found here: United Press International (http://www.upi.com/HealthBusiness/view.php?StoryID=20060215-112957-1569r)

[dionysia]

*cheers*

Di

[LyLMyssChaos]

So much for "free enterprise." :rolleyes:

[lawyerlee]

Um, yeah, cause we don't require any businesses to follow any other laws. Super logical criticism.

[kedzieb]

my father's a pharmacist in MA and couldn't agree more with this. according to him, if you have to dispense Viagra to a fat old man, all medicine is fair play. who's he to judge the medicine people need?

since time is of the essence in EC cases, the idea of a pharmacist lording it over a woman who needs it seems similar to him holding an asthmatic's inhaler over her head while she wheezes.

[LyLMyssChaos]

Um, yeah, cause we don't require any businesses to follow any other laws. Super logical criticism.

No, but I think that a business should be allowed to decide which items it does and does not want to sell. I don't think that we should force them to sell something that they don't want to. If their business drops because they don't carry something the public wants, then that's a consequence they have to deal with.

[gretazmama]

Unlike asthma meds, I question whether emergency contraception falls under "commonly prescribed medications in accordance with the usual needs of the community."

I can't imagine that the morning after pill would be identified -- by those on either side of the debate -- as something people desire/need to use commonly or usually.

[LyLMyssChaos]

Unlike asthma meds, I question whether emergency contraception falls under "commonly prescribed medications in accordance with the usual needs of the community."

I can't imagine that the morning after pill would be identified -- by those on either side of the debate -- as something people desire/need to use commonly or usually.

ITA!

[kedzieb]

Unlike asthma meds, I question whether emergency contraception falls under "commonly prescribed medications in accordance with the usual needs of the community."

I can't imagine that the morning after pill would be identified -- by those on either side of the debate -- as something people desire/need to use commonly or usually.

i think an inhaler is pretty similar actually. most people never need it. some people rarely need it - if they're taking regular meds, they're less likely to need it. and those who do need it, need it right away.

or how about an epi-pen?

ETA: spelling

[LyLMyssChaos]

i think an inhaler is pretty similar actually. most people never need it. some people rarely need it - if they're taking regular meds, they're less likely to need it. and those who do need it, need it right away.

or how about an epi-pen?

ETA: spelling


But inhalers and epi-pens are "commonly prescribed." I don't think that "Plan B" is prescribed all that commonly, or at least it shouldn't be. It's supposed to be an "emergency item." So it really shouldn't be "commonly prescribed" IMO.

[ysolde]

But inhalers and epi-pens are "commonly prescribed." I don't think that "Plan B" is prescribed all that commonly, or at least it shouldn't be. It's supposed to be an "emergency item." So it really shouldn't be "commonly prescribed" IMO.

My gyn gives me a prescription for Plan B every year, just in case. I keep it in my desk. It is not only useful for contraceptive failure (less of an issue for me, as someone who is on the Patch -- but heaven forbid it should fall off), but is also useful to stop really bad breakthrough bleeding. I know a lot of women who have a prescription for Plan B. I don't think it is all that uncommon.

In any event, three cheers for Massachusetts!

[mamahammer]

Wow. Totally disagree with this ruling. If a pharmacy *chooses* to carry the Morning After Pill, then they should be allowed to force their pharmacists to comply. But I am really opposed to the government deciding that*all* pharmacies are under obligation by law to support the morning-after/abortion pill. In the same way I don't think they can or should force every obstetrician to perform abortions. My current OB/GYN chooses not to prescribe any birth control medications and will not refer you outside for an an abortion or for sterilization procedures. he is excellent at what he does, and is very clear about what he doesn't do out of moral obligation on his part. I respect that. And I think every pharmacy ought be allowed the same moral-out so long as their decision is clear-cut, plainly stated for all to see, and is carried out across the board.

[ysolde]

Just so it is clear, the MAP is not RU-486 (the "abortion pill"). The MAP is prescribed for use within 72 hours of contraceptive failure, and prevents pregnancy.

RU-486 (mifepristone, IIRC) is given by a doctor, in a medical facility, within the first eight weeks of pregnancy. It is the first of two sets of pills taken by a pregnant woman to end a pregnancy (chemical abortion).

[pocket]

Isn't MAP just regular BCP taken in different doses?

[kedzieb]

yes, i know lots of people with prescriptions for EC too. not uncommon. but either way, it's a medicine that lots of women need and i'm happy to see that they'll have access to it. now why they're shopping at walmart in the first place is a topic for a different post! :rolleyes:

[ysolde]

Isn't MAP just regular BCP taken in different doses?

Yup. The MAP is just the BCP in a "concentrated" dose (like taking a month's worth of pills in a couple of days).

[chefker]

Anyone find it ironic that Wal-mart is in a snit over this, when they were recently in the news for firing an employee who is pregnant? I have to track down that news story....not sure if it was posted elsewhere here.

Just goes to show, that while Wal-mart corporation purports to uphold moral standards in their business practices, when it comes to their employees, they are completely cut-throat.

[amew]

Hooray for Mass.!

I don't really buy the whole "stores should be allowed to carry what they want" argument, because that is not how pharmacies generally work. Unlike a typical store, pharmacies are more or less required or expected to carry all commonly-prescribed medicines. Can you imagine the problems that would ensue if half the time a doctor called in a prescription, the pharmacist responded by saying "this pharmacy has decided not to carry that medication"? I see no reason to single out birth control for special treatment, when I can't imagine allowing a pharmacy to just decide not to carry inhalers or beta blockers.

But inhalers and epi-pens are "commonly prescribed." I don't think that "Plan B" is prescribed all that commonly, or at least it shouldn't be. It's supposed to be an "emergency item." So it really shouldn't be "commonly prescribed" IMO.

My DH is (slightly) asthmatic and has a potentially fatal nut allergy that requires us to have an epi-pen on hand at all times. He gets a new prescription for each every 2-3 years when the old one expires. I have plenty of friends who have had a condom break and therefore needed emergency contraception with similar frequency, so I would say that in my experience, emergency contraception, epi pens, and inhalers are actually quite comparable.

[pocket]

When i was young and single i always had a spare pack of bcp for this purpose. my NP explained how to use it. lots of the girls i knew had been instructed thusly.

[amew]

Yup. The MAP is just the BCP in a "concentrated" dose (like taking a month's worth of pills in a couple of days).

The last time I was directly exposed to the MAP (which was admittedly about 10 years ago), it consisted of taking four BCPs and then taking another four 12 hours later. So a total of eight BCPs over the course of a day. Not sure if it has changed any since then.

[Txfish]

My current OB/GYN chooses not to prescribe any birth control medications and will not refer you outside for an an abortion or for sterilization procedures.

I'm just in shock that this exists. I mean, holding a personal moral standpoint is one thing -- but he's forcing his patients to follow that view also? I mean, could he refuse to pull the plug on a vegetative patient on moral grounds? Does he not *ever* see a patient for whom b.c. or sterilization is a must, for health reasons?

I guess I feel like, on a personal or business level, (to tie back to the original story) if you can't/don't want to follow the laws as set out, then don't be in that business. Regardless of your moral obligations.

I'm just shaking to think of any dr. having that much control. (I do realize you could switch drs, but that's kind of beside the point for me.)

HOORAY (again) for Mass!

[LyLMyssChaos]

My current OB/GYN chooses not to prescribe any birth control medications and will not refer you outside for an an abortion or for sterilization procedures. he is excellent at what he does, and is very clear about what he doesn't do out of moral obligation on his part.

I wish that I lived closer to his practice! He would definitely win me as a patient! I wish that more professionals took a moral stand and refused to compromise their beliefs. I figure, if you don't agree with the doctor and their treatment methods, you can go elsewhere.

[hockeybrat]

Wow. Totally disagree with this ruling. If a pharmacy *chooses* to carry the Morning After Pill, then they should be allowed to force their pharmacists to comply. But I am really opposed to the government deciding that*all* pharmacies are under obligation by law to support the morning-after/abortion pill. In the same way I don't think they can or should force every obstetrician to perform abortions. My current OB/GYN chooses not to prescribe any birth control medications and will not refer you outside for an an abortion or for sterilization procedures. he is excellent at what he does, and is very clear about what he doesn't do out of moral obligation on his part. I respect that. And I think every pharmacy ought be allowed the same moral-out so long as their decision is clear-cut, plainly stated for all to see, and is carried out across the board.

So you're saying your doctor doesn't prescribe any type of birth control, at all? It doesn't seem right to me? What if a person who is under his care would like bc? I just don't understand. :confused:

Back on topic - that is GREAT about MA!

[ysolde]

For some reason, I thought it (EC) was five and five, but I don't really remember.

[Asha]

My current OB/GYN chooses not to prescribe any birth control medications and will not refer you outside for an an abortion or for sterilization procedures.

:eek: :eek: :eek: !!!

[Txfish]

Yeah, I knew there'd be a few who think that dr. is great news, but glad to see some people having my reaction to it. (horrified shock)

[maxandmolly]

Oh, how I wish I lived in a blue state where things like this make it in court! Hooray for Mass. women! And the women in neighboring states as well.

[BTB]

Just so it is clear, the MAP is not RU-486 (the "abortion pill"). The MAP is prescribed for use within 72 hours of contraceptive failure, and prevents pregnancy.

While emergency contraception does prevent pregnancy *if* ovulation has not yet occurred, it also prevents implantation of an already fertilized (or already ovulated and soon to be fertilized) egg. Therefore some people do consider it an abortifacient. ACOG's definition of an "abortion" is the disruption of an established pregnancy, and therefore some "official" materials and websites will state that EC =/= an abortion, but that's not a universally accepted abortion definition.

Unlike a typical store, pharmacies are more or less required or expected to carry all commonly-prescribed medicines.

Eh, yes and no. During my pregnancy I needed two shots daily of Lovenox, a pretty common medication (and also an urgent one, it was important for me not to miss a dose). That's 60 doses per month, but most pharmacies don't stock more than a dozen doses at a time because of the cost and short shelf-life. The pharmacy would thus limit the amount I could get at one time to three or four prefilled syringes, and special-order the rest, but then my insurance company considered that a "fill" and I could only "fill" the prescription every 30 days. I'd then be on my own the remaining 28 days, with a medication that at that time was retailing for $48/day. I tried to special-order in advance and ran into roadblocks, every month it'd be an argument with both the pharmacist and the insurance company. It's not always easy to get even "noncontroversial" medication - not that I'm saying this should be a normal everyday experience, but let's not think that pharmacies are responsive to other stocking needs. This was all about their profit.

[Asha]

why in the world did he become an ob/gyn? i guess, i could see why he became an ob bc of his "respect" for life, but don't be a gyn bc part of treatment for common gynecological problems are prescriptions for birth control.

[hockeybrat]

Yeah, I knew there'd be a few who think that dr. is great news, but glad to see some people having my reaction to it. (horrified shock)


I thought I was just reading it wrong (which I tend to do since I read too fast) and didn't bother to clarify until you came onboard and asked the very same question.

[maxandmolly]

Yeah, I knew there'd be a few who think that dr. is great news, but glad to see some people having my reaction to it. (horrified shock)
Horrified shock about covers it. I can only hope he at least makes his policy utterly clear before a perspective patient even schedules an appointment, so no woman who needs FULL gynecological care wastes her time.

[Jazz]

Cool beans, MA! :)

[ysolde]

Yeah, I knew there'd be a few who think that dr. is great news, but glad to see some people having my reaction to it. (horrified shock)

Yea, it's pretty horrifying that there are such doctors out there.

Kind of reminds me of the woman who was proud that she went to a doctor who had "never learned abortion procedures." "Be careful," I said, "if you ever have a miscarriage, a D & C can save your life, and it sounds like your doctor, for political reasons, has refused to learn a life-saving procedure. Are you sure that was a wise choice?"

I have to wonder about a doctor who would have refused to give me EC when I was bleeding heavily for five days (not pregnant), a doctor who would refuse to give me birth control even though I take medication that is contraindicated in pregnancy because it causes severe brth defects at best and miscarriage at worst (I suffer from migraines, and I take a pretty heavy duty combination of prophylactic meds to keep myself from having pain), a doctor who would look at a married couple and say, "Sorry, you are out of luck. Can't have you using the most effective methods of birth control, because it goes against my religion. Better for you and your wife to miscarry repeatedly."

[hockeybrat]

SNIP ...a doctor who would look at a married couple and say, "Sorry, you are out of luck. Can't have you using the most effective methods of birth control, because it goes against my religion. Better for you and your wife to miscarry repeatedly."

In that same respect, what about a married couple who don't choose to have kids? Would they be forced to have kids because of this doctor? Obviously, they could find another one but still, it just seems so Medieval.

[ysolde]

In that same respect, what about a married couple who don't choose to have kids? Would they be forced to have kids because of this doctor? Obviously, they could find another one but still, it just seems so Medieval.

Obviously, this doctor thinks all married couples need to have kids. A lot of them. There is nothing wrong with this belief. There is something wrong with his imposing it on his patients, especially if his practice is in a location where there are few choices in women's medical care. Sure, it's easy enough for me to find another ob/gyn, but for a woman in rural parts of the US, findin a doctor who takes her insurance and is within driving distance (or bus distance) is not always so easy.

[BTB]

I'm just in shock that this exists. I mean, holding a personal moral standpoint is one thing -- but he's forcing his patients to follow that view also? I mean, could he refuse to pull the plug on a vegetative patient on moral grounds?

It's not that the doctor is refusing to let the patient take BC (or come off life support), it's that he's refusing to be the one to write the prescription (or turn off the ventilator) himself. The patient (or designee) can still make that choice - in areas with sufficient physicians. Although I do think he's on the border of medical ethics as defined by the AMA in also refusing to provide referrals for those services he refuses to perform.

On the issue of EC dosage - when "regular" BCPs are used as EC, the number of pills taken depends on the brand of BCP (since hormone quantity differs from brand to brand). Prepackaged EC, aka Plan B and Preven, just makes it easier to take the correct dose. Just FYI in case anyone is reading the thread and decides four or five is the "right" number of BCPs - it may or may not be for your brand.

[ysolde]

BTB --

Just as a general thing, don't you think that anyone who has contraceptive failure and needs EC should go to a doctor or health care facility? I mean, we are pretty savvy (and you are a doctor), but I would hope anyone reading this would not go out there and swallow four or five BCPs at a time, KWIM? :o

[mamahammer]

Hm.

Well, he does make his practices very clear. His website goes into great detail about what he does and doesn't do, his appointment secretary makes it clear before scheduling all appointments, and it is clearly posted in the exam room, as well. There is no confusion on the part of the patient. Besides that, most of his patients come to him because of his care and his moral stances on reproduction and human life. Not inspite of it.

His practice is located in the DFW metroplex, and his office is on the same road as at least two other OB's (all three of whom accept most insurance plans). The idea that someone might be "forced" to have children because of his moral position on birth control is baseless. Especially considering that planned Parenthood is less than a mile away from his practice.

As to why he became an OB/GYN? Well, contrary to the sense you would get from this conversation, there is much more to a woman's reproductive health than birth control and/or abortion. He does provide classes on NFP, he performs all routine tests, he performs all annual exams, etc. He treats both mother and child as equal in importance when it comes to pregnancy, which is what his patients desire. He is very, very involved in all aspects (emotional and physical) of miscarriage at all stages of pregnancy, which I find very comforting. He treats the first trimester miscarriage as a loss of life just as he would a third trimester loss. He has a profound respect for life and for the God who creates it, which can be seen in all of his practices.

I don't understand why your (general) "right" to birth control and/or abortion trumps a doctor or pharmacists "right" to religious freedom and expression. Why is your right as the consumer more important than their right as a practitioner and religious observer? No one is stopping you from going to another pharmacy nor another doctor. No one is forcing you into that particular clinic or pharmacy. And, like I said earlier, this is all contigent upon a clear, upfront statement about the position of the doctor/pharmacy. That clear intent is paramount.

[ysolde]

Sorry, mamahammer, but I find it cold comfort to know that this man would be very warm and fuzzy as I miscarried several times a year under his "care".

[Asha]

Why is your right as the consumer more important than their right as a practitioner and religious observer?

actually, i think the right of the consumer does trump the right of the caregiver. for example, my dh has been treated in a racist manner by his patients. he is a pharmacist, and he cannot deny meds just because a patient treats him in this unethical manner.

i do think it is good that the potential patients are informed of his practices; eventhough, i don't agree with them.

[hockeybrat]

Well, he does make his practices very clear. His website goes into great detail about what he does and doesn't do, his appointment secretary makes it clear before scheduling all appointments, and it is clearly posted in the exam room, as well. There is no confusion on the part of the patient. Besides that, most of his patients come to him because of his care and his moral stances on reproduction and human life. Not inspite of it.

It is good that he lets any new patients know about his stance as well as where he is located in relation to OB/GYNs. It wasn't clear on your previous post and as Ysolde mentioned, there might be circumstances where a patient might have difficulty in changing doctors.

[ysolde]

Would we be comfortable if Christian Scientists bought pharmacies and refused to dispense any medicines on religious grounds?

Would we be comfortable if Jehovah's Witness doctors refused to provide blood transfusions to ANY of their patients?

Why not allow a Christian Scientist doctor to refuse to prescribe any medication, and in fact to refuse to provide any medical care, and instead refer all of her patients to a Christian Science healer, on religious grounds?

[wendalah]

I would be OK with the Jehovah's Witness.
The Christian Scientist probably would position him/herself as a healer to begin with, not a doctor. and sure, I say fine if they want to have a pharmacy with no medicine. Some other savvy businessperson would surely love to grab the clientele.

ETA: If the christian scientist doctor isn't prescribing medicine or providing medical care, only referals--does he have a job? Where can I sign up for one of these jobs where I do nothing? ;)

[ysolde]

Imagine if the Christian Science Church decided to buy out all the CVS or Rite Aids. Sound implausible? The RCC has bought out lots and lots of local hospitals, to the point where women can no longer get basic medical care (I remember an expose on 60 Minutes a few years ago, where a woman in a rural area whose fetus had died in utero was denied a procedure to extract the fetus by her newly RCC purchased hospital because it was an "abortion". She was told to return when her life was at risk. When the fetus was rotting within her, and she had dangerously high levels of toxins in her blood, her doctor was finally allowed to perform the procedure he should have performed days earlier. Her health and her life were unnecessarily endangered by this hospital that suddenly cared so much about "human life".

[maxandmolly]

This is going to put me horribly out of line with the liberal girls I normally agree with, but under the circumstances you've described, mamahammer, I don't think I have a problem with a doctor making that choice.
So how does that jive with me being all for Wal-Mart being forced to carry EC? Your doctor is a lone doctor, making a choice for him and him alone. Women who see him, choose to see him. I have lousy health coverage-no Rx coverage, I pay cash for all my medicine (I am on several). So Wal-Mart (and by extension, Sam's Club) decision to carry or not carry a medicine would actually affect my ability to get it filled, since their prices are in general SO much cheaper than anywhere else. And people like me, or in worse financial circumstances, may have no other option but to get their prescriptions filled there. So lone doctor-can do what he wants. Largest corp on earth-carry all normally prescribed meds, not just the ones they deem appropriate.

[thedoorchick]

actually, i think the right of the consumer does trump the right of the caregiver. for example, my dh has been treated in a racist manner by his patients. he is a pharmacist, and he cannot deny meds just because a patient treats him in this unethical manner.
I'm totally confused how this is anything like a doctor choosing not to have involvement with abortions and/or hormonal birth control. That is a professional choosing to conduct his business, and offer his services, in the way that he chooses. Without regard to any characteristic of the patient. And, since we are fortunate enough to live in the capitalist society that we do, people can either choose to patronize him, or not. What you are describing is a situation in which someone is treated poorly by a customer and treats that individual person differently because of that mistreatment. There is probably not a single person among us who has not experience some crappy treatment by a customer or client. That is not the same as a business owner making choices about how to run his business as a whole.

And as mamahammer was saying, since when are abortions and hormonal birth control the primary focus of an OB/GYN's practice? Maybe for some it is (*shudder*) but I am amused at the horror over a doctor's choosing not to involve himself in those particular services.

ysolde, I have read this post time and time again and I cannot understand it - can you explain?
Sorry, mamahammer, but I find it cold comfort to know that this man would be very warm and fuzzy as I miscarried several times a year under his "care".

[pocket]

But most docs aren’t out there with their politics like that. Most doctors won’t let you know that they don’t perform abortions in their practice until you need an abortion and they refer you out. Many many clinics don’t do them. In college the clinic on campus didn’t have a doctor who did abortions. At Berkeley. It’s a real problem. I always ask a new doc and I don’t patronize a clinic that doesn’t do abortions. Why should they get my patronage?

I believe ysolde means that without the bc that doc would refuse to prescribe, she would conceive and miscarry time and again.

[Delta]

I also went to a practice in Virginia for a while that didn't prescribe birth control. It was a purely NFP practice, Catholic-based, and they made that explicitly clear when you call as a new patient, and then on all the forms you fill out. I really don't see the problem.

http://www.tepeyacfamilycenter.com/

[amew]

I think that a doctor refusing to prescribe birth control under any circumstances is acting in an ethically questionable manner. In some situations, denial of birth control is tantamount to harming a patient (and/or that patient's future child). It is hard for me to believe that a physician could, for example, in good conscience deny birth control to a teenager on Accutane (or any patient on a drug that causes a high incidence of birth defects for that matter). Sure, everyone has a right to free exercise of religion, but if that right is in conflict with a physician's ability to provide full and complete care to her patients, I think she has a moral obligation to select another speciality.

[thyme]

You know, I have no problem with emergency contraception. Years and years ago Cosmo printed a chart on how to do it, showing timing and dosages for some popular BCP brands, and I clipped and saved it for a long time. This was years before Plan B and the like came out.

OTOH, telling private businesses that they must sell certain products regardless of their moral or ethical objections to said products makes me uncomfortable.

[thedoorchick]

It is hard for me to believe that a physician could, for example, in good conscience deny birth control to a teenager on Accutane
You get Accutane from a dermatologist, not an OB/GYN; I would certainly presume that the dermatologist would prescribe birth control. As a matter of fact, now that I think about it I had a friend in college who was on Accutane and whose dermatologist insisted she take the pill. She was quite miffed about that, as she wasn't sexually active, but that's another conversation.

ETA: What my point really is, and I didn't really articulate clearly, is that there are plenty of perfectly good reasons why a person would need the birth control pill. I don't think there's any point in saying one use is more noble than another. The point is, there are a thousand places one can get such a product. It's like people think that if this one doctor chooses not to prescribe BC, that no one can get any.

[amew]

OTOH, telling private businesses that they must sell certain products regardless of their moral or ethical objections to said products makes me uncomfortable.

But at some point the obligation to serve the health care needs of patients has to take priority. What if Wal-Mart is the only pharmacy in town? What if they decide they are morally opposed to all birth control? What if they decide a la Tom Cruise they are morally opposed to anti-depressants? Free enterprise is nice, but pharmacies and doctors have a moral obligation to ensure that their patients are not harmed at their hands. And I think that denial of medicines on moral grounds can indeed harm patients.

[amew]

You get Accutane from a dermatologist, not an OB/GYN; I would certainly presume that the dermatologist would prescribe birth control. As a matter of fact, now that I think about it I had a friend in college who was on Accutane and whose dermatologist insisted she take the pill. She was quite miffed about that, as she wasn't sexually active, but that's another conversation.

Maybe so, but that doesn't negate the fact that an OB/GYN may still have patients who request birth control because they are on medications and/or have health conditions that would make pregnancy extremely medically dangerous. It just seems to me that refusing to prescribe it in those situations is violates medical ethics.

[BTB]

BTB --

Just as a general thing, don't you think that anyone who has contraceptive failure and needs EC should go to a doctor or health care facility? I mean, we are pretty savvy (and you are a doctor), but I would hope anyone reading this would not go out there and swallow four or five BCPs at a time, KWIM?

My advice that "the dose depends on your brand" was not meant to mean "here's how to DIY" (although I don't think that information being available is necessarily a bad thing, it's available in Cosmo of all places as a pp pointed out) but to say "it's not that simple" (in case any kids do try this at home).

I'd like to think that everybody reading this thread, lurkers and members alike, is savvy enough not to need to be told that, but that'd be awfully naive of me as I've met scores of patients who've done just that (seek advice on a message board) as well as read scores of posts (even here!) looking for internet-issued medical advice.

In some situations, denial of birth control is tantamount to harming a patient (and/or that patient's future child).

That's a really huge stretch - I don't follow at all. It's not as if the doctor is actually tying down the patient's arms so she can't take her pill, s/he's just not providing that pill. It is a different situation in some parts of the country where access is quite limited, but we seem to be talking for all patients here, not just those in areas of misallocation.

[thedoorchick]

How does it violate medical ethics? Are they somehow preventing the patients from obtaining these services at all?

In the case mamahammer brought up, this is ONE doctor in a very large metropolitan area. I can't begin to imagine how many doctors (and PP clinics) there are around who would gladly dispense BCP's.

[amew]

In the case mamahammer brought up, this is ONE doctor in a very large metropolitan area. I can't begin to imagine how many doctors (and PP clinics) there are around who would gladly dispense BCP's.

So is a doctor's right to refuse to prescribe BCP contingent upon being located in a large metropolitan area? Should we have different standards for docs in big cities vs. the only OB/GYN in a small town?

[BTB]

Let's flip the situation around a little bit.

Doctors who refused to follow German national policy and perform unethical medical testing on POWs and concentration camp inhabitants were killed, or fled the country. They had a moral objection to the status quo.

I'm not suggesting the situations are identical but opposite, but I do think it provides an interesting perspective to the idea that doctors should not be allowed to object on ethical and moral grounds but should do whatever they're "expected" to do.

[thedoorchick]

So is a doctor's right to refuse to prescribe BCP contingent upon being located in a large metropolitan area? Should we have different standards for docs in big cities vs. the only OB/GYN in a small town?

No, we should not. Several have expressed dismay over this doctor and his practices, and I was pointing out that it seems quite baseless.

To your point, I would be shocked and amazed if there was a place in the U.S. where people had only one choice in regard to these things.

Regardless, I don't think we can demand that a doctor practice in a way that violates his/her personal ethics.

My husband owned a photolab. Should he have been compelled to print copyrighted photos without the holder's permission if he was the only lab in town, even though his person ethics say otherwise? Yes, I realize that printing photos is not the same as healthcare. And yes, I realize that copyright violation is against the law, but I assure you there are labs who pay that no regard.

[ysolde]

In answer to your question, thedoorchick, I had stated earlier that, due to the meds I take to prevent migraines, pregnancy will lead to either severe birth defects or, more probably, miscarriage. The denial of the most effective methods of birth control in my case would be unethical, imho.

Please note that the Pill has many uses in maintaining women's health:

The Pill is also widely prescribed by gynecologists and family doctors for other uses, such as clearing up acne, shrinking fibroids, reducing ovarian cancer risk, and controlling endometriosis.

http://www.prevention.com/article/0,5778,s1-1-93-35-4130-1,00.html

And yes, there are many areas in our country where women have very limited access to medical care. They are either on Medicaid, uninsured, or underinsured, there are few doctors in their area, let alone doctors who accept their insurance, and if their doctor refuses to provide a prescription for birth control (and won't even refer them to someone, who is perhaps hundreds of miles away, who would be willing to provide such a prescription), they are just plain out of options.

And again, remember the woman in Louisiana, a single mother of two, with a serious heart condition, on Medicaid, who experienced contraceptive failure and was denied an abortion because her chances of dying from the pregnancy were only 50%. Eventually, she had to go out of state for a much more dangerous second-trimester abortion, funded by third parties, since she did not have the resources to pay for the transportation and medical expenses, nor did she want the state of Louisiana to orphan her children.

Here's something about her:

[Michelle] Lee first sought an abortion at Louisiana State University Medical Center in Shreveport, where she receives treatment for her heart. The hospital refused to perform the procedure because they deemed she had a greater than 50% chance of survival if she carried to term. Lee then contacted the only abortion clinic in Shreveport, but it could not perform the procedure because of the complications of her heart condition. (Lee suffers from cardiomyopathy.)

The National Abortion Federation publicized Lee's case and helped expose the callousness of the hospital in refusing the abortion. Lee's own doctor had stated that carrying a pregnancy to term posed a grave risk to Lee's life. Under Louisiana law, only one doctor's opinion is required to approve a hospital abortion in such circumstances, but the hospital forced through a negative decision by committee, effectively overruling her doctor's opinion.

After a couple of weeks of searching, the National Abortion Federation finally found a doctor in Texas willing to perform the surgery, Dr. Bernard Rosenfeld, of Houston. ''Nobody would let a daughter or sister take a 50% chance of dying," said Rosenfeld.

http://www.prochoiceactionnetwork-canada.org/prochoicepress/98autumn.shtml#heart



Some women's options are limited.

Edited for error.

[maxandmolly]

So is a doctor's right to refuse to prescribe BCP contingent upon being located in a large metropolitan area? Should we have different standards for docs in big cities vs. the only OB/GYN in a small town?
Yes. A doctor, or a pharmacy, or an anything, that is the consumer's ONLY choice, has a larger responsibility, to provide more to their clients/patients/consumers, than a business that is just one the consumer can choose from many. If he were the only doc in an isolated town, the only one women had access to, YES, it would be unethical for him, in my opinion, to hold to his same practices. Slippery slope? Maybe. But that's how I feel about it.

[thedoorchick]

Well, since we're getting into patients' options being limited, what if a doctor, perfectly willing to prescribe birth control, chose not to accept Medicaid? Is that not his/her professional right?

Is a doctor refusing to accept Medicaid the same as refusing to perform services that he/she considers unethical? Or different?

Thank you, ysolde, for answering my question - I apologize for not reading the thread thoroughly enough before asking it.

[BTB]

Well, since we're getting into patients' options being limited, what if a doctor, perfectly willing to prescribe birth control, chose not to accept Medicaid? Is that not his/her professional right?

Increasing numbers of doctors do refuse to accept Medicare/Medicaid, and yes, that is considered a professional right.

[thedoorchick]

Increasing numbers of doctors do refuse to accept Medicare/Medicaid, and yes, that is considered a professional right.

Yes, my father is one of those. He hasn't accepted Medicaid for a lot of years now.

[ysolde]

I have no problem with doctors' refusing to accept Medicaid (or any insurance, for that matter -- two of my doctors simply do not accept insurance). However, a doctor who chooses to practice in a poor, isolated area would do well to think about accepting Medicaid.

[lisainpink]

In my old position- I had 95 or so "clients" who were GPs, FPs, or IM docs. Of the 95 a grand total of 7 accepted Medicaid.
I know physicians who refuse to write for scheduled meds, certain classes of drugs, certain companies' products- the list goes on. If we take away the professionals choice, why have physicians? Why not have wedmd take care of everyone?

(in a rare turn of events;) ) ITA with everything BTB has said.

[thedoorchick]

And speaking of that, my dad also does not do OB care anymore, due to its causing malpractice insurance to be prohibitively expensive. If he is the only family practitioner in town, is he obligated to provide prenatal care?

[thedoorchick]

I have no problem with doctors' refusing to accept Medicaid (or any insurance, for that matter -- two of my doctors simply do not accept insurance). However, a doctor who chooses to practice in a poor, isolated area would do well to think about accepting Medicaid.

I guess my point was, if a doctor is in a poor, isolated area, and chooses for some reason not to accept Medicaid, and therefore those patients cannot get BC from him/her, is this the same as the doctor refusing to provide those services on ethical or moral grounds? Of course, this is not quite the same as the people could, I suppose, choose to pay out of pocket, the same way they would for services not covered by Medicaid.

[ysolde]

I guess my point was, if a doctor is in a poor, isolated area, and chooses for some reason not to accept Medicaid, and therefore those patients cannot get BC from him/her, is this the same as the doctor refusing to provide those services on ethical or moral grounds? Of course, this is not quite the same as the people could, I suppose, choose to pay out of pocket, the same way they would for services not covered by Medicaid.

That's the difference, I think. And I am also thinking in practical terms -- a dctor practicing in a poor, rural area who refuses Medicaid will be out of business quickly, and some other doctor will take her place. A doctor practicing in a poor, rural area who takes Medicaid but refuses to prescribe birth control is putting lives at risk.

[ysolde]

I found this interesting:

Surprisingly, there's no science to back the theory that birth control pills really do discourage implantation. This claim, made by contraceptive manufacturers for decades, has never been proven, Grimes says. Even the American Association of Pro-Life Obstetricians and Gynecologists agrees that it's just speculation.

http://www.prevention.com/article/0,5778,s1-1-93-35-4130-2,00.html

[amew]

Is a doctor refusing to accept Medicaid the same as refusing to perform services that he/she considers unethical? Or different?

With the exception of the obligation to provide emergency care, I do not think it is unethical for a physician to refuse to see a patient because she is on Medicaid. I do, however, think that once a physician agrees to see a patient she has an ethical obligation to provide that patient with the best care possible, which may mean prescribing PCBs.

[ysolde]

And, again, the Pill lays an important role in the prevention of ovarian cancer, which I think is something any good ob/gyn should be concerned about in high-risk patients:

What's more, oral contraceptives aren't only used to prevent pregnancy. The Pill may cut the risk of ovarian cancer by up to 80 percent and is used by women at high genetic risk for this hard-to-detect and usually fatal cancer. "There are easily more than 20 noncontraceptive uses for the Pill in common practice," says Giovannina Anthony, MD, an attending physician of obstetrics and gynecology at Beth Israel Medical Center in New York City. "This drug saves women from surgery for gynecological conditions like endometriosis, fibroids, and severe bleeding and pain."

Most women's doctors agree that contraceptives are an important tool of good medical care. "I have a hard time with people who market themselves as women's health care physicians but who won't prescribe such a basic part of women's health care," says Anne Drapkin Lyerly, MD, a reproductive rights ethicist and an assistant professor of obstetrics and gynecology at Duke University Medical Center. "We're seeing a growing trend among pharmacists and medical practitioners who consider it acceptable to impose their morality on women's bodies. I don't think moral aspects should be a concern. Imagine a pharmacist asking a customer whether his Viagra prescription is to enhance sexual performance in his marriage or in an extramarital affair. Never!"

http://www.prevention.com/article/0,5778,s1-1-93-35-4130-4,00.html

[BTB]

Surprisingly, there's no science to back the theory that birth control pills really do discourage implantation. This claim, made by contraceptive manufacturers for decades, has never been proven, Grimes says. Even the American Association of Pro-Life Obstetricians and Gynecologists agrees that it's just speculation.

You can also find dozens of texts that state combined OCs inhibit ovulation 95% of the time, while POPs inhibit ovulation 50% of the time. Yet, the failure rate for each respective method isn't 5% or 50%. Clearly, there are other mechanisms at work aside from the inhibition of ovulation. The studies haven't been performed in humans because it would be unethical to do so but to portray that as "there's no science" is incredibly misleading. That the American Association of PRO-LIFE Ob/gyns would agree isn't exactly convincing given ACOG's obvious bias.

[mamahammer]

Yes, and breastfeeding plays a role in preventing breast, uterine and ovarian cancer. But we aren't going to start requiring that all OB's give lectures about nursing your children. I don't really see what that has to do with the price of tea in China.

So, a doctor or pharmacist who is in small town USA is obligated to, in his/her mind, be a party to the killing of an unborn child because he's the only one in the area who can provide such services? Really? I realize that not everyone sees it that way, but if you believe abortion and abortaficients to be murder/murderous then you cannot in good conscience be a party to it. And because of that belief you shouldn't be a doctor? Or a pharmacist? Or own a pharmacy?

You don't believe that? Fine! Open your own pharmacy. Supply everyone who comes in with a script the Morning-After Pill. Stock up on RU-487. Go to med school. Become an OBGYN who works specifically in areas where the only doctor is against abortion and be the abortion provider in the area. Tis your right under our current laws. But I simply cannot fathom forcing someone to do something they consider tantamount to murder.

[Delta]

If the patient is fine with or specifically desires a pro-life/NFP doctor, which many (GASP!) do, I fail to see the problem here.

[ysolde]

Yes, and breastfeeding plays a role in preventing breast, uterine and ovarian cancer. But we aren't going to start requiring that all OB's give lectures about nursing your children. I don't really see what that has to do with the price of tea in China.

So, a doctor or pharmacist who is in small town USA is obligated to, in his/her mind, be a party to the killing of an unborn child because he's the only one in the area who can provide such services? Really? I realize that not everyone sees it that way, but if you believe abortion and abortaficients to be murder/murderous then you cannot in good conscience be a party to it. And because of that belief you shouldn't be a doctor? Or a pharmacist? Or own a pharmacy?

You don't believe that? Fine! Open your own pharmacy. Supply everyone who comes in with a script the Morning-After Pill. Stock up on RU-487. Go to med school. Become an OBGYN who works specifically in areas where the only doctor is against abortion and be the abortion provider in the area. Tis your right under our current laws. But I simply cannot fathom forcing someone to do something they consider tantamount to murder.


Ummm, I have yet to go to an ob/gyn who has NOT told me that having children reduces the risk of breast cancer and that breast feeding reduces the risks of breast cancer. All of my friends who have had babies have also been "lectured" on the benefits to the child of breast-feeding. It's called being a good doctor, mamahammer. That is exactly what ob/gyns are supposed to do -- give their patients all of the relevant information pertaining to their health, make all reasonable medical options available to their patients (when I had a bit of a scare a few years ago, my doctor chose to do several colposcopies, and made it clear that I had the choice of a LEEP, although she did not think it was necessary), and let their patients make informed choices regarding their health.

Again, mamahammer, pharmacies neither "stock up on" nor dispense RU-486. Please don't confuse RU-486 with the MAP.

[ysolde]

If the patient is fine with or specifically desires a pro-life/NFP doctor, which many (GASP!) do, I fail to see the problem here.


The problem is where the patient is not "fine" with it, and there is no alternative in her area. Then what? Deal with endometriosis? Fibroids? Ovarian cancer? In my case, miscarry several times a year?

[Delta]

Ummm, I have yet to go to an ob/gyn who has NOT told me that having children reduces the risk of breast cancer and that breast feeding reduces the risks of breast cancer. All of my friends who have had babies have also been "lectured" on the benefits to the child of breast-feeding. It's called being a good doctor, mamahammer.Sooo OT, but I've seen many a family care doc and many an OB/GYN and none have ever brought that up. And they certainly weren't bad doctors.

[Delta]

The problem is where the patient is not "fine" with it, and there is no alternative in her area. Then what? Deal with ovarian cancer? In my case, miscarry several times a year?
Sure, that is a problem. But I think not having an OB in the area at all (which would be the result of mandating that all docs prescribe birth control) would be a bigger problem.

[amew]

So, a doctor or pharmacist who is in small town USA is obligated to, in his/her mind, be a party to the killing of an unborn child because he's the only one in the area who can provide such services? Really? I realize that not everyone sees it that way, but if you believe abortion and abortaficients to be murder/murderous then you cannot in good conscience be a party to it. And because of that belief you shouldn't be a doctor? Or a pharmacist? Or own a pharmacy?

No one should be forced to commit what they believe to be murder. But, yes, if you believe that tasks that doctors or pharmacists are called upon to perform regularly are murder, you should not, IMO, be a doctor or pharmacist. There are fields of law I would be unable to practice in without either compromising my service to my clients or compromising my own moral beliefs, so I don't practice in those areas. Some people's religion or moral beliefs may simply be incompatible with certain professions and/or fields. In that case, I think you can choose to do the job anyway or choose to follow your beliefs and select another field. Many, many people pass up jobs that they might otherwise enjoy because the position is not consistent with aspects of their religion, belief system, or lifestyle. It is unfortunate, but life is full of trade-offs and difficult choices.

[ysolde]

Sooo OT, but I've seen many a family care doc and many an OB/GYN and none have ever brought that up. And they certainly weren't bad doctors.

Well, perhaps I have been fortunate, but this is my third ob-gyn (they have all been women), and they have all been very clear about all of this (and a lot more). If my ob/gyn did not tell me something as basic as the risk factors for breast cancer, I would switch pretty quickly.

[Delta]

And that didn't come out right. What I meant was that yes, I can understand that come people may medically need b/c. But, that doesn't mean you can force docs who are morally against it to prescribe it. All that would do is drive them out of practice.

If a person needs b/c for medical reasons they can find a doc in a neighboring or bigger town.

[ysolde]

No one should be forced to commit what they believe to be murder. But, yes, if you believe that tasks that doctors or pharmacists are called upon to perform regularly are murder, you should not, IMO, be a doctor or pharmacist. There are fields of law I would be unable to practice in without either compromising my service to my clients or compromising my own moral beliefs, so I don't practice in those areas. Some people's religion or moral beliefs may simply be incompatible with certain professions and/or fields. In that case, I think you can choose to do the job anyway or choose to follow your beliefs and select another field. Many, many people pass up jobs that they might otherwise enjoy because the position is not consistent with aspects of their religion, belief system, or lifestyle. It is unfortunate, but life is full of trade-offs and difficult choices.

Exactly right. If you cannot prescribe medicine for religious reasons, don't become a doctor. If you cannot dispense it, don't become a pharmacist.

[ysolde]

And that didn't come out right. What I meant was that yes, I can understand that come people may medically need b/c. But, that doesn't mean you can force docs who are morally against it to prescribe it. All that would do is drive them out of practice.

If a person needs b/c for medical reasons they can find a doc in a neighboring or bigger town.

Any person who cannot provide basic medical care for their patients should be driven out of practice, or practice in an area that does not conflict with their religious beliefs.

[greenbunny]

Despite nine years of extensive testing and invasive exploratory procedures, my GYN has not been able to determine the cause for my ridiculously awful periods. BCP is the only thing that keeps them bearable. To think that a GYN could look me in the eye and just refuse to write a script for me, knowings/he is sentencing me to 17-day periods, complete with vomiting until I dehydrate and black out--that utterly horrifies me. It actually gives me chills.

[Delta]

Please. So faithful, practicing Catholics can't be doctors if they follow the tenants of Humanae Vitae. Sure. Nobody is forcing patients to see these doctors.

[ysolde]

Please. So faithful, practicing Catholics can't be doctors if they follow the tenants of Humanae Vitae. Sure. Nobody is forcing patients to see these doctors.

Sure they can. But maybe they should not be ob/gyns, if they believe that ALL of their patients should be subjected to the tenets of Humanae Vitae.

[Delta]

Sure they can. But maybe they should not be ob/gyns, if they believe that ALL of their patients should be subjected to the tenets of Humanae Vitae.
Again, nobody is forcing these patients to see these doctors.

If you need or want b/c, there are thousands and thousands and thousands of other OBGYNs (and other docs) out there who will prescribe them.

[ysolde]

Again, nobody is forcing these patients to see these doctors.

If you need or want b/c, there are thousands and thousands and thousands of other OBGYNs (and other docs) out there who will prescribe them.

Again, if you are the only doctor who accepts Medicaid for several hundred miles, that may not be all that realistic. If you are one of three doctors who accepts my health plan, and the other two are in New Jersey, I am out of luck, since I can't get to the suburbs (I am in a wheelchair).

[Delta]

Any person who cannot provide basic medical care for their patients should be driven out of practice, or practice in an area that does not conflict with their religious beliefs.
And, OK, so having no doctor in the area is better than having a pro-life/nfp doctor in the area?

[Delta]

Again, if you are the only doctor who accepts Medicaid for several hundred miles, that may not be all that realistic. If you are one of three doctors who accepts my health plan, and the other two are in New Jersey, I am out of luck, since I can't get to the suburbs (I am in a wheelchair).
I don't see your point here.

[ysolde]

And, OK, so having no doctor in the area is better than having a pro-life/nfp doctor in the area?

I meant in an area of medicine (as in dermatology), not a geographic location.

[bookworm]

I understand the argument about having to perform a service you might find morally unacceptable. I'm not sure where I come down on that, but I am leaning toward agreeing with amew (as I often do).

This is a different matter though--pharmacies have to be licensed. The state can put conditions on that licensing. If one of the conditions is that the pharmacy stock a particular drug (whether it's Rogaine or the MAP), well...that's the condition. If a company doesn't like it, they don't have to open a pharmacy in the state.

The ruling doesn't require that any particular pharmacist dispense anything (I don't think--I read quickly), just that the store does. Sure, there are additional costs in backup staffing, and that might be a good reason not to hire someone who will not dispense all of the drugs the pharmacy must provide.

[ysolde]

I don't see your point here.

If I can't get birth control, I will be having several miscarriages a year. Or, I can quit taking my prophylactics, and get about 15-20 migraines a month, the majority of which will have me in the hospital, on a morphine drip.

So, if there are a limited number of ob/gyns on my health plan, and 2/3 not wheelchair accessible, and the one who is is Mr. NFP, what choice do I have? Pain or miscarriage? FUN! And my employer will LOVE me! "She's in the hospital, having ANOTHER miscarriage." How many is that this month?

[thedoorchick]

To think that a GYN could look me in the eye and just refuse to write a script for me, knowings/he is sentencing me to 17-day periods, complete with vomiting until I dehydrate and black out--that utterly horrifies me. It actually gives me chills.
Isn't this a little dramatic? As I and others have said numerous times, this issue is not tantamount to preventing patients from having these services. We are not talking about a large portion of the medical professional population here.

I'm sure we don't want to get into what horrifies and gives ME chills....It's certainly not a birth control pill or lack thereof.

[Delta]

I meant in an area of medicine (as in dermatology), not a geographic location.
No, you said that if a doc doesn't prescribe birth control he should be driven out of business. In my post you responded to I was making the point that if you mandate that all doc prescribe b/c, that will drive the prolife/nfp ones out of business, including the ones who may be the only OB's in that area (a concern you originally brought up.)

So, I am asking, is no OB better than a prolife/nfp OB?

[Delta]

So, if there are a limited number of ob/gyns on my health plan, and 2/3 not wheelchair accessible, and the one who is is Mr. NFP, what choice do I have? This is an extreme hypothetical, and not realistic.

Futhermore, the point I have been trying to make is that what good does it do to drive Mr. NFP out of business? You still won't get the BC you need, and other patients will lose their doctor.

[ysolde]

No, you said that if a doc doesn't prescribe birth control he should be driven out of business. In my post you responded to I was making the point that if you mandate that all doc prescribe b/c, that will drive the prolife/nfp ones out of business, including the ones who may be the only OB's in that area (a concern you originally brought up.)

So, I am asking, is no OB better than a prolife/nfp OB?

As I said earlier, an out-of-business OB will be replaced. An NFP OB (prolife? I doubt that!) who stays in business probably won't have competition in large, sparsely populated, poverty-stricken areas.

[greenbunny]

Isn't this a little dramatic? As I and others have said numerous times, this issue is not tantamount to preventing patients from having these services. We are not talking about a large portion of the medical professional population here.

I'm sure we don't want to get into what horrifies and gives ME chills....It's certainly not a birth control pill or lack thereof.

Excuse me? I'm terribly sorry that you find my long-term health problems "dramatic". And yes, the thought that I might one day have trouble getting the health care I need because the medication is used to also prevent pregnancy IS horrifying. I'm disgusted that you could even say this about my physical suffering.

[ysolde]

Isn't this a little dramatic? As I and others have said numerous times, this issue is not tantamount to preventing patients from having these services. We are not talking about a large portion of the medical professional population here.

I'm sure we don't want to get into what horrifies and gives ME chills....It's certainly not a birth control pill or lack thereof.


The things that give you the chills, does anyone suggest that you should be forced to do them? Because, as a woman with a disability, I would like to point out to you that the very states that had the most severe restrictions on abortion were the same ones that forced women like me to be sterilized and have abortions against our will. The sword cuts both ways. If the state can force you to give birth against your will, it can force me to abort against my will. Me, I like having the choice.

[thedoorchick]

greenbunny, I do not find your long-term health problems dramatic. What I find dramatic is your comment that the idea of one particular doctor not dealing in hormonal BC "gives [you] chills." As I have said time and time again, a particular doctor not prescribing BCP's in no way prevents you from having them.

Are you suggesting that one day BCP's will be simply unavailable to anyone? I find that impossible to believe. I think we can all agree that NFP/pro-life doctors aren't exactly the majority.

[ysolde]

Sometimes, I feel like I am listening to a lecture by the Aunts in "The Handmaid's Tale," "They refused, REFUSED to have children! The birth control pill, widespread abortion . . ." ;)

[ysolde]

Oh, and I am thinking about the NFP docs and those creepy pharmacists, not anyone here, when referring to the Aunts.

[greenbunny]

Are you suggesting that one day BCP's will be simply unavailable to anyone? I find that impossible to believe. I think we can all agree that NFP/pro-life doctors aren't exactly the majority.

Well, frankly, I think that this country is moving farther and farther along the path of people with fundamentalist beliefs...and I do think that prescription birth control will be put on tighter and tigher restrictions in years to come. I think this battle is only just beginning, and I definitely do think that the issue of birth control for medical use will be cast aside in favor of the more "hot button" use, for political gain. So, yes, you could say that I see mamahammer's doc as a harbinger. I honestly hope to go through menopause and hopefully be rid of this problem before that happens.

[Delta]

As I said earlier, an out-of-business OB will be replaced. An NFP OB (prolife? I doubt that!) who stays in business probably won't have competition in large, sparsely populated, poverty-stricken areas.Hmm, I dunno. I currently live in a place I call doctor siberia. We just can't get them to come here. The wait to see the 2 derms is at least 7 months, no joke. And the two ENTs are about to retire in the next 3-5 years and people are already in a tizzy about that. Many people just go out of town to see a doc. I'm pretty sure we'd take a doc that didn't prescribe b/c rather than none.

I just don't think it's wise to drive docs out of business by essentially telling them to do things they find morally objectionable.

It's far, far, far more likely that patients will find access to a b/c prescribing doc (it doesn't even have to be an OB) than the hypothetical scenario that they are left up the creek.

[mamahammer]

Okay. So, an OB/GYN can only be an OB/GYN if he or she is willing to perform abortions and willing to prescibe possible abortifacients - even if that is tantamount to murder in their faith? Seriously?

And a pharmacy can only exist if they are willing to provide medication that, again, is perhaps tantamount to murder in their faith? Again, seriously?

I understand that birth control pills are used for various reasons. I totally get that. But that doesn't make it any less an abortifacient. And thus, for certain people, that doesn't make it any less of a moral wrong.

No one is talking about outlawing birth control pills. No one's saying that you shouldn't have any access at all to them. What is being said is that your desire for a practitioner and/or pharmacy who will fill that need doesn't necessarily trump the need of the practitioner/pharmacy to be uninvolved in what they see as a murderous action.

I do take solace in knowing that my doctor/midwife has the utmost respect for each unborn child in their care. And I am glad to have that kind of care available to me.

I still fail to see what all of the uproar and indignation is about. I'd like to point out, as well, that not prescribing birth control pills doesn't mean not teaching about and empowering women to take control of their bodies. NFP is a very effective, efficient and inexpensive means of birth control.

I think Emily asked this awhile back, but since when did reproductive health become synonymous exclusively with birth control pills? There is so much more to reproductive health.

[thedoorchick]

That makes me want to laugh. Not AT you, but at the fact that I see this irony so often. IMO, if this country is doing anything, it's getting farther and farther away from that possibility.

ETA: this is a response to greenbunny's last post - I just noticed some people xposted and thus it was confusing.

[greenbunny]

That makes me want to laugh. Not AT you, but at the fact that I see this irony so often. IMO, if this country is doing anything, it's getting farther and farther away from that possibility.

:D I guess we both are just expecting the worst, only we see it as the opposite!

[mamahammer]

That makes me want to laugh. Not AT you, but at the fact that I see this irony so often. IMO, if this country is doing anything, it's getting farther and farther away from that possibility.

I agree. I know why it's easy to think the opposite, because the loudest voices seem to be the most fundamental. But I in no way think they are the majority. Or even close to it. I tend to think the majority of this society is planted pretty squarely in the center - with the hot button issues running either slightly left or slightly right. And that doesn't equate with birth control pills being banned suddenly ala prohibition.

[Delta]

Here is a website for NFP docs (not just OB/GYNs.)

http://www.omsoul.com/nfp-doctors.php

There are actually many more out there than I realized. It looks like hundreds if not thousands. I don't know that it would be wise to throw them all out of business.

[ysolde]

mamahammer --

I have heard mixed reviews about NFP. The last person I know who was doing it (charting faithfully, doing that whole icky mucus thing, etc.) is now a mommy. And she and her DH really can't afford it.

It's definitely not for DH and me. My "cycle" is a mess (I am pretty much like greenbunny, except my last "natural" period lasted 18 days). I travel. A LOT. Even if I could do NFP, I doubt we would want to wait for the few days each YEAR we could have intercourse, since I tend to be gone 2-3 weeks a month, and am only back on weekends.

[bookworm]

And a pharmacy can only exist if they are willing to provide medication that, again, is perhaps tantamount to murder in their faith? Again, seriously?


Pharmacy, yes. Pharmacist, no. And yes, seriously--the business gets licensed. It's a condition of the license. Why is that so offensive?

[thedoorchick]

Used properly, NFP is as effective as BCP's. Not used properly, well, there you have it - just as if someone neglected to take her pill.

I should warn you that referring to cervical fluid as "icky mucus" can be considered fighting words by some folk. I'd tread carefully with those kinds of references.

[greenbunny]

I should warn you that referring to cervical fluid as "icky mucus" can be considered fighting words by some folk. I'd tread carefully with those kinds of references.

:D Okay, now I'm picturing an old saloon brawl. "You be talkin' bout my mucus?" Pow, pow!

(It's possible that I'm tired and getting loopy.)

Are the NFP statistics assuming a healthy, normal cycle? What about for someone like me or ysolde with an abnormal one?

[SingleWhiteFemale]

What is being said is that your desire for a practitioner and/or pharmacy who will fill that need doesn't necessarily trump the need of the practitioner/pharmacy to be uninvolved in what they see as a murderous action.What makes the doctor's/pharmacist's morals trumph my own? Why should they be the one to choose my fate? Why should they be able to dictate my morals?

[greenbunny]

I just can't understand why it's okay for someone to not fulfill an aspect of their job, whatever that may be. Besides the concept that they are against XYZ, they are refusing to do their job. Why is this okay? Can a vegan become a butcher, and then refuse to cut up meat?

[Delta]

And to clarify, to me the pharmacist situation is more complicated than the doctor situation. I have no idea why though. Maybe someone could explain what I am thinking. :o

[thedoorchick]

What makes the doctor's/pharmacist's morals trumph my own? Why should they be the one to choose my fate? Why should they be able to dictate my morals?

Crikey. I say once again, where in all this are you forbidden to obtain BCP's? How are your morals being dictated?

[thedoorchick]

Are the NFP statistics assuming a healthy, normal cycle? What about for someone like me or ysolde with an abnormal one?
No, it does not assume a "normal" cycle (whatever that really is) - the beauty of it is that it does not require a woman's cycle to be predictable.

[thedoorchick]

I just can't understand why it's okay for someone to not fulfill an aspect of their job, whatever that may be. Besides the concept that they are against XYZ, they are refusing to do their job. Why is this okay? Can a vegan become a butcher, and then refuse to cut up meat?

This comes back to what mamahammer and I were talking about - It is entirely possible, to my way of thinking, that a doctor can practice in the area of reproductive health without getting into hormonal BC or abortions. There is so much more to that area of medicine.

All a butcher does is cut up meat. That's the ENTIRE job. I can't imagine what vegan would want to be a butcher, but obviously that's beside the point.

[Delta]

All a butcher does is cut up meat. That's the ENTIRE job. I can't imagine what vegan would want to be a butcher, but obviously that's beside the point.Hmm, as long as they don't eat the meat, I think they can be a butcher and still be a vegan. ;)

[SingleWhiteFemale]

Crikey. I say once again, where in all this are you forbidden to obtain BCP's? How are your morals being dictated?Say I have an insurance plan where the only preferred/covered pharmacy is WalMart. I have crappy pay, so if I don't go through my insurance company for a needed drug and have to pay out of pocket, I either forgo food or forgo the prescription. And I live in a state where WalMart isn't forced to dispense/stock it. and I don't live anywhere near a PP. I'm shit out of luck, aren't I?

Reality is, many people think "Well, you're middle class/live in a large metro area/educated/insert other charachteristic here, you know you have other options!" What about the people who lack these options??? Those who don't know their rights or have little access?

But I guess, why should we care about others (especially the less fortunate)? Crikey :rolleyes:

[thedoorchick]

I'm still puzzling over how the Super Size Me guy came to be dating a vegan.

[greenbunny]

I see what you mean about a doctor being able to specialize elsewhere...I was actually thinking about the pharmacist, though. I mean, s/he would be hired to dispense drugs, and in some cases would be refusing to do so. I'd consider that refusal to do one's job.

[thedoorchick]

Say I have an insurance plan where the only preferred/covered pharmacy is WalMart. I have crappy pay, so if I don't go through my insurance company for a needed drug and have to pay out of pocket, I either forgo food or forgo the prescription. And I live in a state where WalMart isn't forced to dispense/stock it. and I don't live anywhere near a PP. I'm shit out of luck, aren't I?

Reality is, many people think "Well, you're middle class/live in a large metro area/educated/insert other charachteristic here, you know you have other options!" What about the people who lack these options??? Those who don't know their rights or have little access?

But I guess, why should we care about others (especially the less fortunate)? Crikey :rolleyes:

Well, for one thing, BCP's are not all that often covered by insurance, and in these situations, the difference in cost is not that much. I don't think insurance is relevant here. As I've said elsewhere (and as we all know), BCP's are available pretty much everywhere, prescribed by MOST doctors and clinics, for a reasonable cost. They're pretty much a commodity.

Why do these conversations always come down to "you big bad rich/educated/middle class/employed person, shame on you for not caring about the less fortunate"? It's getting really old.

This whole thread has been about how it's really just not logical to suggest that one store failing to stock BCP's, or one doctor choosing not to prescribe them, amounts to infringing on anyone's rights or preventing them from getting these drugs.

[mamahammer]

Say I have an insurance plan where the only preferred/covered pharmacy is WalMart. I have crappy pay, so if I don't go through my insurance company for a needed drug and have to pay out of pocket, I either forgo food or forgo the prescription. And I live in a state where WalMart isn't forced to dispense/stock it. and I don't live anywhere near a PP. I'm shit out of luck, aren't I?

Okay, but that's still not the big bad Man preventing you from having access to BCPs. Because of your circumstances you might not be able to afford certain meds through other channels, and that is restrictive, yes. But it isn't a prohibition. With both of my pregnancies, I needed a medication generally used for chemo patients to control hyperemesis. My ins company, at first, refused to pay for it. So, my option was to pay the $3000/month out of pocket, or not get the meds. And that sucked, for sure. I couldn't afford it. But that wasn't the pharmacies fault. And, really, it wasn't the fault of the insurance company. I knew their policies before my husband took the job. It was just plain old run of the mill "I ain't got that kinda money" bad luck. Shitty. Absolutely. But they weren't taking away my right to healthcare. The healthcare was still there and available to me. I just couldn't afford. I can't afford many things. Doesn't mean someone has taken away my right to buy them.

[mamahammer]

I see what you mean about a doctor being able to specialize elsewhere...I was actually thinking about the pharmacist, though. I mean, s/he would be hired to dispense drugs, and in some cases would be refusing to do so. I'd consider that refusal to do one's job.
I totally agree that if you are employed by a pharmacy that has chosen to carry the morning-after pill, or birth control pills of whatever variety, then you are under obligation to fill those prescriptions or have someone else on staff who can. Or the pharmacy should be able to let you go, no questions asked.

My issue is with requiring the pharmacy to carry all of the above medications. If I wanted to open a not-for-profit pharmacy in association with my local church, I should be able to do so without having to fill prescriptions that violate my faith. And I should be able to employee pharmacists who are against MAPs or birth control pills, as well.

[jnettie]

I think that the basic point that ysodle and greenbunny are trying to make is that the asumption that anyone can find a doctor or pharmacy that will follow their moral medical beliefs is not always the case. I can think of lots of places, like Montana, Alaska, Wyoming, where there may be only one doctor or one pharmacy. Driving 100 miles to the next one may just not be an option.

This is, of course, a fiction case, but related. I was watching Boston Legal the other night and one of the story lines involved a teenage girl who was raped and beaten until she was unconscious. The ambulance delivered her to the nearest hospital - a Catholic hospital. When she came to the next morning, she requested MAP, but her attending Dr. refused under moral grounds as a Catholic. By the time she got out of the hospital, it was too late for her regular Dr. to prescribe the MAP and she became pregnant.

So, here is an example where the patient did not have the opportunity to choose her Dr. (unconsious), couldn't go to another Dr. (hospitalized for 2 days), and was denyed MAP based on the religious beliefs of her doctor.

I don't know how realistic this actually is, but it seems like it could happen to me.

[BTB]

What makes the doctor's/pharmacist's morals trumph my own? Why should they be the one to choose my fate? Why should they be able to dictate my morals?

They're not trumping your morals, choosing your fate, or dictating your morals. But forcing them to prescribe for you would be dictating theirs. In the patient-wants-pills, doctor-won't prescribe scenario, there are only two possible outcomes:

1) doctor prescribes, which s/he feels is itself an immoral action as it makes him/her complicit. Patient's desires have won completely and trumped the doctor's.

2) doctor does not prescribe. Patient can seek other options, the quality and number of which may be influenced by geography and income. Both patient and doctor are allowed to act according to their own morality and decide their own fate.

Allowing the doctor to make his own moral judgments simply recognizes his personhood rather than treating him like a public commodity. If the patient has the right to demand therapies the doctor feels are immoral, should the doctor have the right to force the patient to participate in therapies s/he (the patient) feels are abhorrent? Of course not. Allowing each party to choose whether or not to participate in a given therapy preserves the rights of each.

[Delta]

http://www.mothering.com/discussions/images/smilies/yeahthat.gif

[amew]

They're not trumping your morals, choosing your fate, or dictating your morals. But forcing them to prescribe for you would be dictating theirs. In the patient-wants-pills, doctor-won't prescribe scenario, there are only two possible outcomes:

1) doctor prescribes, which s/he feels is itself an immoral action as it makes him/her complicit. Patient's desires have won completely and trumped the doctor's.

2) doctor does not prescribe. Patient can seek other options, the quality and number of which may be influenced by geography and income. Both patient and doctor are allowed to act according to their own morality and decide their own fate.

But what about the option of doctors acting according to their own morality by not going into fields involving tasks to which they morally object? I don't think doctors should be compelled to violate their moral code by prescribing pills they view as murderous, but I do think that we are all responsible for choosing jobs that we can perform without sacrificing our beliefs--and for some people that may mean not being an OB/GYN. Someone who is morally opposed to 75% of the books on a typical high school reading list probably shouldn't be an English teacher, an observant Jew should not take a job that requires the provision of emergency services on the Sabbath, and I should not be a judge in my state of residence (despite how much I would love to) because I could not in good conscience sign an order putting someone to death by execution.

[Delta]

Believe it or not, there is much more to being an ob/gyn than prescribing birth control. And believe it or not, many patients agree and actually seek out these types of doctors.

[BTB]

But what about the option of doctors acting according to their own morality by not going into fields involving tasks to which they morally object?

We've talked about 'dictating patients' fates', how is this not dictating the doctor's fate? It's just not always an option to simply completely avoid things to which you object. My opinions on abortion have changed 180 degrees in just the past 10 years; most people grow and change throughout their lives. What happens to doctors who spend years and hundreds of thousands of dollars on their training (and it is their training, and their career, not the public's even though most doctors truly are altruistic) only to undergo personal change - should they start over to retrain in a different field?

The nature of medical education is such that there are many prerequisite gates to pass through along the way. An ob/gyn resident may be completing residency with the intention of completing fellowship in a subfield that wouldn't require performance of therapeutic abortion; should s/he have to be a participant to what amounts to murder in his or her mind, in order to get to a job which does not require it?

Procedures and therapies unknown to some of my teachers are now commonplace, should they be forced to retrain if something they could not predict even existing is now an occasional part of their specialty's practice? Or should they be allowed to define their practice as excluding that new treatment?

As people first and service providers second, why do doctors have an obligation to override their deepest convictions or choose a different job? What about a patient's claim to this or that gives him the right to look a pre-medical student in the eye and say: "You are not allowed to choose that career path because later you won't do what I want?" The legal procurement of abortion is a right only 33 years old, a good number of physicians currently practicing trained when whether or not they'd perform a pregnancy termination wasn't even an issue. Now that society has changed and it is legal, should all those older docs have to retire? What if politics and society change back, should they then be allowed to return to medicine? Doctors have an important role in society, but their lives and morals shouldn't be dictated by society. I'm unaware of a single licensing or regulatory body that doesn't recognize physicians' rights to conscientious objection.

[LittleFredPunkinHead]

I think I'll be a lot more okay with doctors or pharmacists refusing to write or give out Rxs for birth control when I hear about those same drs and pharms refusing Rxs for Viagra to unmarried men. Until then, pardon my French, but b*llsh*t.

[bookworm]

My issue is with requiring the pharmacy to carry all of the above medications. If I wanted to open a not-for-profit pharmacy in association with my local church, I should be able to do so without having to fill prescriptions that violate my faith.

I'm not familiar with this phenomenon (church-sponsored pharmacy, except in church-sponsored hospitals), but churches get exemptions to many anti-discrimination laws. Maybe they'd file for an exemption?

That isn't the case here--it's not a church (though many people seem to worship there :rolleyes: ), it's Walmart.

[jnettie]

I'm sure we're all aware that Ob/Gyns do much more that prescribe BCP. It's just that's what the issue at hand in this thread is...birth control and its distribution, so that's where the discussion is.

What about this as an alternative?: A doctor is not required to administer any medications or do any procedures he or she finds morally or religiously offensive, but he or she is required to refer that patient to someone who will.

As it stands now, from what I understand, doctors recieving certain types of funding are not allowed to discuss abortion at all or even suggest the patient could go someplace else. And doctors who find these services morally objectionable won't refer patients to someone else. I think that's ultimately the biggest problem; refusing to provide is one thing, but refusing to tell where the patient can get such treatment is really impossing your beliefs on another.

Morals are difficult. There are many other times in the field of medicine where the line is fuzzy. I don't think I agree that every doctor must do every procedure, prescribe every medication possible. But, as long as it isn't illegal, they should direct that patient to someone who will.

[Asha]

The ruling doesn't require that any particular pharmacist dispense anything (I don't think--I read quickly), just that the store does.

you are right that there is not ruling that ind'l pharmacies dispense plan b drugs, but according to my dh you would probably be out of a job if you were did not dispense the drug. most pharmacies only keep one pharmacist on hand, so it is not cost effective for the pharmacies to keep two pharmacists working at the same time.

[Asha]

also, i find it ridiculous that walmart seems to care so much for an unborn life, but doesn't seem to care for the lives of their workers or the lives of the sweatshop workers that make many of their products.

[LyLMyssChaos]

I really don't know how this became an discussion about what a pharmacy dispensing/not dispensing based on moral grounds. The article in the first post clearly said that Wal-Mart was not stocking the drug due to lack of demand.

I worked as a pharmacy tech in a "small town" pharmacy. We were the ONLY pharmacy in town and if you wanted to go to another one, you would have to drive at least 15 minutes to get to it. There were numerous medications we did not stock because they were cost-prohibitive, or just not enough in demand. Did that tick off customers? Sure it did, but we just simply told them that "we're sorry, we don't carry this medication, you'll have to take your prescription to another pharmacy." I also have had an experience where my DD had a medical condition and the medication that was prescibed for her was readily available in pill form, but the demand for the liquid that she as a 2 month old required was so low that we had to go to about 6 different pharmacies to find one that carried it. And we went to chain stores like Walgreens, CVS, Rite-Aid, Wal-mart, etc. Was it annoying?? Yes very much so, especially when my daughter getting medicated was of very high importance to me, but we just kept going from pharmacy to pharmacy until we found one that carried it. And then once we did, it was SUPER Expensive because they were the only pharmacy in the area carrying it. But that's supply and demand for ya. Perhaps since Wal-Mart is being forced to carry something that they think is cost prohibitive to stock, they will end up raising the price to some insane level, thus making it unaffordable to the masses?? Would that be okay for them to do? After all, for the most part, I believe we understand how the laws of supply and demand work.

[LyLMyssChaos]

also, i find it ridiculous that walmart seems to care so much for an unborn life, but doesn't seem to care for the lives of their workers or the lives of the sweatshop workers that make many of their products.

Okay, this may be for a different thread, but these statements annoy me. I worked at Wal-Mart, on 3 seperate occassions, and they were one of the best employers I have ever worked for. They paid VERY well, there were a great deal of employee incentives, and I got great benefits (that I was eligible for only working 28 hours a week.) Also, the line that their products are made in sweatshops??? Come on, you tell me that Target, Kmart, Sears, or any other store doesn't sell the same stuff that Wal-mart does?? It's not like Wal-Mart has it's own factories that only builds products for their stores. So selling "stuff made in sweatshops" is not only limited to Wal-mart.

[Asha]

The article in the first post clearly said that Wal-Mart was not stocking the drug due to lack of demand.

i find this hard to believe since my dh says that he gets a ton of these Rx's a day, and they frequently run out of it bc they get so may prescriptions.

also, a tip for those people who have said it is hard to find drugs at pharmacies. it quite common for chain pharmacies not to carry a lot of drugs. more often than not, a privately owned pharmacy will have those less common Rx's in stock.

oh, i know that many, many places sell sweat shop products. though, i don't believe those places are making any claims about caring about life so much.

[Delta]

I used to be a WalMart hater myself but I've changed my tune. There are still things that I don't like about the company -- mainly that in certain situations when they move into small communities they can tend to drive out the mom and pop stores, but then at the same time, like in our community, a Walmart actually HELPED the local economy and the local stores around it -- so I don't think it is the devil so much any more.

[LyLMyssChaos]

also, a tip for those people who have said it is hard to find drugs at pharmacies. it quite common for chain pharmacies not to carry a lot of drugs. more often than not, a privately owned pharmacy will have those less common Rx's in stock.



So why should Wal-Mart be any different? No one is making these other pharmacies explain why they don't carry specific products, why does Wal-Mart? And no one is requiring these other pharmacies to carry all drugs that exist, why does Wal-Mart have to?

[Asha]

i think walmart would have to prove that it is not cost effective for them to carry the drug. if they cannot prove it, then they are clearly not carrying it for moral reasons. i was referring to pharmacies who don't carrry certain drugs bc it is not cost effective. like pp's have said pharmacies are out to make a big buck, so they aren't going to carry all drugs all the time. also, those chain pharmacies will order any drug you need. if walmart is not going to order the drug on as needed basis, then again they are clearly not filling the Rx's for moral reasons.

[lawyerlee]

I used to be a WalMart hater myself but I've changed my tune. There are still things that I don't like about the company -- mainly that in certain situations when they move into small communities they can tend to drive out the mom and pop stores, but then at the same time, like in our community, a Walmart actually HELPED the local economy and the local stores around it -- so I don't think it is the devil so much any more.
I do have to agree with this in part. Especially because so many communities complain about Wal-Mart building new stores and abandoning old ones, as though it is impossible to stand up to them. We did it in my town, and they have had to modify the existing Wal-Mart to turn it into a Super Wal-Mart, rather than building a completely new store and leaving an empty building. So I think it takes some responsibility on the part of communities, too, to set priorities and fight for them.

[kedzieb]

Reading through these posts, I find it sad that some misguided doctors are abandoning their Hippocratic oath to “do no harm” due to their personal beliefs. I can think whatever I want, and so can a doctor. But I don't have the power to harm anyone with my beliefs.

Some people here are defending a doctor's so-called moral stance on BCP's and abortion. According to that 'principle' what is to stop a doctor from killing people he finds morally reprehensible? Or denying life-saving drugs or treatments to women who need it because he hates Jews? By promising to do no harm, all doctors need to realize that sometimes the most harm they can cause is by doing nothing.

Situation a: the condom breaks. I go to my OB/GYN to get the MAP to prevent a pregnancy (it is not an abortificant, despite some posters' misconceptions - no pun intended). They prescribe it, the pharmacy fills it. I take it - woo! Not knocked up!

Situation b: the condom breaks. I go to my OB/GYN to get the MAP to prevent a pregnancy. They refuse to prescribe it or the pharmacy won't fill it. I have to wait, look for another option, waste time. The sperm has the time to get me pregnant. Now my choices have been limited to abortion or an unplanned pregnancy.

How can anyone claim that imposing your personal beliefs - and everyone thinks their beliefs are the moral ones, not just the anti-choice activists - is synonymous with doing no harm?

[laurenc]

i leave my computer at work for the evening and this is what i miss! ;)

the massachusetts pharmacy board requires pharmacies to stock commonly used medication, and it has deemed the MAP to be a commonly used medication. so for this situation, i don't see what the hoopla is over that -- if something is determined to be "commonly used" (whatever their definition of "commonly used" is) and there is a state mandate to stock all commonly used meds, then a pharmacy simply has to follow. and sure, wal-mart is a private company, but the state dispenses licenses and if wal-mart wants a state license to practice its business, then they have to play by the rules. now, if you want to debate how many prescriptions constitutes "commonly used," or if you want to debate how private companies shoud be regulated by local and federal government, well those are other threads. so this probably explains why wal-mart didn't put up a fight about this. the issue never went to trial. the state board said to stock it, so wal-mart capitulated. so in my opinion, wal-mart couldn't have been *that* concerned about individual pharmacists' moral stances if it folded that quickly. a large corporation like wal-mart surely would have been able to foot the legal bill if it strongly felt obligated to represent its pharmacists.

on another, related note, my DH's uncle is a pharmacist who ran his own pharmacy for a number of years. in his opinion, a pharmacist does not have the background history of every customer who comes into their pharmacy. but a doctor does. if a doctor determines a patient to need the MAP, then the pharmacy -- which acts as a service to the medical profession -- should take it up with the doctor (and not with the patient) if they have an issue with a prescribed medication. so while i'm not a pharmacist myself, DH's uncle is the closest link i have to the profession beyond my CVS counter, and i find his stance on the matter pretty compelling.

[ysolde]

I have a suggestion: take that list of "NFP" docs that Delta posted. Send it to your friends and family. Have them send it to their friends and family. Post it to your internet groups. Make sure everyone knows that these docs harm women and children. Pretty soon, no one but fellow "Humanae Vitae" advocates will go to them. And natural economic forces will take their toll.

You know how the extreme religious right has had great success with its economic blackmail? Perhaps it's time to give them a taste of their own medicine, if you will pardon the pun.

[Asha]

but a doctor does. if a doctor determines a patient to need the MAP, then the pharmacy -- which acts as a service to the medical profession -- should take it up with the doctor (and not with the patient) if they have an issue with a prescribed medication.

yes, that is what pharmacists are supposed to do. that is what my dh has done on several occasions when he questions the drug prescribed by the dr.

[ysolde]

yes, that is what pharmacists are supposed to do. that is what my dh has done on several occasions when he questions the drug prescribed by the dr.

Yup. My pharmacist has called the doctor when he has questions about possible drug interactions, but he has never efused to fill a prescription.

[LyLMyssChaos]

I have a suggestion: take that list of "NFP" docs that Delta posted. Send it to your friends and family. Have them send it to their friends and family. Post it to your internet groups. Make sure everyone knows that these docs harm women and children. Pretty soon, no one but fellow "Humanae Vitae" advocates will go to them. And natural economic forces will take their toll.

You know how the extreme religious right has had great success with its economic blackmail? Perhaps it's time to give them a taste of their own medicine, if you will pardon the pun.

I'm sorry, but I don't feel those doctors are "harming" anyone. I think that is a very harsh and extreme stance on things. Just because they choose not to provide specific services, does not do harm to anyone. For example, my OB's office has doctors that will not work with "high risk" pregnancy, and they have some doctors that ONLY work with "high risk" so should any of those doctors be put out of business because they don't feel comfortable dealing with certain patient situations? I think that sometimes in our society we have too much of an "entitlement" issue.

[BTB]

Reading through these posts, I find it sad that some misguided doctors are abandoning their Hippocratic oath to “do no harm” due to their personal beliefs. I can think whatever I want, and so can a doctor. But I don't have the power to harm anyone with my beliefs

"Primum non nocere" in the context of the Hippocratic oath means "do not act at all unless you are acting for the patient's good." Actually, doctors who are against abortion would be following this precept by abstaining from action in a situation they felt was wrong.

[Asha]

For example, my OB's office has doctors that will not work with "high risk" pregnancy, and they have some doctors that ONLY work with "high risk" so should any of those doctors be put out of business because they don't feel comfortable dealing with certain patient situations?

i venture to say that it is actually the right thing for those dr's to refuse high risk pregnancies. i am sure it takes extensive training to be able to deal with those case, and it would probably be wrong of them to take on those cases if they felt like they were not adequately experienced.

[laurenc]

For example, my OB's office has doctors that will not work with "high risk" pregnancy, and they have some doctors that ONLY work with "high risk" so should any of those doctors be put out of business because they don't feel comfortable dealing with certain patient situations? I think that sometimes in our society we have too much of an "entitlement" issue.

choosing to work with only high-risk or only low-risk pregnancies is NOT a moral issue or an entitlement issue. it's a skill issue. i don't think there are many doctors out there refusing to work with high-risk pregnancies because they're morally opposed to do so. it's about feeling they have the expertise to adequately work with the mom and fetus/baby.

[Delta]

I have a suggestion: take that list of "NFP" docs that Delta posted. Send it to your friends and family. Have them send it to their friends and family. Post it to your internet groups. Make sure everyone knows that these docs harm women and children. Pretty soon, no one but fellow "Humanae Vitae" advocates will go to them. And natural economic forces will take their toll.

You know how the extreme religious right has had great success with its economic blackmail? Perhaps it's time to give them a taste of their own medicine, if you will pardon the pun.Well, the bolded part is a matter of opinion, isn't it?

I am stunned at the level of antipathy towards these doctors. I mean my goodness. They are hurting NOBODY. NO.ONE. Nobody is forcing anyone to go to them. And when taking new patients they make sure the patient is aware of their policies. On the flip side, there are many patients who seek out these NFP doctors. Most doctors have absolutely NO CLUE about NFP.

Take a look at this clinic that I posted earlier:

http://www.tepeyacfamilycenter.com/staff.asp

The place has added 2 more doctors since I was there. The clinic is growing. People want to see these doctors. They aren't going to go out of business.

[Delta]

Reading through these posts, I find it sad that some misguided doctors are abandoning their Hippocratic oath to “do no harm” due to their personal beliefs.Actually, it is likely that many do think that abortion or hormonal birth control is harmful.

[ysolde]

I'm sorry, but I don't feel those doctors are "harming" anyone. I think that is a very harsh and extreme stance on things. Just because they choose not to provide specific services, does not do harm to anyone. For example, my OB's office has doc