Friday, February 03, 2006

Medical ethics of a doctor refusing service, implications for pharmacists?

Conscientious objection in medicine should not be tolerated:
A doctors' conscience has little place in the delivery of modern medical care, writes Julian Savulescu at the University of Oxford. If people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors.



Values are important parts of our lives. But values and conscience have different roles in public and private life, he writes. They should influence discussion on what kind of health system to deliver. But they should not influence the care an individual doctor offers to his or her patients.

The door to "value-driven medicine" is a door to a Pandora's box of idiosyncratic, bigoted, discriminatory medicine. Public servants must act in the public interest, not their own, he concludes.
I was fascinated by the discussion that ensued after I linked to a story about pharmacists refusing to fill valid prescriptions because they object to a patient's treatment. There's a protest in Wichita over a Walgreen's pharmacist who refused to fill a prescription for the morning-after pill, and Walgreen's management took a pretty reasonable stance. If the pharmacist couldn't fill the prescription, rather than turning a customer away, the pharmacist should have gotten another employee to fill the order. When that's practical, it's fine.

But I agree with this medical ethicist that a doctor's or a pharmacist's personal value decisions shouldn't be imposed on a patient. A doctor is entitled to mention his concerns, but should principally lay out the medical case for and against a course of action. Having done so, the patient's choice rules.

The public/private distinction drawn by the ethicist is close to a point JMart was making in the comments. Doctors and pharmacists provide a public service, and must be non-discriminatory in the way they provide the service.