BC ETHICS CODE A TWIST
ON ABORTION DEBATE
I too agree with Ravinder Sodi (“Towards a conscience clause”–Openers, December 1998) that pharmacists–like most healthcare professionals–should be able to follow their consciences in professional practice.
It is interesting to note that one section of the recently released College of Pharmacists of British Columbia Code of Ethics provides guidance for pharmacists facing conflict between pharmacy services requested and their moral beliefs. But I object to Sodi’s appeal to science in describing emergency contraceptive pills (ECPs) that prevent implantation as “nothing short of abortifacients.” Abortion is generally used to describe the expulsion from the uterus of a non-viable fetus. It is quite a stretch to use this term when it involves a fertilized egg.
Putting aside the way contraceptives work, pharmacist Sodi’s central issue is whether a human being exists from the moment of conception. Science will never resolve this point as it is essentially a religious matter. While some religions consider a fertilized egg to be a human being, many ethicists consider that only the potential for a human being exists after conception. This latter principle is supported by current Canadian case law that does not recognize the existence of a human being–with all the associated rights–until birth.
The danger with conscience clauses is that pharmacists may be tempted to provide their own moral views, rather than objective, scientific facts, when discussing some forms of legitimate pharmaceutical care like ECPs. The question, “Will this prevent me from becoming pregnant?” can be answered truthfully by saying, “If you mean, ‘Will this likely prevent a fertilized egg from implanting in my womb,’ the answer is yes.”
There is no ethical reason for a pharmacist to raise the possibility of whether a fertilized egg is a human being or not, especially with a probably anxious–and possibly vulnerable–woman. Such questions are not addressed in scientific-based professional education. Ethical pharmacists should respect the autonomy of their patients, and treat them with respect, rather than attempting to persuade patients to share their personal religious viewpoints.
Another danger of conscience clauses is that some pharmacists may invoke them to deny provision of some recognized pharmaceutical services when there is no alternative for patients. In the BC code, the pharmacist in a moral conflict has a professional responsibility to refer a patient to a colleague who will provide such a service, but where this is either impractical or impossible [the pharmacist] shall provide such a service to a patient, despite personal religious reservations. I would be interested in what Sodi thinks of this section of the code, and whether he would consider it to be a legitimate part of any conscience clause.
Frank M. Archer, B.S.P., R.Ph.
OVER ILLEGIBLE SCRIPTS
I have received a copy of your letter (“Rx Remedy,” Editorial, October 1998) which was addressed to the Honourable Kelvin Ng, minister of health and social services for the Northwest Territories. That letter contained attachments of photocopies of more than 100 prescriptions which had been submitted by pharmacists to yourself in order to raise the issue of illegible prescriptions.
Like you, I share a concern that illegible prescriptions are a cause of potential mistakes both in the dispensing of medication and in compliance with medication. Further, I agree that they have the potential to drive costs within the healthcare system, as well as depriving patients of timely access to medications. The old joke concerning illegible handwriting on the part of physicians is no longer as humorous as it may have been in previous days.
I am dismayed, however, at the disregard for privacy both for physicians and patients shown by your inclusion of these unedited prescriptions. In glancing through the prescriptions provided, the prescribing physician is clearly identified on most and, on a number of instances, the patient for which the medication was prescribed is identified. This represents a significant breech of confidentiality and privacy for both physicians and patients. If the intent of including these prescriptions is to highlight the issue of illegible prescriptions, the text of the prescription is all that is necessary. The letterhead on the prescriptions and the patient’s name are not necessary in order to highlight the issue. I note that the majority of the prescriptions provided do not show the patients’ names, but on several the patients’ names are clearly decipherable and may be familiar to anybody familiar within that geographic area.
Although I consider myself to be in a responsible elected position and am a responsible professional, I have no right or need to know that certain individuals are receiving certain medications. The fact that these prescriptions were sent unedited by pharmacists to your professional journal further adds to this disregard for privacy and professional confidentiality. If this is an example of the professional confidentiality exhibited by pharmacists, it raises serious concerns for physicians in their prescription writing.
As colleagues on the health professional team, physicians and pharmacists must understand and trust one another. This includes the understanding that clinical information shared between physicians and pharmacists concerning specific patients is done so for the benefit of the patient. The use of that information for other purposes such as political lobbying is unethical, unprofessional and, when used without patient consent, specifically prohibited by the Canadian Medication Association’s Privacy Code. If this information is to be used in this way by pharmacists, physicians may have severe misgivings about dealing with certain pharmacists.
Once again, I support your overall goal of addressing the issue of the dangers and costs associated with illegible prescriptions. I believe there are many options available to remedy this, including electronic transfer of information. I do not, however, agree with your method and urge you to refrain from further distribution of confidential patient information.
David Butcher, MD
President, NWT Medical Association
Editor’s response:Thank your for your letter. It is encouraging that physicians like yourself recognize the health threats of illegible prescriptions.
The prescription samples sent to Canada’s health ministers and physician regulatory bodies were in fact edited for patient confidentiality. In most cases the patients’ names were inked out with a marker; however, in some cases, we agree that the patient’s name is still legible and for that we apologize. You are correct in stating that the physicians’ names are mostly legible. We believe that physicians who write sloppy prescriptions should be identified.
Over the years pharmacists across Canada have been sending Pharmacy Practice these illegible prescriptions, under the proviso that neither the patient nor physician will be identified within our publication, and we are grateful to these pharmacists for drawing our attention to this important health matter on behalf of their patients. We felt that it wasn’t enough to simply run the prescriptions in the magazine, but that the time had come to draw attention to the problem in a broader sense by sending these prescriptions to the very people who have the power to do something about them.
As for your charge that “physicians may have severe misgivings about dealing with certain pharmacists” who endorse the use of these prescriptions for what you perceive to be lobbying purposes, we urge you to consider the fact that pharmacists are acting out of a concern for public health. We hope that your organization will do the same by taking action with your members on the problem of illegible prescriptions.
A QUESTION OF RIGHTS
I am a physician and staunch activist against issues like smoking and consumer health fraud. In November 1996, I reserved the URL name www.healthwatch.org and have been using it ever since to provide health information.
In September 1998, Shoppers Drug Mart in Canada protested the name of my website because they felt it represented a trademark infringement (they use the word “healthwatch” to identify their pharmacists in Canada). They have never registered the name in the U.S., or with the Internet provider Internic (or Network Solutions Inc.).
After two and a half months Internic put a hold on the URL. This means that anyone who tries to access my site can’t. It also means Shoppers Drug Mart can’t use it either. I protested the hold but Internic hasn’t responded to any of my e-mails or faxes.
There are more than 1,100 sites on the Net that use the word “healthwatch” somewhere on their site. It is apparent to me that Shoppers has singled me out because I am Canadian-based, anti-tobacco and anti-Shoppers Drug Mart.
I realize Shoppers has a great deal of clout in Canada, but I don’t see how they can go after me and not the others. It is infringing on my right to speak out on vital health topics. Some of the issues we cover for our readers include the Canadian tobacco industry and smoking promotion, alternative health scams, herbal medicine, skin cancer, etc.
I want to know why Shoppers Drug Mart feels the need to suppress free speech. I also want to know why its trademark lawyers feel the need to destroy our efforts to tell Canadians–and the world–that they are part of the international tobacco merchants who addict our children.
Dr. Terry Polevoy
Shoppers Drug Mart responds:For some time, a website calling itself N.O.P.A.T.S.Y. has been disseminating information on the Internet through a second-level domain name of HEALTHWATCH.ORG. From Dr. Polevoy’s letter we assume that he is the directing mind behind N.O.P.A.T.S.Y.
Shoppers Drug Mart Limited owns various Canadian HEALTHWATCH trademarks. Naturally, it is Shoppers’ policy to protect its trademarks and that is why we requested that Dr. Polevoy be stopped from using the “Healthwatch” domain name. The Shoppers Drug Mart organization has made a substantial investment advertising and promoting the various HEALTHWATCH trade marks. The Canadian public associates the trademark with the Shoppers Drug Mart system. In order to protect this valuable asset, we cannot allow anyone to violate our trademark rights conferred by the various registrations and common law.
Internet providers are aware that their customers may sometimes use a domain name that infringes on someone else’s trademarks, and they have instituted procedures to deal with these situations. Network Solutions, Inc., the Internet provider of HEALTHWATCH.ORG, has a Domain Name Dispute Policy. Shoppers Drug Mart Limited availed itself of that dispute policy. In accordance with that policy the Domain Name Registrant was notified of the dispute and the registrant was advised of its options. As a result of the dispute, the Domain Name HEALTHWATCH.ORG was put on hold and cannot be used by anyone.
There is nothing to prevent Dr. Polevoy from using any domain name he elects as long as it does not violate the trademark rights of any other person or organization. Our interest is not to suppress Dr. Polevoy’s “freedom of speech,” but rather it is to protect what is legally ours. Shoppers Drug Mart Limited will continue to vigorously protect and control its trademarks and will not allow anyone to appropriate its trade marks for their own use.
Senior Vice-president, Public Relations
Shoppers Drug Mart
The danger with conscience clauses is that pharmacists may be tempted to provide their own moral views, rather than objective, scientific facts.
ARTICLE LACKS KEY SUPPLEMENTS
Re: “Pump it up” (February, 1999). It was nice to see an article in which an attempt was made to provide information on various nutritional supplements that are being used in athletics. As a pharmacist who lifts weights, I very often get questions with respect to this matter. Unfortunately, Ms. Harris and Mr. Kelly have failed to provide any information on the two most common supplements: creatine and the so-called testosterone precursors (i.e.19-nor-adrostenedione).
Actually, there have been a number of well-done and published studies reporting on the use of creatine in athletes and its positive effects on strength. Interestingly enough, there is also interest from the mainstream medical community over the potential use of this substance for muscle and nerve disorders such as amyotrophic lateral sclerosis and muscular dystrophy.
I acknowledge, however, that with the myriad of products available, an article dealing with all of them would represent an arduous task.
Jeff Chan, B. Sc. Pharm.
Thunder Bay, Ont.
DETROL:In Drug News (February 1999), we stated that the elimination half-life of Detrol is 19-37 hours. In fact, the half-life is 1.9-3.7 hours. Pharmacy Practice regrets the error.