Opinion: Upholding Our Oath

Mohamed A. Jalloh, PharmD

Remember the first and one of the most important lines in the Oath of a Pharmacist? You likely recited it at least a few times in your career-during your white coat ceremony, your graduation, and attendance of either of these ceremonies. It is: “I promise to devote myself to a lifetime of service to others through the profession of pharmacy.” It is followed by another important statement: “I will hold myself and my colleagues to the highest principles of our profession’s moral, ethical, and legal conduct.”

Two Arizona pharmacists made headlines when it seems they may have not adhered to this pledge. 

In the first case, a community pharmacist chose not to fill a hormone prescription for a transgender patient. Based upon news reports, the pharmacist apparently denied filling the prescription and continually asked the patient why she needed the therapy, in front of other customers. The patient claimed the pharmacist refused to give her back the written prescription, forcing the prescriber to call in a new prescription to another pharmacy. The patient reported feeling “mortified.” She eventually filed a complaint with the Arizona State Board of Pharmacy.

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In the second case, a nine-week pregnant woman was told by her prescriber that there was no fetal heartbeat and that her pregnancy would likely end in a miscarriage. The woman had two options: have a surgical procedure to remove the fetal tissue or take a medication, i.e., misoprostol, to produce a miscarriage. She chose the latter. 

When she presented the prescription to the community pharmacy, the pharmacist refused to fill it based upon “ethical beliefs,” and refused to give the prescription back. The patient left the pharmacy feeling “ashamed” and “humiliated,” and contacted her husband. The husband came to the pharmacy to explain the situation, but the pharmacist continued to refuse to fill the prescription. Eventually, the pharmacist sent the prescription to another pharmacy location where the patient was able to pick up the medication. She also filed a complaint with the Arizona State Board of Pharmacy.

In both cases, the pharmacists refused to fill the prescriptions based upon personal moral objections. And while I may morally disagree with their actions, they legally had the right to refuse to fill the medications. 

Arizona is a state with a law that allows pharmacists to refuse to fill a medication because of “sincerely held religious beliefs.” However, pharmacists must make a good faith effort to refer or transfer the prescription to another pharmacist to meet the clinical needs of the patient in a timely manner, as required by the Arizona law. By not doing so, pharmacists may end up getting fired (as was the case with the pharmacist who refused to fill the hormone prescription), and they may be investigated by the State Board of Pharmacy. 

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If you live in a state that allows you to refuse to fill a medication based on moral or religious beliefs-and you have beliefs that could lead you to refuse-consider identifying pharmacists to whom you will be able to refer prescriptions. If you are a pharmacist who does not hold such beliefs, offer to be a referral for pharmacists who do. Also, review your own company and state policies to clarify how you should effectively manage a prescription that you are morally conflicted about. 

Doing so will allow you to continue to devote your lifetime of service to not only patients, but other pharmacists as well.