Muslim pharmacist denies "morning after" pill from woman

[LordShiva]

Originally posted by Sirotnikov
Give me a break.

Pharmacists are give a professional judgement. This decision of his was NOT a professional one, but a religious one. He tried to prevent that woman from aborting a (not yet existing!) pregnancy.

Had he said "I'm sorry maam, but I see you're allergic to chemical X, which is in this pill, and I won't prescribe it to you" I would have applauded his decision.

His motivation however, was his own personal beliefs being PROJECTED on the patient.

What if a doctor has a personal belief that a drug is dangerous or ineffective, even if it's approved by the government? Is the doctor then required to prescribe it to the patient? Should the government take away his license if he doesn't?

[lord of the mark]

Originally posted by Sirotnikov


About Anti-Depressants - the difference is that the doctor's opinion is based on his profession. He does not think that AD's are evil because god had told him so - rather because he thinks there's a better treatment.

.

Oh, cmon, better in what sense. Theres clearly a feeling abroad in certain circles that ADs are immoral, cause they free someone from the moral gain of fighting through their problems. That certainly motivates some anti-AD psychiatrists. How is the belief in the intrinsic human and moral value of fighting ones way through depression using extended talk therapy any less of a value judgement than believing in the right to life of an embryo? Just because the moral value of extended talk therapy isnt in a holy book? Cmon you and I are Jews, you know any clever rabbi worth his salt could figure out a convoluted way to show that talk therapy is mandated in Torah, and ADs are forbidden. OTOH there ARE some secularists who object to abortion (and i presume also the MAP). Now I realize psychiatry intrinsically presents some fuzzier issues than most of medicine, but I really think the issue of whats a medical decision and whats a values decision is not nearly as cut and dried as you think. Theres a reason hospitals now retain medical ethicists, theres lots of value decision tied in with the practice of medicine.

I take it you dont get the show "ER" in Eretz, do you?

[lord of the mark]

Originally posted by LordShiva


What if a doctor has a personal belief that a drug is dangerous or ineffective, even if it's approved by the government? Is the doctor then required to prescribe it to the patient? Should the government take away his license if he doesn't?

a doctor could of course make that decision. The issue is whether a pharmacist can.

[lord of the mark]

Siro

How about the issue of antibiotics? Patients come asking for them whenever they have something that MIGHT be bacterial. "good" docs try not to prescribe them unless theyre sure its bacterial, cause overprescribing them leads to antibiotic resistance. In some instances there may be a conflict between the interests of the patient, and of society. Wrong for the doc to put the societys interests first? Similar question with vaccines, where herd immunity is a reality, and there are real risks. Is it right to impose "kantian" morality on patients?

[Kuciwalker]

What if a doctor has a personal belief that a drug is dangerous or ineffective, even if it's approved by the government? Is the doctor then required to prescribe it to the patient? Should the government take away his license if he doesn't?

Isn't a license certification that the doctor meets the state's standards for a doctor? Otherwise it's meaningless. So yes, if the doctor disagrees significantly with the government about what medical knowledge is correct, he shouldn't have his license.

[Sirotnikov]

Originally posted by lord of the mark
Oh, cmon, better in what sense. Theres clearly a feeling abroad in certain circles that ADs are immoral, cause they free someone from the moral gain of fighting through their problems. That certainly motivates some anti-AD psychiatrists.

Key word highlighted.

Morals is completely and utterly irrelevant in what should be a scientific decision.

A belief in one or another scientific theory about the effect of AD, is an accepted thing. Psychiatrists do have different schools of thought.

However, a moral\religious position on the use of pills is another thing - and if a doctor is acting not from a scientific motivation, but from a religious / moral one, then he should be noted as a "healer" / witch doctor - or what ever.

Agreed that the motivation for a doctor's decision could not always be easy to discern. This does not however, mean that we should make a scientific profession such as medicine, a slave of moralistic religious thinking.

I would claim that it is also difficult to tell when a doctor makes a decision that is based on his personal feelings towards his patient. He could hate someone, and that would skew his professional judgement. Does that mean that we should condone obvious cases where a doctor hinders proper help to a patient with whom he has a discord?

Moralistic / religious views is not part of a doctor's judgement. It is something that "skews" his proper judgement.

How is the belief in the intrinsic human and moral value of fighting ones way through depression using extended talk therapy any less of a value judgement than believing in the right to life of an embryo?

You're mixing things up.

Psychiatrists who are against AD, are against them because they think it doesn't work / does more harm than good. They base it upon studies and surveys. Not a "hunch", a moral conviction, or a scripture in a 5000 year old book. A professional theory is not, in any way a "belief". It is a professional opinion.


Belief that is not based on a scientific theory, like in your example - is just a belief.

Religion is usually quite admittedly, a belief that has little to do with any scientific theory.


I would rather my doctors using their knowledge or their professional convictions, rather than beliefs or unbased opinions..

Just because the moral value of extended talk therapy isnt in a holy book? Cmon you and I are Jews, you know any clever rabbi worth his salt could figure out a convoluted way to show that talk therapy is mandated in Torah, and ADs are forbidden.

That would be a hack, and I wouldn't go to a doctor who would listen to a rabbinical order instead of empirical evidence.

OTOH there ARE some secularists who object to abortion (and i presume also the MAP). Now I realize psychiatry intrinsically presents some fuzzier issues than most of medicine, but I really think the issue of whats a medical decision and whats a values decision is not nearly as cut and dried as you think. Theres a reason hospitals now retain medical ethicists, theres lots of value decision tied in with the practice of medicine.

I take it you dont get the show "ER" in Eretz, do you?

Of course I get it.
I was once a rabid follower too.

There's nothing "fuzzy" about medicine, as long as it is based on empirical medicine.

There's also nothing "fuzzy" about medical procedures that involve ethical decisions, that are taken with consideration towards laws and medical regulations.

Law, btw, is exactly what should be followed.

Law, by definition, represents and dictates the most basic widely shared ethical and moral beliefs in one's society. This is therefore, the only thing that binds.

This is exactly the difference between a group of people "believing" that homosexuality is wrong - and there being a law against homosexuality. What is not a law, can not and should not be projected upon others.


Other than law - there is personal morals - which are fine to live your life by. This is not, however, a good way to treat other people. Morals should not be "projected". I should not force my morals upon other people.

Doctors make very important decisions affecting people other than them. They should always strive to be professional and lawful.

I understand that in a totally religious state, where Sharia or Halacha is the law - then the pharmacist can't act against it - because that is the most widely accepted moral and ethical standard in his society. However, neither the US, nor Israel, are governed by Sharia or Halacha.

[Sirotnikov]

Originally posted by lord of the mark
Siro

How about the issue of antibiotics? Patients come asking for them whenever they have something that MIGHT be bacterial. "good" docs try not to prescribe them unless theyre sure its bacterial, cause overprescribing them leads to antibiotic resistance. In some instances there may be a conflict between the interests of the patient, and of society. Wrong for the doc to put the societys interests first? Similar question with vaccines, where herd immunity is a reality, and there are real risks. Is it right to impose "kantian" morality on patients?

having re read your post - I realized you tried to suggest a conflict here between the good of society and the good of a person.

I don't see it.


Serving a person with extra antibiotics, without proper reason is never in his "interest". It is quite obviously against the interest of the individual to recieve an extra dose of fungii, if he doesn't need it. Whether due to its poisonous side effects, or only due to its contribution to anti-biotic resistance.

When it comes to situations where the good of the patient is clearly at risk (he could die, or have a serious problem) the good of the patient is obviously much "stronger".

Never has a sick man, that needs a certain substance, was denied it "in the name of society". So there is no real conflict there, that a doctor has to settle.

Sometimes, when the doctor can't see enough proof for the need of anti-biotics, a decision is taken that is supposedly "for the good of society". But that doesn't mean that the opposite decision is necessarily "for the good of the person"- since the diagnose is obviously not there to justify it.



----
original post:
(not understanding what you mean)


Note, I'm not arguing against doctors having an opnion and practicing their profession.

The interest of the patient is not necessarily what the patient wants. His "interest" is what's best for him. A doctor is qualified by his study in medicine to determine what is the patient's actual benifit.

People don't go to a doctor to recieve advise based on his religion, or his beliefs or a movie he has seen. People ask the doctor to make a "professional" decision.

Had a patient wanted "religious" or "moral" advise mixed in, he would have went to the rabbi / priest / philosopher.

These two things do not mix.

[lord of the mark]

Originally posted by Sirotnikov

I'm not arguing against doctors having an opnion and practicing their profession.

The interest of the patient is not necessarily what the patient wants. His "interest" is what's best for him. A doctor is qualified by his study in medicine to determine what is the patient's actual benifit.

People don't go to a doctor to recieve advise based on his religion, or his beliefs or a movie he has seen. People ask the doctor to make a "professional" decision.

Had a patient wanted "religious" or "moral" advise mixed in, he would have went to the rabbi / priest / philosopher.

These two things do not mix.

Im still not clear on why a doctor thinking its correct to balance the interests of a patient, and that of others they may infect, is a "professional" and perhaps an "Ethical" decision, while balancing the interests of a woman, and her embryo, is a "moral" decision, and perhaps a "religious" decision. I think you attempt to draw a clear bright line that does not exist. But I doubt I can convince you, and I hereby give up.

[Sirotnikov]

Im still not clear on why a doctor thinking its correct to balance the interests of a patient, and that of others they may infect, is a "professional" and perhaps an "Ethical" decision, while balancing the interests of a woman, and her embryo, is a "moral" decision, and perhaps a "religious" decision. I think you attempt to draw a clear bright line that does not exist. But I doubt I can convince you, and I hereby give up.

I didn't understand what you were asking.

I addressed that in the edited post.

I claim that there is no ethical decision or balance between the interests of a patient and of society - in what you described. Since no one's interest is really put in risk if the doctor does not prescribe medicine to someone with an unclear diagnosis.


Furthermore, I claim that any case which has a call for an ethical decision - it should not be allowed that every doctor solves it for himself. That is why each country has rules and regulations governing many of those grey areas.

Either it is lawful to termine a pregnancy (in certain conditions) or it is not. When there is a law - it should be followed.

If the law allows a pregnancy to be terminated, the doctor has nothing to say, unless he suspects that this will physically hurt the patient.



P.S. - Please don't give up.

It's been a while since I've had an interesting arguement, and I appologize if I wrote something nasty 'in the heat of the arguement'.

[lord of the mark]

Originally posted by Sirotnikov
There's also nothing "fuzzy" about medical procedures that involve ethical decisions, that are taken with consideration towards laws and medical regulations.

Law, btw, is exactly what should be followed.

Law, by definition, represents and dictates the most basic widely shared ethical and moral beliefs in one's society. This is therefore, the only thing that binds.

These days hospitals in the US sometimes employ medical ethicists, precisely because there are situations that arent covered by law. The law allows room (necessarilly) for discretion, and sometimes it is not possible to exclude value judgements from that discretion.

[lord of the mark]

Originally posted by Sirotnikov

Im still not clear on why a doctor thinking its correct to balance the interests of a patient, and that of others they may infect, is a "professional" and perhaps an "Ethical" decision, while balancing the interests of a woman, and her embryo, is a "moral" decision, and perhaps a "religious" decision. I think you attempt to draw a clear bright line that does not exist. But I doubt I can convince you, and I hereby give up.

I didn't understand what you were asking.

I addressed that.

Im assuming a situation where the infection MAY be bacterial, rather than one where it is clearly viral. So it WOULD be in the persons interest to get the antibiotics (which are derived from fungi, theyre not getting fungi)

Alternatively one could the case of a vaccine, that has real side effects, but where there is herd immunity. Its in societys interest that everyone be vaccinated, but the individual is best off free-riding. What should the doctor do then? Follow the law? But the law doesnt require patients to be vaccinated, and also doesnt ban a doctor from considering public health effects. Hes got to make a CHOICE. He can do it based on the hippocratic oath, on Kant, by flipping a coin, or based on the Shulchan Aruch.

[lord of the mark]

Originally posted by Kuciwalker

What if a doctor has a personal belief that a drug is dangerous or ineffective, even if it's approved by the government? Is the doctor then required to prescribe it to the patient? Should the government take away his license if he doesn't?

Isn't a license certification that the doctor meets the state's standards for a doctor? Otherwise it's meaningless. So yes, if the doctor disagrees significantly with the government about what medical knowledge is correct, he shouldn't have his license.

Then I doubt theres more than a handful of doctors in the USA who should keep their license by your standards, and many of those not the best. Ive known docs whove prescribed combos off label, cause they considered the reasons for pulling drugs from the market junk science, and docs who wont prescribe certain things cause they dont think their worth the risk.

[Sirotnikov]

Originally posted by lord of the mark


These days hospitals in the US sometimes employ medical ethicists, precisely because there are situations that arent covered by law. The law allows room (necessarilly) for discretion, and sometimes it is not possible to exclude value judgements from that discretion.

I agree that it is impossible to compeltely exclude that.

However, I find it important that doctors continue to rely on their science for as many decisions as they can, and not be given leeway, to act according to their personal convictions or habits.

[Sirotnikov]

Then I doubt theres more than a handful of doctors in the USA who should keep their license by your standards, and many of those not the best. Ive known docs whove prescribed combos off label, cause they considered the reasons for pulling drugs from the market junk science, and docs who wont prescribe certain things cause they dont think their worth the risk.

Please notice that in both cases, doctors use their scientific training to make a decision, even though the second one is "ethical" in essense.
,
"Is this dangerous, but potencially life saving, drug worth the risk"?

This is an almost ethical decision that patients often rely on the doctors advice, because they lack the qualification to compare the amount of danger and the potential chance for a good result.

And yet, doctors rarely "Decide for the patients" and present them with options, accompanied by an explanation, where the patients eventually choose for themselves, or their relatives choose for them.

The choise is rarely left to the doctors.


If a doctor was to refuse a procedure, it is because he knows (due to his science) that a procedure could cause insormountable harm to the patient. Not because he "dislikes" a certain treatment.

[Sirotnikov]

Im assuming a situation where the infection MAY be bacterial, rather than one where it is clearly viral. So it WOULD be in the persons interest to get the antibiotics (which are derived from fungi, theyre not getting fungi)

just joking about the fungi there

I imagine that if the infection is serious enough, then he would indeed be treated by something that has the potencial to save his life.

However, giving a person the wrong medicine for his disease is always a risk. Thus unlike your claim - it is not necessarily "in his benefit" to recieve something that might cure him, and might be the wrong medicine.

Alternatively one could the case of a vaccine, that has real side effects, but where there is herd immunity. Its in societys interest that everyone be vaccinated, but the individual is best off free-riding. What should the doctor do then? Follow the law? But the law doesnt require patients to be vaccinated, and also doesnt ban a doctor from considering public health effects. Hes got to make a CHOICE. He can do it based on the hippocratic oath, on Kant, by flipping a coin, or based on the Shulchan Aruch.

I'm not proficient enough in some of the terms to realize the conflict here.

What is herd-immunity?
If I realize correctly - it means that a certain number of vaccinations will cause immunity.

Then it is not clearly the society's interest that EVERYONE be vaccinated.

Also the side effects, are a good example of professional judgement / assesment - the risk of the disease vs. the risk of the vaccine.

Eventually - for most diseases that develop immunity, unless they are fatal - they are not obligatory.

Some are - as decided by the government (for instance - polio).

Some aren't - such as the common flu.

Where does the doctor make a choise here?