COHEN'S CORNER

Moral decisions are never easy

Healthcare professionals have had to deal with the ethical issues related to morals and religious beliefs since the beginning of medical care. The laws passed over the years, especially those dealing with privacy, ultimately addressed many of them. But there still remain many that are unresolved, and these are sometimes the most difficult for healthcare professionals to navigate in their daily practices.

Let's face it. Some of these issues just grow out of ignorance. For example, as a child I remember clearly that some people thought you could catch cancer if you kissed or spent time close to someone with the disease. I recall having to wait outside the hospital room of a relative with cancer as my parents "took the chance" in visiting with him. More than two decades ago, AIDS, a little-known disease then, reared its ugly head in the United States. AIDS was originally linked by most only to the gay community; of course, that is no longer true. Today the reuse of dirty needles, careless sex, and blood transfusions from AIDS-infected individuals have unfortunately spread this disease across the entire populace.

I remember working on an AIDS cover story some 20 years ago and having difficulty getting someone to pose for the cover photo because of the stigma attached to the disease. And, as crazy as it may sound today, a customer of mine thought a person with epilepsy was somehow possessed, as evidenced by his seizure. Yet while the healthcare community has done an excellent job of educating the world about epilepsy, AIDS, cancer, and a host of other diseases, unfortunately some healthcare practitioners' ethical, moral, and religious beliefs continue to drive them away from treating these individuals.

Probably no article published in Drug Topics created more mail than a story we ran about a pharmacist who refused to fill an oral contraceptive for a patient because he claimed his moral and religious beliefs prohibited him from doing so. What made this case even more noteworthy was that the pharmacist refused to return the prescription so the patient could have it filled at another pharmacy. (See Drug Topics, Feb. 23.) This story was more recently followed up by a cover story on ethics and moral dilemmas (see Drug Topics, July 26), which is generating even more mail.

An overwhelming number of letters criticized pharmacists who push their moral and religious beliefs on their patients. I have to agree with these correspondents. Once an individual enters into health care as a profession, there is a tacit understanding that the sick and dying will be treated within legal limits to the best of our ability, regardless of our moral or religious beliefs. When I became a pharmacist, I knew I might have to make decisions that would challenge my personal moral and religious beliefs. But I also knew that I had to put those aside and do what is right for the patient. I still believe that.

One issue that always gets a great deal of media attention is a patient's right to die. Thankfully, patients today can choose to make out a "living will" that spells out their desires about life and death, taking these decisions out of the hands of the healthcare professionals. But what about assisted suicide, or drugs used in death by injection in states with a death penalty?

Making moral decisions, especially those that go against one's religious beliefs, is never easy. On the other hand, those beliefs should never get in the way of a healthcare practitioner's primary role—offering compassionate care for the sick and dying. If you are having difficulty in this area, perhaps it is time for you to consider another profession, because when it comes to life-and-death situations, there is no place for hesitation to fulfill your obligation to the patient.

By Harold E. Cohen, R.Ph.

 

Harold Cohen. Cohen's Corner: Moral decisions are never easy. Drug Topics Aug. 23, 2004;148:18.