Eye on ethics: To dispense or not to dispense

June 6, 2005

Q: You receive a faxed prescription for a patient you've never met. After reviewing records and speaking with the patient's family, you are unable to reach the prescriber. You have a gut feeling that the drug may endanger the patient's health. Your manager insists, "If it's a valid prescription, you have to dispense the drug. Stop trying to play doctor." What do you do?

Q:You receive a faxed prescription for a patient you've never met. After reviewing records and speaking with the patient's family, you are unable to reach the prescriber. You have a gut feeling that the drug may endanger the patient's health. Your manager insists, "If it's a valid prescription, you have to dispense the drug. Stop trying to play doctor." What do you do?

A: Does a pharmacist have the right to refuse to dispense a drug? According to certain state pharmacy boards, Yes-but this right is not arbitrary. A rational decision rests on education, experienced judgment, and scientific principle.

So what should pharmacists consider when they are concerned about dispensing a drug?

It is important to use sound judgment regarding the appropriate use of drugs without being judgmental about the patient. Pharmacists seldom have access to the patient's entire medical record when dispensing a drug, and they may not always have a long-term relationship with the patient. We simply may not have all the facts at our fingertips.

It is also the pharmacist's responsibility to base his or her evaluation on scientific data when considering whether to dispense a drug. Every pharmacist needs immediate access to quality drug information, including on-line databases and clinical references; our opinions and practice experience are not enough.

Conceivably, there might be days when patients are not happy with our decisions. Potentially, the patient, the prescriber, the insurance company, and even those in charge may all be angry when we decline to dispense a drug. Therefore, pharmacists should carefully plan their response when faced with an order about which they have reservations. Here are some tips:

If you repeatedly find yourself at odds with a prescriber's use of medication, highlight your evidence within a positive framework-use staff meetings and newsletters, consult a supervisor, or make a collegial call and mail follow-up references.

If you feel that you can't dispense a frequently prescribed drug, consider working only in settings where another pharmacist is willing to dispense the drug. This, too, is part of your professional responsibility, to work where you can be effective, lawful, and responsive to the needs of your patients.

Here in Oregon, shortly after implementation of new administrative rules, an R.Ph. was fired for refusing to dispense a drug prescribed for an assisted suicide. Later, area physicians quietly collected a list of pharmacists willing to dispense such Rxs to prevent another pharmacist from suffering the same outcome.