Thursday, August 19, 2010

The end can never really justify the means

By Cristina Alarcon, The Province, July 25, 2010
Last week, Canadian Army captain Robert Semrau was convicted of disgraceful conduct in the shooting a badly wounded Taliban insurgent in Afghanistan. But a military panel acquitted him of murder.

The court martial in Gatineau, Que., had been told by an eyewitness that Capt. Semrau "could not live with himself if he left an injured human being -- and that no one should suffer like that."

The suggestion was, in other words, that the 36-year-old father of two children was engaged in a wartime mercy killing.

Around the world, the trial sparked much debate, and got me thinking about what I might do in the young captain's place.

That's not an easy task, as scenes of wartime chaos are but shadows on a TV screen glimpsed from the bulwarks of a comfy couch.

Still, I can try. The young insurgent's legs were severed, his innards protruding, a horrific sight to behold. It was something a paramedic might encounter in the aftermath of an airline crash.

I had the same sort of feeling that can sometimes come over me when dealing with the hopelessly chronically ill . . . though I always manage to shake it off.

Confronted by such wartime misery, would I still hold firm to my principles that the ends (relief of suffering) can never justify the means (killing)?

Or would the stress of wartime terror blur my usual moral clarity, my sense of the uniqueness of human worth?

Would I, like Red Cross founder Henry Dunant, be inspired to greater self-giving?

Dunant embarked on his great project in 1862 from the "chaotic disorder, despair unspeakable and misery of every kind" he earlier witnessed in the bloody Battle of Solferino in modern-day Italy.

As a pharmacist, I have witnessed the devastating psychological effects of war on men many years after combat.

Stress, much like drugs, can affect us in unpredictable ways. It can bring out the best and the worst in us. Still, our actions remain free.

Writing on his blog about the moral justification for killing in war, U.S. soldier-ethicist Pete Kilner points out that good rules of engagement provide guidelines to assist [the] decision-making process.

Nevertheless, given the complexity of combat, mistakes happen.

Kilner explains that the default setting for a human being is to possess the right not to be killed, so when a person is no longer a threat he should not be killed.

This is why it is morally wrong to kill a detainee or an incapacitated insurgent.

Still, Kilner maintains, the profession of arms has two moral codes. There's the public one, based on black-and-white legal rules, and private code, known only by those who have to do the messy work of war.

It's not healthy psychologically, he says, to have made difficult moral decisions that you cannot talk about publicly for fear of being punished.

The prosecution alleged that Semrau committed a mercy killing because he felt bound by a "soldier's pact" to end the suffering of gravely wounded combatants.

There is no defence for mercy killing in the law.

Nor is it, in my view, something that ought to be applauded.

Still, supporters argue it was unfair for a soldier to have to face prosecution for decisions made on the battlefield.

If during wartime, we can succumb to less than humane actions, what excuse is there for us at home in a comfortable world of Ritalin for the young, Viagra for the old -- and, as some propose, an overdose of pills to help us along, should kick-the-bucket time draw near?

We can be tempted to lose moral clarity, to lose the sense of the uniqueness of our species, of the fact that we are the ones for which the planet was made.

Though most of us would like to have it otherwise, the end or purpose of our actions can never justify the means.

If mercy killing is allowed in some instances, why not in others, and who is to decide?

Yes, from the sanctuary of my couch it is all too easy for me to judge.

Yet it also gives me a clearer perspective from which to respectfully ask: How could anyone in his right mind finish off a dying man as he would a dying horse?

Vancouver pharmacist Cristina Alarcon can be reached at

© Copyright (c) The Province

Pharmacy Plan will Hurt Quality Control

By Cristina Alarcon, Special to Coquitlam NOW, August 13, 2010
Next time you walk into a drugstore, you may want to ensure your prescription has been properly filled and checked by a real apothecary -- a pharmacist, that is.

And if you or your loved ones are on a complicated medication regime and technicians are doing the final check on your medicine, then perhaps you ought to be signing a consent form.

This is because the College of Pharmacists of British Columbia has decided to pursue the licensing of technicians by Dec. 31, triggering a debate among community pharmacists who fret over liability, the profession's integrity and public safety.

For years now, the pharmacy profession has been easing the technical aspect of the job, first via specialized technology, then via technical support, but never before by leaving order entry, preparation and final check of prescriptions to unsupervised, largely under-qualified personnel.

While the college claims that pharmacists will still be ensuring the appropriateness of the drugs prescribed to begin with, quality control will certainly give way to monetary gain.

If one pharmacist must oversee the appropriateness of hundreds of scrips churned out daily by an army of techs, major mishaps will undoubtedly occur.

This idea may well work in a hospital setting, where errors are quickly caught and contained. Not so out in the community where once the wrong drug goes out that door it's gone -- and so, perhaps, is the patient.

But let's face it: most people have no clue just how much care goes into filling prescriptions. From searching for drug incompatibilities to making phone calls to refusals to fill when directions are inadequate or the wrong drugs are prescribed for a given condition -- you name it, good pharmacists catch it. There are myriad prescribing errors made and caught daily. This is far from mindless work.

Yet from their ivory towers academics believe the technical and cognitive aspects of this work can be separated -- imagine a chef who cannot cook, a plumber who cannot use a pump -- while drug store chain owners greedily wait to cash in on the techs' much-lower wages.

The regulation of pharmacy technicians will ultimately result in the creation of a new health-care professional and new registrant of the College of Pharmacists of BC.

Regulated pharmacy technicians will essentially take over the technical functions of the pharmacists' job, and pharmacists will be sitting back sipping margaritas by their pools, waiting for a call from their lawyers over the next casualty.

No really, the idea is to free up the pharmacist for consultation on disease management and drug care, but for a hefty, never-before-seen fee. Thus the most readily accessible health-care professional will be available no more, and your drug reviews and queries will be charged speedily to your Master Card or Visa.

Largely taken over by bureaucrats, academics and drug store chain owners, the College of Pharmacists of BC is giving in to their vested conflicts of interest. Meanwhile, the college board is conveniently silencing those who oppose their agenda by claiming that all must speak with "one voice."

Most recently, input was seemingly sought from the public on proposed bylaw changes that would create this new technical profession. Yet board member Bev Harris (a Coquitlam pharmacist) was reprimanded for speaking in a public forum to point out the problematic draft changes. And so it appears the consultation process was merely a sham. Fruitful discussion was never really the aim.

Over 500 community pharmacists have petitioned the college to hold off on bylaw changes that would give technicians the authority to take over their dispensing functions after a mere eight months of training. Technician certification, rather than licensing, is what pharmacists would like to see.

And it's not that pharmacists want to go back to all that counting and licking and sticking. Trained technicians are already helping greatly with that and much more.

While providing appropriate and timely services, pharmacists want to be sure that no errors are made along any step of the way, and that what your label says you're getting is really what's in the bottle.

A wrong drug or dosage may not be life threatening when you are young and healthy, but it may be lethal if dispensed to your 80-year-old mother or to your two-year-old son.

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Cristina Alarcon is a Vancouver pharmacist.

© Copyright (c) Coquitlam Now