tag:blogger.com,1999:blog-295691662024-02-28T09:58:12.073-08:00Conscience and HealthcareCristina Alarconhttp://www.blogger.com/profile/04161176184582593579noreply@blogger.comBlogger25125tag:blogger.com,1999:blog-29569166.post-65974216247483685332019-03-26T11:05:00.001-07:002019-03-26T11:05:31.170-07:00It has been a long time since I have written on this blog. For my latest writing, please visit the Canadian Healthcare Network.Cristina Alarconhttp://www.blogger.com/profile/04161176184582593579noreply@blogger.com0tag:blogger.com,1999:blog-29569166.post-71244490562010301462011-05-24T19:37:00.000-07:002011-05-24T19:48:41.356-07:00Cutbacks may jeopardize safety<em>I would have to complete over 150 med reviews per month to make up for revenues lost due to government cutbacks.</em><br /><br />Sue had been taking Cymbalta for fibromyalgia when she became acutely aware of an oft-forgotten ill-effect while visiting Paris. Contemplating the magnificent Eiffel tower as though it were a mere “peanut butter sandwich” (not her favourite), she realized something had gone askew.<br /><br />“I would rather feel the pain than a lack of feeling,” she told me. “Will you help me wean off this dreadful thing?”<br /><br />So I did some sleuthing, whilst looking at all of Sue’s meds, and had her come in for a chat thus meeting the requirements of a med review, and billing tax-payers $60. Next, I proceeded to get a new prescription for the half-strength capsules, billing the $70 consultation fee with the aim of eventually stopping the mood-blunting-culprit completely, and I intend to do a follow-up in a month for a $15 fee.<br /><br />Instead of adding to our work load, would it not be much simpler to just compensate us for what we already do?<br /><br />It is ironic that I completed my very first med review and consultation—according to the new B.C. government <a href="http://http//www.health.gov.bc.ca/pharmacare/pdf/medrevguide.pdf">requirements</a>—on the eve of the damning <a href="http://www.vancouversun.com/health/Takes+generic+drugs/4807933/story.html">Vancouver Sun </a>article pointing out that Canadians pay top dollars for generics, with B.C. taking the hit.<br /><br />Yes, UBC researchers say that if the rest of Canada followed Ontario’s model for generic drug pricing, we could save nearly $1.3 billion a year. But the study does not take into account new money some provinces are giving pharmacies to help compensate for services like patient consultations and medication reviews. In fact, it only serves to reinforce in people’s minds the idea that pharmacists work for free.<br /><br />In all I spent about half an hour—between dispensing—doing some research, phoning up the drug company and printing out interesting reading material for my patient on what to expect upon Cymbalta withdrawal.<br /><br />Loss of Cymbalta sales aside, my first med review and consultation has been a most rewarding experience, as helping others always is. But from a business perspective, my mind is blown away by the impossible number of med reviews (over 150 per month) that would go to make up for lost yearly revenues due to government cutbacks.<br /><br />And while I can understand the need to separate our professional allowances from product reimbursements, I am afraid that the need to candy-wrap what most of us have already been doing on a daily basis in order to justify billing, may be leading to inadequate compensation. Ultimately, pharmacists are being asked to do more (in paper-work requirements) for less, and patients are still under the illusion that the most readily accessible professional lives on air alone.<br /><br /><br />This is perhaps why some pharmacists will be tempted to cheat the system, a maddening phenomenon that I suspected could happen but did not expect to encounter so soon…<br /><br />A few days after my med review, I was filling a prescription for a new patient when I noticed that her profile included a recent med review allegedly performed at another pharmacy. Curious about how she had found the whole process, and eager to compare this with my own experience, I asked how the med review had been, only to meet with a blank stare.<br /><br />“What’s that?” the woman asked—no, she is not on Aricept.<br /><br />“You mean the pharmacist did not sit you down last month to go through all your medications with you …?” I queried in disbelief.<br /><br />The woman looked at me in alarm afraid she had been billed for something she had not asked for… “ Well no… the pharmacist did nothing different than what she always does…<br /><br />While not excusing the pharmacist, I can totally understand why someone might be tempted to bill without sitting the patient down for 20 minutes. Yet her unethical demeanor is highly detrimental to the profession and very unfair for those of us who are trying to do things right. Ultimately, abuse of this sort could result in the government pulling back its offer.<br /><br />But there may be another alternative.<br /><br />Instead of adding to our work load, would it not be much simpler for the government, private insurers and private payers to just compensate us for what we already do?<br /><br />Being fully aware that it is not I who will be paid, but the business, I should still be able to bill every time I counsel a patient on a new prescription, every time I phone a doctor to clarify a dosage or to change an order. I should bill, as my doctor does, for every telephone consultation and not just for sit-down med reviews. I should be paid (the business compensated) fairly for every justifiable refusal to fill, and not only when the patient is a Pharmacare subscriber.<br /><br />True, in B.C. we are currently reimbursed for adaptations and renewals, but adaptation requires lengthy documentation. Also, some physicians are instructing us not to adapt.<br /><br />And so, until both the government and the public can better appreciate all the hidden work that we do to improve health outcomes, all walk-ins with queries shall be escorted to the Consultation Room. Phone callers will be asked to make appointments.<br /><br />Yes, patients’ best interests must always come first. But if business is stressed and pharmacists overworked, patient safety will be jeopardized and the interests of no one at all will be served.<br /><br />Written for the <a href="http://www.canadianhealthcarenetwork.ca/pharmacists/discussions/blogs/pill-to-till/my-first-paid-med-review-professionally-satisfying-financially-unjustified-11106">Canadian Healthcare Network </a>under the title <strong>"My first paid med review: Professionally satisfying, financially unjustified"</strong> on May 24 2011.Cristina Alarconhttp://www.blogger.com/profile/04161176184582593579noreply@blogger.com0tag:blogger.com,1999:blog-29569166.post-73919504816872870112010-12-09T17:51:00.000-08:002010-12-09T18:09:47.862-08:00Pharmacy Profession changing by Force?<em><strong>Pharmacists deserve a more democratic governing model.</strong></em>Written by Cristina Alarcon on November 3, 2010 for CanadianHealthcareNetwork.ca <br /><br /><br />I hope Manitoba pharmacists realize just how lucky they are. Their Governing Body, The <a href="http://http//www.napra.org/pages/Manitoba/default.aspx">Manitoba Pharmaceutical Association</a>, is one of a kind, a pearl to be prized…<br /><br />As reported for Drugstore Canada by <a href="http://http//www.canadianhealthcarenetwork.ca/pharmacists/discussions/blogs/news/special-reports/2010-state-of-the-industry-report-manitoba-6560">Judy Waytiuk</a>, Manitoba pharmacists are one of the only Canadian health professions with individual voting authority over their practice regulations. This is unlike the rest of Canada, where the regulatory body consults on, sets and implements practice changes.<br /><br />And so, lucky Manitoba pharmacists get to voice their concerns on important issues ranging from technicians’ scope of practice, to prescribing authority, to a position on inducements.<br /><br />Input is not merely advisory in nature, and pharmacists get the respect they deserve…<br /><br />True, the Manitoban-democratic-approach can potentially slow down and—to the horror of policy drafters—squash brilliant initiatives. But pondered delay is not only salutary, it is essential.<br /><br />Sure, asking for full membership participation in proposed <a href="http://http//www.bcpharmacists.org/library/D-Legislation_Standards/D-2_Provincial_Legislation/5078-HPA_Bylaws_Community.pdf">regulatory</a> changes would be a tedious, time-consuming task, but as the Manitoba experience shows, the licensing body is better off for it.<br />Never is this truer than when clouds loom dark on the horizon, something not uncommon in British Columbia… where, in fact, an event of unprecedented importance took place this year….<br /><br />Welcome to Vancouver EGM 2010<br />At the petition of 500 community pharmacists, an Extraordinary General Meeting (EGM) was convoked by the <a href="http://http//www.bcpharmacists.org/">College of Pharmacists of British Columbia </a>and held in Vancouver on July 13, 2010. Over 160 pharmacists from across the province took great pains to be present in order to voice their concerns over regulatory changes that will make technicians a new class of College registrant, authorizing them to perform final prescription checks and take verbal orders from physicians.<br /><br />Highlighting this event was the <a href="http://http//www.bcpharmacists.org/">resignation</a> of Board members Doug Kipp and <a href="http://http//www.thenownews.com/news/Pharmacist+resigns+from+board/3304326/story.html">Bev Harris</a>, who courageously stepped down—later to be re-elected in landslide wins—so they could speak out freely against College policy changes, bypassing a newly reinforced rule requiring all Board members to “<a href="http://http//www.bcpharmacists.org/library/A-About_Us/A-4_Board/Board_Highlights-Jun18-10.pdf">Speak with One Voice</a>” .<br /><br />Later, the tidy Board-approved <a href="http://http//www.bcpharmacists.org/library/A-About_Us/A-4_Board/EGM_Minutes-July13-10.pdf">minutes</a> would fail to capture the lively <a href="http://http//www.youtube.com/user/CommunityPharmacist?feature=mhum">exchange</a> that transpired on that historical July evening when over 160 pharmacists took the College to task, leaving those who were there with a taste of Orwellian Double-Speak…<br /><br />There, a resolution was presented calling on the Board to “reconsider its decision to establish the profession of Regulated Pharmacy Technicians for community pharmacy”. It was supported and passed by an overwhelming majority.<br /><br />Attendees were reminded, lest they forget, that due to the College’s overriding mandate to protect the public the vote would be only advisory in nature. However, they added, results would be given “due consideration” at the next regularly scheduled Board meeting in September. Pharmacists did not hold their breath.<br /><br />Come September…<br />On August 1st, just weeks after the EGM and over a month before the much-awaited September Board <a href="http://http//www.bcpharmacists.org/library/A-About_Us/A-4_Board/Board_Highlights-Sep24-10.pdf">meeting</a>, Ministerial approval of revised HPA <a href="http://http//www.bcpharmacists.org/legislation_standards/provincial_legislation/bylaws.php">Bylaws</a> (inclusive of regulated pharmacy technicians) came into force. The changes will allow the College to bulldoze ahead in the New Year as planned, leaving pharmacists with the impression that “due consideration” of their resolution had never really been intended at all.<br /><br />Having previously resigned her position, Bev Harris attended the September 24th Board meeting as an observer. “It all took about 30 seconds,” she told me.<br /><br />The BC College of Pharmacists’ Board consists of elected members and non-pharmacist government appointees. At this meeting, one non-pharmacist moved the motion that the College go ahead as planned with technician regulation. This was seconded by another government appointee. The majority voted in favour, and so, it was…<br /><br />No discussion ever took place.<br /><br />And so it is that, in spite of unresolved concerns, the final step in the approval process regarding the legislative authority to register pharmacy technicians as registrants of the College of Pharmacists of BC is now complete.<br /><br />After only eight months of training, technicians will be allowed to perform final med checks and take verbal orders. Meanwhile, pharmacists’ concerns—ranging from liability, to employment loss, to patient safety—remain unaddressed.<br /><br />In all fairness, the College has <a href="http://http//www.bcpharmacists.org/library/H-Resources/H-7_TechTalk/TechTalk-20101022.pdf">expressed</a> the need for “further communication and support to help manage change”. However, there is something terribly wrong with a professional governing body that appears to listen but fails to act on the concerns of its registrants, seeking instead to impose change by force. Alienation is the only possible outcome.<br /><br />Re-education anyone?<br /><br />Sure, asking for full membership participation in proposed regulatory changes would be a tedious, time-consuming task, but as the Manitoba experience shows, the licensing body is better off for it.<br /><br />If anything, a more democratic governing model would ensure that our yearly dues were better spent. It would also shield the governing body against perceptions (however unfounded) of government run amok.Cristina Alarconhttp://www.blogger.com/profile/04161176184582593579noreply@blogger.com0tag:blogger.com,1999:blog-29569166.post-89591718097641304412010-12-09T12:57:00.000-08:002010-12-09T13:03:38.570-08:00An ecological blind spotThere is a huge effort today to protect the physical environment from the unintended effects of human activity. We have international agreements and national policies to reduce global warming by curbing excess carbon, produced as human beings pursue their material wellbeing. <br />On a smaller scale, we each do our best to turn off the taps, turn down the lights, use public transport, cut down on the fumes, recycle, recycle, and definitely not flush any medicines down the sink – especially not the brain-altering or endocrine-disrupting kind. Yes, we are constantly seeking ways to reduce air and water pollution, and in Canada, the Environment Act even allows citizens to bring civil action when the government is not enforcing environmental laws.....<br />(to read more click on title above)Cristina Alarconhttp://www.blogger.com/profile/04161176184582593579noreply@blogger.com0tag:blogger.com,1999:blog-29569166.post-74056624580477879212010-10-21T19:56:00.000-07:002010-10-21T19:59:52.901-07:00Choice impacts Everyone!Humans are notably inconsistent beings, which may account for the contradictory attitudes we currently see to the phenomenon of suicide. On the one hand, every effort is made to prevent people taking their own lives; there are safety barriers on bridges, crisis hotlines, suicide prevention programmes in schools. At the same time there are organised campaigns for assisted suicide and other forms of euthanasia to be sanctioned by law.<br /><br />According to euthanasia advocates, we have the right to end our lives, and as autonomous individuals, each one should choose whether to live or die. There are people, it’s true, who think that autonomy and choice are too good to be wasted on just anyone. Someone commenting on a National Post blog recently insisted that “a 90 year old suffering dementia who is also blind, deaf and unable to walk is no longer a person.” The implication is that the infirm can have the time of their death chosen for them- by someone else of course.<br /><br />Yet autonomy and choice do lend respectability to the pro-suicide campaign because, when not used as mere buzz words, they are truly signs of the rational spark that differentiates us from our pet birds and rabbits. Autonomy, however, is only part of the human story. No man is an island, and, as part of the universal human family, both the way we choose to live and the way we die does have an impact on others.<br /><br />To read more click on title above.......Cristina Alarconhttp://www.blogger.com/profile/04161176184582593579noreply@blogger.com0tag:blogger.com,1999:blog-29569166.post-31089200972632886612010-10-21T19:47:00.000-07:002010-10-21T19:54:17.468-07:00EGM Technician RegulationHere are the EGM meeting highlights re: Technician Regulation....<br />The meeting was held in Vancouver on July 13 2010-- College of Pharmacists of BC.<br />(click on the title to view video)Cristina Alarconhttp://www.blogger.com/profile/04161176184582593579noreply@blogger.com0tag:blogger.com,1999:blog-29569166.post-47892388040668677702010-09-26T11:15:00.000-07:002010-09-26T11:24:54.742-07:00With euthanasia, ‘choice’ is a lieWith euthanasia and assisted suicide, the proponents of “choice” are rather naïve.<br /><br />A favourite of euthanasia proponents is the autonomy/choice argument. When not used as mere buzz words, autonomy and choice are truly signs of the rational spark that differentiates us from our pet birds and rabbits. Yet though autonomous, no man is an island.<br /><br /><br />As part of the universal human family, both the way we choose to live and the way we die does have an impact on others. This is never truer than in the case of suicide… Across the globe, the suicidal jump off bridges every day. And from erection of safety barriers to provision of emergency hotlines, every effort is made to stop them.<br /><br />To read more, click on the title above......Cristina Alarconhttp://www.blogger.com/profile/04161176184582593579noreply@blogger.com0tag:blogger.com,1999:blog-29569166.post-70090615399204872932010-08-19T18:36:00.000-07:002010-08-19T18:38:07.883-07:00The end can never really justify the meansBy Cristina Alarcon, The Province, July 25, 2010<br /> 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. <br /><br />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." <br /><br />The suggestion was, in other words, that the 36-year-old father of two children was engaged in a wartime mercy killing. <br /><br />Around the world, the trial sparked much debate, and got me thinking about what I might do in the young captain's place. <br /><br />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. <br /><br />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. <br /><br />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. <br /><br />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)? <br /><br />Or would the stress of wartime terror blur my usual moral clarity, my sense of the uniqueness of human worth? <br /><br />Would I, like Red Cross founder Henry Dunant, be inspired to greater self-giving? <br /><br />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. <br /><br />As a pharmacist, I have witnessed the devastating psychological effects of war on men many years after combat. <br /><br />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. <br /><br />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. <br /><br />Nevertheless, given the complexity of combat, mistakes happen. <br /><br />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. <br /><br />This is why it is morally wrong to kill a detainee or an incapacitated insurgent. <br /><br />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. <br /><br />It's not healthy psychologically, he says, to have made difficult moral decisions that you cannot talk about publicly for fear of being punished. <br /><br />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. <br /><br />There is no defence for mercy killing in the law. <br /><br />Nor is it, in my view, something that ought to be applauded. <br /><br />Still, supporters argue it was unfair for a soldier to have to face prosecution for decisions made on the battlefield. <br /><br />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? <br /><br />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. <br /><br />Though most of us would like to have it otherwise, the end or purpose of our actions can never justify the means. <br /><br />If mercy killing is allowed in some instances, why not in others, and who is to decide? <br /><br />Yes, from the sanctuary of my couch it is all too easy for me to judge. <br /><br />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? <br /><br />Vancouver pharmacist Cristina Alarcon can be reached at cristinaalarcon365@hotmail.com<br /><br />© Copyright (c) The ProvinceCristina Alarconhttp://www.blogger.com/profile/04161176184582593579noreply@blogger.com0tag:blogger.com,1999:blog-29569166.post-62728748357155235942010-08-19T18:32:00.000-07:002010-08-19T18:34:56.643-07:00Pharmacy Plan will Hurt Quality ControlBy Cristina Alarcon, Special to Coquitlam NOW, August 13, 2010<br /> 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. <br /><br />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. <br /><br />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. <br /><br />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. <br /><br />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. <br /><br />If one pharmacist must oversee the appropriateness of hundreds of scrips churned out daily by an army of techs, major mishaps will undoubtedly occur. <br /><br />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. <br /><br />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. <br /><br />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. <br /><br />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. <br /><br />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. <br /><br />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. <br /><br />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." <br /><br />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. <br /><br />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. <br /><br />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. <br /><br />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. <br /><br />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. <br /><br />- - - <br /><br />Cristina Alarcon is a Vancouver pharmacist.<br /><br />© Copyright (c) Coquitlam NowCristina Alarconhttp://www.blogger.com/profile/04161176184582593579noreply@blogger.com4tag:blogger.com,1999:blog-29569166.post-61494540601419310612010-07-17T11:22:00.000-07:002010-07-30T18:53:08.679-07:00Washington State victoryI was thrilled to learn that Washington State will be creating new rules for pharmacists who have conscientious objections to providing services or products they find morally objectionable. It will allow pharmacists to refuse to sell anything or provide services that go against their conscience and deeply held beliefs.<br />The reason for the new rules was because of a lawsuit concerning a pharmacy that, against the objections of the state, refused to stock or dispense the Plan B morning-after pill, based on their belief that life is sacred from the moment of conception and the pill can sometimes work as an abortifacient.<br />This is a great turnaround by both the state and the Pharmacy State Board, which for several years maintained that religious freedoms of pharmacies and pharmacists had to be restricted in order to ensure patient access to the morning-after pill.<br />In 2006, Pharmacy Board members unanimously supported a rule that would protect conscience for pharmacists and pharmacy owners. Shortly after, though, the board buckled under political pressure and mandated pharmacies to stock and dispense the medication despite any conscientious objections.<br />The board adopted this regulation even though it admitted it found no evidence that anyone in the state had ever been unable to obtain Plan B (or any other time-sensitive medication) due to religious objections.<br />In the aftermath, a pharmacy and two individual pharmacists filed suit to prevent the new regulation from forcing them out of their profession. The Becket Fund also came to their defence.<br />In its most recent filing, the state conceded that allowing pharmacists with conscientious objections to refer patients to other pharmacies “is a time-honoured pharmacy practice that is often in the best interest of patients, pharmacies and pharmacists, and [does] not pose a threat to timely access to lawfully prescribed medications.”<br />Although I do not advocate mandated referral, this is a clear victory for the profession and it sends a clear message to all: The state and professional boards ought to remain neutral in matters of faith and morals as they relate to individual conscience, in so far as there is no threat to public safety or to the common good.<br />While the state plays an important role in ensuring the health, peace, morality and safety of its citizens, it should not use its power in a dictatorial way, imposing limits on individual conscience in legitimately disputable matters.<br />But is this not a case of a religious pharmacist or store owner imposing his or her values on others, and will it not cause great inconvenience to customers, which some would argue should be a professional’s first priority?<br />To the question of fairness I would answer that justice is for all. In any agreement, one party must not be oppressed at the expense of another. In the case of the Plan B provision, both parties can be readily respected by placing the onus on provincial pharmacy boards to provide information on non-dissenting providers via toll-free numbers.<br />Some might argue that inconvenience is a form of oppression. But isn’t it a greater oppression to ask one to betray deeply held beliefs than walk a few extra blocks?<br />A version of this article was originally published in “Holy Post”, the religion blog of the National Post.<br /><a href="http://life.nationalpost.com/2010/07/10/religious-freedoms-new-plan-b/"></a>Cristina Alarconhttp://www.blogger.com/profile/04161176184582593579noreply@blogger.com1tag:blogger.com,1999:blog-29569166.post-18746342817366020482009-11-21T19:28:00.000-08:002010-06-24T18:02:16.094-07:00Guest column: As a pharmacist in the longevity concoctions business, I prefer to keep my 'oldies' aliveAs Canada's Parliament debates Bill C-384, why are more pharmacists not rising up in protest over possible legalization of euthanasia and assisted suicide? Is it because we ought to remain neutral? Yet if this debate is supposed to be all about choice, then, as a pharmacist, I choose not to remain neutral on an issue that could impact my livelihood.<br /> <br /> I'm in the business of health and wellness; longevity concoctions, my specialty. I believe it is more lucrative to keep my oldies alive and kicking longer; eliminating them is against my mission statement, and it would surely kill my business too. Unless, of course, I could charge a hefty sum for how-to-exit kits, including arsenic, asphyxiation bags, and other death paraphernalia.<br /> <br /> But then comes another dilemma; as the elderly get knocked off, replacements will be needed -- so I can continue to offer my services. Yet most pharmacies are also in the birth control business; sooner rather than later, my clients will largely come from overseas. Time to brush up on my Arab and Cantonese.<br /> <br />Are health-care providers prepared for the impact a euthanasia law could have on their day-to-day practice? If, for moral or ethical reasons they find themselves unable to comply with such <br />a law, would they risk being fined or put in prison? Would I be accused of imposing my morality were I to dissuade sweet Ms. Jones from being euthanized by her inheritance-ravenous offspring? Yes, they will all claim it was her own choice, and really, in everyone else's best interests.<br /> <br />How about the lady with the severe arthritis or the man with the club foot? How about the child with the MS or the severely depressed teenager? Will our answer to their pain be their death too? If the Right To Die movement has its way, it will all boil down to "personal" choice. But whose choice will it really be? For example, as a pharmacist, I had no choice over the following briefing which states that everyone should have a choice.<br /> <br /> In 1994, a government brief was presented to the Senate Committee Studying Euthanasia and Assisted Suicide by the Canadian Pharmacists Association. This brief clearly shows that pharmacists, like the Canadian population as a whole, are "largely divided on the issue [of euthanasia] and cannot make a strong recommendation on the legalization of euthanasia or <br /> assisted suicide." The briefing statements make it appear as though everyone involved will have a choice, but the reality is there will need to be a balancing of rights; the right of the <br />patient to receive what he wants, versus the right of the health-care professional not to participate in the patient's demise. For many, referral will not be a viable option.<br /> <br />So if such a law should pass, I want to make something clear; I want two choices; the choice not to kill off my business by concocting death potions, and also the choice not to refer my oldies or disabled youngsters for liquidation elsewhere.<br /> <br />But, with all our "rights and choice" talk, are we not neglecting the underlying issues causing the euthanasia debate in the first place? And why are we not learning from the Netherlands? According to Dr. Herbert Hendin, American author of, Seduced by Death, the broad "safety" guidelines to prevent people from being euthanized against their will have been largely ignored, to the point where the doctors who help set euthanasia guidelines will privately admit that euthanasia in the Netherlands is basically out of control.<br /> <br />What we really need to be asking ourselves is: How did the patient reach the decision to put an end to his or her life in the first place? Was there any pressure? Was there fear of pain, of loneliness, or of the unknown? Has our society become so cold and ruthless that a sick person would rather die than be subjected to humiliating treatment by those who ought to care? <br /> The reality is that were euthanasia to be legalized in Canada, we would be embarking on a "social experiment" of great magnitude.<br /><br /> Once the experiment is unleashed there will be no turning back. Your "choice" and mine may become somebody else's. <br /><br /> Alarcon is a Vancouver pharmacist with a masters in bioethics. <br /> Published in Vancouver on October 29, 2009 in The ProvinceCristina Alarconhttp://www.blogger.com/profile/04161176184582593579noreply@blogger.com5tag:blogger.com,1999:blog-29569166.post-46738361314990172692009-10-11T17:54:00.000-07:002009-10-11T17:59:31.910-07:00Pharmacists must have Freedom of ConscienceI met Martha a few years ago, a beautiful young woman. She started frequently visiting the pharmacy, nearly every month, just to purchase a home pregnancy kit. Her hands always trembled, and there was fear in her eyes. Finally I decided to ask her whether she was okay, if not, what was the matter. She looked at me tearfully and confided, “I don’t want to go through another abortion and if I get pregnant I know he will leave me.”......(click on title to read more)<br /><br /><br />Read more: http://network.nationalpost.com/np/blogs/holy-post/archive/2009/10/08/cristina-alarcon-trusted-professionals-must-have-freedom-of-conscience.aspx#ixzz0Tg8uMRRG <br />The New Financial Post Stock Market Challenge starts in October. You could WIN your share of $60,000 in prizing. Register NOWCristina Alarconhttp://www.blogger.com/profile/04161176184582593579noreply@blogger.com0tag:blogger.com,1999:blog-29569166.post-67504712013835649872009-06-13T11:59:00.000-07:002009-06-13T12:02:23.265-07:00Cristina Alarcon in National Post: Right to die? How about right to liveI had just returned from Washington, D.C., where I attended the Second International Symposium on Euthanasia and Assisted Suicide. The theme: “Never Again.”<br /><br />The night before, I had mused over the intense weekend in Washington, the moving testimonials and the lively plane ride where I had become engulfed in conversations that betrayed the pervading culture of confusion surrounding assisted suicide and euthanasia. No, euthanasia is not about withdrawal of life support so as to allow a terminally ill person to die, I had explained to the lady on the plane. No, physician-assisted suicide “guidelines” are not always strictly enforced.......Cristina Alarconhttp://www.blogger.com/profile/04161176184582593579noreply@blogger.com0tag:blogger.com,1999:blog-29569166.post-13313456422076304902009-05-08T18:22:00.000-07:002009-05-08T18:27:59.160-07:00LETTER IN RESPONSE TO JULIE CANTOR (NEJM)<strong><strong>Re: Conscientious Objection Gone Awry---Restoring Selfless Professionalism in Medicine</strong></strong> <br /><br />Dr. Cantor maintains that those who disagree with her perfectly contestable philosophical and ethical viewpoints ought to remain neutral, while she herself cannot. Accussing others of selfishly telling half-truths, while she falsely implies that a woman’s right to birth control is Constitutionally protected and self-servingly stomping on the truly Constitutionally protected rights of freedom of conscience and religion of healthcare providers, Dr Cantor betrays her own lack of impartiality.<br /><br />True, Church and State are autonomous; yet this is not to say that religious believers within a secular society ought therefore to be treated as second-class citizens. . <br /><br />Cantor’s obvious intent is to promote greater access to a variety of options for women, yet this cannot be done at the expense of relegating professionals to function as automatons or fragmented individuals who live via different mores in different settings. <br /><br />Just as Dr Cantor has a right to live via her own beliefs and her own conscience, so do those who oppose her beliefs have the right to live with integrity as truly responsible moral agents. <br /><br /><em>Cristina Alarcon </em>, Bpharm, Masters Bioethics<br /> <br /> <br /><strong>Longer version of letter:</strong><br /><strong>Re: Conscientious Objection Gone Awry---Restoring Selfless Professionalism in Medicine</strong><br /> <br /><br />Unmatched is the candor of Dr Cantor in “conscientious objection gone awry…”. Not only is she transparently unfair to those who would disagree with her perfectly contestable philosophical and ethical viewpoints, but she also dares to insinuate that healthcare providers ought to remain neutral while she herself cannot. <br /><br />While it is true that Church and State must each maintain their autonomy, it is false to conclude that religious believers (as opposed to non-religious believers) ought therefore to be treated as second-class citizens. She dares to accuse others of selfishly telling half-truths, while falsely implying that a woman’s right to birth control is Constitutionally protected and self-servingly stomping on the truly Constitutionally protected rights of freedom of conscience and religion of all citizens, those of healthcare providers included. <br /><br />Cantor’s obvious intent is to promote greater access to a variety of options for women, yet this cannot be done at the expense of relegating professionals to function as automatons or fragmented individuals who live via different mores in different settings. <br /><br />Furthermore, her myopic views on women’s health issues, which reduces women to the sum of their reproductive organs lacks vision and imagination. It is an insult to the women who, as patients, may not all share her views, and to the professionals who selflessly care for them. To compare the non provision of abortion services to non provision of lifesaving treatments such as blood transfusions and diabetic medicines shows a further lack of deep reflection on the fact that pregnancy is not an illness, and premature delivery is rarely a therapeutically lifesaving intervention. On the contrary, abortion takes the life of an innocent bystander.<br /><br />Finally, just as Dr Cantor has a right to live via her own beliefs and her own conscience, be it religiously informed or not, so do those who oppose her beliefs have the right to live with integrity as truly responsible moral agents. <br /><br /><em>Cristina Alarcon</em><br />Bpharm. Masters BioethicsCristina Alarconhttp://www.blogger.com/profile/04161176184582593579noreply@blogger.com1tag:blogger.com,1999:blog-29569166.post-67517470552137705162009-04-18T09:56:00.000-07:002009-04-18T09:59:29.919-07:00Cristina Alarcon:Mixing conscience and medicine is a good thing (National Post blog)Let me tell you about Jane*. Jane was in her 60s and had been my patient for many years. As her pharmacist, I knew she had been battling depression for a long time, but she was always chirp and cheerful when she walked into the pharmacy for her monthly pills. <br /><br />Slowly, she started going downhill. Medications were not helping and she said she just wanted to die. One day she came in and asked specifically to see me. From her pocket she pulled out several tablets, one I recognized as a powerful narcotic, the other a sleeping pill. She said, “My friend gave me these … how many would I need to take to make sure I die?”Cristina Alarconhttp://www.blogger.com/profile/04161176184582593579noreply@blogger.com0tag:blogger.com,1999:blog-29569166.post-51650688848201754082009-04-15T18:31:00.000-07:002009-04-15T18:34:19.079-07:00Professionals or Automatons?The right of acting according to one’s conscience is under threat in many countries at the moment. In the US, the Federal government is studying whether to rescind protection of conscience regulations implemented in the dying days of the Bush Administration. Healthcare workers there are worried that they may have to participate in unethical procedures – or lose their jobs. This interview explains what is at stake in my profession.Cristina Alarconhttp://www.blogger.com/profile/04161176184582593579noreply@blogger.com0tag:blogger.com,1999:blog-29569166.post-28937539056974335082009-04-08T13:09:00.000-07:002009-04-08T13:11:01.762-07:00Roadkill Radio interview on ConscienceListen-in on the important issue of freedom of conscience and religion in healthcare!Cristina Alarconhttp://www.blogger.com/profile/04161176184582593579noreply@blogger.com0tag:blogger.com,1999:blog-29569166.post-50997613040216876242009-04-04T13:55:00.000-07:002009-04-05T16:42:14.099-07:00The next moral quagmire: conscienceThank you Charles Lewis once again for an excellent and timely article on a very important issue! Although it is inaccurate to say that I ever raised the ire of customers and colleagues over refusing to fill prescriptions for morning-after pills, it is true to say that I refuse to fill them or to refer for the drug for the reasons stated in the article. It was in Toronto that a colleague suggested I leave my beliefs at the door and in Vancouver that a pharmacy manager warned me about “imposing my morality”, after which I was let go under other pretexts. Why is this significant? Because this is a national problem for pharmacists, and not limited to Calgary, where yet another pharmacist, Maria Bizecki suffered a lengthy suspension from her job for kindly asking a customer to come back for the product she requested next day when someone else would be all too happy to meet her needs. In Ontario, pharmacist Michael Izzotti was also severely reprimanded when a doctor made a formal complaint to the Ontario College of Pharmacists; Michael had merely asked the doctor to please fax in the prescription so a colleague could take care of it next day. Many other pharmacists will not come forward with their stories for fear of losing their livelihood. <br />When convenience takes precedence over the basic human rights of freedom of conscience and religion, our Canadian democracy is in very bad shape indeed!<br />For more on this, please see “The ‘Hijacking’ of Moral Conscience from Pharmacy Practice: A Canadian Perspective” at www.theannals.com or at www.culturalrenewal.caCristina Alarconhttp://www.blogger.com/profile/04161176184582593579noreply@blogger.com0tag:blogger.com,1999:blog-29569166.post-24231090389849030212009-04-03T20:24:00.000-07:002009-04-04T11:45:54.333-07:00Protection of Conscience LiveFreedom of conscience and religion is under attack in the US ....please take the time to listen to these videos and to reflect on the importance of freedom of conscience and of ethical thought and expression for a healthy democracy!Cristina Alarconhttp://www.blogger.com/profile/04161176184582593579noreply@blogger.com0tag:blogger.com,1999:blog-29569166.post-73356381856825921982009-04-01T19:00:00.000-07:002009-04-01T19:04:17.525-07:00Rights of Conscience a Dangerous Issue VideoThe Christian Medical & Dental Associations (CMDA) have posted a great new <a href="http://www.youtube.com/watch?v=XxCVw1vX1lM" target="_blank">YouTube video</a> outlining the rights of conscience issue and its expected impact on healthcare in America. Please watch it and pass it along!Cristina Alarconhttp://www.blogger.com/profile/04161176184582593579noreply@blogger.com0tag:blogger.com,1999:blog-29569166.post-77269390479995400662009-03-29T11:13:00.000-07:002009-03-29T11:14:32.901-07:00Pro-euthanasia stance teeters on a slippery slopeCristina Alarconhttp://www.blogger.com/profile/04161176184582593579noreply@blogger.com0tag:blogger.com,1999:blog-29569166.post-35526751687620662092009-03-29T11:11:00.000-07:002009-03-29T11:12:42.246-07:00Embryos are worthy of respectCristina Alarconhttp://www.blogger.com/profile/04161176184582593579noreply@blogger.com0tag:blogger.com,1999:blog-29569166.post-64307094166029914002009-03-29T11:08:00.000-07:002009-03-29T11:09:25.783-07:00Putting Fear in people who protect livesCristina Alarconhttp://www.blogger.com/profile/04161176184582593579noreply@blogger.com0tag:blogger.com,1999:blog-29569166.post-40973392875790641812009-03-28T18:46:00.000-07:002009-06-07T20:47:24.857-07:00The "Hijacking" of Moral Conscience from HealthcareFor an interesting article on this, please visit <a href="http://www.theannals.com/">http://www.theannals.com/</a> (April 2009 issue)<br /><br />Today more than ever before, <span class="blsp-spelling-error" id="SPELLING_ERROR_0">healthcare</span> professionals are under great pressure to practice the art and science of medicine according to pragmatic ideologies that fail to protect their rights of conscience. This is largely because patient autonomy (not something bad in itself), has been crowned as the highest <span class="blsp-spelling-error" id="SPELLING_ERROR_1">bioethical</span> principle. Unfortunately, the notion of autonomy has falsely come to be equated to the concept of human dignity. As a child in the womb is seen by some not to have any worth, so a woman who lacks autonomy may be perceived by some to have been stripped of her dignity. This <span class="blsp-spelling-error" id="SPELLING_ERROR_2">ofcourse</span>, is nonsense. The dignity of a person is not an add-on, it is inherent because that person belongs to the human species and therefore, regardless of their being or not autonomous, that person is worthy of respect.<br />Respect for the person also implies respect for their integrity; this respect is due to the body and to the spirit. Thus, just as it would be wrong to physically harm a person's body, so it is wrong to attack their spirit. This applies in a special way to healthcare workers who are being forced to act against the dictates of their conscience when the perceived rights of patients to non-lifethreatening, non-lifesaving "needs" are forced upon them.Cristina Alarconhttp://www.blogger.com/profile/04161176184582593579noreply@blogger.com3tag:blogger.com,1999:blog-29569166.post-1150058920282937152006-06-11T13:47:00.000-07:002006-06-11T13:48:40.290-07:00Cristina Alarconhttp://www.blogger.com/profile/04161176184582593579noreply@blogger.com0