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 cristinaalarcon365@hotmail.com
© Copyright (c) The Province
Thursday, August 19, 2010
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.
- - -
Cristina Alarcon is a Vancouver pharmacist.
© Copyright (c) Coquitlam Now
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.
- - -
Cristina Alarcon is a Vancouver pharmacist.
© Copyright (c) Coquitlam Now
Saturday, July 17, 2010
Washington State victory
I 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.
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.
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.
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.
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.
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.
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.”
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.
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.
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?
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.
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?
A version of this article was originally published in “Holy Post”, the religion blog of the National Post.
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.
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.
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.
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.
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.
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.”
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.
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.
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?
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.
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?
A version of this article was originally published in “Holy Post”, the religion blog of the National Post.
Saturday, November 21, 2009
Guest column: As a pharmacist in the longevity concoctions business, I prefer to keep my 'oldies' alive
As 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.
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.
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.
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
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.
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.
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
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
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.
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.
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.
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?
The reality is that were euthanasia to be legalized in Canada, we would be embarking on a "social experiment" of great magnitude.
Once the experiment is unleashed there will be no turning back. Your "choice" and mine may become somebody else's.
Alarcon is a Vancouver pharmacist with a masters in bioethics.
Published in Vancouver on October 29, 2009 in The Province
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.
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.
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
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.
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.
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
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
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.
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.
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.
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?
The reality is that were euthanasia to be legalized in Canada, we would be embarking on a "social experiment" of great magnitude.
Once the experiment is unleashed there will be no turning back. Your "choice" and mine may become somebody else's.
Alarcon is a Vancouver pharmacist with a masters in bioethics.
Published in Vancouver on October 29, 2009 in The Province
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