First, I will preface this diary by saying that I am not a doctor, health care provider, pharmacist, medical expert, nor do I work in the medical field. When it comes to my body, however, I am a medical provider, a pharmacist, and an expert, and it is from that perspective that I write. Both Trapper John and DemfromCt have diaried on this issue, however, the point(s) I raise in my dairy have not really been covered up to this point, other than in some comments (including a few of mine in DemfromCt’s diary). This is my first diary, and I’m somewhat of a newbie kossack, so please bear with me.
Also, this diary was originally titled "Viagra, oral contraception, and moral dilemmas." In an effort to make the title more eye-catching, I asked a few friends for suggestions. Many involved the V word. However, my son, who doesn't care for the word 'vagina' has his own colloquialism for that part of the female anatomy - vergeegee (don't ask, I have no idea where he got that from, but he's been using it forEVER)... in case anyone was wondering.
It seems that our current administration, via the Health and Human Services pew in the Church of Our Lady of Governmental Righteousness, in its continuing effort to undermine women’s rights and further its religious intrusion in our political and private lives (not to mention my uterus), is attempting to redefine use of the oral contraceptive known most commonly as "the pill," as falling under the umbrella of "termination of pregnancy" (i.e., it’s a pre-abortion, if you will). The proposal specifically states:
"any of the various procedures — including the prescription, dispensing and administration of any drug or the performance of any procedure or any other action — that results in the termination of the life of a human being in utero between conception and natural birth, whether before or after implantation." NY Times, July 15, 2008
Putting aside arguments regading separation of Church and State aside (I can't go there in this diary), the implication of this new "definition" means: Insurance companies will no longer be required to cover oral contraceptives (including Plan B), pharmacies will no longer be required to stock oral contraceptives, pharmacists can opt out of dispensing them, federal funding can be withheld if health care providers (hospitals and pharmacies included) do not agree to sign a covenant regarding dispensing oral contraception, and we women can just, you know, go screw ourselves if we don’t want to get pregnant.
But, here’s the thing about oral contraception. It is not prescribed only to prevent pregnancy. It is prescribed for a plethora of medical reasons, which include:
- to regulate irregular periods
- to control PMS, excessive cramping and heavy bleeding
- to shorten the menstrual cycle
- to help control acne
- to help control endometriosis
- used for hormone replacement therapy
- used in treating polycystic ovary syndrome
- to control/reduce/eliminate ovarian fibroids
- to help with chemotherapy induced menstrual irregularities
- to lower the risk of anemia (caused by extremely heavy bleeding)
I, like many women, take oral contraceptives for several of those reasons. I am trying to avoid another trip to the ER because of a burst ovarian cyst. I appreciate being able to function when I get my period instead of suffering from debilitating pain. I like not being on a hormonal rollercoaster two weeks out of every month. I glad I'm no longer anemic. I relish not wanting to strangle everyone in my house for, well, breathing. I am thankful I don’t have to take fists-full of Advil (or stronger prescribed pain meds, i.e. Percocet) every month. I'm particularly happy that I no longer have to spend half my net earnings on feminine protection products. And for these reasons, I thank GOD that someone invented the pill. And, my son (15) would like to add that HE also thanks God that he no longer has to deal with these things either.
Yes, the pill has risks (may increase risk for uterine and breast cancer, smokers should definitely not take the pill, has some mild side effects), but those risks for most women are far outweighed by its benefits. For many women, the fact that the pill helps prevent pregnancy is an added perk, not the main reason it’s been prescribed to them. Currently, many insurance plans (including mine) cover the pill, when properly prescribed (with a co-pay of course).
Now we come to Viagra. Viagra is covered by insurance companies. I have no problem with that. It's prescribed to treat a medical condition and many men need it. No argument there. (And, I’m sure there are plenty of happy women out there who have no issue with Viagra or the fact that it’s covered by insurance.) But here’s the thing, Viagra is prescribed to treat:
- erectile dysfunction
That’s it. Yes, I've heard that Viagra is also showing promise in treating depression in women, and that’s great. Depression is a big problem in this country, so I’m not joking when I say that if Viagra can also be prescribed to help treat depression in women, bravo. But, we all know THAT’S not what it’s being manufactured or chiefly prescribed for. I have not been able to find one other prescribed use for Viagra, other than to help a man achieve and/or maintain an erection. And not to make light of this, but I’m all for a good erection. Not having a penis, but understanding its importance and affect on the male psyche, particularly if it's not functioning properly, I don’t begrudge a man his Viagra.
But here’s my question – in the battle between oral contraceptives, Viagra and moral dilemmas:
is the same pharmacist who refuses to dispense birth control pills on moral (religious) grounds going to ask a man presenting his Viagra prescription whether he’s married? If he’s not married, why does he need Viagra? Is he having sex outside of marriage? That’s a sin too, no? Is he going to ask him if he’s in a marriage between one man and one woman? Because anything else is a sin also, no? Or, is he going to ask if he’s having sex with another man?
An oversimplification? Hardly.
Am I joking? Oh hell no.
Where do we draw the line? One question begets the next ... if a pharmacist claims moral high ground, then he’d better be prepared to dispense that morality equally across the board ... will he stop selling condoms too? Because they were specifically designed to prevent pregnancy (and nowadays, to prevent the spread of sexually transmitted diseases, now also a critically important function).
Where does the moral dilemma end and the discrimination begin?
And a reminder to pharmacists everywhere who took an oath:
Oath of a Pharmacist
At this time, I vow to devote my professional life to the service of all humankind through the profession of pharmacy.
I will consider the welfare of humanity and relief of human suffering my primary concerns.
I will apply my knowledge, experience, and skills to the best of my ability to assure optimal drug therapy outcomes for the patients I serve.
I will keep abreast of developments and maintain professional competency in my profession of pharmacy.
I will maintain the highest principles of moral, ethical, and legal conduct.
I will embrace and advocate change in the profession of pharmacy that improves patient care.
I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.
Developed by the American Pharmaceutical Association Academy of Students of Pharmacy/American Association of Colleges of Pharmacy Council of Deans (APhA-ASP/AACP-COD) Task Force on Professionalism; June 26, 1994 (Emphasis added.)
I’m sorry – I just do not read anything in that oath that specifically allows a pharmacist to exclude ANY medication properly prescribed by a doctor, whether the pharmacist believes that it is or is not for a medically necessary reason. I also don’t read anything in that oath that states that you get to refuse dispensing a properly prescribed medication based on a religious belief. In fact, I don't see any mention of God, The Bible (Talmud, Koran), or religion of any sort in that Oath.
Not to mention that, by refusing to fill my prescription, you are, at the same time, putting my health at risk. Or is that kind of collateral damage acceptable?
I guess my point is – if it causes you any discomfort because your religious beliefs run counter to the oath you took and/or your job description, GET ANOTHER FUCKING JOB. Please, stay out of my vergeegee, my politics, my religion and my life. Do your job, fill my prescription, or lose your job.
Yes, it really is THAT black and white.
P.S. I did not touch on Plan B (commonly known as the "morning after" pill), most commonly prescribed to rape victims to prevent a pregnancy resulting from the rape. Not because it’s not important – it is. But for me it falls under the broader category of oral contraception, because that’s the category in which it is defined and how the HHS proposal references it in its description of oral contraception (quoted above).
One thing to add: I have never had a problem filling my birth control prescription. And God help the wo/man who refuses to fill my Rx...
Oh, and - HAPPY BIRTHDAY BARACK OBAMA!