Last week, Missouri Gov. Mike Parson signed a bill that shields health care providers who prescribe off-label drugs to treat COVID-19. Studies show that the drugs in question — hydroxychloroquine and ivermectin — do not treat COVID-19 and may cause harm. Major medical and pharmacy organizations have urged members not to provide these drugs, but prescribing continues.
Missouri’s new law forbids pharmacists from questioning the physician or patient, and prevents professional boards from disciplining providers who prescribe or dispense the drugs.
This is not the first time legislators have veered too far into professional lanes. Lawmakers prohibit physicians from asking about guns in the home with physician “gag laws” and require physicians to share misinformation about abortion risks during pre-abortion counseling.
Notably, lawmakers have allowed pharmacists to impose their moral beliefs on patients. When pharmacists refused to dispense the morning-after pill in the early aughts, states adopted conscience clause laws to protect them. Republican supporters argued that pharmacists were professionals, not automatons, and their religious beliefs should shape their practice.
Today, the same lawmakers are singing a different tune. They are fine with pharmacists making moral decisions, but do not trust them to make health care decisions. They want to muzzle pharmacists who don’t support their political agenda.
I am a medical sociologist and my co-author is a pharmacist. We have grave concerns that these laws remove important guardrails that keep patients safe. Primary among them is pharmacists’ expertise.
The fundamental problem is that professionals are supposed to make decisions based on professional training and ethics, not cater to elected officials’ whims. Doing anything else threatens professional authority and undermines patient care.
Professionals are unique in that they have struck a bargain with the state. They regulate themselves but promise to act in the public interest. The job of state agencies such as boards of pharmacy and medicine is to protect the public from providers who would do them harm. Legislators who attempt to control professional behavior undermine this bargain and put patient health at risk, especially when the medications they support cause injury. Surely, patient care should depend on what is best for the patient, not political expediency.
Another hallmark of professional work is that professionals operate under formal codes of ethics. Legislative efforts threaten to undermine these as well. Most people know that health care providers are supposed to “do no harm.” However, they are also supposed to do good, ensure that everyone is treated fairly and respect patient autonomy. It might seem like patients who wish to take hydroxychloroquine and ivermectin should be able to. However, the principle of autonomy depends on informed consent. Health care professionals can fulfill their ethical obligations only if they ensure that patients know all possible benefits and harms associated with taking the drugs. This is exactly the information that lawmakers want to deny patients.
Health care providers might think that laws that constrain abortion providers or pharmacists have no bearing on their work. If you don’t work on politically-charged issues, why worry if lawmakers try to control professionals who do? However, laws like these create a slippery slope for further state infringement into professional territory. What will legislators try next? Health care providers must fortify boundaries around their work now so they don’t have to find out.
Certainly there are problems with professional self-regulation. Professionals do not always discipline one another as effectively as the public might hope, and these failures can result in patient harm. However, there is no reason to believe that adding political meddlers into the mix or weakening professional boards will make things better.
Legislators should stop practicing medicine via legislation and free physicians and pharmacists to do what they do best: patient care.