Pill of Rights
Pieces first started popping up a few months back about pharmacists refusing to issue birth control pills, and the most recent treatment of the burgeoning phenomenon shares the same infirmity as those earlier pieces (and polls). That is, they tend to focus on the useless question of whether pharmacists "have a right" to fail to dispense birth control or the morning after pill, without clarifying whether they mean:
(1) Should the state require pharmacists to dispense those medications?—or
(2) Is a pharmacy entitled to require its employees to provide customers with the medication on pain of dismissal?
The answer to (1) is clearly "no": If someone wants to provide a limited set of services in accordance with the dictates of his conscience, it's not the state's business to tell him he's got to violate his belief system to do more if he's going to ply the trade at all. But the answer to the second question is equally clearly "yes": You can't insist that a company continue to employ you if you're going to refuse to serve their customers at your discretion. Now, practically speaking, consideration (2) will probably end up being dominant: It's not in CVS's interest to refuse to sell a legal product to willing customers. Unfortunately, states seem to be considering legislation that would ignore that distinction in both directions: Some would seek to immunize pharmacists who refuse to do their jobs as a matter of purported freedom of conscience, while others would define every pharmacists job to conflict with that conscience.
Now, again, I don't expect pharamcists who presume to judge and lecture their customers to last long. But let them be punished by the market; let them be pushed into penury by their own indignant customers rather than granting their presumption the glow of martyrdom.
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Given how popular birth control pills are, is there really any point to laws that punish pharmacists who don't prescribe it? Yes, I know, undoubtedly there's a handful of people in small towns with bad insurance who will be at the mercy of pharmacists who don't sell the pill. Still, I'd imagine that such pharmacists will be rare, because most pharmacists will have a very strong incentive to provide the pill. It's not like pharmacists who refuse to sell contraception are only losing out on that particular medication. I'd guess that most customers will go elsewhere for all of their prescriptions and whatever else they buy from drug stores.
Besides, I'm sure there are some people in Canada who will be happy to ship birth control pills to women who can't get them from the local pharmacist.
So, I'd say that the market forces here are all pointing in the direction of greater access to contraception.
No one has the right to deny medication to someone who is legally entitled to it. If I sought to fill a prescription for some sort of hemorrhoid remedy, should I have to listen to a lecture about why queers like me shouldn't be engaging in anal sex? All of these cases involve some blowhard male telling a young woman that she's evil, and all the support comes from men as well. Why aren't women allowed to go about their lives without having to put up with "advice" from patriarchial assholes every time they want to get laid? How about libertarianism for both sexes?
If the "conscience law" passes, I plan to convert to Christian Science, get a pharmacology degree, land a job, and then insist that my conscience forbids me to give out ANY medication at all.
Also, if a pharmacist, say, refuses to give the "morning-after" pill to a young woman who consequently gets pregnant, I think the woman should be allowed to sue the pharmacist for either childcare costs or the cost of an abortion, in addition to lost wages, and pain and suffering.
Jennifer,
That would be sweet, You could sit behind the counter, looking at internet porn, and say "Beat it iron lung! I can't in clear conscience give you any pills. Praise the lord."to any pain in the ass customers who screw up the flow of your day.
I saw the President of Pharmacists for Life this morning on CNN. She didn't have the guts to be honest about her position, instead harping on "the potential health risks that women who use birth control aren't aware of" . She wouldn't just say "because I believe that orthonovum makes the baby Jesus cry." I went from disrespecting their opinion but defending their rights to saying "fuck it, if they won't be honest about it, they don't deserve any protection".
Jennifer,
That's no different then saying the woman should be able to sue a doctor who refuses to give her an abortion. You're way off base with that line of thinking. Julian's reasoning is sound. Let the market decide.
"No one has the right to deny medication to someone who is legally entitled to it."
When the discussion is about abortion, the refrain I keep hearing is that whether or not the fetus has any rights is irrelevant because the mother's right to choose has to trump whatever right the fetus might have. In other words, the mother cannot be forced to keep the fetus alive. So why doesn't the pharmacist have a similar right not to be forced to assist the contraceptor. I would have thought the right to engage in contracepted intercourse was somewhere lower on the scale than the right to live--not that it matters if the paramount right is the right to choose. But for some reason that right doesn't seem to be one that a pharmacist has. What happened?
The wrench in the works is that Pharmacy is a heavily regulated profession. Limited numbers of people are licensed by the state to correctly dispense medications as prescribed by a physician. It's nice if one customer gets all their meds from the same pharmacist, so that he can double-check for adverse combinations.
So, I don't have a problem if the hand of God, State or CVS smites some pharmacist who will not dispense the meds as written. These guys are paid in large part by Medicare, and therefore they have to play by whatever rules the State makes up.
At the same time, I have never seen a doctor's office that wasn't stuffed to the gills with sample packs of oral contraceptives. Surely a pack or two can tide over the rural woman until she gets her prescription filled by mail order.
Bubba, it's not quite that simple, the pills are not all the same. It's difficult to switch form one med to another. Most birth control pills have to be administered in measured doses over the course over a month. Messing with the dosage can play all sorts of havoc with a woman's menstrual periods.
I agree with the general consensus here, but with one qualifier. I hear about stupid, moralist pharmacist fucks who not only refuse to fill a prescription, but have the balls to withhold the paperwork so the patient can't go elsewhere. In those cases, the assholes should be sued out of existence.
Fuck these moralizing pharmacists. Like smokers, they already knew the prevalence of the meds long before they went into business. Same goes for any conflicts with new drugs such as the morning after pill, those conflicts have existed forever.
Most pharmacists would be out of work if it wasn't for the insane regulation of drugs, I think it's safe to say most customers would prefer to get everything OTC. A pharmacist's main "value add" is to be consulted on the effects of medications, but 90% of their function is to be a cop (including filling out insurance paperwork).
I agree with bubba. It would be all good and well if the legal barriers for entry to the practice of pharmacology were as low as, say, massage therapy, but they're not. Pharmacies are in most respects analogous to public utilities and should be obliged to offer services in the same manner: if a customer has a valid prescription and money to pay, they get the product they're asking for, end of story.
Seamus,
But isn't Julian allowing pharmacists that right? They don't have to assist the contraceptor, but should they choose that route the pharmacy can certainly fire them.
Or are you endorsing the more obstructionist route Mr. Nice Guy refers to? Julian, would you agree that such an obstructionist pharmacist should be subject to (civil) state sanction as well as firing? It does seem that once a pharmacist acts to foil a customer's efforts to obtain medication, he/she has crossed a line.
bubba raises a point I was wondering about. Pharmacists are heavily regulated, and I don't anything about how large the pool of pharmacists is -- As a result, letting the market sort things out might be quite a disruptive process. I think this would impact the elderly the most, as a revolving roster of pharmacists would surely play havoc with ensuring the consistency of their medication. Maybe somebody should point this out to the them.
Anon
Anon-
Yeah, sure. A pharmacist is no more entitled to refuse to transfer your paperwork than the guy at the parking garage can decide he's grown fond of your car stereo.
I wouldn't agree with state sanction for the mere denial of medication because in that case we would still be using the state to enforce the values of the group over the individual. Thes store should be able to fire them (although one would expect religious anti-discrimination lawsuits to result). In the case where the pharmacist take your prescription away, and refuses to give it back, they should lose their license.
That is the thrust of the legislation proposed, that one pharmacist can effectively block a person from ever having a presciption filled because they don't agree with the intended use.
I do find it interesting that most(all) of the Pharmacists for Life argument hinges on birth control. If they divisified their stance they could probably gain more sympathy.
Is this a summer re-run column? I thought this was already covered. Anyway, if you don't agree with the ethics , find another line of work.
I just had a creepy thought.. sometime in the future some moralist pharmicist refuses to give back my medical MJ prescription..
eyes bulging.. veins popping..
MP-
There IS a difference with my example. Morning-after contraception only works for a limited time, and if the only pharmacist in town refuses to dispense it, a woman out in the sticks is screwed. Frankly, since pharmacists have to be licensed, I think they should have their license taken away if they refuse to give prescriptions that hurt their widdle sensibilities, just as I'd think a male doctor who converts to Islam and refuses to treats female patients should also lose his license.
A family member of mine recently encountered a GYN who apparently felt the need to offer Catholic approved advice to patients on the appropriate way to handle birth control. Strange choice for a career, I know. There is apparently some sort of organization out there of such creatures.
The market did exactly what it was supposed to in this case. This provider is relegated to a boutique status, and another provider was chosen instead. Just like magic.
Jennifer-
Your example about the morning after pill does raise a good point, because it is so time-dependent. So I can see how some women might be at the mercy of that pharmacist, and so (hypothetically) one could argue in favor of regulating the only pharmacist in town in those cases.
But there is a third option that gets us out of the regulate or not dilemma: Some people are pushing to let doctors prescribe a larger quantity of the morning-after pill pre-emptively, rather than one at a time. In that case women wouldn't have to hope that they're near a sympathetic pharmacist after each incidence of unprotected sex.
I think this solution is superior to mandatory dispensing for a numer of reasons. First, free market yadda yadda yadda. More importantly, on a pragmatic note, it gives women more flexibility. Laws requiring a pharmacist to dispense the medicine are of no use if the woman can't find a doctor to prescribe it in time, or the pharmacy is closed during a blizzard (a real possibility in the rural areas where your proposed regulation might be needed), or whatever else.
As to Muslim doctors refusing to treat women: My understanding is that in strict Muslim countries it's usually the government that prohibits male doctors from treating women, not the doctors themselves. And my mother recently had a rather, um, sensitive surgery performed by a doctor from Pakistan. He was more thorough than some of the American-born doctors she's worked with. (She's a nurse, so she's seen her share of bad doctors.)
Thoreau-
But pre-emptive prescription would only help those who knew in advance that they'd be having sex. I read of one pharmacist who refused to give the morning-after pill to a RAPE VICTIM. Besides, those who say "let the free market solve all ills" are basically saying "pharmacists, not doctors or patients, ultimately have the right to decide which medicines people receive."
And yes, I know most Muslim doctors are no more sexist or racist or anything-else-ist than anyone else. That was just an example I pulled off the top of my head.
Jennifer,
You are dangerously close to asserting a right to a morning after pill. Any other merchant can refuse to sell tobacco products for strictly ideological reasons. A smoker in the throes of a nic fit may think this is entirely unfair. I'm not ready to say that morning after pill good, cigarrette bad, so we all can force someone to provide us with one and not the other.
You are dangerously close to asserting a right to a morning after pill. Any other merchant can refuse to sell tobacco products for strictly ideological reasons. A smoker in the throes of a nic fit may think this is entirely unfair. I'm not ready to say that morning after pill good, cigarrette bad, so we all can force someone to provide us with one and not the other
Sure. And when I go to the emergency room, the doctor there would be FULLY within his rights not to treat me because he doesn't believe in "interracial medicine".
That'll be some great comfort as I fucking BLEED TO DEATH.
Jennifer-
Pre-emptive issuance of morning after pills to rape crisis centers might also be helpful.
Basically, I'm saying that with so many legally mandated barriers to receiving the morning after pill, it's better for first focus on those obstacles rather than force somebody to dispense it if he or she has personal issues with doing it. Let's remove those barriers and make it available in enough channels so that the handful of pharmacists who object are irrelevant.
Jason Ligon-
If you can link to a study showing that doing without a cigarette will make it impossible to avoid an unwanted pregnancy, I'll fully accept your analogy.
Y'know, I can nic fit with the best of 'em, but I think the comparison of emergency contraception for a rape victim to a craving for a pack of smokes is in poor taste. That said, though, there are all sorts of medications a pharmacist might not stock at any given time; we don't think this constitutes an abrogation of patients' rights. And if the one phramacist in town either doesn't carry or won't dispense a morning after pill, well, my recollection is that the window is 72 hours (48 for maximum effectiveness), and I expect that for the vast majority of people in the U.S., that's time to find another pharmacy in the general vicinity; maybe the next town over.
And keep in mind that I'm not convinced that the free market is the ultimate solution on each and every problem facing the world. But I am convinced that when there's a product that A LOT of people would find useful, and there are restrictive laws standing between people and that product, the priority should be on removing those laws and letting the product get into as many distribution channels as possible.
If, after the market has done what it can, a lot of people still aren't served then we can talk about doing something more. But let's let the market work here rather than propose laws to control the behavior of those who are able to control distribution under the current laws. I'd rather pull the rug out from under them.
For the people in the sticks,(red states, I presume) the petty side of me says "serves them right" for giving the fundamentalists their "mandate".
I agree with thoreau. we should stop regulating drugs based on "moral" arguments to the point where they're over the counter, and the pharmacists cease to be part of the picture. After all, why would a person need a prescription for the morning after pill, if not for the need to try to prevent them from getting it in time?
The abortion comparison is completely bogus. Birth control pills in of themselves are not what anyone would consider an immoral act. Having sex for any purpose other than reproduction is the immoral act, and choosing whether to engage in that would be the equivalent of choosing whether to perform an abortion.
If the pharmacist was forced to fuck the birth-control recipients, then the comparison might hold some water. For the record: I am all for a pharmacists being allowed to choose who they want to have sexual relations with.
Is it too late to jump in and say that drugs shouldn't be regulated? The only exceptions I see are antibiotics and antivirals, where misuse by individuals lessens their effectiveness for everyone.
Maurkov-
I agree! Although I would want to keep the antibiotic regulations as light as possible, at least with antibiotics you can argue that misuse directly harms other people.
Anyway, let's pull the rug out from under the theocrat pharmacists by opening up other channels. If, after the market has done what it can, there are still a lot of people cut off from morning after pills then we can talk about other stuff. But the laws seem to be a far more serious barrier to access than theocrat pharmacists.
'Besides, those who say "let the free market solve all ills" are basically saying "pharmacists, not doctors or patients, ultimately have the right to decide which medicines people receive."'
This is is like saying, 'stores, not customers, have the right to decide what color underwear people receive.'
Jason-
You're in love with the bad analogies today, are you not? Is there any evidence that a woman who can't buy a particular color of underwear RIGHT NOW will be unable to avoid an unwanted pregnancy as a result?
Julian/Jennifer:
I can accept the burden of making an analogy in poor taste. I suppose it doesn't help my case too much to say that I did it on purpose?
The fact of the matter is, the drug is a commodity and not a right. I find myself making obnoxious analogies like this in the Right to Free Medicine debate, as well. People respond to criticisms of the free for all debate with, "But People will DIEEE!" If you don't go all the way out there with them, they feel as though they have you at a point where you abandon the market. At some point, I think it is important to be up front about the idea that such a response is completely irrelevant to the argument being made.
If I don't think that any other form of medicine, even that which would save someone's life, creates an affirmative burden on suppliers to always carry and dispense, I don't see how I can go there for the morning after pill. There should certainly be no state restrictions on the attainment of such medicines if supply and willingness to sell permit, but that is as far as I am willing to go.
Apologies if I have upset anyone's sensibilities here.
"You're in love with the bad analogies today, are you not? Is there any evidence that a woman who can't buy a particular color of underwear RIGHT NOW will be unable to avoid an unwanted pregnancy as a result?"
It is a bad analogy as long as I do not concede the point. Let me be explicit. This:
"Is there any evidence that a woman who can't buy a particular color of underwear RIGHT NOW will be unable to avoid an unwanted pregnancy as a result?" is completely meaningless to anyone who believes that a drug is a commodity. Nevermind pregnancy, if that drug would save your life, I STILL don't think your demand places an affirmative burden on someone to provide it to you.
"Sure. And when I go to the emergency room, the doctor there would be FULLY within his rights not to treat me because he doesn't believe in "interracial medicine"."
Sigh. Sad to say, this is correct to the extent that the doctor is employed at a private hospital willing to put up with such things. Your need does not create an affirmative obligation for someone else to fix you up.
Jennifer-
Jason's bad analogies aside, you still haven't addressed my suggestion that mandatory dispensing vs. optional dispensing is a false dichotomy. If contraceptives of all sorts (including the morning after pill) were more easily available through more channels, pharmacists who refuse to dispense it would be less of an issue.
As it is, I'm guessing that most women in the US already can get to more than one pharmacy. The biggest problem in access to the morning after pill is frequently the difficulty in getting to a doctor in time.
Really, mandatory dispensing seems like a way to apply a little more pressure to a clogged pipe. Sure, it will get a little more through, but removing the clog would be much better.
Thoreau-
I freely agree with the notion that with the exception of antibiotics and antivirals, drugs shouldn't be available on a prescription-only basis, but since they are I'm trying to make the system AS IT STANDS less likely to harm people.
Jason-
Couldn't your examples be just another way of saying "A pharmacist has a RIGHT to a particular job even if he doesn't want to do all aspects of it?"
Jennifer-
One need not abandon prescriptions completely to liberalize access to contraception. For instance, one could allow doctors to prescribe several doses of the morning after pill in advance. Or, for rape victims, make the pill available through emergency rooms, clinics, and rape crisis centers as well as pharmacies.
Or do something truly radical like make this particular medication available over the counter, in which case you could go somewhere other than a pharmacy to buy it. Grocery stores, for instance, frequently sell over the counter drugs. The regimen of prescription drugs would still exist, it's just that this particular drug wouldn't be on that list.
As to contraceptives taken regularly instead of in emergencies, I still think market forces are sufficient there. Most women in the US aren't at the mercy of a single pharmacist who opposes birth control. And for those few who are in that situation, there's always mail order from Canada.* Regular birth control pills don't have to be taken under the same time constraint as the morning after pill, so one can afford to wait for the first order and then remember to order refills in advance.
*Yes, I know, it's technically illegal to order from Canada, but everybody's doing it. Thanks to the kind folks in Canada I'm going to avoid the family legacy of male pattern baldness.
...and if the medicines don't work as well as I'm hoping, I'll go the Moby route and shave my head completely. No comb-over for me!
Thank you for your honest intentions, thoreau. We can only hope that this will set a good example for other balding men across the world.
thoreau is right. There needs to be less restrictions on obtaining medicines in general, period. I don't even think that it should be illegal to order medicines online or from Cananada. Once we do away with these other, unneccessary restrictions on medication, we won't have to worry about putting more restricitions on private companies as well, because the companies that refuse to sell the wanted goods will just not survive if they can't satisfy market demand.
Speaking of demand, would anyone be interested in writing my IHS essays for me? I am feeling lazy and wealthy today.
How much are you offering?
"Couldn't your examples be just another way of saying "A pharmacist has a RIGHT to a particular job even if he doesn't want to do all aspects of it?""
I'm not saying that a pharmacist has a right to his job. I certainly don't believe that to be the case. I do believe that the pharmacist can choose which services and products he wants to offer, much like any other provider of any other good.
If no one wants to pay him for the limited service he provides, he can choose to go out of business or change his policy.
How much are you offering?
Uh, it depends. I'd have to see a copy of the essay in question, first.
[snicker]
I mean, if it's not up to my quality standards, I wouldn't want to be paying through the nose. It's just Quality Control. [I'm a capitalist, you know.]
I have to warn you, I have no idea what IHS even stands for. But I do work cheaply. 😉
David Macharelli,
The problem with the spokesperson's line of reasoning is that (a) there are very few drugs which don't have some risk associated with them and (b) that risk assessment should ultimately be up to the consumer (if the pharmacist is willing to sell her the drug).
David,
You can get shots that last around three months.
I have to warn you, I have no idea what IHS even stands for. But I do work cheaply.
David,
These are the ones I want to apply for:
http://www.theihs.org/subcategory.php/36.html?menuid=5
http://www.theihs.org/subcategory.php/35.html
These are the essays I need done:
Essay A: A brief statement, 500 words or less, about why you would like to participate in a seminar. You might discuss: what interests you about classical liberal ideas or the seminar topic; what intellectual figures or works have most contributed to your thinking on political, social, or economic issues; or what you hope to gain from your seminar experience.
*Essay B: A brief statement, 200 words or less, about your career interests. You might describe your career interests, discuss your plans for the next 2-5 years, or explain how your career plans relate to your seminar choice.
Whatever you make up I'm sure would be fine.
Gary, both Davids are me. lousy autofill.
The problem I had wasn't so much her line of reasoning as the unwillingness to admit the truth behind it. I feel that these drugs are presciption-only as a concession to the pro-life crowd.
I'm aware of the hormone shots as well. My point was that a woman can't just switch drugs at the drop of a hat. In the case of my girlfriend, she has had to switch a few times to minimize negative interaction with her seizure meds. Each time, it throws her whole body out of whack for a few weeks.
The first seminar is fascinating. I wish is was still in school, I'd love to go.
I'd write how I hoped to use the seminar to try to examine whether the cause/effect relationship between art and society truly exists. If it does exist is one exclusively the cause, or is the relationship more symbiotic. How does it compare with other societal forces? To explore what causes the fear and anger generated by films, novels whose protagonists exercise free choices that the fearful disagree with. I would end with how I'd like to use the data gathered to make my own work more resonant. Something like that.
David,
Just in case you're really interested, you don't have to currently be a student. You can be a "recent graduate", too (whatever that means) and still be accepted into a seminar. I am no longer a student myself. Thanks a lot for your input. The exploitive, capitalist pig in me really appreciates your help and will probably incorporate it into my essay, if I ever actually sit down and do it. The more honest,libertarian part of me is shaming and chiding myself for trying to pass off your intellectual work as my own. [Note To Self: For shame, smacky, for shame.]
Oh yeah...payment...I'll have to get back to you on that...must think of something really good...
No payment required. In a perverse reversal of Randian thought, I'm only really good at altruism. I just wish I could come up with ideas for myself as easily as I do to help others.
I was only half-serious about going. CA is across the country and I doubt I could get the time off.
BTW Your use of those ideas wouldn't be plagiaristic. It's just a rough outline of scattered thoughts. Any substance would be yours.
I was only half-serious about going. CA is across the country and I doubt I could get the time off.
Well, so am I, but I think it's worth a shot. Besides, they pay for your travel and accomodations. (Just more FYI)
Rhetorical Questions I Feel I Must Spout Aloud: What is it with working Americans who don't take their vacation time? Am I just spoiled since I work in the environs of easygoing research and can usually take time off on a whim? Is it a sinus headache I'm suffering, or something contagious? Why do they call it margarine? Am I still thinking out loud?
smacky,
To answer your first two questions, I have no clue. I work in the corporate world and have no problem using my vacation time when I want to (with sufficient warning of course), but some of my coworkers complain that they?re close to the limit of built up vacation, which takes 1-2 years to do depending on your pay grade. I?ve never even built mine up to 3 weeks, let alone the 4 -5 that you max out at. 4-5 weeks of vacation that needs to be used, talk about problems I wish I had.
"But isn't Julian allowing pharmacists that right? They don't have to assist the contraceptor, but should they choose that route the pharmacy can certainly fire them."
Julian is indeed allowing them that right, and that's fine, but I note that others expressing their views here are perfectly willing to have the state compel pharmacists to dispense contraceptives. I find that morally indistinguishable from requiring obstetricians to perform abortions, which come to think of it is something a lot of people would like to see too, but is something I find repugnant.
"Or are you endorsing the more obstructionist route Mr. Nice Guy refers to?"
No, of course not. That would be conversion of private property (that is, the written prescription).
In Denmark Pharmacies are reulated so much that you wouldn't believe it.
A pharmacy is a private business, but it MUST carry all approved pharmaceuticals - if they don't stock a particular kind, they can supply it within 24 hours. (usually less), as they get deliveries at least once a day.
The doctor (also a private business - even though all expenses are paid by the state) writes a prescription, and if she does not state otherwise the pharmacy MUST fill this prescription. The doctor can choose to mark the prescription - in which case the pharmacist must supply - or at least make an offer of - the cheapest brand of the prescriped drug.
The prices of drugs are determined once every 14 days - set by the pharmaceutical companies - the pharmacies are required by law to only mark up the drugs by a set percentage.
I'm not saying our solution is the best possible, but it certainly solves any problems with strange ideas in the head of pharmacists
/Soren
How hard can it be to run a dispensary? Don't you just count out pills from a big bottle and put them in a smaller bottle? I say de-regulate the pharmacy business. If artificial barriers to entry into the dispensary business were removed, I'd say let pharmacists trade or refuse to trade as they like. As long as they are operating under a state enforced monopoly, screw them.
"What is it with working Americans who don't take their vacation time?"
well, speaking as someone with almost 2 months of vacation time sitting about and no time off until june, there's no one else who can do what i do here. (aside from fucking off, that is)
on the plus side, i'll probably take a week in june, a week in august, and a week or two in december and carry the rest over.
Well in Denmark (once again with the nationalist propaganda) the law gives everyone 5 weeks of vacation time. Relatively recent most if all unions have effected a 6th week of vacation like time for most of the working force in Denmark. On top of that we have a 37 hour work week. But still the Economist put Denmark in top of the business climate
http://www.dr.dk/nyheder/penge/article.jhtml?articleID=244250
Soren