Calling ahead - How hard is it?

Every retail pharmacist in every pharmacy around the world have dealt with this issue.

Patient comes in to the pharmacy and wants a refill. He has 0 refills left on his medication. You tell him that you need to request refills from the doctor. He gives you a blank stare with the response "but I'm out! ". Of course he wants his seizure or di-a-beetus medication (that he cannot go without). It can't be something stupid like Zantac or Vicodin.

When it comes to refills and calling ahead, patients fucking fail every single time. I mean the number of refills you have left on the bottle isn't a secret, it says right on the damn container. However patients, being the most retarded creatures on the planet, just don't "get it" that sometimes a little planning ahead goes a long way. Even if you put a big note on the Rx that you must call ahead to get refills they still pull this stunt!

Moreover, this puts pharmacists in a very interesting situation. Technically its illegal for us to fill an Rx that has no refills remaining without a doctors approval. The patient obviously doesn't have his bottles (you think he's going to make it easy for you?) with him, so you can't just put a few in there to last him. You have the following choices:

• Use a typical TAP Response: "Tough shit. I warned you the last 5 times you pulled this shit that you need to call ahead. A lack of planning on your part does not constitute an emergency on my part. Maybe after you seize or end up in the hospital you'll get the simple concept of calling ahead when you have 0 refills remaining. Quit crying, I don't care!"
• Waste the money on your labor, yet another vial, and another label for a whopping 4 tablets to advance him (since you obviously just cant dump tablets in his hands) until you get the OK from the Dr
• Fill the Rx anyways and deal with the doctor if he denies/changes it.
• Run and hide and let your tech deal with it.

Can't say what the right answer is. Obviously for controlled stuff (vicodin, etc) the backlash of filling it without an OK is greater than shit you can justify (BP, diabetes, seizure, etc). I mean really, if a patient has been on the same Tegretol dose for the last 5 years, there is a good chance that the doctor will okay it, however, that's illegal by the letter of the law, but allowing someone to seize because they are a dumbass is ethically not-right.

Breaking the law vs caring for your patient, where do you draw the line?