Druggists Refuse to Give Out Pill

Newspaper article

By: Charisse Jones

Date: November 9, 2004

Source: Jones, Charisse. "Druggists Refuse to Give Out Pill." USA Today (November 9, 2004): A3.

About the Author: Charisse Jones is a national correspondent for USA Today and is a former staff writer with the New York Times. She is the co-author of Shifting: The Double Lives of Black Women in America.

INTRODUCTION

After the Supreme Court's 1973 Roe v. Wade decision on abortion in the United States, many states adopted "refusal laws," laws that gave health care providers the right to refuse to perform an abortion or to assist in the performance of an abortion, and for hospitals to refuse to allow abortions to be performed on their premises. These laws gave healthcare providers a choice to act—or not act—based on their personal, religious, or philosophical beliefs.

In 1998, South Dakota became the first state in the nation to adopt a "conscience clause" for pharmacists who did not want to dispense birth control pills or emergency "morning after" pills. Like the refusal laws, conscience clauses are designed to give pharmacists a choice in administering medications that conflict with the pharmacists' personal, religious, or philosophical beliefs. Four states—Arkansas, Georgia, Mississippi, and South Dakota—now have laws that protect a pharmacist from liability associated with refusing to dispense medications based on personal choice.

More than thirty other states either have "conscience clause" bills or, on the other side of the debate, bills requiring pharmacists to dispense medication regardless of personal, religious, or philosophical belief. Throughout 2003, 2004, and 2005, news media outlets published increasing numbers of stories describing contraception prescriptions and "morning after" pill prescriptions that were denied by pharmacists on personal ethical grounds.

PRIMARY SOURCE

For a year, Julee Lacey stopped in a CVS pharmacy near her home in a Fort Worth suburb to get refills of her birth-control pills. Then one day last March, the pharmacist refused to fill Lacey's prescription because she did not believe in birth control.

"I was shocked," says Lacey, 33, who was not able to get her prescription until the next day and missed taking one of her pills. "Their job is not to regulate what people take or do. It's just to fill the prescription that was ordered by my physician."

Some pharmacists, however, disagree and refuse on moral grounds to fill prescriptions for contraceptives. And states from Rhode Island to Washington have proposed laws that would protect such decisions. Mississippi enacted a sweeping statute that went into effect in July that allows health care providers, including pharmacists, to not participate in procedures that go against their conscience. South Dakota and Arkansas already had laws that protect a pharmacist's right to refuse to dispense medicines. Ten other states considered similar bills this year.

The American Pharmacists Association, with 50,000 members, has a policy that says druggists can refuse to fill prescriptions if they object on moral grounds, but they must make arrangements so a patient can still get the pills. Yet some pharmacists have refused to hand the prescription to another druggist to fill.

In Madison, Wis., a pharmacist faces possible disciplinary action by the state pharmacy board for refusing to transfer a woman's prescription for birth-control pills to another druggist or to give the slip back to her. He would not refill it because of his religious views.

Some advocates for women's reproductive rights are worried that such actions by pharmacists and legislatures are gaining momentum. The U.S. House of Representatives passed a provision in September that would block federal funds from local, state and federal authorities if they make health care workers perform, pay for or make referrals for abortions.

"We have always understood that the battles about abortion were just the tip of a larger ideological iceberg, and that it's really birth control that they're after also," says Gloria Feldt, president of Planned Parenthood Federation of America. "The explosion in the number of legislative initiatives and the number of individuals who are just saying, 'We're not going to fill that prescription for you because we don't believe in it' is astonishing," she said.

Pharmacists have moved to the front of the debate because of such drugs as the "morning-after" pill, which is emergency contraception that can prevent fertilization if taken within 120 hours of unprotected intercourse.

While some pharmacists cite religious reasons for opposing birth control, others believe life begins with fertilization and see hormonal contraceptives, and the morning-after pill in particular, as capable of causing an abortion.

"I refuse to dispense a drug with a significant mechanism to stop human life," says Karen Brauer, president of the 1,500-member Pharmacists for Life International. Brauer was fired in 1996 after she refused to refill a pre-scription for birth-control pills at a Kmart in the Cincinnati suburb of Delhi Township.

Lacey, of North Richland Hills, Texas, filed a complaint with the Texas Board of Pharmacy after her prescription was refused in March. In February, another Texas pharmacist at an Eckerd drug store in Denton wouldn't give contraceptives to a woman who was said to be a rape victim.

In the Madison case, pharmacist Neil Noesen, 30, after refusing to refill a birth-control prescription, did not transfer it to another pharmacist or return it to the woman. She was able to get her prescription refilled two days later at the same pharmacy, but she missed a pill because of the delay.

She filed a complaint after the incident occurred in the summer of 2002 in Menomonie, Wis. Christopher Klein, spokesman for Wisconsin's Department of Regulation and Licensing, says the issue is that Noesen didn't transfer or return the prescription. A hearing was held in October. The most severe punishment would be revoking Noesen's pharmacist license, but Klein says that is unlikely.

Susan Winckler, spokeswoman and staff counsel for the American Pharmacists Association, says it is rare that pharmacists refuse to fill a prescription for moral reasons. She says it is even less common for a pharmacist to refuse to provide a referral.

"The reality is every one of those instances is one too many," Winckler says. "Our policy supports stepping away but not obstructing." In the 1970s, because of abortion and sterilization, some states adopted refusal clauses to allow certain health care professionals to opt out of providing those services. The issue re-emerged in the 1990s, says Adam Sonfield of the Alan Guttmacher Institute, which researches reproductive issues.

Sonfield says medical workers, insurers and employers increasingly want the right to refuse certain services because of medical developments, such as the "morning-after" pill, embryonic stem-cell research and assisted suicide.

"The more health care items you have that people feel are controversial, some people are going to object and want to opt out of being a part of that," he says.

In Wisconsin, a petition drive is underway to revive a proposed law that would protect pharmacists who refuse to prescribe drugs they believe could cause an abortion or be used for assisted suicide. "It just recognizes that pharmacists should not be forced to choose between their consciences and their livelihoods," says Matt Sande of Pro-Life Wisconsin. "They should not be compelled to become parties to abortion."

SIGNIFICANCE

The question of pharmacists' ethical rights vs. women's right to access physician-prescribed contraception or "morning after" pills emerged at the beginning of the twenty-first century as a major tipping point in the pro-choice/anti-choice debates in the United States. The American Pharmacists Association, the national professional association for pharmacists, issued a statement of ethics in 1998 that supports the right of a pharmacist to refuse to dispense a drug that conflicts with his or her personal beliefs, but also assigns responsibility to the pharmacist to make certain the patient has access to the drug requested.

The clause states that "APhA recognizes the individual pharmacist's right to exercise conscientious refusal and supports the establishment of systems to ensure patient access to legally prescribed therapy without compromising the pharmacist's right of conscientious refusal." The American College of Clinical Pharmacists also developed a clause of conscience, adopted in August 2005, which puts forth similar statements and also adds the requirement that pharmacists be clear and open about their beliefs with employers and colleagues so that patients' needs can be met without the conflict of conscience hindering patient access to prescribed drugs.

Groups such as Planned Parenthood, the National Abortion Rights Action League (NARAL Pro-Choice America), and the National Organization for Women (NOW) all condemn the actions of pharmacists who refuse to dispense contraception and "morning after" pills to women. These groups argue that women in rural areas are unfairly penalized for their pharmacists' choices. Finding another pharmacy with the needed drug is not easy in areas where the nearest pharmacy could be 100 miles away or inaccessible by public transportation. In addition, the increasing reports of pharmacists who violate the standard that the pharmacist protect the patient's right to access—by transferring the prescription to a different drugstore or handing the prescription to an on-site colleague for dispensing—lead women's rights groups to charge that this "conscience clause" movement is a stealth attempt at eroding a woman's right to access birth control.

Planned Parenthood issued a press release on February 3, 2006, that focused on Wal-Mart, the largest supplier of pharmaceutical drugs in the United States. The press release calls on Wal-Mart to begin stocking the "morning after" pill in its pharmacies, and highlights a lawsuit by three Massachusetts women against Wal-Mart for failure to do so. A portion of the statement reads: "[t]o be most effective, emergency contraception should be taken within 72 hours of unprotected intercourse or contraceptive failure. Because Wal-Mart has put so many smaller stores out of business, in a number of areas it is the only pharmacy for miles." Women's health advocates counter the question of morality by pointing to economics and access; if Wal-Mart is the only pharmacy in town, and all the pharmacists refuse to dispense a particular birth control pill or emergency contraception, where does that leave patients?

Other groups such as Pharmacists for Life International, which claims to have over 1,600 members on six continents, state that pharmacists should have legal protections for their personal choices. Karen L. Brauer, president of Pharmacists for Life International, was fired from her job as a pharmacist at a K-Mart in Ohio for refusing to dispense the "morning after" pill. Her group claims that pharmacists should have the freedom not to participate in the dispensing of drugs that they believe to cause actions that violate their personal beliefs.

In addition, some proponents of pharmacists' right to choose which medications to dispense question whether conscience clauses go far enough. Peter Kreeft, a professor of philosophy at Boston College, has written on this subject in Inside the Vatican magazine. Kreeft argues that requiring the pharmacist to refer the patient elsewhere is a violation of conscience as well, since it forces the pharmacist to facilitate the patient's access to a drug that conflicts with the pharmacist's personal ethics.

On April 1, 2005, Illinois Gov. Rod R. Blagojevich issued an emergency ruling requiring Illinois pharmacies to fill all prescribed medications; if a pharmacist objects to filling a particular medication, there must be another pharmacist on site who will fill it. Pharmacists for Life International condemned the Illinois ruling. On April 14, 2005, the backers in both houses of the U.S. Congress put forth a bill dubbed the Access to Legal Pharmaceuticals Act (ALPhA), designed to make access to properly prescribed medications of all kinds federal law.

FURTHER RESOURCES

Periodicals

Kantor, Julie, and Ken Baum. "The Limits of Conscientious Objection—May Pharmacists Refuse to Fill Prescriptions for Emergency Contraception?" New England Journal of Medicine 351 (November 4, 2004): 2008-2012.

Stein, Rob. "Health Workers' Choice Debated." Washington Post (January 30, 2006): A01.

Web sites

American College of Clinical Pharmacists. "Prerogative of a Pharmacist to Decline to Provide Professional Services Based on Conscience." 〈http://www.accp.com/position/pos31_200508.pdf〉 (accessed February 6, 2006).

Inside the Vatican. "Conscience and the Dictatorship of Relativism." 〈http://www.insidethevatican.com/articles/conscience.htm〉 (accessed February 6, 2006).

National Conference of State Legislatures. "Pharmacist Conscience Clauses and Legislation 2005." 〈http://www.ncsl.org/programs/health/conscienceclauses.htm〉 (accessed February 6, 2006).

Pharmacists for Life International. 〈http://www.pfli.org〉 (accessed February 6, 2006).