“Moral” Objections to Vital Care

When Pharmacists Refuse to Fill Prescriptions

Across the country, pharmacists are becoming the new ground troops in the right-wing war on women’s rights and health. Rather than filling prescriptions for birth control, a growing number of pharmacists are now giving lectures instead.

In West Virginia, a pharmacist refused to fill Joanna’s prescription and lied about the effects of the contraceptive prescribed to her. “She took me aside and explained to me that she shouldn’t fill my prescription because my birth control method could cause a miscarriage and birth defects. I felt as if I was trying to do something illegal, when I was doing something that should be considered very responsible for someone who is not yet ready to bring a child into the world.”

Despite the critical role contraception plays in ensuring the reproductive health of women and allowing couples to plan their families, a growing number of pharmacists across the country have been denying women their birth control pills. In addition, many have refused to let other pharmacists fill the prescriptions in question or to refer the customers to other pharmacies—effectively barring women from obtaining their pills. These pharmacists attempt to justify their actions with their conservative moral and/or religious beliefs that they believe trump patients’ right to obtain prescribed medications.

The bottom line? The “pharmacist refusal” movement is a direct threat to the relationship between patients and their physicians, as well as women’s legal right to birth control.

“Right of Conscience” pharmacist

In December 2008, President Bush announced a new policy through the Department of Health and Human Services (HHS) that seriously endangered women’s reproductive health. The “right of conscience” rule required any clinic, pharmacy, or hospital that received federal funding to allow employees to refuse any care that they found morally objectionable. Included in the list of threatened services were infertility treatments, birth control, and emergency contraception.

Doctors and nurses have had the right to refuse to perform abortions since Roe vs. Wade legalized abortion in 1973. Although advocates of the HHS regulation claimed it was simply intended to protect this right, those familiar with the policy understood its true implications.

Fortunately, President Obama rescinded the odious HHS regulation and returned moral judgment to the women seeking care. In February 2011, HHS enacted a new rule acknowledging that the term “abortion” in federal refusal laws does not include contraception.

Emergency Contraception

With the introduction of emergency contraception (also known as EC, the morning after pill, or its brand name, Plan B), women have an unprecedented ability to protect themselves from unwanted pregnancy, particularly after experiencing rape or contraceptive failure. The drug has been available by prescription since 1999, and over-the-counter for women 18 and older since 2006. A federal judge ordered in 2009 that the drug be made available over-the-counter to 17-year-olds. He also ordered that the agency consider expanding over-the-counter access to women of all ages. However, in December 2011 HHS Secretary Kathleen Sebelius overruled a Food and Drug Administration decision that would have permitted the over-the-counter sale of emergency contraception to all women, regardless of age.

The active ingredient in Plan B—progestin— is one of the two hormones in birth control pills. Dr. Robert Kauffman, professor and director of reproductive medicine and infertility at Texas Tech University Health Sciences Center in Amarillo, said, “If birth control pills have not proven to be dangerous in teenagers, why would Plan B?”

Plan B is kept behind the counter so pharmacists may verify customers’ ages. Yet pharmacists across the country are abusing their power and refusing to dispense emergency contraception to women of qualifying ages. Plan B is a time-sensitive drug. It is most effective when taken within 24 hours after unprotected intercourse, and significantly less effective after 72 hours. Therefore, a pharmacist’s refusal or reluctance to provide it can be detrimental, especially to rural and lowincome women who may have limited resources and nowhere else to buy the medication.

Some pharmacists invoke personal moral or religious beliefs—preaching rather than providing—while others simply lack adequate information about the drug. In many cases, both are true. Beverly Schaefer, a pharmacist from Seattle, says, “When I go to national meetings for pharmacists I hear all of the misconceptions. I think that the biggest misconception about EC is that it will interrupt a pregnancy or cause an abortion.” In fact, emergency contraception has no effect on an established pregnancy—it simply prevents ovulation if a woman is not already pregnant.

Until recently, emergency contraception was not required to be available to women stationed overseas in the Armed Services. This is especially alarming given the high rate of sexual assault among active duty troops. The military estimated that in 2010, 19,000 sexual assaults occurred. Fortunately, in 2010 the Department of Defense introduced a new policy mandating that all U.S. military health facilities worldwide carry Plan B.

“Pro-Life” Pharmacies

A new breed of pharmacy is cropping up across America. The organization Pharmacists for Life International lists seven “pro-life” pharmacies on its website, but claims that many more exist, both nationally and internationally. One such pharmacy opened in a Washington, DC suburb in the summer of 2008. The drug store did not carry contraceptives of any kind, including condoms. It was forced to close in 2010, citing insufficient business.

Many are concerned by the rise of these pharmacies. “I’m very, very troubled by this,” said Marcia Greenberger of the National Women’s Law Center, a Washington advocacy group. “Contraception is essential for women’s health. A pharmacy like this is walling off an essential part of health care.”

A pharmacist’s job is to dispense medication for which patients have a prescription. Pharmacists who refuse to stock birth control pills because of moral objections are essentially refusing to do their jobs. “If you are a health-care professional, you are bound by professional obligations,” said Nancy Berlinger, deputy director of the Hastings Center, a bioethics think tank. “You can’t say you won’t do part of that profession.”

Worrying that anti-contraception pharmacists will curb women’s access to full reproductive health care, Greenberger warns, “We’ve seen an alarming development of pharmacists over the last several years refusing to fill prescriptions, and sometimes even taking the prescription from the woman and refusing to give it back to her so she can fill it in another pharmacy.”

Pharmacology is a hard science. There is no room for personal convictions or religious beliefs in science, especially when women’s health is at stake.

The Legal Lowdown

Most states have regulations that implicitly require pharmacists to fill all valid prescriptions. Six states, however, protect pharmacists who refuse to dispense emergency contraception: Arizona, Arkansas, Georgia, Idaho, Mississippi, and South Dakota. Five states (Colorado, Florida, Illinois, Maine, and Tennessee) have “conscience clauses” that do not specifically mention pharmacists, but could be interpreted to include them.

In order to protect every American’s right to birth control, Congress must act. Several members of the U.S. House and Senate have filed legislation to address the issue, but most of these bills have expired in committee.

Public opinion polls have shown that the American people overwhelmingly condemn pharmacist refusal or “conscience clauses.” An August 2006 poll by The Pew Research Center for the People & the Press found that 80 percent of Americans believe pharmacists should not be able to refuse to sell birth control based on their religious beliefs. This was true across political party lines and religious affiliations.

Americans understand the vital role pharmacists play in helping us and the people we care about stay healthy. Pharmacies, after all, exist so that people can easily access the medications they need. When we go to the drugstore to obtain our prescribed medications, we should be confident that we’ll get them. Just the pills—not a lecture.

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