by Heather Bradford, CNM, ARNP
Chair, ACNM Government Affairs Committee
Here in WA State, a prescription refusal issue is working its way through the legal system. Many people are calling it “Refuse and Refer” claiming that it is appropriate for a pharmacy or a pharmacist to refuse to fill prescriptions to which they object on religious or moral grounds, and refer clients elsewhere. A few claim they should be able to refuse with no responsibility to refer at all.
A bit of history: In 2007, at the urging of Governor Christine Gregoire, the WA State Board of Pharmacy adopted two sets of rules governing pharmacy and pharmacist responsibilities to protect patients’ access to lawful prescription medications. Under these rules, a pharmacy can accommodate a pharmacist who objects to dispensing a medication as long as the pharmacy ensures the prescription is filled at that pharmacy in a reasonably timely manner.
Soon thereafter, two pharmacists and a pharmacy challenged these rules, arguing that that filling prescriptions with which they morally disagree violates their constitutional rights. Specifically, the issue was Plan B, as they considered it an abortion-producing drug. However, there are many other drugs that need to be filled in a timely manner, and whose efficacy (and therefore the patient’s health) is compromised by delay, such as drugs treating mental health and HIV.
One could also argue – how is this any different than health care providers being restrained in their practice to follow certain rules? If I am not an advocate of circumcision, should I be required to perform it?
Ultimately, however, I believe this is an access to care issue. I realize that for these pharmacists, it is a religious issue. But should a woman have to drive an extra 50 miles to get her Plan B? Can she afford the extra cost of gas? Will the next pharmacy be open? Will there be another pharmacist who objects there? Will she have an unwanted pregnancy that could have been avoided had the prescription been filled at the objecting pharmacy?
Note: A special thanks to Ann Darlington, CNM, from Seattle for following this issue closely and for keeping us WA State midwives aware and at “the table” of this hot topic discussion.