Tuesday, December 8, 2009

Should a pharmacist be able to refuse to fill a prescription?

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.


Kathy said...

But to the pharmacists in question, it is forcing them to participate in the murder of another human. Which should not be forced on anybody.

Amie Newman said...


I think you are mistakenly referring to RU-486 or the medication used for a medication abortion. The post above is about Plan B or emergency contraception. It is not the medication used for an abortion but, rather, it is a contraceptive method. You cannot get any sort of medication, from a pharmacist, that causes an abortion. This discussion is about whether or not pharmacists have the right to opt out of providing legal, safe, FDA approved birth control to the women of their community. There is no major, mainstream medical organization in this country that considers the results of using emergency contraception "the murder of another human."

Do pharmacists, ultimately, have the right to discriminate against women by refusing to provide EC? Personally, I would say that if a pharmacist has an issue with the provision of birth control to women, they should probably find another line of work as 98% of American women use birth control at some point in their lives - 98%! That means that women who consider themselves pro-life, pro-choice, religious or not - we're all using it. To deny services to women is unethical and, I believe, discriminatory.

Thanks for writing the post, Heather!

Amie Newman
RH Reality Check

Anonymous said...

I find this rule very distressing, because my rather troubled and religiously fundamentalist sister-in-law works at a pharmacy. So I know how judgmental and misinformed even a professional can be. She would refuse everyone EC if she was permitted to- because she thinks that people should "suffer the consequences of their actions." I find her viewpoint repugnant. She doesn't know if someone repeatedly needs EC because they are making poor choices, or, let's just say as an extreme... if someone is being raped by their own abusive father.

And, yes, frankly I do think she should find another job where she is not pitting her ideas against other people's legal rights and needs.

Sam said...

I agree with you Amie. I cannot understand asking an individual to drive across town, to another town, to another county, etc... to have access to birth control.

Chris Niedland said...

These Pharmacists are not there to play "god" with these people's lives-they are there to fill prescriptions for the paying customer-that's all. If they have a problem with that, then they need to find another line of work. The medical profession is just that....a business-not a church.

Kathy said...

Actually, you can get Cytotec from a pharmacy, which does cause abortions.

But, it depends on how you define the various terms. In the mid-60s, obstetricians successfully redefined pregnancy as starting not with conception (which was the time it historically was considered to have started), but after the fertilized egg implanted, which meant that anything that interferes with implantation is technically not abortifacient -- even though it stops a new developing human from being able to live and develop further. But if life begins at conception, then preventing that new life from implanting in the uterus, the sole way this new life can continue to live, then, yes, it is interfering with that, and causing the death of the genetically unique human.

I agree that there is a double-standard in a pharmacy dispensing and stocking standard birth control pills but not plan B, because BCPs can also interfere with implantation. It's not the primary method of pregnancy prevention (supposedly), but it is one of the secondary or tertiary methods -- and the same with Plan B. The only difference might be the percentage of the time that BCPs prevent implantation as opposed to that of Plan B. For instance, if Plan B worked to delay or prevent ovulation 10% of the time and prevent implantation 90% of the time, that might make a difference in people's minds, as opposed to BCPs preventing ovulation 90% of the time and only preventing implantation 10% of the time. [Hypothetical numbers.]

What if euthanasia or "assisted suicide" were legal -- would you suggest that doctors be required to assist in ending the person's life, though s/he were morally or ethically opposed to it? After all, it's a medical condition -- they are there to do what the patient wants, not play God. What if any doctor in the state could be required to come and execute a criminal by lethal injection, although s/he was opposed to the death penalty, or thought the person to be convicted was not guilty? After all, it's a legal decision; what does ethics, morality or religion have to do with it? What if a doctor felt that abortion was murder, but a woman wanted to abort her 20-week fetus after finding out that the baby was a girl, and not the boy she wanted? That's a medical decision -- who cares if it's discriminatory against infant women -- they're there to perform a medical function for a paying customer -- that's all. It's a business -- no room for morals or ethics in business, eh? Especially in the business of medicine? (Which leaves me wondering why you find ethicists in hospitals, helping to make decisions in hospital policy.) Frankly, I think we need a heapin' helpin' of ethics particularly in medicine!

I've met numerous people who never knew that chemical birth control (not just pills, but all forms) could allow ovulation but prevent implantation; many were upset that they were never told of that possibility. Most stopped taking it after finding it out, because they could not in good conscience use it. So, just because 98% of women use it, it doesn't mean that they were fully informed of the consequences of it -- especially if doctors and pharmacists don't know (because of the above definition of pregnancy and abortifacients).

To require people to assist in what they consider to be murder is unethical and most certainly discriminatory.

Melissa Garvey said...

Please remember the first rule in the Midwife Connection Code of Conduct: Be respectful of others, especially when disagreeing with them. Be courteous to every blogger and reader, even those whose beliefs you think are false. Debate is great, but express your opinion about a person's ideas, not about them personally. The complete guidelines are available at http://www.midwife.org/blog_code_of_conduct.cfm.