Wednesday, March 30, 2005

Pharmacists balk at filling some prescriptions because of beliefs
The Boston Globe
Pharmacists balk at filling some prescriptions because of beliefs

By Rob Stein, Washington Post | March 30, 2005

WASHINGTON -- Some pharmacists around the country are refusing to fill prescriptions for birth control and morning-after pills, saying that dispensing the medications violates their personal moral or religious beliefs.

The trend has opened a new front in the nation's battle over reproductive rights, sparking an intense debate over the competing rights of pharmacists to refuse to participate in something they consider repugnant vs. a woman's right to get medications her doctor has prescribed. It has triggered pitched political battles in State Houses across the nation as politicians seek to pass laws either to protect pharmacists from being penalized or force them to carry out their duties.

''This is a very big issue that's just beginning to surface," said Steven H. Aden of the Christian Legal Society's Center for Law and Religious Freedom in Annandale, Va., which defends pharmacists. ''More and more pharmacists are becoming aware of their right to conscientiously refuse to pass objectionable medications across the counter. We are on the very front edge of a wave that's going to break not too far down the line."

Clashes are occurring more frequently. Pharmacists often risk dismissal or other disciplinary action to stand up for their beliefs, while shaken teenage girls and women desperately call their doctors, frequently late at night, after being turned away by sometimes lecturing men and women in white coats.

''There are pharmacists who will only give birth control pills to a woman if she's married. There are pharmacists who mistakenly believe contraception is a form of abortion and refuse to prescribe it to anyone," said Adam Sonfield of the Alan Guttmacher Institute in New York, which tracks reproductive issues. ''There are even cases of pharmacists holding prescriptions hostage, where they won't even transfer it to another pharmacy when time is of the essence."

That's what happened to Kathleen Pulz and her husband, who panicked when the condom they were using broke. The Walgreens pharmacy near their home in Milwaukee refused to fill an emergency prescription for the morning-after pill.

''I couldn't believe it," said Pulz, 43, who with her husband had long ago decided they could not afford a fifth child. ''How can they make that decision for us? I was outraged."

Supporters of pharmacists' rights see the trend as a welcome expression of personal belief. Women's groups see it as a major threat to reproductive rights. ''This is another indication of the current political atmosphere and climate," said Rachel Laser of the National Women's Law Center in Washington. ''It's outrageous. It's sex discrimination. It prevents access to a basic form of healthcare for women. We're going back in time."

The issue could intensify further if the Food and Drug Administration approves the sale of the Plan B morning-after pill without a prescription, a step that would probably make pharmacists the primary gatekeeper.

The question of healthcare workers refusing to provide certain services first emerged among doctors, nurses, and other healthcare workers over abortions. The trend began to spread to pharmacists with the approval of the morning-after pill and physician-assisted suicide in Oregon, with support from such organizations as the Pharmacists for Life International.

''Our group was founded with the idea of returning pharmacy to a healing-only profession. What's been going on is the use of medication to stop human life," said Karen L. Brauer, the group's president, who was fired from a Kmart pharmacy in Delhi, Ohio, for refusing to fill birth control prescriptions.

No one knows how often that is happening, but cases have been reported across the country, including in Massachusetts, California, Washington, Georgia, Illinois, Louisiana, Texas, New Hampshire, Ohio, and North Carolina. Advocates on both sides say the refusals appear to be spreading.

Eleven states are considering ''conscience clause" laws that would protect pharmacists like Noesen. Four states have laws that specifically allow pharmacists to refuse to fill prescriptions that violate their beliefs. At the same time, at least four states are considering laws that would require pharmacists to fill all prescriptions.

The American Pharmacists Association recently reaffirmed its policy that pharmacists can refuse to fill prescriptions as long as they make sure customers can get their medications some other way. That can include making sure another pharmacist is on duty or another pharmacy nearby is willing to fill the prescription.

Large pharmacy chains, including Walgreens, Wal-Mart, and CVS, have instituted policies that try to balance pharmacists' and customers' rights.

Women's advocates say such policies are impractical, especially late at night in emergency situations involving the morning-after pill, which must be taken within 72 hours.