By Molly M. Ginty
Monday, May 2, 2005
As pharmacists in a growing number of states use "conscience clauses" to press the anti-choice agenda, the battle over how far pharmacists can go in blocking women's access to contraception is coming to a head.
(WOMENSENEWS)--In Laconia, N.H., a pharmacist denied a patient emergency contraception, forcing her to drive in vain around her rural area looking for another druggist to help.
In Menomonie, Wisc., a pharmacist refused to transfer a college student's birth control prescription elsewhere.
In Denton, Texas, a druggist refused to fill an emergency contraception prescription even though it was for a rape survivor.
These stories are among the 180 recently reported incidents of pharmacists denying women birth control pills or emergency contraception (a high-dose birth control pill that prevents the establishment of a pregnancy and is also called the morning-after pill) because pharmacists have moral or religious objections to these medications.
Within the past year, pharmacists have refused to dispense reproductive medications in 11 states.
Pro-choice advocates say these incidents--if left unchecked--could undermine reproductive rights as the shift to managed health care makes patient interactions with pharmacists more common and complex.
"In recent years, pharmacists have been taking on more responsibilities such as helping diabetics develop medication plans," says Adam Sonfield, a public policy associate for the Washington-based Alan Guttmacher Institute. "In some states, pharmacists are even being allowed to dispense emergency contraception without a doctor's prescription. Today, they hold more power over our medical decisions than ever before."
On the state as well as the federal level, this is helping to bring the battle over prescription access to a head.
"The anti-choice movement is using prescription access to advance its agenda," says Karen Pearl, interim president of the New York-based Planned Parenthood Federation of America. "But with new congressional legislation and with other initiatives, pro-choice organizations are fighting to prevent them from imposing their ideology on American women, 95 percent of whom use these medications at some point in their lives."
In mid-April, Sen. Frank Lautenberg (D-N.J.), and Rep. Carolyn Maloney (D-N.Y.), introduced bills that would require pharmacies to either fill these prescriptions immediately or forward them straight to other drugstores.
In recent years, a growing number of states have started adopting "conscience clauses" for pharmacists. "These laws say pharmacists can step out of the way, but can't get in the way," explains Rod Shafer of the Washington State Pharmacy Association.
Originally, these laws were meant to safeguard pharmacists who objected to dispensing drugs that could be used in assisted suicide (which Oregon legalized in 1994 and which other states have considered sanctioning).
But pro-choice advocates say that in recent years, policies designed to honor pharmacists' ethics have been used to fuel a disturbing trend.
"Just as anti-choice ambulance drivers have started refusing to transport patients for emergency abortions, anti-choice pharmacists have started exploiting existing pharmacy provisions and lobbying for new ones," says Eve Gartner, a senior attorney at the New York-based Planned Parenthood Federation of America.
"Pharmacists have been asserting their right to exercise conscience for decades," counters Casey Mattox of the Center for Law and Religious Freedom, an Annandale, Va., firm that represents druggists with objections to birth control pills and emergency contraception. "In fact, they have been refusing to dispense birth control pills since they were first developed 30 years ago. All that's new are laws that could force pharmacists to either fill prescriptions over their moral or religious beliefs or leave their profession."
In the past six months, 14 states have considered "conscience clauses" that would allow pharmacists to opt out of dispensing drugs to which they have ethical objections. Four states (Arkansas, Georgia, Mississippi, and South Dakota) have already enacted such laws. And four others (California, West Virginia, Missouri and New Jersey) are weighing laws that would protect customers' ability to get prescriptions filled.
The clash may be most contentious in Illinois, where Gov. Rod Blagojevich moved on April 1 to issue an emergency rule requiring pharmacies that carry contraceptives to fill birth control and morning-after pill prescriptions "without delay."
In mid-April, three Illinois pharmacists lashed back by suing Blagojevich, alleging that his rule violates laws on religious freedom.
"The political climate has brought us to a place where pharmacists feel emboldened to obstruct access to health care in the guise of religion," says Rachel Laser, senior council at the Washington-based National Women's Law Center.
The Chicago-based American College of Obstetricians and Gynecologists and the Bethesda-based National Institutes of Health both define pregnancy as beginning at implantation (when the united sperm and egg nest in the uterine lining). Some anti-choice pharmacists, however, define pregnancy as beginning earlier, when the sperm and egg first unite before implantation.
This difference is crucial when it comes to birth control pills and emergency contraception (which reduces a woman's risk of becoming pregnant if taken within 72 hours of unprotected sex). Both the pill and emergency contraception can prevent the united sperm and egg from implanting in the uterus, avoiding a pregnancy or preventing "life" as some anti-choice proponents define it.
The most vocal group of pharmacists espousing the pregnancy-at-fertilization argument is Pharmacists for Life International, an anti-choice organization based in Powell, Ohio, with 1,600 members on six continents.
The organization's current president, Karen Brauer, was fired in 1996 from a Kmart pharmacy in Delhi, Ohio, for refusing to fill a customer's birth control prescription then lying to the customer by claiming the pharmacy did not carry her medication in the first place. Brauer's case was one of the first incidents of pharmacy refusal and has been used as a rallying cry for her organization's cause.
Pharmacists for Life, which did not return Women's eNews' calls for comment, defends druggists' rights to not only refuse to fill prescriptions, but to refuse to transfer them to other pharmacies. On its Web site, the organization calls birth control pills "chemical abortion" an "evil" and a form of "baby killing."
Such extreme views are actually relatively rare among the country's approximate 200,000 pharmacists, says Kathy Besinque, an associate professor at the University of Southern California School of Pharmacy in Los Angeles.
"When it comes to birth control and emergency contraception access, surveys show that only 9 percent of pharmacists have qualms about these medications, but that even they are dispensing these drugs nonetheless," she said.
The Washington-based American Pharmacists Association maintains that pharmacists can refuse to fill prescriptions based on moral or religious objections, provided they have another pharmacist on hand to do the job or transfer prescriptions to a nearby pharmacy.
"If the pharmacist is the only one practicing in a rural area, he or she can alert local doctors and have them dispense medications instead," says Susan Winckler, a spokesperson for the association.
--With additional reporting by WeNews correspondent Cynthia L. Cooper.
Molly M. Ginty is a freelance writer based in New York City.
Alan Guttmacher Institute--
New Refusal Clauses Shatter Balance Between Provider 'Conscience,' Patient Needs:
Planned Parenthood Federation of America--
Refusal Clauses: A Threat to Reproductive Rights:
National Women's Law Center--
Pharmacy Refusal Project: