Pharmacist Knows Best? Women Beg to Differ

December 17, 2004

An alarming trend has been making news recently. It's nothing new; in fact, it's been going on for years. We're talking about the Pharmacists' Refusal Clause—referred to by its anti-choice advocates as a conscience clause—which allows pharmacists to refuse to fill certain prescriptions because of their own "moral objections" to the medication. Only a handful of states have passed refusal clause legislation specific to pharmacists, but more and more state legislatures are considering adding it, an effort that the majority of people living in the U.S. oppose.

Over the past several years, a series of incidents have been reported of pharmacists refusing to fill women's prescriptions for emergency contraception, also known as the morning-after pill or "EC." Some pharmacists, however, have also refused to dispense regular oral contraceptives. In some of these cases, the pharmacists who refused service were fired, but in many others, no formal actions were taken. As a result, some patients have left their pharmacies empty-handed and confused about what to do next.

According to the ethics policy of the American Pharmacists Association, which represents over 50,000 members, a pharmacist who refuses service must make arrangements to ensure that patients get their medications, which include giving the prescription to another pharmacist at the same location or referring the customer to another pharmacy. The group claims this has not been a serious problem and that they are aware of fewer than ten incidents where a pharmacist has stepped away from providing medication and then obstructed or hindered a patient from obtaining the medication elsewhere.

There are a number of reasons why the Pharmacists' Refusal Clause is problematic. The most targeted drug, EC, is a time-sensitive medication which must be taken within 72 hours of intercourse to most effectively prevent conception. A woman's likelihood of becoming pregnant increases the longer she waits to take EC. Women who are refused the medication by one pharmacist may not have the ability to obtain it from another pharmacy before time runs out. Women who live in rural areas, especially, are at a disadvantage since they may not have multiple pharmacies in their areas. And poor women may not have transportation or the additional time or money needed to track down a cooperative pharmacy.

Refusal clauses added to state legislation are nothing new. Six months after Roe v. Wade was decided in 1973, most states voted to introduce some kind of refusal clause into their laws to prevent medical providers from being required to perform abortions. However, each state's laws are worded differently, covering different health-care providers and procedures. According to the latest reproductive rights reports, only three states' laws—South Dakota, Mississippi, and Arkansas—allow pharmacists who object to dispensing certain medications to refuse service, but since EC has been approved by the Food and Drug Administration as a prescription drug, more states are considering adding Pharmacists' Refusal Clauses to their legislation.

A 2002 report by the American Civil Liberties Union's Reproductive Freedom Project showed that the majority of those living in the U.S. overwhelmingly opposed allowing health-care providers to deny services on the basis of religious or moral objections. Those polled especially objected to refusals that would interfere with a woman's access to reproductive health-care services, with 86 percent opposed to allowing pharmacies to refuse to fill prescriptions they object to on religious grounds.

Pharmacists for Life International, an organization made up of more than 1,600 pharmacists and their supporters, is one of the major advocates for the Pharmacists' Refusal Clause. Their web site calls for a "conscience clause" to be added to state laws immediately, and the ultra-conservative language they use to make their case is indicative of the brutal fight in store for reproductive health advocates.

Pharmacists for Life International states that pharmacists can "refuse to cooperate knowingly with the evils of contraception, abortion, euthanasia and assisted suicide, among others, in violation of their sincerely held religious moral or ethical beliefs." Furthermore, the group asserts that "it is not an inconvenience to refuse to refer such a client [to another pharmacist] since the pharmacist is doing the woman and her preborn child a favor in terms of physical and spiritual health."

"These refusal clauses are another example of ultra-conservatives trying to deny women control over their own bodies. They can't have it both ways. If they want abortion rates to decline, then they can't keep opposing birth control and emergency contraception," said NOW President Kim Gandy. "As for these so-called 'moral' pharmacists, I'd like to know if any of them have objections to filling prescriptions for Viagra. I suspect not."