Instances of individual pharmacists refusing to fill prescriptions for family planning and emergency contraception continue to occur throughout the nation, 1 despite experts on the pharmaceutical profession stating that pharmacists are "expected to exercise special skill and care to place the interests of their clients above their own immediate interests." 2 A recent court case found that such refusals fall short of the professionally required standard of care, but, in some states, recently proposed legislation seeks to grant pharmacists this option to refuse.
Pharmacists who refuse to dispense prescribed contraception argue that they have a right to act in accordance with their own belief system. For example, in January of 2004, a Texas pharmacist refused to provide emergency contraception (EC) to a rape victim because "his religion said she shouldn't have it." Then, in March, another pharmacist in Texas refused to fill a married woman's birth control because it went against his own beliefs. 3 In Ohio , a pharmacist was fired for refusing to dispense hormonal contraception to a patient and has since sued the company for dismissing her. The pharmacist claims that using this form of contraception is a form of abortion, which contradicts with her personal beliefs. 4 "Medical associations, government agencies, and many religious groups agree that [emergency contraception] is not akin to abortion. 5 In many cases of pharmacist refusal, pharmacists rely upon medically inaccurate information such as this pharmacist's position to support their choices.
In February 2005, Wisconsin Administrative Law Judge Collen M. Baird ruled that a pharmacist who refused to fill or transfer a college student's prescription for birth control "fell far short of satisfying the standard of care" required of pharmacists based on the pharmacists' code of ethics. 6 She continued by stating that the pharmacist did not do enough to guarantee that the woman had another way to fill her prescription and recommended that his pharmaceutical license be restricted for at least two years. The judge explicitly stated that the pharmacist's testimony "gave the distinct impression that satisfying his own moral code was his only concern." 7
Some of these pharmacists also rely on refusal clauses to justify their actions. Refusal clauses, sometimes called "conscience clauses" by anti-choice groups, debuted in 1973 following the landmark decision in Roe v. Wade. Adopted by the federal government and most U.S. states, this type of legislation was intended to allow doctors to refuse to participate in abortions.8 This legislation, however, does not usually apply to pharmacists, nor do pharmacists generally participate in abortion procedures. Pharmacists' practices are regulated by state boards of pharmacy, and, while these regulations differ among states, they commonly require a pharmacist to dispense all medications for which he/she is licensed. 9 To date, only Arkansas , Mississippi , and South Dakota have laws permitting pharmacists to refuse to fill prescriptions for contraception.10
During the 2004 legislative session, however, 13 more states introduced legislation that would allow pharmacists to refuse to fill oral contraception. Several states, including Rhode Island and Vermont , have already introduced legislation in the 2005 legislative session that, should it pass, would allow a pharmacist to refuse to dispense contraception and even to refuse transferring a prescription to another pharmacy due to the "religious, moral, or ethical principles held by a health care provider." 11
This type of legislation is criticized by both medical professionals and sexual and reproductive health advocates for permitting a pharmacist to interfere with the patient/physician relationship. A recent article of the New England Journal of Medicine (NEJM) states that such laws frequently fail to address the "potential for abuse by pharmacists." 12 The NEJM article explains that emphasizing a right to refuse a patient her prescription may allow for and respect the "autonomy of pharmacists, but diminishes their professional obligation to serve patients." 13 The professional association of pharmacists, the American Pharmaceutical Association (APhA), has adopted a policy that "recognizes the individual pharmacist's right to exercise conscientious refusal and supports the establishment of systems to ensure patient access to legally prescribed therapy without compromising the pharmacist's right of conscientious refusal." 14
William Smith , vice president for public policy at the Sexuality Information and Education Council of the U.S. (SIECUS) stated, "the practice of refusing to fill a woman's prescription becomes especially dangerous in sexual assault situations when access to emergency contraception (EC) is especially time-sensitive." Smith continued, " when a pharmacist is allowed to interject his/her beliefs into a relationship of trust between a doctor and his/her patient, it unnecessarily hinders that patient's access to necessary medical treatment."
For more information, refer to the National Women's Law Center ( www.nwlc.org ).
1 "Although the total number of incidents is unknown, reports of pharmacists who refused to dispense emergency contraception date back to 1991." Julie Cantor and Ken Baum, "The Limits of Conscientious Objection - May Pharmacists Refuse to Fill Prescriptions for Emergency Contraception?," New England Journal of Medicine 351.19 (4 November 2004): 2008.
2 Ibid., 2009.
3Politics of Birth Control - Access Denied in Texas , accessed 17 March 2005, < http://www.ppnt.org/default.asp?pageid=1370 >.
4 Cynthia L. Cooper, Suit Claims Using Birth Control Pills is Abortion (24 April 2001), accessed 17 March 2005, < http://www.womensenews.org/article.cfm?aid=527 >.
5 Julie Cantor and Ken Baum, "The Limits of Conscientious Objection - May Pharmacists Refuse to Fill Prescriptions for Emergency Contraception?," New England Journal of Medicine 351.19 (4 November 2004): 2009.
6 Stacy Forster, "Reprimand Advised for Pharmacist - Beliefs, Duties clash; He Refused to Fill Birth Control Oder," Milwaukee Jounral-Sentinel , 28 February 2005, accessed 4 March 2005, < http://www.jsonline.com/news/state/feb05/305752.asp >.
8 Adam Sonfield, "New Refusal Clauses Shatter Balance Between Provider 'Conscience,' Patient Needs," The Guttmacher Report on Public Policy 7.3 (August 2004): 1.
9 Susan A. Cohen, "Objections, Confusion Among Pharmacists Threaten Access to Emergency Contraception," The Guttmacher Report on Public Policy 2.3 (June 1999): 2.
10 Julie Cantor and Ken Baum, "The Limits of Conscientious Objection - May Pharmacists Refuse to Fill Prescriptions for Emergency Contraception?," New England Journal of Medicine 351.19 (4 November 2004): 2008.
11 Information obtained via the LexisNexis database.
12 Julie Cantor and Ken Baum, "The Limits of Conscientious Objection - May Pharmacists Refuse to Fill Prescriptions for Emergency Contraception?," New England Journal of Medicine 351.19 (4 November 2004): 2010.
14 Susan A. Cohen, "Objections, Confusion Among Pharmacists Threaten Access to Emergency Contraception," The Guttmacher Report on Public Policy 2.3 (June 1999): 2.