Druggists refuse to give out pill
For a year, Julee Lacey stopped in a CVS pharmacy near her home in a Fort Worth suburb to get refills of her birth-control pills. Then one day last March, the pharmacist refused to fill Lacey's prescription because she did not believe in birth control.
"I was shocked," says Lacey, 33, who was not able to get her prescription until the next day and missed taking one of her pills. "Their job is not to regulate what people take or do. It's just to fill the prescription that was ordered by my physician."
Some pharmacists, however, disagree and refuse on moral grounds to fill prescriptions for contraceptives. And states from Rhode Island to Washington have proposed laws that would protect such decisions.
Mississippi enacted a sweeping statute that went into effect in July that allows health care providers, including pharmacists, to not participate in procedures that go against their conscience. South Dakota and Arkansas already had laws that protect a pharmacist's right to refuse to dispense medicines. Ten other states considered similar bills this year.
The American Pharmacists Association, with 50,000 members, has a policy that says druggists can refuse to fill prescriptions if they object on moral grounds, but they must make arrangements so a patient can still get the pills. Yet some pharmacists have refused to hand the prescription to another druggist to fill.
In Madison, Wis., a pharmacist faces possible disciplinary action by the state pharmacy board for refusing to transfer a woman's prescription for birth-control pills to another druggist or to give the slip back to her. He would not refill it because of his religious views.
Some advocates for women's reproductive rights are worried that such actions by pharmacists and legislatures are gaining momentum.
The U.S. House of Representatives passed a provision in September that would block federal funds from local, state and federal authorities if they make health care workers perform, pay for or make referrals for abortions.
"We have always understood that the battles about abortion were just the tip of a larger ideological iceberg, and that it's really birth control that they're after also," says Gloria Feldt, president of Planned Parenthood Federation of America.
"The explosion in the number of legislative initiatives and the number of individuals who are just saying, 'We're not going to fill that prescription for you because we don't believe in it' is astonishing," she said.
Pharmacists have moved to the front of the debate because of such drugs as the "morning-after" pill, which is emergency contraception that can prevent fertilization if taken within 120 hours of unprotected intercourse.
While some pharmacists cite religious reasons for opposing birth control, others believe life begins with fertilization and see hormonal contraceptives, and the morning-after pill in particular, as capable of causing an abortion.
"I refuse to dispense a drug with a significant mechanism to stop human life," says Karen Brauer, president of the 1,500-member Pharmacists for Life International. Brauer was fired in 1996 after she refused to refill a prescription for birth-control pills at a Kmart in the Cincinnati suburb of Delhi Township.
Lacey, of North Richland Hills, Texas, filed a complaint with the Texas Board of Pharmacy after her prescription was refused in March. In February, another Texas pharmacist at an Eckerd drug store in Denton wouldn't give contraceptives to a woman who was said to be a rape victim.
In the Madison case, pharmacist Neil Noesen, 30, after refusing to refill a birth-control prescription, did not transfer it to another pharmacist or return it to the woman. She was able to get her prescription refilled two days later at the same pharmacy, but she missed a pill because of the delay.
She filed a complaint after the incident occurred in the summer of 2002 in Menomonie, Wis. Christopher Klein, spokesman for Wisconsin's Department of Regulation and Licensing, says the issue is that Noesen didn't transfer or return the prescription. A hearing was held in October. The most severe punishment would be revoking Noesen's pharmacist license, but Klein says that is unlikely.
Susan Winckler, spokeswoman and staff counsel for the American Pharmacists Association, says it is rare that pharmacists refuse to fill a prescription for moral reasons. She says it is even less common for a pharmacist to refuse to provide a referral.
"The reality is every one of those instances is one too many," Winckler says. "Our policy supports stepping away but not obstructing."
In the 1970s, because of abortion and sterilization, some states adopted refusal clauses to allow certain health care professionals to opt out of providing those services. The issue re-emerged in the 1990s, says Adam Sonfield of the Alan Guttmacher Institute, which researches reproductive issues.
Sonfield says medical workers, insurers and employers increasingly want the right to refuse certain services because of medical developments, such as the "morning-after" pill, embryonic stem-cell research and assisted suicide.
"The more health care items you have that people feel are controversial, some people are going to object and want to opt out of being a part of that," he says.
In Wisconsin, a petition drive is underway to revive a proposed law that would protect pharmacists who refuse to prescribe drugs they believe could cause an abortion or be used for assisted suicide.
"It just recognizes that pharmacists should not be forced to choose between their consciences and their livelihoods," says Matt Sande of Pro-Life Wisconsin. "They should not be compelled to become parties to abortion."
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