IMAGINE walking into your local pharmacy one afternoon, expecting to pick up a prescription that your doctor had called in for you the night before. When you arrive at the counter, the pharmacist promptly tells you that he will not fill your prescription because it could cause an abortion. You miss taking your daily birth control pill because of somebody else's moral dilemma, which could have consequences for your health. "Abortion?" you think to yourself. You had never thought of taking an oral contraceptive as abortion before.
As bizarre as this might sound, it reflects a growing trend in the pharmaceutical profession where pharmacists are making moral judgments regarding the medications that they dispense. The most common drug that pharmacists withhold from patients is birth control, but it also includes a range of other medications, from emergency oral contraceptives (the "morning-after" pill) to painkillers. It is hardly appropriate for health care professionals' personal beliefs to interfere with the professional relationships that they maintain with their patients.
At the heart of the issue regarding birth control is the ongoing debate over what defines an abortion -- more specifically, when a life begins. A growing number of people are citing fertilization as the beginning of life, and thus see hormonal contraceptives and the morning-after pill as capable of causing abortions.
This debate, while worthwhile, is not one that I'm interested in taking up here. The more immediate issue is whether health care professionals should allow their personal convictions to affect their work and the health of their patients. Not surprisingly, our conservative-leaning Congress has answered with a resounding "yes." In 2004, Congress passed the Abortion Non-Discrimination Act, which effectively removed sanctions blocking federal funding from medical institutions that refuse to provide abortion services, referrals, and training.
The issue has also been taken on by state legislatures. In July, Mississippi's state legislature enacted a statute that allows all health care providers to not participate in procedures that violate their convictions. Both Arkansas and South Dakota already had laws on the books with respect to pharmacists, and 10 other states considered similar statutes this year. Furthermore, it is the official policy of the American Pharmacists Association that pharmacists are not obliged to fill prescriptions that they object to on moral grounds. They must, however, make provisions that would allow their patients to obtain the drugs in question elsewhere.
The problem is that some do not, and measures to ensure that pharmacists do make referrals are not in place. The consequences of such behavior may vary based on factors like geography. For instance, women seeking out birth control in New York City have thousands of options as far as pharmacies go. If one's prescription is refused, she could simply take it elsewhere. The situation gets more complicated, though, in more rural, less densely populated areas. Generally, residents of these areas are also more likely to be more socially conservative than those who live in major metropolitan centers. If a druggist at a small town's locally-owned pharmacy refuses to fill a prescription for birth control, there may not be another pharmacy to refer the patient to. In this situation, the patient also has little recourse.
By putting this type of legislation into effect under the guise of protecting medical professionals, legislators are allowing them to enforce their moral convictions on others. In an interview with USA Today, Gloria Feldt, president of Planned Parenthood Federation of America, acknowledged that those leading the fight against abortion are also after birth control. "We have always understood that the battles about abortion were just the tip of a larger ideological iceberg," Feldt said.
There are other reasons why we should be wary of governmental protections of pharmacists' decisions. In certain cases, physicians prescribe oral contraceptives not for the purpose of preventing fertilization, but instead out of a medical need to regulate a woman's hormonal activity. Furthermore, this legislation creates somewhat of a slippery slope in terms of pharmacists' discretion. For instance, if a racist pharmacist was opposed to dispensing heart disease medication to blacks, could he refuse to do so based on so-called moral convictions? These statutes have implications that go far beyond advancing a pro-life agenda, and we must consider how much we will allow the government to interfere in our professional and medical business in the future.
Todd Rosenbaum's column normally appears Thursdays in The Cavalier Daily. He can be reached at trosenbaum@cavalierdaily.com.
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