TWENTY-THREE states are currently considering legislation that explicitly grants pharmacists the right to trump a patient's access to healthcare through refusing to fill prescriptions based on religious, moral or ideological grounds.
"Refusal clauses" for pharmacists already exist in 10 states, allowing the pharmacist to refuse to fill any legal prescription for contraceptives due to moral objections.
A pharmacist is, of course, entitled to his or her own conscience. However, a pharmacist who refuses to fill a prescription based on personal moral beliefs is inflicting those values on both the patient and doctor. This is unethical, as the pharmacist's personal beliefs should not override the joint decision of the doctor and patient.
In four states -- Mississippi, Arkansas, South Dakota and Georgia -- the refusal clause is even broader, allowing pharmacists to refuse to fill "any prescription based on his or her moral beliefs." Unlike the other six states with similar clauses, the pharmacist is not limited to refusing just prescriptions for contraceptives.
This notion is particularly dangerous. Where does one draw the line? If a pharmacist is allowed the freedom to reject any prescription, then a pharmacist could theoretically also refuse to dispense AIDS medication if he or she subscribes to the view that those suffering from AIDS do not deserve treatment because they are suffering from a punishment for immoral behavior.
According to The Washington Post, women in at least 12 states have encountered pharmacists refusing to fill their prescriptions. According to Karen Pearl, national president of Planned Parenthood, "some women are being denied birth control and the pharmacists keep their prescriptions. They are also being given moral lectures, religious lectures."
Last year in Denton, Texas, a woman was raped and prescribed emergency contraception by a local hospital. She was turned away by three pharmacies before eventually having her prescription filled. Two of the pharmacies claimed they don't stock the drug and at the third, not one of the three pharmacists on duty would fill her prescription. All three cited religious convictions.
Luckily, the woman was in reasonable distance from a fourth pharmacy that filled the prescription in less than five minutes. However, especially in rural communities, there is often a lack of alternatives. There are numerous reports from organizations which attempt to track prescription refusal, such as Planned Parenthood, of women unable to obtain birth control and traveling for hours to another pharmacy. This is of crucial importance in the case of emergency contraception which loses its effectiveness the longer after intercourse a woman takes it.
As long as a prescription is legal and does not interfere with any other medication the patient is taking, the pharmacist should not interfere with dispensing the drug. Perhaps one of the pharmacists in Texas would not have objected if they knew the woman had been raped, however, pharmacists should not reserve the right to demand to know why a woman is taking birth control.
Pharmacists refusing to fill prescriptions and subsequently subjecting women to lectures on the immorality of their actions is highly unethical and far beyond the job description of a pharmacist. A patient does not visit a pharmacist to seek moral counseling.
Recognizing the need for standards governing the practice, a law was implemented in Illinois on April 1 that requires pharmacists to fill all prescriptions in a timely manner. The law mandates penalties for refusal, ranging from a fine to a revocation of the pharmacy's license to dispense medicine.
The controversial law was signed by Gov. Rod Blagojevich after two women complained that a pharmacist had refused to fill their prescriptions for emergency contraception. According to The New York Times, as of April 19, two more women in Illinois have filed complaints of prescription refusal.
So what can be done to ensure patients are being treated fairly by their pharmacists? Following Illinois' example to mandating by federal law that prescriptions are filled would solve the problem. While many advocate the refusal clause as an issue of state's rights, allowing states to decide whether and how to implement such laws results in a few fundamental problems.
Most states have the de facto policy of allowing pharmacists to refuse, so long as someone else on duty or another pharmacy will fill the prescription. But this policy is too ambiguous. In rural communities, where there is only one pharmacy within a reasonable distance, a patient should not be required to drive for hours to fill a prescription.
Everyone reserves the right to his or her own beliefs. However, the policy of prescription refusal is both unethical and unjust. Patients are not prescribed a healthy dose of morality by their doctors, so pharmacists should not dispense morality by imposing his or her personal beliefs on the patient.
Sophia Brumby's column appears Fridays in tTe Cavalier Daily. She can be reached at sbrumby@cavalierdaily.com.
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