Sunday, April 03, 2005

Corner Pharmacist as Arrogant Morals Police

Another on-target New York Times editorial today....Moralists at the Pharmacy. This is an intimate decision that belongs a woman and her physician, not the corner pharmacist role-playing morals police.
Scattered reports suggest that a growing number of pharmacists around the country are refusing to fill prescriptions for contraceptives or morning-after birth control pills because of moral or religious objections. Although the refusals are cast as important matters of conscience for self-described "pro-life" pharmacists, they have the pernicious effect of delaying, and sometimes even denying, a woman's access to medications that may be urgently needed. This is an intolerable abuse of power by pharmacists who have no business forcing their own moral or ethical views onto customers who may not share them. Any pharmacist who cannot dispense medicines lawfully prescribed by a doctor should find another line of work.

Incidents in which pharmacists have refused to dispense contraceptives or morning-after pills have been reported for well over a decade, but the number may be rising. By one count there were some 180 reports of refusals in a six-month period last year, some describing earlier incidents, and the number is likely to grow now that religious conservatives are flexing their muscles in many spheres of life.

An organization of antiabortion pharmacists is pushing for professional associations and state legislatures to adopt "conscience clauses" recognizing the pharmacist's right to refuse to dispense a drug or even refer the customer to a pharmacist who will; many pharmacy associations have already adopted such clauses. Several states have laws granting pharmacists the right to refuse, and legislators in at least 10 states are pushing similar legislation.

Meanwhile, legislators in other states are trying to force pharmacists to fill valid prescriptions, and Gov. Rod Blagojevich of Illinois, responding to a Chicago pharmacist's recent refusal to provide contraceptives to two women, issued a rule on Friday that pharmacies must fill contraceptive prescriptions without delay. The nationwide struggle was described in a Washington Post article last Monday.

The most responsible conscience clauses try to balance the rights of the pharmacist and the rights of the clients by insisting that steps be taken to ensure patient access to legally prescribed therapy, either through another pharmacist at the same store or through another pharmacy. That may seem at first blush like a reasonable compromise but it is a prescription for disaster in the real world.

To begin with, some pharmacists are so certain of their moral high ground that they berate, belittle or lecture their customers. They are not likely to be helpful in guiding patients to alternative supplies of medications that they deem evil. Worse yet, if this movement picks up steam, right-to-life groups in some areas may pressure one pharmacy after another to refuse service, leaving a diminished pool of pharmacies available to fill prescriptions for birth control purposes. It is disheartening that Wal-Mart, for some years now, has refused to stock the morning-after pill.

In rural areas there may not be another pharmacy nearby, so customers who are turned away may go without the medication or waste time finding another pharmacy. In the case of the morning-after pills, which work best in the first 12 to 24 hours after a sexual encounter, delay could render the treatment ineffective.

Indeed, pharmacists who refuse to fill prescriptions for morning-after pills are inadvertently strengthening the case for providing them as nonprescription medicines on the open shelves. Such availability would allow women to get the pills promptly without going first to a doctor and then to a potentially obstructionist pharmacist.

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