Protecting pharmacists who refuse to fill valid prescriptions for legal drugs

| February 12, 2007 | 23 Replies

The Missouri legislature will soon consider Senate Bill 285 to protect the right of pharmacists who refuse to dispense birth control pills.  Here’s the text of the bill:

This act protects the conscience rights of pharmaceutical professionals. Such pharmaceutical professionals shall not be required to perform, assist, recommend, refer for, or participate in any service involving a particular drug or device that they have a good faith belief is used for abortions. In these instances, the pharmaceutical professional shall be immune from civil or criminal liability and will not have their license suspended or revoked.

As I’ve discussed before, many conservatives argue that birth control pills cause “abortions” because it is possible that they could cause a fertilized egg to fail to implant.  This is the reason that the hundreds of “Pregnancy Resource Centers” that dot the country refuse to tell their clients about the existence of birth control pills (and see here).  Instead, such fake pregnancy clinics recommend only “natural family planning” (formerly known as rhythm), which has a failure rate of 20% per year.  Is that the kind of birth control you want for your wife, girlfriend or daughter?

It’s important to note that anti-abortion sites freely admit that the “vast majority of women” using birth control pills are not causing “abortions,” however defined.

This proposed Missouri law, if passed, would invite the following conversation between an adult woman customer and a pharmacist:

[Woman]:  I’d like you to fill this prescription for birth control pills.  My doctor wrote this prescription for me.

[Pharmacist]: I won’t do that.  I have a good faith belief that you are using those pills to have abortions.  I’m the only pharmacist on duty at this store, so that’s the final answer.

[Woman]:  This is ridiculous.  Tell me where I can find another pharmacy that will fill this perfectly legal prescription.

[Pharmacist]:  I refuse to refer you to such an evil place, as I am entitled to do pursuant to Senate Bill 285.

[Woman]: I need to talk to your boss.

[Pharmacist’s Boss]:  I’d like to fire this guy, but Senate Bill 285 provides that if I fire him, he can sue me for triple damages plus attorneys fees.

To top off this insanity, many women take birth control pills for reasons other than avoiding pregnancy.

The hormones in “the Pill” can be used to treat some medical conditions, such as polycystic ovary syndrome (PCOS), endometriosis, adenomyosis, anemia related to menstruation, and painful menstruation (dysmenorrhea). In addition, oral contraceptives are often prescribed as medication for mild or moderate acne. 

For Wikipedia’s article on the main mechanism of birth control pills, click here.  

This bill is likely to be heard at the following place and time:

Hearing on Bills Regarding Reproductive Healthcare
Senate Judiciary and Civil and
Criminal Jurisprudence Committee
Capitol Building, Jefferson City, MO
Monday, February 19th, 6:00 pm

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Category: Politics, Reproductive Rights, Sex

About the Author ()

Erich Vieth is an attorney focusing on consumer law litigation and appellate practice. He is also a working musician and a writer, having founded Dangerous Intersection in 2006. Erich and his wife, Anne Jay, live in the Shaw Neighborhood of St. Louis, Missouri, where they are raising their two extraordinary daughters.

Comments (23)

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  1. Devi says:

    What if my religion believes that insulin is a tool of satan? Can a pharmacist of that religion refuse to fill a diabetic's prescriptions? What if I'm a jehovah's witness pharmacist and I extend the belief against blood transfusions to exclude anything that builds the blood. Can I refuse to fill the prescriptions of a cancer patient?

    What if my religion dictates no sex before marriage- can I refuse to fill a prescription to treat an STD when the patient is unmarried?

    Why pick on one prescription drug? Let's just let pharmacists override the doctor's decision anytime the pharmacist doesn't like the prescription.

    If the pharmacist doesn't want to do his/her job, for whatever reason, they should get a job at a fast food restaurant, where they can refuse to sell unhealthy food. Funny story: once at a McDonald's drive through I asked for salt. The attendant told me salt wasn't good for me (as she handed it to me). I told her that if she should not bring up the issue of health to her customers, or it would make us think twice about buying anything from McDonald's. She didn't get it.

  2. Dan Klarmann says:

    The wording of the bill is quite clever, intending to set as a legal precedent and tacitly define that an unborn from fertilized egg forward is a legal human being with full constitutional protection.

    <a href="http://www.senate.mo.gov/07info/pdf-bill/intro/SB285.pdf” target=”_blank”>www.senate.mo.gov/07info/pdf-bill/intro/SB285.pdf.
    The text also prohibits employers from assigning back-room positions to pharmacists who choose to deny service to customers for moral beliefs.

    Here's the guy who puts this on the program.

    This identical bill was voted down in 2006. We can hope that sense prevails.

  3. I strongly disagree with the statement that natural family planning (NFP) is only 80% effective. NFP can be 99% effective. Often forgotten, is the most natural of natural family planning methods called ecological breastfeeding or eco-breastfeeding. Nature intended mothers to go one or two years or more without menstruation due to breastfeeding. This natural infertility is a great baby-spacer. In addition, proper breastfeeding is the most effective for the first six months after childbirth. For info on all one needs to know about NFP and eco-breastfeeding, go to http://www.nfpandmore.org. The online manual is short, easy-to-read, and free.

    Sheila Kippley, volunteer for NFP International

  4. Mr. Smug says:

    Sheila:  The *FACT* is that natural family planning is approximately 80 percent effective. When citing statistics, be careful not to leave out the details, like the truth.

    See wikipedia before jumping to conclusions.
    http://en.wikipedia.org/wiki/NFP

  5. Erich Vieth says:

    Sheila: How is BFP/breasteeding supposed to prevent a woman from getting pregnant for the FIRST time?

  6. Devi says:

    Ms. Kippley,

    Some women are far more fertile than your personal experience suggests. My personal experience is quite different. I got pregnant on the 27th day of my cycle (I know that for sure because I hadn't had sex for a month). And when I was breastfeeding my first child, I got pregnant again when she was 8 months old, and before I had even resumed a single menstrual cycle.

    I have two aunts who had 12 children each. They both practiced 'natural family planning', too. After one of those aunts had the 12th, she began birth control pills and didn't have any more children (despite another decade plus of fertility). The second aunt didn't have any more children because her husband died in an accident while she was pregnant with the last child.

    So much for the ability to plan, or even space out pregnancies for some of us.

  7. grumpypilgrim says:

    Further to Dan's comment, even if a fertilized egg is legally defined as a human being with full constitutional protection, this still doesn't resolve the abortion question. See: http://dangerousintersection.org/?p=912.

  8. Vogon Barthovsky says:

    Sheila, so if NFP and breastfeeding make a woman infertile for 2 years then a woman will have "only" 10 kids from age 20 to age 40. Sounds like a good idea to me! College costs $40K a year now, so that's 4 million dollars per average family. Yup, a great idea.

  9. handheld says:

    i for one welcome a bill providing for moral objections. i work in an emergency room and i have a moral problem with treating holier-than-thou pharmacists that have been beaten up by already stressed and worried women trying to get the morning after pill.

  10. Robert Andersen says:

    Sheila Kippley,

    This nonsense that you espouse it about as useful as teaching abstinence. It is utter fecal matter. Am I a doctor? Nope. Am I a health care provider? Nope.

    Was my own mother told this tripe by her ob-gyn some 42 years ago? Yes. Do I have a sister who is 14 months my junior? Yessiree. Do the math. My sister was concieved a mere 5 months after my mother had given birth to me. My mother was a brest feeding Mom, for all three of her children.

    So, in conclusion the mere idea that breast feeding is any form of birth control is utter rubbish. I know from being the breast feed-ee.

  11. aggieben says:

    It sounds to me like people are put off by a law that would protect a pharmacist's ability to judge another person's behavior. I suppose that's a fair sentiment. What's more worrisome, though: a law protecting a pharmacist's ability to refuse service for a reason that is offensive to some people, or laws forcing a pharmacist to perform services he doesn't want to perform? The latter, and by far. What then? Are we going to force doctors to provide abortion services? What happens if one of the northeastern states legalizes infanticide? Are those doctors going to be forced to provide such services? Jeez people…just find another pharmacist. By the way…that imagined conversation in the parent is pretty blatant hyperbole. Find me a pharmacist that would respond that way, and I'll buy you dinner.

    As long as I'm in an argumentative mood, a little clean-up action for fun:

    The answer to all of Devi's questions is: "yes". That's what a free market means. Don't like it? Find another business to patron.

    Vogon: College most definitely does not cost $40K a year now. One can complete a 4-year degree for that much if he plans well. Some colleges may cost that, but saying what you said is like saying "buying a car costs $80K!" with a Cadillac XLR in mind.

    Sheila: I understand the sentiments of those who believe that NFP is the only moral category of birth control methods. However, it should be clear to anyone willing to believe empirical evidence that it simply isn't very effective when compared with modern biomedical techniques, such as hormone regulation (i.e., the pill).

  12. Mike B. says:

    As a graphic designer I was offered a position with a company with many diverse clients. One of the clients was Phillip Morris, the tobacco company. I was asked at the interview if I had any objections to creating ads that would promote the use of cigarettes, and I said that I did. I could still have taken the job but it would have made things difficult for them and for me to have to shuffle things around so that someone else would have to work with them. I ended up not taking the job due to other reasons but the point is how it relates to the issue at hand.

    The agency was nice to offer to make arrangements for me to not have to work with an objectionable company. They didn't have to do that. Most pharmacies wouldn't do that.

    If you are planning to be a pharmacist, you have to spend money and go to school for it. It's not a job you're forced to do, or that you drew from a hat or random lottery. During this schooling it should become painfully clear that you will be put into a position where you will have to dole out certain medications that could conflict with your personal beliefs. It is at this point where you should weigh the importance of your moral and spiritual beliefs with your need for gainful employment. If you can't do the job, do something else but don't subject your employer and the people whom you profess to want to help to your personal beliefs on how life should be lived.

  13. Jason Rayl says:

    Aggieben,

    A doctor is required to treat people who come to him, or refer them to someone who can (and will). Why should a pharmacist be any different? If your presumed "right" to refuse service to me violates my "right" to have access to perfectly legal service, then which right is based on a false standard of public ethics? Presumably, by comparison, a family of Christian Scientists has a right to deny medical attention for their children and, through prayer, let those children die–but the law of the land has found that no such right exists. The child didn't participate in that choice. The essence of this is that, in the case of legal services, one person may not make that choice for another, not even if related, unless specifically agreed by legal instrument between the individuals involved (living wills, etc). This is a nonsense argument that when removed from this context does not hold water. It is only in this area where anyone finds sympathy with such a position. Why is that? I suspect it has nothing to do with moral rights and everything to do with moral prejudice.

  14. Dr. Smug says:

    "Jeez people…just find another pharmacist"

    I have a problem with that statement. Pharmacies are created (by God) so that people can buy the medicine that they need. Why do you want to take God's medicine away from our children? That is anti-Christian more than killing babies is. That is downright facist…like saying "love it or leave it". Just a thought, not a sermon.

  15. grumpypilgrim says:

    Aggieben, you should not accuse others of "blatant hyperbole" when you so heavily rely on it yourself: your remarks about "one of the northeastern states legalizing infanticide" and "forc[ing] doctors to provide abortion services," obviously scream of hyperbole.

    Please leave such nonsense aside and try again to argue against laws that require pharmacists to dispense *legal medicines*, because when we remove the above two bizarre remarks from your comment, absolutely nothing remains of your argument. If you have *any* valid argument at all to support your position, please tell us what it is.

    BTW, your analogy between pharmacists and doctors is deeply flawed. The purpose of a pharmacist is to serve as a check-and-balance against doctors, so doctors do not sell the drugs they prescribe and, thus, have a direct financial incentive to prescribe medicines. As such, a pharmacist is analogous to a financial auditor or an accountant who verifies accounts, not to a doctor who must make choices about patient care. Simply put: pharmacists are not paid to make moral choices for their customers; they are paid to dispense pills.

  16. Yana Kanarski says:

    "Jeez people…just find another pharmacist."

    Aggieben, the biggest problem with this issue is that pharmacies are not obligated to have other pharmacists on board who can fill a perfectly legal prescription if one of their employees refuses to do it. If they can provide this kind of backup, we would not have a problem with their "moral objections" because people's prescriptions would still get filled. However, I would definitely draw the line when pharmacies start allowing their employees' religious beliefs to interfere with their customers' right to obtain the pills legally prescribed to them by doctors. Of course, it would put a strain on the pharmacies to ensure this kind of backup at all times, so it would be easier if they keep this nonsensical bill from being passed in the first place.

    Besides, if we start allowing unfounded "moral" claims by Christian fundamentalists to supercede people's rights to obtain legal medical supplies, why not respect the rights of all the other religions, like Scientology? These folks oppose all psychiatric medications, so wouldn't they also have a right to refuse to provide a patient with medicine to treat, say, epilepsy? The bottom line is that people should have a right to practice their personal moral beliefs as long as they do not interfere with the rights of others. When we make legislative decisions about moral issues, we should only do so on secular grounds, which are concerned with the happiness and suffering of conscious beings. Religion has this interesting tendency to extend morality outside this realm, applying it to actions that do not harm anyone, or to extend human rights to nonsentient entities. If something can be justified without a reference to any religious dictums, then it passes the test for genuine morality.

  17. Ben says:

    I just wanna make sure we all know the subtle difference between Scientology and Christianity (Christian Science).

    http://en.wikipedia.org/wiki/Scientology http://en.wikipedia.org/wiki/Christian_science

    I often tell stubborn (faithful) Christians I meet that I am a stout believer in Scientology, just so they will blurt something like, "how can you believe in that crazy crap". Bingo! By the time they realize what they have said, they have already made most of my argument against religion for me. At this point I allude to possibly being atheist, and play it from there .

  18. Yana Kanarski says:

    Ben, most people regard "Christian Science" as a cult separate from mainstream Christianity, although many Christians do believe in the efficacy of prayer to varying degrees.

  19. Ben says:

    Well, we know that *most* people are ignorant of science too. In my opinion, religion is the Devil.

  20. grumpypilgrim says:

    One problem with letting pharmacists impose their "moral" beliefs on their customers is, as Yana describes, deciding where to stop. This is a classic slippery slope. There simply is no clear line to decide what sorts of meds a pharmacist should be required to sell and what sorts they should be free to withhold based on their personal "moral" values. No matter where the line is drawn, it invites pharmacists, subjest to their individual opinion and knowledge level, to decide whether or not FDA-approved medications should be dispensed to particular individual patients. Not only is that not their job, but they're unqualified to do it.

    Why would any society want to create a patchwork, where each pharmacist sells some drugs and perhaps none sells them all, thus forcing medical patients to travel all over town in search of their medications, utterly dependent upon which individual pharmacist happens to be working at the counter at that particular hour? Go to the pharmacy at noon and you can get your birth control pills, but go at 7 p.m., when the radical fundamentalist pharmacist is on staff, and you can't get them. Not only would this be burdensome for the public, but it could also expose patients to dangerous drug interactions: when patients must get meds from different places, there is always a risk that they might end up with drugs that should not be taken simultaneously. When a patient can get their meds all at one place, the risk of this virtually disappears.

    Furthermore, what about pharmacists who impose their "moral beliefs" inconsistently or arbitrarily? What if a pharmacist refuses to dispense birth control (or psychiatric or other) meds only to people of one particular race, ethnic group, religion, etc., citing their personal "religious" beliefs? Once we begin to allow arbitrary dispensing of medication, exactly how arbitrary will we allow it to be? Where do we draw the line?

    Bottom line: this nonsense of letting pharmacists choose which FDA-approved drugs to let their patients buy is just another asinine strategy of religious fundamentalists who have lost on every other front their ability to impose their radical religious beliefs on others. This is merely their latest attempt at Taliban-style totalitarianism, and one of the many reasons why they are considered fringe extremists.

  21. Niklaus Pfirsig says:

    This is a really sneaky "end-run" political play. Besides just filling perscriptions, pharmacists are expected to consider the welfare of the patient above their political beliefs. Another responsibility of the pharmacist is to cross-reference the patients meds and screen for known interactions, and in some cases consult with the prescribing doctor concerning alternates meds in cases where harmful interactions exist.

    So they want to let the pharmacist override the descision of the doctor, based on moral objections? I knew one pharmacist who morally objected to providing meds to immigrants. What if your pharmacists "moraly" objects to dispening meds based on political affiliations?

    On the other had, if the law passes and a few self righteous pharmacists excercise this protected discretion. most customers will take all their business elsewhere, and the pharmacists will lose their jobs due to lay-off and store closings.

    What a stupid excuse for a law.

  22. Niklaus Pfirsig says:

    Devi.. at one time, insulin was prohibited by 2 major religions. At the time the only compatible source of insulin was from the pancreas of slaughtered pigs or cattle. Since both the Jewish and Muslim faiths prohibit the introduction of pork products into the body, this was a problem if the source was unknown.

    Modern insulin is made through recombinant DNA modification of e. coli bacteria with human DNA.

    Q: Do you know what they call women who rely on natural birth control methods?

    A: Mothers.

  23. Manning says:

    InvitationToVisit:

    http://christian-birthcontrol.angelcities.com/ind

    Online examination of a Christian's God-given family-planning right (Christians have a right to use birth-control).

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