Medication becomes morality: Conscience clauses’ hit legislatures

Increased availability of emergency contraception is spurring the development of state measures to excuse pharmacists who want nothing to do with it.

In the past legislative session, Indiana, Kansas, Louisiana, Oregon, and Wisconsin have considered proposals that would allow pharmacists to opt out of dispensing drugs they consider morally objectionable, including doses of oral contraceptives taken after unprotected intercourse. Oregon’s bill is the most comprehensive, states an analysis in the June issue of Alan Guttmacher Institute’s Family Planning Perspectives, addressing drugstore owners and operators as well as pharmacists and encompassing all drugs in its scope.

The Washington, DC-based American Pharmaceutical Association has discussed—but never adopted—a position regarding so-called "conscience clauses," says Karen Winckler, the association’s group director of policy and advocacy.

"There’s some question as to whether it’s necessary," she says, noting that licensing statutes and regulations generally respect the role of conscience and personal values in professional pharmaceutical activities.

By the association’s reckoning, South Dakota is the only state that has passed explicit legislation to protect a pharmacist’s right to demur from dispensing certain prescriptions.

The law excuses pharmacists from dispensing responsibilities when they believe the medication would do any of the following:

• "cause an abortion"

• "destroy an unborn child"

• be used for an assisted suicide, euthanasia, or mercy killing.

An association policy adopted in 1998 recognizes a pharmacist’s right to exercise "conscientious refusal" in his or her professional activities. At the same time, the association supported the "establishment of systems to ensure [a] patient’s access to legally prescribed therapy."

Referral not always the answer

The association stopped short of recommending referral to another source for a prescription, Ms. Winckler says, suggesting that option is not necessarily "the most efficient system." Instead, she cited mechanisms such as those in place for Washington state’s collaborative prescribing arrangements between physicians and pharmacists. (See State Health Watch, January 1999, p. 10.)

The profession has explored several alternatives for respecting both the rights of patients and pharmacists, says Ms. Winckler, including providing a toll-free number for information on emergency contraception. For rural areas that may have only one pharmacist, she suggests the pharmacist explore ways to allow the physician to dispense emergency contraception.

Some of the concern over conscience clauses, Ms. Winckler says, may stem from instances in which pharmacists have clashed with the policies of their chain drugstore employers.

In August, the American Center for Law and Justice, an advocate for "pro-liberty, pro-life, and pro-family causes," filed suit in U.S. District Court in Cincinnati on behalf of a pharmacist claiming to have been fired for refusing to dispense Ortho Pharmaceutical’s Micronor and similar prescriptions.

Contact Ms. Winckler at (202) 628-4410.