Choice for Pharmacists

by Jay Johansen

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In February, three people in Boston sued Wal-Mart because the store didn't carry a product they wanted to buy. A Wal-Mart spokesman explained that there are many products they don't carry for a variety of reasons, starting with, not enough people would buy them. But a state agency intervened and ordered all Wal-Marts in Massachusetts to carry this product.

The product was "Plan B". The manufacturer, Barr Pharmaceuticals, describes it as an "emergency contraceptive", but it is more accurately called an "abortifacient" -- abortion-causing drug -- because it must be taken after conception (within three days) and works by preventing implantation of the developing baby in the lining of the womb. (1,2)

When pro-abortion activists threatened similar legal action against Wal-Mart in other states, Wal-Mart quickly gave in, and on March 3 announced that all its stores across the country would begin stocking "Plan B". (3)

This follows a similar incident in Illinois last April (2005), in which a woman complained because her pharmacy did not sell abortifacients, and Governor Blagojevich responded by issuing an "emergency executive order" requiring all pharmacies in the state to stock contraceptive and abortifacient drugs. The Illinois case is particularly interesting because the state has a law specifically stating that health care professionals cannot be required to participate in medical procedures that violate their conscience. The governor explained that pharmacists are not "health care professionals", and the law only applies to doctors and nurses. Various pharmacist and pro-life groups have sued to block enforcement of this order. The cases are still working their way through the legal process.

Walgreens has a national policy of allowing any pharmacist who works for them to decline to participate in selling abortifacients or contraceptives. Nevertheless, Walgreens fired four Illinois pharmacists for refusing to sign a pledge that they would dispense such drugs. This led some pro-life groups to criticize Walgreens, while others accepted the company's explanation that they had no choice because they must follow state law. Walgreens later offered the four pharmacists jobs at stores in other states.

(K-Mart and Target have also fired pharmacists for refusing to dispense contraceptives or abortifacients, though as of this writing we do not know if this is a chain policy or isolated instances. Albertsons has a national policy of respecting pharmacists' consciences.)

Pro-choice organizations have come out strongly against the idea that pharmacists should have a choice to not make sales that they believe to be immoral. Planned Parenthood issued a press release about the Boston case in which they declared, "Wal-Mart's CEO ... should not decide what medicines women may or may not take. Wal-Mart's actions are clearly an outrageous intrusion into the health and privacy of all U.S. women. When a doctor prescribes emergency contraception for a woman, Wal-Mart does not have the right to overrule that decision." (4) A Washington Post editorial on Illinois made similar arguments, concluding, "If your personal beliefs hinder your ability to do your job, it may be prudent to look into another line of work." (5) The American Pharmacist Association called for a compromise, where pharmacists who object to abortion or contraception should be allowed to refuse to participate directly, but they must promptly refer the patient to another pharmacist who will oblige. That wasn't far enough for the American Medical Association, which declared that they "support legislation that requires individual pharmacists or pharmacy chains to fill legally valid prescriptions or to provide immediate referral to an appropriate alternative dispensing pharmacy without interference". Pharmacists reply that their professional ethics often REQUIRE them to refuse to fill a presciption. In testimony before the Illinois legislature, pharmacist Peggy Pace pointed out, "[M]any times I have had to advise a physician of a dosage error for a patient. Other times I’ve had to contact the prescriber because of a drug interaction, or a disease state contraindication, and I do not dispense the drug until such time as I can discuss with him or her how to proceed. Still other times I refuse to fill a habit-forming drug when it is clear that the patient is overusing it, and may, in fact, be forming an unhealthy habit that the prescribing physician never intended. In each of these situations, if I were to act otherwise it would be immoral, because it is immoral to harm a patient. These types of decisions are required by [the state] licensing body ..."(6)

But in any case ... would we even be having this debate if the product was anything other than an abortion-causing drug? If I tried to sue my local Wal-Mart for not selling chopsticks or orange pencils or used cars, would any court or government agency take such a suit seriously for a moment? Surely the obvious reply would be, No store can possibly stock every product in the world. Surely a store owner has a right to decide whether he wants to run a hardware store or a pet shop, without having to fear that some customer will sue him for running the “wrong” kind of store. And why shouldn’t he be allowed to apply moral considerations to this decision? It is legal (for adults) to buy pornography. Should all bookstores therefore be required to sell pornographic magazines? If they fail to do so, is that a violation of the customer's rights? Many people have health or moral objections to smoking. Should all convenience stores nevertheless be required by law to sell cigarettes? Should a vegetarian grocery store owner be required to sell meat? Et cetera.

If a product is legal, then I have the right to buy it, whether you like it or not. But only when it comes to abortion does anyone suggest that just because abortion-related drugs are legal, you should be required to carry them in your store and sell them to me.


  1. CBS 4 Boston, Feb 4, 2006
  2. CNN, Feb 16, 2006
  3. Catholic World News, Mar 6, 2006
  4. Planned Parenthood press release, Feb 3, 2006
  5. Washington Post, Apr 4, 2005
  6. Public Hearing on Proposed Amendment to Illinois Pharmacy Practice Act, Jun 2, 2005

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Posted 12 May 2006.

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