The Conscience of a Pharmacist

by Jay Johansen
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No Fill

Should a pharmacist be required to fill any prescription brought to him?

Governor Blagojevich of Illinois says yes. In April of 2005 he issued an executive order requiring pharmacists to fill any legal prescription. As of this writing, three states -- California, Missouri, and New Jersey -- are considering laws to this effect, and such a law has been proposed in Congress.

What even prompts such a law? Why would a pharmacist not want to fill a prescription? Well, some pharmacists have religious or moral objections to birth control, especially to forms of birth control that can cause very early abortions. They don't want anything to do with what they believe is the killing of an innocent baby.

Prevention magazine printed an article they entitled "Access Denied". While they made an effort to give some balance and present both sides, they came down on the side of requiring pharmacists to fill prescriptions even if they have moral objections. After giving some lip service to the concerns of a pharmacist who does not want to be a party to something he considers immoral, they ask, "But at what point does personal belief undermine public health? If more women lose access to hormonal contraceptives, rates of unintended pregnancy and abortions will rise in the US, predicts Beth Jordan, MD, medical director of the Washington, DC-based Feminist Majority Foundation ... What's more, oral contraceptives aren't only used to prevent pregnancy. The Pill may cut the risk of ovarian cancer by up to 80 percent and is used by women at high genetic risk for this hard-to-detect and usually fatal cancer."

(It is certainly touching to hear that the Femnist Majority Foundation, an outspoken pro-abortion group, is concerned that something might cause an increase in the abortion rate. This is a little like the National Rifle Association wringing its hands in concern that some proposed legislation might result in more people buying guns.)

Stepping Away

The American Pharmacist Association took issue with the Prevention article. "Pharmacists and physicians who refuse to provide access to oral contraceptives are painted the villains in an article in the current issue of Prevention magazine, read by 10 million Americans each month. The article fails to portray accurately pharmacists’ rights of conscience ..." They proposed a compromise: Pharmacists should have the right to "step away but not step in the way". They explained that what they meant by this was "... when a pharmacist has a moral or ethical dilemma with dispensing any product, another pharmacist on duty can fill the prescription, the patient can be sent to a pharmacy that will provide the therapy, or other mechanisms can be established." But note that even their proposed compromise requires the objecting pharmacist to help the patient get this prescription filled.

The American Medical Association went a step further. They passed a resolution stating 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 ... if an individual pharmacist exercises a conscientious refusal to dispense a legal prescription, a patient’s right to obtain legal prescriptions will be protected by immediate referral to an appropriate dispensing pharmacy." This theoretically affirms the pharmacist's rights of conscience, but all the guarantees are on the other side.

Legal = Required?

In short, the argument for requiring pharmacists to fill such prescriptions is that patients have a legal right to have these prescriptions filled, and for a pharmacist to refuse to fill one violates the rights of the patient. Advocates of these "must fill" policies or laws regularly point out that contraceptives and abortifacients are legal, and that this makes the moral objections of the pharmacist irrelevant.

But surely just because something is legal doesn't mean that others are obligated to help you do it. I have yet to hear this line of reasoning applied to any other product someone might want to buy. Like, "It is legal (for adults) to buy pornography. Therefore, every bookstore should be required to sell pornography. For a bookstore to refuse to sell a customer pornography would violate the customer's rights." Or, should every gas station be required to sell cigarettes? Does the fact that cigarettes are legal mean that a gas station owner with moral objections to smoking has no right to place obstacles in the way of smokers by refusing to carry cigarettes?

Indeed, retailers routinely decide not to stock products for all sorts of reasons. Kentucky Fried Chicken doesn't sell pizza. My local Ford dealer doesn't sell Chryslers. My local grocery store doesn't sell any used cars at all. Should we have laws to require every store to carry every legal product that exists in the world?

How does any of this violate the patient's rights? If a pharmacist refuses to fill certain types of prescriptions, there are surely other pharmacists who will be happy to take the business. No one is even suggesting that these pharmacists tried to prevent patients from getting their prescriptions somewhere else.

Interestingly enough, Prevention magazine doesn't even apply this logic to their own web site. They have forums where readers may post comments, but they include a long list of types of comments that they will not accept, including anything "harmful, threatening, abusive, harassing, tortious, defamatory, sexist, vulgar, obscene, libelous, invasive of another's privacy, hateful, or racially, ethnically or otherwise objectionable". Some of these things are illegal, but most are not. So just because something is legal doesn't mean they will post it on their web site. Why not? Why don't they want sexist, vulgar, or racist comments on their web site? Surely it is because they have moral objections to such things. If they have the right to refuse to be a party to conduct that violates their moral standards, why shouldn't pharmacists have that same right?

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Posted 27 Aug 2005.

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