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Monday, March 28, 2005 - Page updated at 12:00 a.m.

Some pharmacists say no to filling birth-control prescriptions

The Washington Post

An increasing number of pharmacists around the country are refusing to fill prescriptions for birth-control and morning-after pills, saying that dispensing the medications violates their personal moral or religious beliefs.

The trend has opened a new front in the nation's battle over reproductive rights, sparking an intense debate over a pharmacist's right to refuse to participate in something he or she considers repugnant, versus a woman's right to get medications her doctor has prescribed.

It has triggered pitched political battles in state legislatures across the nation as politicians seek to pass laws either to protect pharmacists from being penalized or to force them to carry out their professional duties.

"This is a very big issue that's just beginning to surface," said Steven Aden of the Christian Legal Society's Center for Law and Religious Freedom in Annandale, Va., which defends pharmacists.

"More and more pharmacists are becoming aware of their right to conscientiously refuse to pass objectionable medications across the counter. We are on the very front edge of a wave that's going to break not too far down the line."

An increasing number of clashes are occurring. Pharmacists often risk dismissal or other disciplinary action to stand up for their beliefs, while shaken teenage girls and women desperately call their doctors, frequently late at night, after being turned away by sometimes-lecturing men and women in white coats.

"There are pharmacists who will only give birth-control pills to a woman if she's married. There are pharmacists who mistakenly believe contraception is a form of abortion and refuse to [dispense] it to anyone," said Adam Sonfield of the Alan Guttmacher Institute in New York, which tracks reproductive issues. "There are even cases of pharmacists holding prescriptions hostage, where they won't even transfer it to another pharmacy when time is of the essence."

That's what happened to Kathleen Pulz and her husband, who panicked when the condom they were using broke. Their fear spiked when the Walgreens pharmacy near their home in Milwaukee refused to fill an emergency prescription for the morning-after pill.

"I couldn't believe it," said Pulz, 43, who with her husband had long ago decided they could not afford a fifth child. "How can they make that decision for us? I was outraged."

Supporters of pharmacists' rights see the trend as a welcome expression of personal belief. Women's groups see it as a major threat to reproductive rights and one of the latest manifestations of the religious right's growing political reach.

"This is another indication of the current political atmosphere and climate," said Rachel Laser of the National Women's Law Center in Washington. "It's outrageous. It's sex discrimination. It prevents access to a basic form of health care for women. We're going back in time."

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The issue could intensify further if the Food and Drug Administration approves the sale of the Plan B morning-after pill without a prescription — a step that would likely make pharmacists the primary gatekeepers.

The question of health-care workers refusing to provide certain services first emerged over abortions. The trend began to spread to pharmacists with the approval of the morning-after pill and physician-assisted suicide in Oregon, with support from such organizations as the U.S. Conference of Catholic Bishops and the Pharmacists for Life International, which claims 1,600 members on six continents, primarily the United States, Canada and Britain.

"Our group was founded with the idea of returning pharmacy to a healing-only profession. What's been going on is the use of medication to stop human life. That violates the ideal of the Hippocratic Oath that medical practitioners should do no harm," said Karen Brauer, the Pharmacists for Life president, who was fired from a Kmart pharmacy in Delhi, Ohio, for refusing to fill birth-control prescriptions.

No one knows exactly how often that is happening, but cases have been reported across the country, including in Washington, California, Georgia, Illinois, Louisiana, Massachusetts, Texas, New Hampshire, Ohio and North Carolina. Advocates on both sides say the refusals appear to be spreading, often surfacing only in the rare instances when women file complaints.

Pharmacists are regulated by state laws and can face disciplinary action from licensing boards. But the only case that has gotten that far involves Neil Noesen, who in 2002 refused to fill a University of Wisconsin student's prescription for birth-control pills at a Kmart in Menomonie, Wis., or transfer the prescription elsewhere.

An administrative judge last month recommended Noesen be required to take ethics classes, alert future employers to his beliefs and pay what could be as much as $20,000 to cover the costs of the legal proceedings. The state pharmacy board will decide whether to impose that penalty next month.

Wisconsin is one of at least 11 states considering "conscience-clause" laws that would protect pharmacists like Noesen. Four states have laws that specifically allow pharmacists to refuse to fill prescriptions that violate their beliefs. At the same time, at least four states are considering laws that would explicitly require pharmacists to fill all prescriptions.

The American Pharmacists Association recently reaffirmed its policy that pharmacists can refuse to fill prescriptions as long as they make sure customers can get their medications some other way.

The alternative system can include making sure another pharmacist is on duty who can take over or making sure another pharmacy nearby is willing to fill the prescription, said Susan Winckler, the association's vice president for policy and communications.

"The key is that it should be seamless and avoids a conflict between the pharmacist's right to step away and the patient's right to obtain their medication," she said.

Large pharmacy chains, including Walgreens, Wal-Mart and CVS, have instituted similar policies that try to balance pharmacists' and customers' rights.

Women's advocates say such policies are impractical, especially late at night in emergency situations involving the morning-after pill, which must be taken within 72 hours.

Even in nonurgent cases, poor women have a hard time getting enough time off work to go from one pharmacy to another. Young women, who are often already frightened and unsure of themselves, may simply give up when confronted by a judgmental pharmacist.

"What is a women supposed to do in rural America, in places where there may only be one pharmacy?" asked Nancy Keenan, president of NARAL Pro-Choice America, which is launching a campaign today to counter the trend. "It's a slap in the face to women."

But Brauer defends the right of pharmacists not only to decline to fill prescriptions themselves but also to refuse to refer customers elsewhere or transfer prescriptions.

"That's like saying, 'I don't kill people myself, but let me tell you about the guy down the street who does.' "

Pulz, of Milwaukee, eventually obtained her prescription directly from her doctor.

"I was lucky," Pulz said. "I can sympathize with someone who feels strongly and doesn't want to be involved. But they should just step out of the way and not interfere with someone else's decision."

Copyright © 2005 The Seattle Times Company

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