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See Inside October 2005

Fill This Prescription

morning-after pills



DAMIEN LOVEGROVE Photo Researchers, Inc.
No one's health should be hostage to a caregiver's opinion of his or her morality. In prisons, even hardened murderers are entitled to decent, prompt medical attention. A woman walking into a pharmacy with a prescription deserves no less.

Yet in at least a dozen states, pharmacists have refused to fill clients' orders for birth control on personal moral grounds. Often the prescriptions have been for emergency contraception--the "morning-after" pills marketed as Plan B and Preven that prevent a fertilized egg from implanting in the uterus if taken within 72 hours of unprotected sex. By medical definition, the pills block rather than terminate pregnancy. To the objecting pharmacists, however, it is abortion, and they want no part of it.

The responsibilities of pharmacists in this regard are murky. As the only licensed gatekeepers of public access to legal medications, pharmacists have an implicit duty to dispense them as needed. The American Pharmacists Association upholds the prerogative of its workers to protect their conscience if they can efficiently refer the prescription elsewhere. At least three states have laws that bar pharmacists from refusing drugs for personal reasons, but at least four others specifically permit a conscientious exception for birth control. The rest are in a gray zone.

It is tempting to wonder how far the principle of denying medicines for ethical reasons could stretch. Could one who disapproves of homosexuality refuse antiretrovirals to an HIV-positive gay man? If suffering is good for the soul, can one refuse to give out pain medication? But the pharmacists are not really fighting for a broad entitlement to morally judge which prescriptions to fill. And it is unnecessary to play "Where will this stop?" on an issue that already threatens women's vital reproductive rights.

Since 1973 physicians and nurses in the U.S. have conditionally had legal leave to abstain from abortions for personal reasons; the objecting pharmacists want that same option. But physicians are directly involved in the abortion procedure, and ethics aside, compelling them to perform it against their will is impractical and potentially unsafe. Druggists cannot make the same claim.

This fall Congress will consider a bill that would put the burden on pharmacies to fill birth-control prescriptions: an individual druggist could refuse but only if another can fill the order. That solution may be unworkable for small pharmacies in remote settings where standby pharmacists are uncommon.

The best answer is probably to make the morning-after pill available without prescription. Two Food and Drug Administration panels have recommended as much, but the agency continues to drag its feet. Over-the-counter versions of the product have nonetheless shown themselves to be safe in the U.K. and other countries.

If pharmacists can legitimately refuse to dispense the morning-after pill, then it is appropriate to consider seriously the American Medical Association's proposal that physicians be allowed to do so instead. Patients should always have confidence in their access to the drugs they need. We also suggest that if pharmacists are going to sift clients' prescriptions through the sieve of their own morals, they should prominently post signs to that effect. Let female customers know what to expect well before their health is at the mercy of their pharmacist's conscience.

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