Pharmacists say ‘no’ to Plan B

(originally published on February 14, 2007 by The American Observer)

Photo by Edythe Cooke

Pharmacists may have the final say in the Plan B debate. Six months after the FDA approved the over-the-counter sale of the emergency contraception, pharmacists may now refuse to sell it.

According to Barr Pharmaceuticals, Inc., the manufacturer of Plan B, the emergency contraception is effective for up to 72 hours after unprotected sex, but it is most effective within the first 24 hours.

If a woman assumes that she can purchase Plan B at her local pharmacy and her pharmacist refuses to dispense the emergency birth control because of his or her moral beliefs, she will have to locate another pharmacy where she can purchase it. As the hours pass by, the effectiveness of Plan B decreases. Laws protecting pharmacists’ moral beliefs, known as conscience clauses, may prevent some women from accessing Plan B, also known as the “morning-after pill.”

State legislation allows pharmacists to deny service to patients if they believe that the service goes against their conscience and personal convictions. On the other hand, pharmacists are also obligated to promote public health, safety and welfare. Can pharmacists fulfill these obligations if they refuse to dispense drugs based on their moral beliefs?

The battle between patients’ rights and pharmacists’ rights to follow their moral convictions is a state-by-state struggle despite the national over-the-counter sale approval.

“We don’t have the authority to force stores to sell Plan B,” said Julie Zawisza, a spokeswoman for the FDA. While the FDA regulates medicines, it is the states that regulate pharmacies by granting and revoking licenses.

Colorado, South Dakota, Arkansas, Illinois, Mississippi, Tennessee, Georgia, Florida and Maine have conscience clauses that grant pharmacists the right to refuse to dispense emergency contraception based on moral objections. Colorado, Florida, Maine and Tennessee also have general refusal clauses.

Some states have taken the opposite approach, taking action to protect patients’ rights to access drugs. In California, for example, a pharmacist can only refuse to dispense a prescription when their employer approves the refusal and the patient can still access his or her prescription from another pharmacist in a timely manner.

Pharmacists in Illinois, Texas and Wisconsin have lost their jobs for refusing to dispense Plan B. State officials in Illinois and Massachusetts ordered pharmacies to carry the emergency contraception; forcing Wal-mart, the largest retail chain in the U.S., to carry the pill in all of its 4,000 pharmacies. A month after the chain’s pharmacies did not stock the drug at all.

Retail chains like Wal-mart have stores in communities across the country, ranging from the most conservative to the most liberal areas.

“In a company like Wal-mart or Walgreens, some pharmacists, depending on the area, don’t want to be in the same building as the drug,” said Sandra Johnson, a professor at the Saint Louis University School of Law.

John Juergens, associate professor of pharmacy administration at the University of Mississippi School of Pharmacy, said conscience clauses are dangerous for patients and pharmacists. “The credibility of a pharmacist is at stake,” he said. “Pharmacists have an ethical obligation to the patient.”

Juergens said patients should not have to suffer because of pharmacists’ moral convictions. “The pharmacist has to separate his personal beliefs from his duties,” he said. “You can’t refuse to dispense something.”

Conscience clauses first came onto the healthcare scene in 1973 when the Supreme Court legalized abortion in Roe v. Wade. Physicians could refuse to perform abortions because of their religious or moral beliefs. Some pharmacists may object to the emergency contraception because they view it as a form of abortion.

After Roe v. Wade, states began adopting clauses that allowed healthcare providers to refuse to serve patients who wanted contraception, including birth control pills. Some of these clauses were not specific and allowed pharmacists to use their moral judgment as they saw fit.

R. Alta Charo, a bioethics professor at the University of Wisconsin, said conscience clauses risk patients’ health and give too much power to pharmacists. “It creates a tremendously asymmetrical relationship,” she said. “Pharmacists have a monopolistic power.”

“It’s an undue hardship on patients,” she said. “It’s also a humiliation. Patients should have timely access without humiliation.”

Charo said patients who are not able to get the birth control they need may not be able to resume having sex comfortably because they do not have confidence in other birth control methods like condoms.

Tom Van Hassel, director of pharmacy at the Yuma Regional Medical Center in Arizona and member of the state’s board of pharmacy, said conscience clauses should not be the standard of care.

“I think the pharmacist has a right to protect patients’ health and welfare,” he said. “The patient’s rights come first.”

Juergens said he once worked with a pharmacist who abused his power to impose his morals on patients. Juergens said the pharmacist had a “personal campaign against alcohol consumption” and labeled drugs to say that they were not safe to take with alcohol.

He said that he discusses conscience clauses with his pharmacy students. “I tell them to plan ahead of time,” said Juergens. He said he advises his students to talk to potential employers before they go to work for them to let them know of any moral or religious objections they may have to dispensing certain types of medication or providing any type of service.

“They have got to think this through ahead of time,” Juergens said. He said patients should also plan ahead. Juergens suggested that patients have one pharmacy that they can go to on a regular basis. “By shopping around, you lose that patient-pharmacist relationship,” he said. Juergens said that relationship would allow a patient to know whether or not a pharmacist objects to dispensing any drugs.

He said that a mobile society, however, makes it difficult for patients to develop this important relationship. “With chains like Wal-mart, it’s not like the old days when people have the one grocery store or butcher shop that they go to,” he said.

“Patients should be proactive,” said Juergens. He said patients could also call another pharmacist to get the drugs they need.

Charo also said that patients should be proactive. “Patients should go to pharmacies and demand that there be a notice posted clearly for everyone to see, maybe even advertise it in the papers,” she said.

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