Emergency contraception: As health care professionals, can pharmacists just say no?

When taken within 72 hours of sexual intercourse, emergency contraception (EC) can prevent pregnancy. Target recently announced that it would allow pharmacists at its stores to refuse to fill prescriptions for EC, if dispensing it would violate their religious beliefs.

The retailer will require pharmacists who refuse to fill the order to ask another pharmacist at their location to fill the prescription, or confirm for the patient that it can be obtained elsewhere. Target has now joined Kmart and Costco in allowing pharmacists to refuse to fill a prescription for EC.

There has been an ongoing struggle over the past year between pharmacists who refuse to fill prescriptions for EC and birth control pills, and various municipal and state governments who either support or oppose these actions. In April 2005, Illinois Gov. Rod Blagojevich issued an administrative order that allows pharmacies not to sell contraceptives of any kind. However, if they do sell contraceptives, they must also fill prescriptions for EC or risk losing their license. The state has moved to revoke the licenses of two Walgreens pharmacies and an Osco pharmacy for refusing to fill the prescriptions.

In Austin, Texas, the City Council passed a measure in August requiring Walgreens, the pharmaceutical vendor for the city’s medical assistance program, to fill any prescription “without discrimination or delay.” The measure was specifically aimed at pharmacies that have refused to fill prescriptions for EC. The measure requires the pharmacies to fill prescriptions in the store where patients present their prescriptions, regardless of a pharmacist’s religious beliefs. Austin is the first city in the nation to require pharmacies to fill all orders they receive.

On the other hand, the Arizona Legislature is considering legislation that would permit pharmacists to refuse to fill prescriptions for any contraception if they are morally opposed to it. Pharmacists would not be required to assist the patient in filling the prescription elsewhere. Michigan’s Legislature is considering a similar bill. The California Assembly has taken a much wider approach. It is considering legislation that would allow a pharmacist to refuse to fill any prescription for religious reasons.

The University of Wisconsin at Madison ran an advertisement in the campus newspaper advising students to take EC to avoid unwanted pregnancies. This so incensed conservative members of the state Legislature that they introduced a bill that would prevent the University of Wisconsin health system from distributing or advocating the use of EC.

In the U.S. Senate, Rick Santorum (R-Pa.) and John Kerry (D-Mass.) have introduced the “Workplace Religious Freedom Act,” which would allow a pharmacist to refuse to fill a prescription for religious reasons as long as another pharmacist is available to serve the patient.

Allowing pharmacists to refuse to fill an EC prescription on religious grounds is poor health policy. And it sets a dangerous legal precedent. If a pharmacist can decline to dispense EC there would be little grounds to prevent them from declining to fill other prescriptions owing to their religious beliefs. For example, what would prevent a pharmacist from refusing to dispense AZT, the drug used to treat AIDS patients, on the grounds that the patient may be a homosexual and this violates their religious beliefs? Pharmacists, of course, have a right to their personal religious beliefs. But they shouldn’t be allowed to act on them in their capacity as health care professionals.