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Pharmacists' Rights at Front Of New Debate

Because of Beliefs, Some Refuse To Fill Birth Control Prescriptions

By Rob Stein
Washington Post Staff Writer
Monday, March 28, 2005; Page A01

Some pharmacists across 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 the competing rights of pharmacists to refuse to participate in something they consider repugnant and a woman's right to get medications her doctor has prescribed. It has also triggered pitched political battles in statehouses across the nation as politicians seek to pass laws either to protect pharmacists from being penalized -- or force them to carry out their duties.


Karen L. Brauer, Pharmacists for Life president, defends the right of pharmacists to refuse medicine. (Courtesy of Karen L. Bauer)

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Refill Laws by States: A number of states have either passed laws or are considering laws that allow pharmacists to refuse to fill prescriptions, such as birth control and morning-after pills.
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"This is a very big issue that's just beginning to surface," said Steven H. Aden of the Christian Legal Society's Center for Law and Religious Freedom in Annandale, 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 in drugstores across the country. 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 prescribe 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 is what happened to Kathleen Pulz and her husband, who panicked when the condom they were using broke. Their fear really spiked when the Walgreens pharmacy down the street from their home in Milwaukee refused to fill an emergency prescription for the morning-after pill.

"I couldn't believe it," said Pulz, 44, 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. At the same time, I was sad that we had to do this. But I was scared. I didn't know what we were going to do."

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 time into the neighborhood pharmacy.

"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."

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 controversial step that would likely make pharmacists the primary gatekeeper.

The question of health care workers refusing to provide certain services first emerged among doctors, nurses and other health care workers 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 Pharmacists for Life International, which claims 1,600 members on six continents. Its members are primarily in 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 L. Brauer, president of Pharmacists for Life, 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 California, Washington, 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 T. Noesen, who in 2002 refused to fill a University of Wisconsin student's birth control pill prescription 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.


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