By Rob Stein
Washington Post Staff Writer
Monday, June 16, 2008
When DMC Pharmacy opens this summer on Route 50 in Chantilly, the shelves will be stocked with allergy remedies, pain relievers, antiseptic ointments and almost everything else sold in any drugstore. But anyone who wants condoms, birth control pills or the Plan B emergency contraceptive will be turned away.
That's because the drugstore, located in a typical shopping plaza featuring a Ruby Tuesday, a Papa John's and a Kmart, will be a "pro-life pharmacy" -- meaning, among other things, that it will eschew all contraceptives.
The pharmacy is one of a small but growing number of drugstores around the country that have become the latest front in a conflict pitting patients' rights against those of health-care workers who assert a "right of conscience" to refuse to provide care or products that they find objectionable.
"The United States was founded on the idea that people act on their conscience -- that they have a sense of right and wrong and do what they think is right and moral," said Tom Brejcha, president and chief counsel at the Thomas More Society, a Chicago public-interest law firm that is defending a pharmacist who was fined and reprimanded for refusing to fill prescriptions for birth control pills. "Every pharmacist has the right to do the same thing," Brejcha said.
But critics say the stores could create dangerous obstacles for women seeking legal, safe and widely used birth control methods.
"I'm very, very troubled by this," said Marcia Greenberger of the National Women's Law Center, a Washington advocacy group. "Contraception is essential for women's health. A pharmacy like this is walling off an essential part of health care. That could endanger women's health."
The pharmacies are emerging at a time when a variety of health-care workers are refusing to perform medical procedures they find objectionable. Fertility doctors have refused to inseminate gay women. Ambulance drivers have refused to transport patients for abortions. Anesthesiologists have refused to assist in sterilizations.
The most common, widely publicized conflicts have involved pharmacists who refuse to fill prescriptions for birth control pills, morning-after pills and other forms of contraception. They say they believe that such methods can cause what amounts to an abortion and that the contraceptives promote promiscuity, divorce, the spread of sexually transmitted diseases and other societal woes. The result has been confrontations that have left women traumatized and resulted in pharmacists being fired, fined or reprimanded.
In response, some pharmacists have stopped carrying the products or have opened pharmacies that do not stock any.
"This allows a pharmacist who does not wish to be involved in stopping a human life in any way to practice in a way that feels comfortable," said Karen Brauer, president of Pharmacists for Life International, which promotes a pharmacist's right to refuse to fill such prescriptions. The group's Web site lists seven pharmacies around the country that have signed a pledge to follow "pro-life" guidelines, but Brauer said there are many others.
"It's just the tip of the iceberg," she said. "And there's new ones happening all the time."
Some pro-life pharmacies are identical to typical drugstores except that they do not stock some or all forms of contraception. Others also refuse to sell tobacco, rolling papers or pornography. Many offer "alternative" products, including individually compounded prescription drugs, as well as vitamins and homeopathic and herbal remedies.
"We try to practice pharmacy in a way that we feel is best to help our community and promote healthy lifestyles," said Lloyd Duplantis, who owns Lloyd's Remedies in Gray, La., and is a deacon in his Catholic church. "After researching the science behind steroidal contraceptives, I decided they could hurt the woman and possibly hurt her unborn child. I decided to opt out."
Some critics question how such pharmacies justify carrying drugs, such as Viagra, for male reproductive issues, but not those for women.
"Why do you care about the sexual health of men but not women?" asked Anita L. Nelson, a professor of obstetrics and gynecology at the David Geffen School of Medicine at UCLA. "If he gets his Viagra, why can't she get her contraception?"
The DMC Pharmacy opening in August marks an expansion by Divine Mercy Care in Fairfax, a nonprofit health-care organization that adheres to the teachings of the Catholic Church. The group runs the Tepeyac Family Center, an obstetrics-gynecology practice in Fairfax that offers "natural family planning" instead of contraceptives, sterilization or abortion.
"We're trying not to leave our faith at the door," said John Bruchalski, who chairs the group's board of directors, noting that one of the organization's major goals is helping needy, uninsured patients obtain health care. "We're trying to create an environment where belief and professionalism come together."
Like the doctors, nurses and other staff members at Tepeyac, Robert Semler, the pharmacist who will run DMC Pharmacy, plans to start each workday with a prayer with his staff, which at first will just be his wife, Pam, a nurse.
"Being a faith-based workplace, it's a logical thing to do," Semler said.
Bioethicists disagree about the pharmacies. Some argue that they are consistent with national values that accommodate a spectrum of beliefs.
"In general, I think product differentiation expressive of differing values is a very good thing for a free, pluralistic society," said Loren E. Lomasky, a bioethicist at the University of Virginia in Charlottesville. "If we can have 20 different brands of toothpaste, why not a few different conceptions of how pharmacies ought to operate?"
Others maintain that pharmacists, like other professionals, have a responsibility to put their patients' needs ahead of their personal beliefs.
"If you are a health-care professional, you are bound by professional obligations," said Nancy Berlinger, deputy director of the Hastings Center, a bioethics think tank in Garrison, N.Y. "You can't say you won't do part of that profession."
California, New Jersey, Illinois and Washington state recently began requiring pharmacies to fill all prescriptions or help women fill them elsewhere, and at least another 10 states are considering such requirements. But some states exempt pharmacies that do not generally stock contraceptives, and it is unclear how other existing rules and laws and those being considered would apply to those pharmacies.
"These are uncharted waters, since the issue of so-called pro-life pharmacies are so new," said Elizabeth Nash, a public policy associate at the Guttmacher Institute, a private, nonprofit organization that researches reproductive issues.
Virginia does not have any laws or regulations that would prohibit a pro-life pharmacy, and is not considering adopting any, according to the Virginia Board of Pharmacy.
Critics also worry that women might unsuspectingly seek contraceptives at such a store and be humiliated, or that women needing the morning-after pill, which is most effective when used quickly, may waste precious time.
"Rape victims could end up in a pharmacy not understanding this pharmacy will not meet their needs," Greenberger said. "We've seen an alarming development of pharmacists over the last several years refusing to fill prescriptions, and sometimes even taking the prescription from the woman and refusing to give it back to her so she can fill it in another pharmacy."
Pharmacists at eight pro-life drugstores contacted by The Washington Post said they would not actively interfere with a woman trying to fill a prescription elsewhere, but none posts signs announcing restrictions or offers to help women get what they need elsewhere.
"If I don't believe something is right, the last thing I want to do is refer to someone else," said Michael G. Koelzer, who owns Kay Pharmacy in Grand Rapids, Mich. "It's up to that person to be able to find it."
Semler, at DMC Pharmacy, said he does not feel that will be an impediment.
"We just say there are other pharmacies in the area they can go to," he said, noting that the Kmart across the parking lot has a pharmacy and that there are several other national chains nearby. "We're not threatening anybody. We're just trying to serve a niche market of like-minded individuals."
But others worry about what will happen if such pharmacies proliferate, especially in rural areas.
"We may find ourselves with whole regions of the country where virtually every pharmacy follows these limiting, discriminatory policies and women are unable to access legal, physician-prescribed medications," said R. Alta Charo, a University of Wisconsin lawyer and bioethicist. "We're talking about creating a separate universe of pharmacies that puts women at a disadvantage."