In Good Conscience: Can Pharmacists Decline to Fill Some Prescriptions?
Lustig, Andrew, Commonweal
In the aftermath of Roe v. Wade came statutes allowing health-care providers to refuse to provide procedures, such as abortion or sterilization, to which they objected on moral or religious grounds. Today such "conscience clauses" exist in forty-five states, and potentially affect not merely abortion and other aspects of reproductive medicine, but end-of-life care, stem-cell-related technologies, and a host of other issues. Gradually the exemptions have expanded beyond physicians to include other individuals and entities involved in health care: nurses and counselors, insurers and hospitals. Should health-care workers be allowed to refuse to provide treatments they deem morally objectionable? When does professional obligation override the sense of moral responsibility? Such questions are playing out every day in hospitals and clinics across the country.
And now in drug stores. During the past year, several jurisdictions have passed laws extending the exemptions to pharmacists. The controversy has zeroed in on emergency contraception (EC), or the so-called morning-after pill. The FDA approved various drugs in 1998 and 1999 as emergency "contraceptives," but not everyone finds that description accurate. In many cases, EC functions like other birth-control drugs: it prevents ovulation or fertilization. But it can also act as an abortifacient, preventing implantation of an already fertilized ovum. This is the source of certain pharmacists' objections. Some have refused to fill prescriptions and referred patients elsewhere. Some have abstained from the latter.
How should we balance consumers' right to medical services with the moral concerns of pharmacists, physicians, and other providers? In 1998, the American Pharmacists Association (APhA) released a statement recognizing "the individual pharmacist's right to exercise conscientious refusal." At the same time, it advocated the "establishment of systems to ensure [the] patient's access to legally prescribed therapy." All pharmacies, the APhA argued, should be staffed to ensure that a pharmacist without moral qualms will be available. Absent that, dissenting pharmacists should be required to refer patients to a pharmacy that would provide the services they seek.
Seeking a middle ground that honors the rights of both patients and providers is certainly laudable. But assuming that every health-care facility can include both dissenters and assenters ignores the reality that some institutions--especially religious ones--may define themselves according to shared values, and refuse certain services as a matter of collective conscience. For some individual providers, moreover, even referral is morally problematic. A Catholic physician may believe referring a patient to an abortion provider entails moral complicity. Some Catholic pharmacists may have similar reservations concerning abortifacient EC. …