There’s Got to be a Morning After Pill

The Chicago Tribune reports that a deal has been reached between the State of Illinois, its licensed pharmacists, and Walgreen Company regarding the refusal of some pharmacists to dispense Plan B, the “morning-after” emergency contraceptive.

Illinois pharmacies must fill prescriptions for Plan B and other emergency contraceptive pills “without delay,” as Gov. Rod Blagojevich decreed in 2005. But individual pharmacists who believe dispensing the pills would violate their religious beliefs don’t have to get involved. Instead, the customer can receive the medication from the pharmacy owner or another employee after an off-site pharmacist approves the prescription by phone or fax.

Should pharmacists be permitted the latitude to refuse service under a conscience clause? This is not a question with an easy answer. Even a poll on the conservative Wall Street Journal’s Health Blog yields mixed results.

While the Illinois decision is is a step toward ensuring the availability of these contraceptives (note: Plan B is now available over-the-counter for women over 18), the resolution still doesn’t seem entirely satisfying. As noted in a previous post (Rx Regnant Sed Non Gubernat):

We would scarely tolerate such moralizing by providers of non-essential services (e.g. a hotel refusing a room to a homosexual couple or a bookstore refusing the sale of books promoting secular Humanism), and must not tolerate it among physicians, pharmacists, soldiers and first-response emergency personnel. Accepting such jobs means that, to some degree, personal morality is suspended while on duty.

The exercise of conscience clauses by healthcare providers puts the field on a well-oiled downward trajectory (that is, a slippery slope). One can imagine (and there may already be cases demonstrating) pharmacists refusing to fill prescriptions for psychotropic or mood stabilizing drugs, fertility enhancement, erectile dysfunction, venereal diseases or contraception. In the very near future, we may have drugs developed using or derived from human embryonic stem cells; will they be rendered unavailable by individual pharmacists?

Balancing personal religious autonomy between healthcare providers and patients will not be easy. Certainly, we wouldn’t insist that an obstetrician perform an abortion against his or her will, even though a woman may be wholly within her rights to obtain one. And a number of physicians will refuse to prescribe medications for one reason or another. Should we, then, limit discretion to those with medical degrees, and insist that all others simply comply with the physician’s instructions? Essentially, this is the situation we currently face. And patients can only circumvent such obstacles by seeking a provider who does not object to the desired treatment.

What of those who are not possessed of medical licenses? One would hope that the nurses, assistants and others would not choose to work for a physician involved in the voluntary termination of pregnancies. Similarly, then, it might be reasonable to expect that those who cannot in good conscience dispense medication on the order of a licensed physician should seek careers other than as pharmacists.

A lingering question, though, is whether or not pharmacies will be permitted to base hiring decisions on the willingness of pharmacists to dispense medication without regard to their personal beliefs. Would this be tantamount to a religious test as a condition of employment? A case in Illinois, filed under the state’s Health Care Right of Consience Act, alleges just such religious discrimination.

Is this really a case of discrimination on the basis of religion? No more so than a school refusing to hire a science teacher unwilling to teach a unit on biological evolution, or a restaurant refusing employment to a Muslim who would not serve or handle pork products that are on the menu. People have a right to not seek employment they find objectionable, but should not be permitted to impose their religious belief on either their employers or their customers.

As in all complex issues, though, the first step is to engage in an honest public dialogue. Hopefully the solution devised in Illinois will spur further discussion of this important subject.

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