Battleground Walgreens
Published in the Contra Costa Times
January 29, 2006
Since 2004, a number of pharmacists have made news because of their refusal to
dispense emergency contraception (EC) to women with prescriptions for it. They have
justified their conscientious objection in the name of protecting an unborn child. “What’s
been going on violates the ideal of the Hippocratic Oath that medical practitioners should
do no harm,” states Karen Bauer, president of Pharmacists for Life.
While those pharmacists may sincerely believe this, all they are really doing is
shifting that harm away from their prescription counter. Data published by the Institute
of Medicine and others about unwanted pregnancies suggest that pharmacists who refuse
to dispense EC discriminate against certain socioeconomic groups. Women with the
highest risk for an unwanted pregnancy are disproportionately younger (18-24 years old),
poorer (living150% below the poverty line), and unmarried. A woman who has a child
under these circumstances faces tremendous pressure, making it harder to care of herself
and her child. A pharmacist’s conscientious objection, therefore, unfairly harms her
chance to overcome social and economic adversity.
The children of these mothers also face risks. Again, data from the Institute of
Medicine tell the story: Women with unwanted pregnancies seek prenatal care later and
have more pregnancy-related medical complications, such as toxemia, then those who
planned to conceive. Their children are more likely to be premature, of lower
birthweight, and less likely to be breastfed than those born to women who intended to
have children. Both mother and child are greater risk of mental illness like depression.
Most disturbing is that these children are at higher risk for neglect and abuse. Other
studies show higher rates of academic problems and juvenile delinquency in children of
unwanted pregnancies.
Not knowing patient’s medical history is another reason why objecting
pharmacists may be doing more harm than good. What led to a woman’s being given an
EC prescription is privy to the doctor-patient relationship. So when a pharmacist objects
to filling that prescription, he does so without any context. This has potential to be most
harmful in cases of sexual assault. According to Planned Parenthood, 25,000 pregnancies
a year result from rape. In these situations, when a woman deserves sensitive and
expeditious care, a pharmacists’ refusal creates a barrier to that care. And if that woman
was assaulted by a man infected with HIV or other sexually transmitted infections, a
pregnancy risks the health of both mother and child.
Pharmacists also need to consider what harm they may be doing to themselves by
refusing to dispense medications. An objecting pharmacist will earn a reputation as one
and see his business drop as doctors and other customers warn patrons away, or prochoice protestors demonstrate outside his store.
One simple solution to the EC dilemma is to put it over the counter. It’s safe,
effective, and easy to use. Most importantly, respects the autonomy of the patient and
eliminates any third party interference.
Given the chaos at the FDA about doing that, however, the next most reasonable
option is for objecting pharmacists to pass an EC prescription to a non-objecting
colleague or to another pharmacy. The American Pharmacists’ Association has endorsed
this alternative. But a few pharmacists have even refused to do this for their patients.
While refusing and referring is appropriate, those pharmacists who simply refuse
a patient’s needs deserve an ethics lesson. If, as a physician, I refuse to care for someone
without providing alternatives I risk Abandonment—grounds for malpractice and
disciplinary action. Pharmacists who act in this way must be held to the same standard,
because conscientious objection should never supersede patient negligence.
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