Can Pharmacists Withhold Birth Control?

April 6, 2004 — -- When Julee Lacey, a married mother of two, tried to get her birth control pill prescription refilled at a CVS near her home in suburban Dallas, the pharmacist refused.

"She began to tell me that she personally does not believe in birth control, and that therefore she would not fill my prescription," said Lacey, who attends church regularly and is a former teacher of the year.

Lacey's situation could happen with increasing frequency, since many conservatives are seeking laws that would protect pharmacists' jobs if they refuse to fill any prescription they oppose on religious or moral grounds.

"Pharmacists should not be forced to do anything," said Karen Brauer, president of Pharmacists for Life International. "Pharmacists should be practicing pharmacy for the purpose and benefit of enhancing human health and human life."

Brauer and other conservative pharmacists do not believe birth control pills enhance human life — in fact, they see them as doing quite the opposite.

The Food and Drug Administration and American College of Obstetrics and Gynecology have defined pregnancy as beginning at the moment a fertilized egg is implanted in the uterine wall. But many conservatives believe pregnancy — and therefore life — begins at the moment of fertilization, up to a week before implantation. Since the pill, the so-called morning-after pill, and other hormonal contraceptives can take effect after fertilization, they see these medications as ending human life.

Currently, only two states — Arkansas and South Dakota — have laws protecting pharmacists from having to dispense medications they oppose, which supporters call "conscience clauses" and opponents call "refusal laws." Ten other states — Indiana, Michigan, Minnesota, Mississippi, Missouri, Ohio, Rhode Island, Vermont, Washington and Wisconsin — are considering such legislation.

Fierce Debate

"These so-called conscience laws are unconscionable," said Terry O'Neill, vice president of membership for the National Organization for Women. "Any pharmacist who is not willing to care for a woman's total health should not be a pharmacist. Central to a woman's reproductive health is her ability to get birth control."

The controversy over the legality of hormonal birth control often only pops up during debates over abortion, even though the numbers of women who use birth control vastly outnumber those who have sought abortions. Often the same sides are represented; those opposed to abortion rights often oppose such birth control methods.

"I will not be supportive of covering medications that would lead to a fertilized egg not implanted in the uterus," Sen. Rick Santorum, R-Pa., said during the March 2003 Senate debate over what opponents call partial-birth abortion. "I believe life begins at conception. I would not support drugs that would prevent a conceived embryo to be implanted."

Sen. Dick Durbin, D-Ill., a supporter of abortion rights, said he "was stunned when I came to Congress many years ago to find that the people most vehemently opposed to abortion were equally opposed to contraception. How can that make sense?

"If you don't offer to a woman — a wife, for example, in a family situation — an option to plan her pregnancies, then you are just inviting an unplanned or unwanted pregnancy, inviting the possibility of abortion," he said.

But to many conservatives, some forms of birth control and abortion are essentially the same thing: the ending of a human life.

The Referral Process

Attempting to straddle the fence on this issue, the leading pharmacists' association says conscience clauses are fine as long patients aren't entirely left out in the cold.

"The American Pharmacists Association supports the right of a pharmacist to excuse themselves from activity which they find objectionable," said Susan Winckler, the APA's vice president for policy and communications. "But the second part of that right to exercise a conscientious objection is that they establish a system or an alternative way for the patient to be able to access legally prescribed therapy."

The alternative could be a referral to another pharmacist or a separate pharmacy altogether.

But that isn't good enough — for either side.

"A person who is able to go to a pharmacy to obtain a medication is able to locate a pharmacy that can serve their needs," said Brauer, of Pharmacists for Life International. "They can call and determine if the pharmacy carries their medication. There is really no need for a referral. There are mail-order pharmacies, there's Federal Express. There's the ability to deliver things onto a person's doorstep."

NOW's O'Neill calls the referral process "completely unacceptable" and a humiliating experience for women. She suggests the pharmacist should be the one referred "to a different occupation."

When the APA's House of Delegates came to this policy position in 1998, it was "hotly debated," Winckler said. "The fact that either extreme doesn't agree with it may indeed show that in fact, it's the right approach."

Drug Stores Adopt Different Policies

The CVS pharmacist who refused to fill Lacey's prescription still has her job. Lacey had been taking her birth control pills for nine years — with pauses to have her two children — and filling her prescription at that CVS for a year.

As she was driving home from CVS after being denied, Lacey got angry. "It was not right to deny me my medication that was prescribed to my by my licensed doctor," she said. "I really couldn't believe that she had the right to withhold my medication from me."

Lacey contemplated taking her business to the local Eckerd Drugs store. But this week, CVS announced it had purchased roughly 1,200 Eckerd stores in Texas, Florida and several other Southern states. CVS says its policy is to dispense legally prescribed therapies to customers as quickly as possible, but it will not force pharmacists to do things that would violate their religious beliefs.

Eckerd, however, sided with the customer in a case involving a pharmacist at one of its Texas stores. In late January, Gene Herr — then a pharmacist at a Denton, Texas, Eckerd Drugs — declined to fill a prescription for a morning-after pill. It had been prescribed for a woman who had just been raped.

It was a "worst-case scenario," Herr told ABCNEWS. "I went in the back and prayed about it a little bit. I called my associate pastor, and asked him what he thought about it and basically he just confirmed what I was already thinking."

Herr went back to the counter and explained that if that if the rape victim had conceived, the morning-after pill "would take the child's life, and I can't fill it."

"Pharmacists aren't vending machines," said Herr. "We have morals, we are human beings as well, we have beliefs. I mean, everyone wants to live consistently with their own beliefs."

Herr paid a price for acting on those beliefs; Eckerd fired him within the week.

Herr has since found another job. Lacey has since found another pharmacy to fill her prescriptions. They are two Texas Christians with vastly different views of a pharmacists' obligation to his patient.