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When Pharmacists Say "No"

Pharmacists tend to believe that they provide dispassionate service and care for their customers who are, after all, patients. But in the 2000s, a passion-filled controversy is dividing pharmacists, engendering activity in Congress and dozens of state legislatures and creating questions about future practices in this field.

The crux of the matter: Should pharmacists have the right to refuse to dispense a medication if its use runs contrary to their moral or religious beliefs?

The issue could hardly be more divisive. Pharmacists in several states have refused to fill prescriptions for morning-after emergency contraceptives. In other cases, pharmacists have declined to dispense conventional birth-control pills, and some even refused to return the prescription to the patient. For pharmacists who exercise their conscience this way without legal protection, the consequences can be profound.

Both Sides Feel the Pressure

“Community pharmacists are under extreme pressure,” says Karen Brauer, president of Pharmacists for Life International, which advocates for pharmacists’ right to refuse and claims 1,500 members. “They’re threatened with loss of jobs and possibly licenses for refusing to stop human life.”

On the flip side, pharmacists who are handed prescriptions that a colleague has refused to fill may experience intense workplace stress.

The legal landscape is complex and unresolved. As of May 2007, six states – California, Illinois, Maine, Massachusetts, Nevada and Washington – had passed laws requiring pharmacists to fill prescriptions, according to a report from the National Women’s Law Center (NWLC) in Washington, DC.

Meanwhile, four states – Arkansas, Georgia, Mississippi and South Dakota – have passed laws explicitly permitting pharmacists to refuse to fill prescriptions based on personal beliefs. What’s more, in the 2006 legislative session, 20 states considered such laws, according to the NWLC report. Various related bills are pending on the federal level.

Is There a Middle Ground?

Some in the industry are seeking a middle ground so pharmacists who refuse to fill contraceptive prescriptions can coexist with pharmacists who will, as most state boards of pharmacy require. “We like to say that we support pharmacists stepping away, not stepping in the way,” says Kristina Lunner, director of federal government affairs at the American Pharmacists Association in Washington, DC.

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