Pharmacists' moral beliefs vs. women's legal rights

When pharmacist Neil Noesen refused to fill a customer's prescription for birth-control pills at a Kmart in Menomonie, Wis., he did so on the basis of his religious beliefs. But when he also refused to transfer the woman's prescription to another pharmacy, she went to the police.

Next week, on May 4, Mr. Noesen will appear before a court commissioner in Madison, Wis., to face a disciplinary hearing on charges of unprofessional conduct. The Wisconsin Department of Regulation and Licensing could fine him or revoke his license.

Noesen's case mirrors two incidents in Texas that are pitting a woman's legal right to contraceptives against a pharmacist's right to follow his or her conscience. In Denton, Texas, a pharmacist at an Eckerd pharmacy lost his job in January after turning away a rape victim who wanted to fill a prescription for a morning-after contraceptive. And in suburban Dallas last month, a CVS pharmacist refused to fill a prescription for birth-control pills for a married mother of two. CVS says it is "addressing the situation" with the pharmacist.

Referring to cases like these, Lisa Boyce, vice president of public affairs for Planned Parenthood of Wisconsin, says, "It's certainly not an epidemic, but it's noteworthy." She and other activists express concern that women's access to birth control could be threatened by such refusals.

"No woman should have to shop around until she finds a pharmacist who will dispense her doctor- prescribed birth-control prescription," she says.

Noesen's attorney, Krystal Williams-Oby of Madison, explains his actions on July 6, 2002, when a university student handed him her prescription. "My client was not judging the patient," she says. "He was judging his own heart. He sincerely believes he would be committing an act of sin to dispense [birth control], and to call someone else to dispense it." She sees this as a religious liberty issue.

The American Pharmacists Association maintains a two-part policy. "The pharmacist has the right to conscience, and the patient has the right to legally prescribed medication," says spokesman Michael Stewart. A pharmacist who objects to dispensing a particular medication must tell an employer. If one pharmacist refuses to fill a prescription on grounds of conscience, another pharmacist must do it. Some customers may be referred to another pharmacy. Other prescriptions may be delivered by mail.

"In the great majority of cases, the pharmacist's right to conscience is exercised appropriately and seamlessly, so the patient is not even aware that the pharmacist has exercised that right," Mr. Stewart says. "A pharmacist can say, 'Let me get Bob for you, ma'am,' and that's the end of that."

Two states - South Dakota and Arkansas - already have laws protecting pharmacists who refuse to fill birth-control prescriptions on moral or religious grounds. Ten other states, including Wisconsin, are considering such legislation - Indiana, Michigan, Minnesota, Mississippi, Missouri, Ohio, Rhode Island, Vermont, and Washington.

Karen Brauer, president of Pharmacists for Life International, believes that states without protection for pharmacists will eventually face a pharmacists' shortage. She was fired by Kmart in 1999 for refusing to fill a contraceptive prescription.

Store policies differ. CVS states that its pharmacists must ensure that "customers promptly receive all medications for which they have a lawfully written prescription."

At Wal-Mart, pharmacists do not stock the morning-after pill. Danette Thompson, a spokeswoman, calls the policy a business decision. "When we look at the number of prescriptions filled for a given drug and the frequency with which that's requested by a customer, those kinds of things are taken into consideration," she says.

Critics counter that Wal-Mart's dominance in rural areas leaves many women with few alternatives if they need emergency contraception in cases of rape or incest.

Also, "many rural communities only have one pharmacy," says Ms. Boyce, "so you have only one pharmacist. Or the next pharmacy is miles away.

Calling the recent refusals by pharmacists "very troubling," Kelda Helen Roys, executive director of NARAL Pro-Choice Wisconsin, says, "If we let pharmacists pick and choose which prescriptions they're going to honor, you basically invalidate that healthcare for large numbers of people in the state." More than 90 percent of women will use birth control at some point in their lives, according to Planned Parenthood.

Others see the issue differently. "This is a situation where certain people of certain faiths seem to be fair game for discrimination, which is egregious," says Peggy Hamill, director of Pro-Life Wisconsin in Brookfield. She tells of pharmacists who refused to fill prescriptions and have had to move from one place to another. Others have taken jobs in nursing homes.

Contraceptives are not the only moral and ethical issue some pharmacists face. Mr. Stewart says that in Oregon, where assisted suicide is legal, the American Pharmacists Association policy would support a pharmacist who does not want to dispense medication that would facilitate assisted suicide. And in other states, he adds, "Our policy supports pharmacists who do not want to dispense lethal injections as capital punishment."

As pharmacists and women's groups await the results of Noesen's hearing, some ethicists are considering the ramifications as well. Linda Rankin, a medical ethicist and philosophy professor at the University of Tennessee in Knoxville, calls this a complex issue.

"It's clearly legal that women are entitled to get morning-after pills," she says. "Morality is a lot slipperier. If we don't protect personal integrity, we would go down a dangerous avenue. By taking a professional license, you do in fact step out of your personal morality. You have taken on an additional responsibility, but that does not mean you have given up your integrity as a person.

"When people take on the life of a pharmacist, they have to realize what might be asked of them," Professor Rankin continues. "Would they be able to fill these prescriptions? If they can't, then they have a moral obligation not to practice at a place where they are the only pharmacist, and where not to do this would cause serious harm to other people."