Deborah Oyer, M.D.: No room for personal beliefs in pharmacies

I magine being in urgent need of medical care and being turned away by a health care provider. It is a frightening thought that evokes images of America generations ago, when people were denied emergency care because they were poor, or because of their race or ethnicity.

Yet in many states women still experience this situation today when they try to fill prescriptions for contraception. A proposal before the Washington State Board of Pharmacy would open the door to a similar situation in our state.

Many states allow pharmacists to refuse to fill prescriptions for birth control and emergency contraception if they are personally opposed to contraceptive use. Some pharmacists not only refuse to fill the prescription, but also refuse to provide women with referrals to other pharmacies who will fill it.

As a physician, I am very concerned about pharmacists refusing to fill my patients’ prescriptions based not on medical or scientific judgments, but on the pharmacist’s personal beliefs.

I am very aware of the complexity of pharmacists’ responsibilities, which include ensuring that patients receive proper dosages of medications and that they do not take medications that may interact negatively together. They have an important role to play in the provision of health care and their professional judgment must be valued and respected.

However, that does not mean that pharmacists should be allowed to deny patients appropriate, safe and needed medications based on their personal, non-medical judgments, or worse yet, to make hostile attempts to dissuade women from using the method.

Pharmacists in Washington have been and continue to be leaders in the movement to improve access to emergency contraception through pharmacies.

In July 1997, the Washington State Board of Pharmacy and The Washington Pharmacy Association, along with a group of community organizations, made emergency contraception more widely available to women in our state by making it possible for women to access the medication directly from their pharmacists. This program is remarkably successful and seven other states now allow women to access emergency contraception through pharmacies directly.

I want to be very clear what we are talking about when we say “emergency contraception.” Emergency contraception is a high dose of the same medication found in regular birth control pills that can help prevent pregnancy after unprotected sex.

Pharmacists, along with many members of the American public, are sometimes misled by deceptive statements from “anti-choice” advocacy organizations around the country which have engaged in a calculated misinformation campaign that ignores all scientific evidence and attempts to convince the public and health care providers that emergency contraception is not contraception. These advocacy organizations irresponsibly claim that the pills can cause a “very early abortion.”

This claim is simply untrue. Emergency contraceptive pills will not affect an existing pregnancy.

What is so dangerous about a pharmacist telling a woman seeking emergency contraception that he or she is opposed to the medication and that the woman will have to go to another pharmacy to have her prescription filled? Emergency contraception is a time-sensitive medication, becoming less effective the longer a woman takes it after unprotected intercourse.

If a pharmacist refuses to fill a woman’s prescription and refers her to another pharmacy, even if she is able to fill the prescription elsewhere, the referring pharmacist is forcing the woman to use a contraceptive that is less effective than it would have been if she had access to it sooner. This, however, is the best-case scenario.

When women living in rural areas are refused emergency contraception and referred on, they may face a trip of many miles to another pharmacy, and may face financial barriers as well if their insurance is tied to their pharmacy. Some women will be unable to make this journey due to inadequate transportation, lack of childcare or inflexibility of work schedule.

For these women, a refuse and refer policy has the effect of a flat-out refusal, a refusal which may lead to an unwanted pregnancy that could have been prevented. In this scenario, instead of being allowed to take responsibility for preventing an unwanted pregnancy by accessing timely contraception, a woman is compelled to become pregnant based on the individual moral beliefs of someone who is likely a stranger to her.

The Washington State Board of Pharmacy must not allow pharmacists to refuse to fill legal, valid prescriptions because of their personal, non-medical beliefs.