Death of a Conscience Clause
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Tue May 02, 2006 at 08:43:18 AM EST
Women all across the country continue to walk into pharmacies, present prescriptions for emergency contraception, common birth control pills, or even medications such as antibiotics, and find themselves at the mercy of a growing number of graduates of the Faith-Based School of Pharmacology.  

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In most states besides Illinois -- where Governor Rod  Blagojevich outraged the Operation Save America-affiliated Angela Michael and other self-appointed guardians of "Christian" morality by requiring pharmacists to do their jobs -- women continue to be denied prescribed medication with seeming impunity. This, despite the fact that only Arkansas, Georgia, Mississippi, and South Dakota have passed laws protecting pharmacists who refuse to dispense emergency contraception.

In 2005 such a piece of legislation was introduced in Texas, where it might have been expected to barrel through our rabidly anti-choice legislature like the Wabash Cannonball. But strangely enough, the bill was swiftly killed off in committee - and by avowedly "pro-life" Republicans. In an unexpected twist of irony instructive to those fighting for a woman's right to contraception in the face of the religious right's campaign against birth control, an abortion statute already in existence dealt the death blow to a "conscience clause."

Photobucket - Video and Image HostingIn early 2005, Texas State Representative Frank "The Fetus" Corte was so eager to deny women in Texas access to emergency contraception that he pre-filed his House Bill 16 before the legislative session had even convened. Quite typically for a "moral refusal" bill - and like pharmacists who perhaps skipped class for Bible study while their professors were explaining the pharmacology of birth control pills - Corte's HB 16 attempted to conflate emergency contraception and abortion.

A BILL TO BE ENTITLED AN ACT

relating to the right to object to participation in an abortion procedure or to the dispensing of an emergency contraceptive.
:::
A physician, pharmacist, nurse, staff member, or employee of a hospital, [or other] health care facility, or pharmacy who objects to directly or indirectly
performing or participating in an abortion procedure or dispensing an emergency contraceptive may not be required to directly or indirectly:

(1)  perform or participate in the procedure; or                
(2)  dispense or participate in the dispensing of the contraceptive.

In a state like Texas, where Corte and his Senate counterpart Tommy Williams had steamrollered a draconian antiabortion bill through the legislature only two years before, passage of HB 16 should have been assured.  But Corte ran into an unexpected obstacle as his bill was being considered by the State Affairs Committee of the Texas House.  

To Frank Corte's consternation, someone stood up in the committee hearing room and read from the "Woman's Right to Know Act" that Corte himself had authored only two years before: "An abortion may be performed only by a physician licensed to practice medicine in this state."  That one sentence, introduced into law by Corte himself, spelled the death of his "conscience clause" bill.

Of course, the peculiar religiously-based notion that EC constitutes an abortion is the sole grounds upon which some pharmacists refuse to dispense it.  Even members of the committee who were as opposed to reproductive choice as Corte is were quick to realize the possible, and even probable, repercussions. Once a state statute had codified and sanctioned the concept that the hormones contained in emergency contraception - hormones identical to those in 21 commonly prescribed brands of birth control pills that are used for EC - could be deemed capable of producing an abortion, it could plausibly be argued that only a physician could legally dispense a daily birth control pill.  

The voters wouldn't like that. After all, with 70% of sexually active American women wishing to avoid pregnancy, even most nominally anti-choice women need birth control. The major drug chains wouldn't like the loss of such a lucrative source of income much, either. You know, companies like Walgreens, which is racking up quite a record as a defender of pharmacists who equate their own diplomas with those issued by schools of divinity.

The city of Austin, Texas has even found it necessary to legally constrain Walgreens from denying city employees contraception. Nevertheless, Walgreens spokesman Michael Polzin says that his company has a comprehensive policy in place for accommodating the delicate moral sensibilities of any of its more than 15,000 pharmacists who might be so professionally deficient as to believe that emergency contraception is a form of abortion, while making sure that women who would like to avoid a real abortion are able to obtain a simple dose of hormones that gold standard studies show to do nothing but delay ovulation. And Polzin insists that any such refusals are rare events. As he explained after a complaint was lodged against Walgreens in Wichita, Kansas, "We think our policy is a good one and that it first and foremost meets our obligations to take care of the patients' health care needs while at the same time respecting the views of our pharmacists."

Polzin's explanation of Walgreens' "good" policy is quoted in an article detailing the results of a Kentucky study conducted by the Reproductive Freedom Project.

Walgreens: Spokesman Michael Polzin said in a phone interview last week: "We stock it in our pharmacies as we would any other medication, according to demand. Our policy is that we want to respect the views of our pharmacists while still meeting the health care needs of our patients. We feel we can do that by allowing the pharmacists to step away from filling a prescription they have a moral objection to. However, the pharmacist must refer that prescription to another pharmacist on duty," or alert store management. Management will arrange to have it filled at a nearby pharmacy, before the patient leaves the store, he said. One caveat is that where applicable, state law trumps store policy.

And sometimes, as Walgreens found out last year in Illinois, anti-choice intimidation trumps almost anything.

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Fortunately for the women of Illinois, Governor Blagojevich wasn't impressed.

So far, if the many published reports of pharmacy refusal complaints are anything to go by, corporate policies haven't let respect for state legal requirements get in the way of respect for "moral objections."  As just one example, let's take a peek at pharmacy licensing standards in Texas regarding the filling of prescriptions.  

(b) Prescription dispensing and delivery.
 :::
(A) All prescription drugs and/or devices shall be dispensed and delivered safely and accurately as prescribed.
:::
(C) The pharmacy shall utilize a delivery system which is designed to assure that the drugs are delivered to the appropriate patient.

(D) All Pharmacists shall exercise sound professional judgment with respect to the accuracy and authenticity of any prescription drug order they dispense. If the pharmacist questions the accuracy or authenticity of a prescription drug order, he/she shall verify the order with the practitioner prior to dispensing.

(E) Prior to dispensing a prescription, pharmacists shall determine, in the exercise of sound professional judgment, that the prescription is a valid prescription. A pharmacist may not dispense a prescription drug if the pharmacist knows or should have known that the prescription was issued on the basis of an Internet-based or telephonic consultation without a valid patient-practitioner relationship.

(F) Subparagraph (E) of this paragraph does not prohibit a pharmacist from dispensing a prescription when a valid patient-practitioner relationship is not present in an emergency situation (e.g. a practitioner taking calls for the patient's regular practitioner).

Aside from a few lines about the proper packaging and shipping of prescription drugs, that's about it - with nary a word that possibly could be construed as permitting a pharmacy's employees to impose the rigid strictures of their own peculiarly religious, and decidedly unscientific, "views" upon a woman who asks only that a pharmacist do the job for which he or she was issued a professional license, the retention of which is subject to a pharmacist's compliance with state standards of practice.  

Even in the absence of a direct order such as the one issued by the governor of Illinois, Texas pharmacists have no legal ground to stand on when refusing to fill a prescription for contraceptives on "moral grounds."  That is why Frank Corte recognized the need for his quickly aborted attempt to provide legal cover for dominion-minded pharmacists with his "conscience clause" measure, HB 16. And despite the spin of corporate front men such as Michael Polzin, no straddle-the-fence corporate policy overrides compliance with any state's requirements for pharmacy licensure.

But laws only matter when they're enforced. Last Friday our clinic received a call from a young woman who reported that a pharmacist in her East Texas city had just informed her that his store, owned by a major pharmacy chain with a history of refusal incidents, would not honor her prescription for Plan B because "even if we have it, we don't sell it, for ethical reasons."  

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The young woman had called because she wanted to help ensure that no other woman would be subjected to such humiliating treatment, and asked for information about how to file a complaint.

On Monday, I had the great pleasure of wishing that young woman every success in her new client relationship with the National Women's Law Center.  

[Title image copyrighted by Eleanor Mills, reproduced by permission]




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Increasingly, "conscience clause" exemptions that allow pharmacists from "opting out" of their jobs to provide prescribed birth control are using these exemptions to refuse other medications:

a) There are reports that Valtrex has been refused patients based on "conscience clauses" on the sole basis Valtrex is an antiherpetic which can be used to treat genital herpes (Valtrex has many other indications besides genital herpes--the most common being for treatment of and prevention of chickenpox infection in immunocompromised children and in adults, treatment of shingles, and preventive treatment of simian herpesvirus B (a fatal infection in man, and an industrial hazard for zoo workers and primate researchers).

b) There are reports that people have been refused HIV medications on the same grounds, especially earlier in the AIDS crisis.

c) There are reliable reports that women have been refused all medications, including antibiotics, who have gotten prescriptions at women's clinics that are believed to perform abortion services.  

Sadly, the "refusal despite endangerment of life" has its own precedent with birth control--as the most common non-contraceptive reason for use of the birth control pill is management of polycystic ovary disease, which can lead to fatal consequences (including cyst ruptures, diabetes, and severe obesity) if untreated.

by dogemperor on Tue May 02, 2006 at 05:45:11 PM EST

There are reliable reports that women have been refused all medications, including antibiotics, who have gotten prescriptions at women's clinics that are believed to perform abortion services.

And unfortunately, this is nothing new. A colleague in Louisiana related several years ago that a Wal-Mart pharmacist in the northern part of the state had refused to dispense doxycycline to one of their patients after seeing the clinic's name at the top of the prescription form.

But now, with the support of anti-choice organizations and politicians, such rogue pharmacists are becoming bolder, and asserting nonexistent "rights" that supposedly supersede the explicit legal entitlement that a patient has to a properly prescribed and medically necessary drug.

The public spokesman for a pharmacy chain like Walgreens can get away with characterizing refusal incidents as "rare" only because most women feel so humiliated that they don't file complaints.

by moiv on Tue May 02, 2006 at 09:58:35 PM EST
Parent



The Religious Institute on Sexual Morality, Justice, and Healing, advocates a faith-based commitment to sexual and reproductive rights,, including access to voluntary contraception, abortion and HIV/STD prevention and treatment. Measures which limit women's access are punitive and do nothing to promote moral decision making. When there is a conflict between the conscience of the provider and the woman, the institution delivering the services has an obligation to assure that the woman's conscience and decision will be respected and that she has access to reproductive health care, either directly or through referral.

For more information, visit Rev. Haffner's blog at http://debrahaffner.blogspot.com or The Religious Institute's homepage at www.religiousinstitute.org

by Religious Institute on Wed May 03, 2006 at 01:49:39 AM EST

is the best. She just plain rocks.

Thanks for posting the link.

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Parent

Thank you so much for your supportive comment.  If you go to my blog, you'll see it was a bad day yesterday for "hate blog comments", so I especially appreciated it.  You also did a great job on this article.  

I'm wondering if you could add the Religious Institute on Sexual Morality, Justice, and Healing to the list of "Resources" on the right hand side of the page as well as my blog, "Sexuality and Religion: What's the Connection" at http://debrahaffner.blogspot.com  Or could you tell us who else to approach to do so?

Keep up the great work.

Rev. Debra

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