Problems with the Rx
Editorial
Fort Worth Star-Telegram
December 2004
The notion that a pharmacist could, without warning, refuse to fill a prescription because of a moral objection to some uses of the drug sounds on its face like an unwarranted invasion of a patient's privacy.
But the issue isn't that simple. And a bill prefiled in the Texas Legislature offers a poor response. Two incidents earlier this year in which North Texas pharmacists wouldn't fill prescriptions for contraceptives drew attention to the concerns of both pharmacists and patients. Several years ago, the American Pharmacists Association adopted a policy that recognizes an individual pharmacist's right to opt out of dispensing certain drugs based on moral or ethical reasons but calls for pharmacies to have mechanisms in place so that patients still will have access to medications that are legally and properly prescribed. There are several difficulties in balancing the competing interests. A patient's primary medical relationship typically is with the physician who prescribed a particular drug therapy. But pharmacists, who are required to fully inform patients about the drugs they receive, aren't just the equivalent of a drink machine -- money in, product out. A pharmacist's duty to fill legal prescriptions also carries a duty to not fill a prescription that is fraudulent or erroneous or will harm the patient. An example might be concern about a negative reaction with another drug already being taken. Those exceptions, though, are based on the patient's interests, not the pharmacist's. Allowing other exceptions for personal beliefs could let individual pharmacists -- be it out of conscience or whim -- affect health care decisions for customers with little or no knowledge of their circumstances. A pharmacist who doesn't want to be party to abortion or pregnancy prevention could decline to fill a contraceptive prescription for a woman who needs the drug to treat a condition -- such as severe acne or wildly fluctuating hormones -- unrelated to birth control. Drawing a standard that protects only pharmacists who object to the use of abortion-inducing drugs or other contraceptives runs the risk of gender discrimination claims. It also doesn't address other morally fraught situations, such as when medicines are intended for assisted suicide. On the other hand, a broad conscience-based provision could open the door to socially undesirable moralizing. Part of the debate about conscience clauses has focused on the dispensing of drugs, such as RU-486, that end pregnancy in the earliest stages. But a few outspoken pharmacists also object to other "morning-after" pills that prevent an egg from implanting in the uterus and even to standard birth control pills. That has occurred even though the American Pharmaceutical Association and the American College of Obstetricians and Gynecologists define pregnancy as beginning when a fertilized egg implants itself. Those groups do not classify birth control pills or emergency post-intercourse contraceptives that prevent implantation as abortifacients. The bill filed in November by Rep. Frank Corte Jr., R-San Antonio, is both too narrow and too broad. It focuses only on pharmacists who object to "directly or indirectly performing or participating in an abortion procedure or dispensing an emergency contraceptive." It doesn't include other legitimate moral conflicts, nor does it address reasons for objecting. At the same time, the bill defines "emergency contraceptive" as "a prescription drug containing an elevated dose of hormones that is used to prevent pregnancy." That could include hormone-based birth control pills beyond those used to end pregnancy. And the bill pertains only to pharmacists -- including giving them a right to sue their employer for damages and lost wages -- without requiring protections for patients. According to state association guidelines, Texas pharmacists are expected to talk with their employers before refusing to fill a prescription, and pharmacies are supposed to arrange for a backup so that customers aren't denied service. This issue is worth discussing so that pharmacies are prepared before conflicts arise; so that employees and employers understand expectations and procedures; and so that patients are informed. But this bill, as drafted, is not a good alternative to letting companies develop the proper safeguards that keep in mind their obligation to those they serve. Copyright 2004 Star-Telegram, Inc.
Record Number: 11270784
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