There is a growing movement of pharmacists who want the right to refuse to fill prescriptions for birth control pills, especially for the purpose of emergency contraception (also known as Plan B or morning after pills) arguing that the pills may “terminate pregnancies” and they don’t want to be complicit in abortions. The problem is, though, that this requires a rhetorically useful but nevertheless dishonest change to the definition of “pregnancy.”
Contraception is any means of preventing a pregnancy from occurring. Here, the focus is on oral contraceptives which prevent pregnancies by introducing synthetic hormones to a woman’s body, thereby preventing the release of natural hormones which cause ovaries to release eggs. Taken properly they have a high success rate and their introduction to America helped cause a widespread revolution in sexual mores and women’s social roles which the Christian Right hates to this day.
Emergency contraceptives are large doses of standard oral contraceptives, taken after sexual intercourse has occurred. Sometimes called “morning after pills” or Plan B, they are most effective when taken 24 to 72 hours after intercourse. These pills are taken when physical contraceptive devices such as condoms fail or when a woman has been raped. They prevent ovulation entirely, prevent tubal transport of an ovum and/or sperm, prevent fertilization, or in some cases even prevent implantation.
Some argue that emergency contraception’s preventing a fertilized egg from implanting is a form of abortion. Medically, though, it’s not an abortion — an abortion only involves the removal of an implanted embryo because pregnancy doesn’t start until the egg is implanted. Where the implantation of a fertilized egg is prevented, it is because of the same changes to the uterine lining which are caused by breast feeding. So, if emergency contraception is an abortifacient, so is breast feeding.
The primary job of a pharmacist is to provide accurate, safe, and timely dispensation of medications which have been prescribed by a doctor. It is the physician who best knows the patient and her needs and who has, upon that basis, decided what medication is in the patient’s best interests. If dispensing safe medication is the pharmacist’s primary job, then pharmacists who refuse to dispense such medication are specifically refusing to do what their job ultimately is.
Pharmacists have a professional obligation to refuse to dispense that medication if, in their professional opinion, there are medical reasons to think that the patient may be harmed. An example this would be refusing to dispense medication that would have a deadly reaction with some other medicine that the doctor was unaware of the patient using. Pharmacists do not have a personal right to refuse to dispense medication because they have a religious opinion against its use.
Should pharmacists be allowed to refuse to dispense emergency contraception? If so, why stop there — why not let them refuse to dispense any medication they object to, for whatever reason? Because this would make a mockery of being a pharmacist in the first place. If a person is unwilling to unable to dispense safe, effective medications that are accepted treatments according to current medical standards, then they should not be pharmacists in the first place.
Many imagine that the Christian Right is only focused on abortion, but in fact they are opposed to the entire gamut of reproductive choices people enjoy today. Contraceptives, not just emergency contraception, are on their hit list. If pharmacists can deny patients access to legal, valid medications prescribed by their physicians, what will prevent them from being forced through community, social, and political pressure to refuse to provide the medications — even if they would like to?
Many pharmacies around the nation won’t even carry emergency contraceptives because they don’t want to deal with the controversy — right-wing religious groups have made contraception such a controversial issue that rape victims are being prevented from obtaining basic medical treatment. When asked, pharmacies typically say that there isn’t enough demand, but Planned Parenthood reports a dramatic upswing in demand for it. Women’s reproductive choices are being undermined by religious extremists.
If a person’s religious objections to contraception are so great that they sincerely believe that dispensing it amounts to being complicit in an evil act, a sin against God, then they shouldn’t be forced to dispense it — and, by the same token, they shouldn’t be pharmacists, either. If a person has strong and sincere objections to performing a basic, routine aspect of their job, then they shouldn’t be in that job and they certainly shouldn’t demand that the world revolve around them by adjusting the parameters of the job just to suit them.
This is a fundamentally undemocratic demand. In a democracy, everyone is equally free and everyone has an equal say in the community’s public policies. What the pharmacists and their allies are demanding, however, is veto power over others’ liberty and over the implementation of public policy. They are standing in the doorway and preventing women from taking a legal action because their position is too much of a minority to achieve the same goals through the democratic process.
Ellen Goodman offered this nice summary of what the Christian Right and certain pharmacists are seeking: conscience without consequence. Refusing to do something because your conscience won’t allow it may be laudable in some cases, but it stops being laudable when you refuse to accept the consequences of your refusal. Society cannot function if people are able to ignore whatever rules, regulations, standards, or laws they want on the basis of “conscience” or religious desire.
Where will this process stop? Pharmacists in some places are also refusing to dispense other medication, like psychotropics and even pain relievers. Can bus drivers refuse to stop near fertility clinics? Can regular delivery drivers refuse to deliver things like office supplies to clinics? Individual moral conscience must be protected, but not to the extent that it prevents others in society from being free as well.
