Plan C, for conscience

One American state has thought better of its policy to browbeat pharmacists into selling the morning after pill.
Cristina Alarcon | Jul 19 2010 | comment  



I was thrilled to learn that Washington State will be creating new rules for pharmacists who have conscientious objections to providing services or products they find morally objectionable. The new regulations would give plaintiffs in a Washington lawsuit -- the owners of Ralph's Thriftway pharmacy and two pharmacists -- the right to refuse to stock or dispense Plan B "morning after pill" based on their belief that life is sacred from the moment of conception.

This is a great turn-around by both the state and the Pharmacy College Board, which for several years maintained that pharmacists’ freedom of conscience had to be restricted in order to ensure consumer access to the morning after pill. Although in 2006 Pharmacy Board members had unanimously supported a rule that would protect conscience for pharmacists and pharmacy owners, an ideological move by Governor Christine Gregoire saw their jobs imperilled should they stick to that position.

Buckling under pressure, the board adopted new language mandating pharmacists to stock and dispense the medication even when doing so violates their conscience. The board adopted this regulation even though it admitted that it found no evidence that anyone in the state had ever been unable to obtain Plan B (or any other time-sensitive medication) due to moral or religious objections. The Becket Fund, which came to the defence of the family owned pharmacy and its two pharmacists, filed suit to prevent the new regulation from forcing them out of their profession.

In its most recent filing, the state concedes that allowing pharmacists with conscientious objections to refer patients to other pharmacies "is a time-honoured pharmacy practice" that is "often in the best interest of patients, pharmacies, and pharmacists" and "do[es] not pose a threat to timely access to lawfully prescribed medications."

Although I am not an advocate for mandated referral -- I believe that the onus should be on the authorities to find alternate means of service provision -- the Washington ruling is a clear victory for the profession of pharmacy and it sends a clear message to all: the state -- and, I would add, professional boards -- ought to remain neutral in matters of faith and morals as they relate to individual conscience, in so far as there is no threat to public safety or to the common good. While the state plays an important role in ensuring the health, peace, morality and safety of its citizens, it should not use its power in a dictatorial way, imposing limits on individual conscience in matters which are legitimately open to dispute.

But is this not unfair? Is it not a case of a pharmacist or store owner imposing his or her values on others, and will it not cause great inconvenience to customers, which, some would argue, should be a professional’s first priority?

On the question of fairness, I would answer that justice is for all. In any agreement, one party must not be oppressed at the expense of another. In the case of the Plan B provision, both parties can be readily respected by placing the onus on provincial pharmacy boards to provide information on non-dissenting providers via toll-free numbers.

Although some might argue that inconvenience is a form of oppression, in reality it is nothing more than the frustration I might feel at having to walk several blocks to find my favourite brew. True, coffee is not comparable to morning after pills, but then neither is the importance of conscience comparable to hurt feelings.

But this is not simply a question of protecting my own conscience. While no professional would go out of his or her way to inconvenience a client, the priority of healthcare professionals must be patient safety, which may not always coincide with patient satisfaction. This is more obvious in the case of refusal to fill an inappropriately written prescription, or one that poses significant risks to the patient. As a pharmacist who refuses to sell Plan B, my concern is for the woman before me and also for a potential new life should conception have already taken place after a single act of intercourse. All patients are important to me, from the weakest and most vulnerable folks I can see, to the ones that have yet to develop and see the light of day.

Legal counsel Luke Goodrich has summed up the issues well: "Americans should not be forced out of their professions solely because of their religious beliefs -- but that is exactly what Washington State sought to do. The government should accommodate and protect the fundamental rights of all members of the medical profession, not punish some members because of their religious beliefs."

Cristina Alarcon is a Vancouver pharmacist and writer. She holds a Masters in Bioethics.



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