Woman suing two pharmacies after being denied emergency contraception

The US case brings to light concerns around conscientious objection at a time when a federal religious discrimination bill is being debated in Australia

Sheshtyn Paola

Woman suing two pharmacies after being denied emergency contraception

A woman has filed a lawsuit against a Thrifty White Pharmacy and a CVS Pharmacy in Minnesota in the US, alleging the two pharmacies illegally kept her from accessing emergency contraception.

Andrea Anderson, a 39-year-old mother of five, says she asked the pharmacist at her drugstore in Minnesota more than once why he couldn’t fill her prescription for emergency contraception, according to the Star Tribune.

“I then realised what was happening: he was refusing to fill my prescription for emergency contraception because he did not believe in it,” Ms Anderson said on Tuesday. . . [Full text]

Paola S. Woman suing two pharmacies after being denied emergency contraception. Australian Pharm J [Internet]. 2019 Dec 12.

Conscience Legislation, the Personhood Movement, and Access to Emergency Contraception

Jonathon F. Will

Faulkner Law Review

Introduction:  In the medical setting, conscience legislation serves to protect health care professionals who refuse to provide certain procedures or services that would violate their consciences.  The “Personhood Movement,” on the other hand, is characterized by advocates’ attempts to adopt legislation or constitutional amendments at the state and/or federal level that would extend the legal and moral protection associated with personhood to members of the human species at the earliest stages of biological development.  The relationship between conscience legislation and the Personhood Movement may not be self-evident, but the connection becomes apparent when considering trends in conscience legislation.  This is particularly true in the context of expanding legal protection to health care professionals who object to certain forms of birth control, such as emergency contraception (EC).


Will JF. Conscience Legislation, the Personhood Movement, and Access to Emergency Contraception. 4 Faulkner Law Review  411 (2013)

The fox and the grapes: An Anglo-Irish perspective on conscientious objection to the supply of emergency hormonal contraception without prescription

Cathal T. Gallagher, Alice Holton, Lisa J. McDonald, Paul J. Gallagher

Journal of Medical Ethics

Abstract

Emergency hormonal contraception (EHC) has been available from pharmacies in the UK without prescription for 11 years. In the Republic of Ireland this service was made available in 2011. In both jurisdictions the respective regulators have included conscience clauses  which allow pharmacists to opt out of providing EHC on religious or moral grounds providing certain criteria are met. In effect, conscientious objectors must refer patients to other providers who are willing to supply these medicines. Inclusion of such clauses leads to a cycle of cognitive dissonance on behalf of both parties.

Objectors convince themselves of the existence of a moral difference between supply of EHC and referral to another supplier, while the regulators must feign satisfaction that a form of regulation lacking universality will not lead to adverse consequences in the long term. We contend that whichever of these two parties truly believes in that which they purport to must act to end this unsatisfactory status quo. Either the regulators must compel all pharmacists to dispense emergency contraception to all suitable patients who request it, or a pharmacist must refuse either to supply EHC or to refer the patient to an alternative supplier and challenge any subsequent sanctions imposed by their regulator.


Gallagher CT, Holton A, McDonald LJ, Gallagher PJ. The fox and the grapes: An Anglo-Irish perspective on conscientious objection to the supply of emergency hormonal contraception without prescription. J Med Ethics. 2013 Oct;39(10):638-42.doi: 10.1136/medethics-2012-100975. Epub 2013 Jan 30.

Preventing unintended pregnancy: pharmacists’ roles in practice and policy via partnerships

Karen B. Farris, Daniel Ashwood, Jennifer McIntosh, Natalie A. DiPietro, Nicole Monastersky Maderas, Sharon Cohen Landau, John Swegle, Orod Solemani

Journal of the American Pharmacists Association

Abstract:  Objectives: To review the literature regarding pharmacists’ roles in preventing unintended pregnancy, review the relevant laws and policies in the United States to describe pharmacists’ and/or pharmacy’s role in policy development related to unintended pregnancy, and identify partners who pharmacists can work with in this public health area.

Data sources: A systematic review was conducted focusing on the role of pharmacists in unintended pregnancy. For practice, articles were identified in Medline through July 1, 2009, using MeSH and keywords. For policy, two authors examined the current status of access issues related to over-the-counter (OTC) status and collaborative practice agreements. Partners were identified in the reviews and authors’ experiences.

Data extraction: English-language, U.S.-based articles that contained either qualitative or quantitative data or were review articles addressing pharmacist interventions, pharmacists’ knowledge and attitudes regarding contraception, and pharmacists’ comfort and ability to counsel on preventing unintended pregnancy were included.

Data synthesis: Some improvements to emergency contraception (EC) access in pharmacies have occurred during the previous decade. Studies focused on counseling, pharmacist provision of depot reinjection, and pharmacist initiation of oral contraceptives were positive. No studies linked increased contraceptive access in pharmacies to lower pregnancy rates. In terms of policy, the literature described three access-related areas, including (1) EC and conscience clauses, (2) collaborative practice agreements, and (3) changes in prescription to OTC status. Pharmacists’ partnerships may include physicians/clinicians, local health departments, family planning organizations, nongovernmental organizations, and colleges of pharmacy.

Conclusion: Currently, pharmacists may increase access to contraceptives primarily via EC and use of collaborative practice agreements to initiate and/or continue hormonal contraceptives. New practice models should be implemented in community or clinic practices as allowed by collaborative practice regulations in each state. We encourage researchers and practitioners to consider a community approach in their endeavors by working with numerous types of primary care providers and organizations to explore ways to increase contraceptive access.


Farris KB, Ashwood D, McIntosh J, DiPietro NA, Maderas NM, Landau SC, Swegle J, Solemani O. Preventing unintended pregnancy: pharmacists’ roles in practice and policy via partnerships. J Am Pharm Assoc (2003). 2010 Sep-Oct;50(5):604-12. Review.

When Two Fundamental Rights Collide at the Pharmacy: The Struggle to Balance the Consumer’s Right to Access Contraception and the Pharmacist’s Right of Conscience

Suzanne Davis, Paul Lansing

DePaul Journal of Health Care Law

Introduction:  The dangerous intersection between a pharmacist’s right of moral belief and a woman’s right of contraceptive use continues to be an important topic for debate across the nation. In fact, the area of contraceptive rights has been a controversial issue since the United States Supreme Court’s decision in Griswold v. Connecticut in 1965, which recognized a constitutional right of privacy in family planning decisions implicit within the meaning of the Bill of Rights. Now, over forty years since this landmark decision, courts continue to grapple with the notion of women’s rights and how contraceptive use should be protected.

New developments in pharmaceutical research and technology have resulted in the formation of new legal and ethical issues. The most recent dilemma faced by both federal and state courts features women who desire a recently FDA approved contraceptive drug called Plan B and pharmacists who are morally opposed to the mode of action of the drug. This newfound ability to prevent birth using a drug taken after sexual activity presents a scenario the Griswold Court would have never anticipated. Nonetheless, the precedent beginning with Griswold has created a necessary collision between these two fundamental rights.

Pharmacists are placed in a unique position in this controversy. Pharmacists are licensed by the state yet some believe that they cannot comply with state requirements due to their individual religious beliefs. As nearly all Americans are familiar, the right to religious belief has been protected since the drafting of the Bill of …


Davis S, Lansing P. When Two Fundamental Rights Collide at the Pharmacy: The Struggle to Balance the Consumer’s Right to Access Contraception and the Pharmacist’s Right of Conscience. 12 Depaul J. Health Care L. 67, 89-91 (2009)

Conscientious Objectors Behind the Counter: Statutory Defenses to Tort Liability for Failure to Dispense Contraceptives

Jennifer E. Spreng

Journal of Health Law & Policy

Introduction:  The United States Food and Drug Administration’s decisions in the past decade to approve both RU-486 and Plan B have created crises of conscience for some religious pharmacists. RU-486 induces abortion in the first trimester of pregnancy without surgical intervention and Plan B is a two-pill “emergency contraceptive” regimen that may have abortifacient properties. Some religious pharmacists prefer not to dispense the drugs because their religious scruples forbid them from participating in abortions.  Some also object to dispensing daily oral contraceptives6 on the same basis.


Spreng JE. Conscientious Objectors Behind the Counter: Statutory Defenses to Tort Liability for Failure to Dispense Contraceptives. 1 St. Louis U. J. Health L. & Pol’y 337, 337-40 (2008)

Reconciling principles and prescriptions: Do pharmacist refusal clauses strike the appropriate balance between pharmacists’ and patients’ rights?

Sarah Tomkowiak   

University of Illinois Law Review

Conclusion: When a woman and her physician decide that a prescription for contraception is in her best health interests, legal, professional, and ethical obligations should prevent a pharmacist from being able to effectively override that determination. The right of a pharmacist to abide by her moral or religious principles when faced with a prescription that goes against those principles is an important right to protect. However, this right should never be allowed to infringe on a patient’s right to access birth control, an equally important right that has significant implications for the majority of American women’s reproductive health. Pharmacist refusal clauses acknowledge pharmacists’ right to refuse at the expense of women’s right to access contraceptives, inappropriately reconciling these rights. Griswold v. Connecticut may be forty years old, but the issues debated before the Supreme Court then have risen anew today, this time behind the pharmacy counter. Following in the footsteps of the Griswold Court, we must now reaffirm that women have the right to make their own family planning decisions, including the decision to use contraception. Legislatures, pharmacy boards, pharmacies, pharmacists, and patients must work together to put the needs of patients back where they belong—as the first priority of the pharmacy profession.


Tomkowiak S. Reconciling principles and prescriptions: Do pharmacist refusal clauses strike the appropriate balance between pharmacists’ and patients’ rights? U Illinois L Rev 2007(4) 1329-1360

The Ever-Expanding Health Care Conscience Clause: The Quest for Immunity in the Struggle Between Professional Duties and Moral Beliefs

Maxine M. Harrington

Florida State University Law Review

Introduction:  During the past few years, the debate over whether health care professionals should be required to provide services that conflict with their personal beliefs has focused primarily on pharmacists refusing to fill prescriptions.1 According to one media account, during a sixmonth period in 2004 there were approximately 180 reports of pharmacists refusing to dispense routine or emergency oral contraceptives. 2 This controversy, however, extends beyond the pharmacy into every facet of the heath care system. . .


Harrington MM. The Ever-Expanding Health Care Conscience Clause: The Quest for Immunity in the Struggle Between Professional Duties and Moral Beliefs. 34 Fla. St. U. L. Rev. 779, 816 n.237 (2007)