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.

Community pharmacists’ attitudes on suicide: A preliminary analysis with implications for medical assistance in dying

Andrea L. Murphy, Claire O’Reilly, Ruth Martin-Misener, Randa Ataya, David Gardner

Canadian Pharmacists Journal

Conclusion

Pharmacists are likely underestimating their frequency of interactions with people with thoughts of dying or with intentions to die either by suicide or through medical assistance in dying procedures. Pharmacists report empathetic responses for those with severe and incurable diseases wishing to end their life, but most do not support death by suicide or through medical assistance. From the preliminary analysis, a personal connection to mental illness or suicide does not appear to influence the permissiveness of pharmacists’ attitudes towards suicide. Framing effects in survey research for pharmacists have not been adequately considered, and more work is needed to determine how this influences the responses of pharmacists.


Murphy AL, O’Reilly C, Martin-Misener R, Ataya R,Gardner D. Community pharmacists’ attitudes on suicide: A preliminary analysis with implications for medical assistance in dying. Can Pharm J (Ott). 2017 Dec 1;151(1):17-23. doi: 10.1177/1715163517744225.

Conscientious objections in pharmacy practice in Great Britain

Zuzana Deans
Bioethics

Abstract

Pharmacists who refuse to provide certain services or treatment for reasons of conscience have been criticized for failing to fulfil their professional obligations. Currently, individual pharmacists in Great Britain can withhold services or treatment for moral or religious reasons, provided they refer the patient to an alternative source. The most high-profile cases have concerned the refusal to supply emergency hormonal contraception, which will serve as an example in this article.

I propose that the pharmacy profession’s policy on conscientious objections should be altered slightly. Building on the work of Brock and Wicclair, I argue that conscientious refusals should be acceptable provided that the patient is informed of the service, the patient is redirected to an alternative source, the refusal does not cause an unreasonable burden to the patient, and the reasons for the refusal are based on the core values of the profession. Finally, I argue that a principled categorical refusal by an individual pharmacist is not morally permissible. I claim that, contrary to current practice, a pharmacist cannot legitimately claim universal exemption from providing a standard service, even if that service is available elsewhere.


Deans Z. Conscientious objections in pharmacy practice in Great Britain. Bioethics. 2013 Jan;27(1):48-57. doi: 10.1111/j.1467-8519.2011.01918.x. Epub
2011 Jul 29. PubMed PMID: 21797914.

Alternative Burdens on Freedom of Conscience

Adam J. Kolber

San Diego Law Review

Abstract: Suppose a pharmacist refuses to dispense pills that induce abortion claiming that dispensing such pills runs counter to principles he holds dear. Indeed, the pharmacist claims that forcing him to dispense the pills would violate his freedom of conscience. He even claims that he would not have become a pharmacist had he foreseen an obligation to dispense such pills at the time he entered his profession. Should the pharmacist’s job be protected if he is making a bona fide claim of conscience? And does it matter whether the pharmacist’s objection to dispensing the pills is rooted in religious or nonreligious reasons?


Kolber AJ. Alternative Burdens on Freedom of Conscience, 47 San Diego L. Rev. 919 (2010).

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.

Religion and conscientious objection: a survey of pharmacists’ willingness to dispense medications

Laura A.Davidson, Clare T.Pettis, Amber J.Joiner, Daniel M.Cook, Craig M.Klugmand

Social Science & Medicine

Abstract: Some US states allow pharmacists to refuse to dispense medications to which they have moral objections, and federal rules for all health care providers are in development. This study examines whether demographics such as age, religion, gender influence 668 Nevada pharmacists’ willingness to dispense or transfer five potentially controversial medications to patients 18 years and older: emergency contraception, medical abortifacients, erectile dysfunction medications, oral contraceptives, and infertility medications. Almost 6% of pharmacists indicated that they would refuse to dispense and refuse to transfer at least one of these medications.  Religious affiliation significantly predicted pharmacists’ willingness to dispense emergency contraception and medical abortifacients, while age significantly predicted pharmacists’ willingness to distribute infertility medications.  Evangelical Protestants, Catholics and other-religious pharmacists were significantly more likely to refuse to dispense at least one medication in comparison to non-religious pharmacists in multinomial logistic regression analyses.  Awareness of the influence of religion in the provision of pharmacy services should inform health care policies that appropriately balance the rights of patients, physicians, and pharmacists alike.  The results from Nevada pharmacists may suggest similar tendencies among other health care workers, who may be given latitude to consider morality and value systems when making clinical decisions about care.


Davidson LA, Pettis CT, Joiner AJ, Cook DM, Klugman CM. Religion and conscientious objection: a survey of pharmacists’ willingness to dispense medications. Soc Sci Med. 2010 Jul;71(1):161-5. Epub 2010 Apr 13. PubMed PMID: 20447746

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