Rx for conflict

June 16, 1997


Staff Writer

Pharmacist Jeff Moyer knows what he would do if confronted with a request to fill a prescription that violated his religious beliefs on abortion or birth control.

"I wouldn't be able to fill it," he said.

Moyer, manager of Waynesboro (Pa.) Hospital's pharmacy, said he would invoke a hospital policy that allows employees to decline to participate in an aspect of patient care that conflicts with their cultural values, ethics or religious beliefs and then he would refer the customer to one of the other two pharmacists there.

Because the pharmacy only serves hospital inpatients "there really isn't much of a demand here" for those type of prescriptions, Moyer said.


But pharmacists like Moyer who oppose abortion can expect to increasingly face conflicts between their professional duties and their personal beliefs.

The Food and Drug Administration recently proclaimed safe emergency contraception or "morning after" birth control pills, prescribed to prevent a fertilized egg from implanting in the uterus and the RU-486 abortion pill is awaiting approval.

The ethical issues are only multiplying. Oregon has legalized drugs for physician-assisted suicide and other states may soon follow.

The 48,000-member American Pharmaceutical Association supports pharmacists' right of refusal but says patients' right to treatment must also be accomodated, perhaps by referring them to another pharmacist.

But some health care professionals express concern about the effect on patients of having their prescriptions refused.

"It's very difficult to dictate personal beliefs and a pharmacist's refusal to fill a prescription based on his own beliefs would certainly put the patient at an inconvenience," Dr. Rachel Mandel, a Hagerstown gynecologist/obstetrician, said.

Diane Silas, director of Hagerstown Reproductive Services, said her clinic can dispense emergency contraception but she finds it "horrifying" that some pharmacists might refuse to fill such a prescription.

"It represents an inappropriate intrusion by a pharmacist into a woman's life and her decision-making," Silas said. "There seems to be no shortage of people willing to do that."

'We're not robots'

Bo Kuhar, executive director of the 13-year-old Pharmacists for Life International association based in Powell, Ohio, disagrees.

"We're not robots, just dispensing whatever's written down," Kuhar said.

His organization, which he estimates has more than 1,400 members, adopted a "Model Pharmacist's Conscience Clause" that says pharmacists have the right to refuse "on personal, ethical, moral or religious grounds" to perform any act in the normal course of their job.

The clause calls for protection of pharmacists who make such a "claim of conscience" from damages, recriminatory or discriminatory action and denial of employment.

Independent pharmacists have more flexibility than those who work for a retail chain, Hagerstown family practitioner Dr. Allan Ditto pointed out.

Pharmacists who own their own pharmacies "should have that freedom" to refuse to fill a prescription that violates their personal beliefs, Ditto said.

But they should make their policy known to their customers and offer them the alternative of going to another pharmacy, he said.

State laws vary

Pharmacists' options under the law vary depending upon where they practice.

Maryland law was just changed to give pharmacists a "professional judgment mandate," said David Russo, president of the Maryland State Board of Pharmacy and a pharmacist at The Medicine Shoppe in Hagerstown.

"A pharmacist is always free to decline to fill a prescription" and the mandate prevents an employer from forcing a pharmacist to fill it, Russo said.

But the pharmacist must discuss why a prescription isn't being filled with both the patient and the doctor, he said.

Pennsylvania pharmacists can refuse to fill a prescription if they believe it is not "in the best interests of the patient," said Carmen DiCello, executive director of the Pennsylvania Pharmacists Association.

In West Virginia, pharmacists can only refuse to fill a prescription for clinical or professional reasons, said Richard Stevens, executive director of the West Virginia Pharmacists Association.

If a pharmacist were to refuse to fill a prescription for any other reason, it "may be a cause for a patient to bring some legal action," he said.

The West Virginia Pharmacists Association takes the position that a pharmacist should not let personal beliefs interfere with professional responsibilities, Stevens said.

Pharmacists seldom know the patient's diagnosis and so they don't always know how a prescription is being used, he said.

As an example Stevens pointed to birth control pills which can be prescribed for a variety of female ailments and not just as a means of contraception, he said.

Leeway suggested

Linda Smith, a pharmacist and the former vice president of the National Organization of Women chapter in Washington County, said she believes that "they should give the patient another option if they are refusing to fill (the prescription) themselves but on the other hand I understand why this is an area that's very tricky."

Sometimes a pharmacist doesn't want to fill a prescription because of suspected drug abuse, she said.

"There has to be some leeway for pharmacists. There has to be some room for pharmacists to make decisions based on the situation," Smith said.

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