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"Conscience" Bill Unclear

Pharmacists already have no access to "abortion pill"

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A proposed law that's supposed to protect pharmacists' rights is worrying groups like Planned Parenthood and the ACLU, but it hasn't attracted much attention from the lobbyists who represent the very professionals the bill is supposed to help.And it probably won't unless the bill picks up steam, and soon. "It's just not on the radar screen," said John Goodman, a lobbyist for the North Carolina Association of Pharmacists. "To my knowledge, our association has not discussed this issue or posed this issue with its membership."

What the bill could do is anyone's guess. The "conscience protection" proposal filed by Rep. Jeff Barnhart, R-Cabarrus — and four other Republicans who oppose abortion — would protect from legal action the small number of pharmacists, nurses and other healthcare providers who refuse to participate in an abortion or "prescribe or dispense drugs or devices which result in an abortion."

But there are a couple of catches: First, the bill gives no indication of what drugs or devices cause an abortion. Nor did the bill specify who would determine such criteria.

Second, the American Medical Association and the Food and Drug Administration do not consider either birth control pills or emergency contraception (the higher-dose pills meant to prevent pregnancy after sex) as abortion-causing medications.

Barnhart was not available for comment, but one of the bill's co-sponsors, Rep. Bill McGee, R-Forsyth, said he wasn't sure if such specifics were even discussed during the bill's drafting. Still, McGee said, pharmacists and other healthcare workers should be treated like any other group of conscientious objectors.

"I think this protection needs to be offered to individuals who, with conscience, do not want to do these type things," McGee said.

Though the bill doesn't specify what "type things" the bill is aimed at, Planned Parenthood is alarmed. Mifepristone, sometimes called RU-486, is the only chemical abortion pill available in the US — and it's not available in any pharmacy.

"This bill doesn't even make sense if it's about abortion," said Paige Johnson, a lobbyist and spokeswoman for Planned Parenthood of Central North Carolina. "It gives us pause; why would you include pharmacists — who do not dispense mifepristone — if the real intent wasn't to broaden the denial clause to encompass birth control."

Jennifer Rudinger, executive director of the ACLU of North Carolina, said the bill doesn't contain provisions for emergencies women might have or for referrals that women might need. "This bill, while well-intentioned, contains some very serious problems," Rudinger said.

One of the problems is over the definition of "abortion." Major doctors' groups, like the 280,000-member AMA or the 46,000-member American College of Obstetricians and Gynecologists, define pregnancy as beginning after a fertilized egg attaches to the lining of the uterus. But some anti-abortion groups, such as the 1,600-member Pharmacists for Life International, say that obstructing implantation is killing a fertilized egg — and tantamount to murder.

For more than a decade, doctors and pharmacists have occasionally drawn attention for refusing to prescribe or dispense birth control pills, particularly emergency contraception. But recently, the reports of pharmacist refusals have either grown more frequent or gained higher profile.

After two women complained to state health authorities, Illinois Gov. Rod Blagojevich in April issued an order that for 150 days ordered all that state's pharmacists to fill contraceptive prescriptions as written. But that same month, Colorado Gov. Bill Owens vetoed a bill that would have required hospitals to tell rape victims about emergency contraception.

In North Carolina, Planned Parenthood since November has tracked about one to two complaints each month from women who have had trouble getting pills, said Leigh Ann Robbins, who coordinates the organization's emergency contraception hot line. It's not likely a complete tally of how many women have had problems, she said, because the list only includes women who obtain a prescription from Planned Parenthood.

Each major drug retailer contacted by Creative Loafing — Walgreens, Target, Wal-Mart and CVS (which owns the Eckerd stores in North Carolina) said they allow pharmacists to refuse to dispense medications they find morally objectionable — as long as they make sure the patient is able to fill her prescription somewhere. Wal-Mart, however, does not carry emergency contraception.

"They can't just say no and send the patient away," said Carol Hively, spokeswoman for Walgreens. "They have to follow through with the patient."

Generally, industry groups such as the North Carolina Association of Pharmacists applaud efforts to protect their members' jobs and professional autonomy, said Fred Eckel, the organization's executive director. Six years after the American Pharmacists Association approved a similar policy, the state Board of Pharmacy in December approved a conscience clause that allows pharmacists to refuse to dispense medicines if they morally object to them.

Many pharmacists have been mystified and offended by some conscience clause opponents' characterization of pharmacists' roles. A reply from pharmacist groups to a New York Times editorial summed up the feeling that some opponents, including that newspaper's editorial board, seek to "transform pharmacists from thinking health care professionals into robots or automatons forbidden from having personal beliefs, and from exercising their considerable professional judgment."

Robert Buerki, co-author of a respected pharmacy ethics textbook, remembers that, before the 1960s, a pharmacist might be seen as unethical if he even talked to customers/patients about the medicine they had been prescribed.

Pharmacy has changed measurably in the intervening decades, he says. These days, federal law requires pharmacists actually offer to talk with each customer, and pharmacists can play a larger role in a patient's treatment. "That's where pharmacy is going," said Buerki, a professor at Ohio State University. "They're actually very proactive."

That direction is one factor that has drawn pharmacists, like doctors and hospitals before them, into the murky waters of reproductive politics. Lawmakers in several states have introduced legislation ostensibly aimed at giving legal protection to the rights of pharmacists who won't prescribe emergency contraception — or even the birth control pills that, according to the Centers for Disease Control and Prevention, 82 percent of women take at some point during their childbearing years.

Regardless of a pharmacist's rights, several pharmacists said, that doesn't mean a professional isn't responsible for making sure people can still obtain the medicine they need.

"What I tell my students," Buerki says. "Is if you have these strongly held religious beliefs, you can exercise your conscience. However, from an ethical standpoint, you have a responsibility to the patient who wants to get those prescriptions filled to either refer them to another pharmacist in your store or refer them to another pharmacy."

karen.shugart@creativeloafing.com

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