Access to Birth Control
February 9, 2009
One issue that continues to come up in state legislatures and assemblies across the US is access to birth control. Do Pharmacists have the right to refuse to fill birth control prescriptions or do women have the right to have their proscriptions filled without delay or interference?
Is it really appropriate for a person to refuse to do their job on religious grounds, while retaining that job?
Here in Montana there are several bills currently in committee that relate to this issue. On the side of those who support the supposed right to refuse is HB 351. It provides protections to pharmacists and medical practitioners who refuse services on religious grounds. It elevates this supposed right to refuse prescriptions or services to that of a basic civil right. It allows practitioners to refuse to advise, prescribe, provide, or perform certain drugs or health care services, or assist in those activities. It goes on to specify that the health care services that may be refused include artificial birth control, abortifacients and abortion, amongst others. For the moment, I’ll focus on birth control.
HB 351 offers these practitioners protection against, among other things, hiring discrimination, demotion, transfer, termination, and denial of licensing or certification. So if a pharmacist starts to refuse to fill prescriptions for birth control, this would protect them from being fired. In most jobs that I know of, refusing to do your job is perfectly reasonable grounds for termination.
The bill also states that there can’t be hiring discrimination or refusal to license or certify these providers. How can someone be certified or licensed to do a job that they won’t do? How can employers be required to consider applicants who admit up front that they will be refusing to do part of their job? That wouldn’t fly in any other hiring situation I can think of.
On the side of those who support access to birth control are two very similar bills, HB 257 and HB 307. HB 257 would enable a woman to have her prescription filled directly by her doctor or other medical practitioner who has prescriptive rights when no pharmacy is available within her community. It also goes on to allow certain prescriptions to be filled by a nonpharmacist auxiliary and require the board of pharmacy to determine procedures necessary for the licensing and registration of these auxiliaries. HB 307 is very similar except that it does not allow for these auxiliaries and it specifies the distance to the nearest available pharmacy as 25 miles from the patients residence.
I can see where some might object to the auxiliaries listed in 257, but I don’t personally see a big issue there. The stipulation that the board of pharmacy will determine the licensing and registration procedures seems reasonable. However, I see a significant issue with the distance requirement in 307. Twenty five miles may seem like a short distance to most of us, but consider that these situations have the greatest impact on the poorest amongst us, such as those most likely to lack a reliable vehicle to travel these distances with. Imagine a woman who is struggling to make it on minimum wage, without a car, trying to find a way to travel to a pharmacy that is 24.7 miles away. That seems like an undue burden to me.
HB 284, the Montana Pharmacy Patient Protection Act addresses the issue more directly. The language of this bill states that pharmacies have a duty to fill prescriptions for any drugs or devices that they carry, without undue delay. Undue delay is defined as “an extension of the normal delivery cycle sufficient to jeopardize or alter the patient treatment plan.” It goes on to state that if the pharmacy has run out of the drug or device that it shall offer to obtain the drug or device according to normal procedure. Additionally, if the drug or device is not normally carried by the pharmacy the pharmacy should locate a reasonably accessible pharmacy that does carry the drug or device and transfer the prescription.
HB 284 adds further protections in that pharmacists are not allowed to begin refusing to provide services without 90 days notice to their employer. They also may not destroy unfilled prescriptions (yes, this has happened).
None of these bills is perfect. I would rather see one that combines the patient protections of 284 with the provisions of 257 and 307, allowing for medical practitioners to provide these prescriptions should the need arise.
I don’t believe that pharmacists have a right to impose their religious beliefs on the public they serve. The right they do have is a right to change careers, should they find that their conscience will no longer allow them to perform their required job duties.
On the other hand, I believe that patients do have a right to have their prescriptions filled, without delay, interference or judgment, unless there is some sort of medical danger that can be shown to exist, as in the case of medications that will interact in dangerous ways. I also believe that women have a right to control their fertility and that this right is fundamental to achieving gender equality.
In the end, this sort of refusal to provide drugs and procedures is gender discrimination, plain and simple. It isn’t about religious objections to birth control as much as it is about controlling women. I believe the law must protect us against this sort of discrimination, rather than allowing or enabling it.
42nd Wave Feminist 
February 10, 2009 at 12:24
Oh I knew you and I would probably have a difference of opinion, however I do agree anyone should be able to get any prescription at any time. But (this is what seems to be the crusher) most pharmacies are private enterprises and should be allowed to hire as well as dispense legal drugs in accordance with their company policy. In the case of state or federal subsidized that pharmacies that obviously would not apply and should be required to dispense regardless of employee considerations. The issue I have with your argument is really minimal but you refer to… pharmacists have a right to impose their religious beliefs……HR 351 says… “Conscience” means the religious, moral, or ethical principles held by a health care provider or health care institution. I suggest pointing at only religious beliefs is dangerous to any arguments position (and I’m an atheist). Having read thru your reference HB’s I can only say you’re lucky to live in Montana—read some of our New York crap sometime.
February 10, 2009 at 12:45
Hi there, towp! I get what you’re saying. The way the law is and the way this sort of thing would most likely be applied aren’t quite the same, though.
What non-religious moral or ethical principles are pharmacists using to deny people their prescriptions? Perhaps it happens, but doesn’t make the news, but I’ve certainly never heard of such a thing. I wonder if the writers of this bill really mean to include a pharmacist who has begun to deny patients ritalin prescriptions because of an ethical objection to the over medication of young people.
The bill was written to be more inclusive and less objectionable, but it’s real intent is pretty clear.
As for pharmacies being private institutions, it’s a sticky area, I know. Generally I would make allowances for private businesses. However, these folks are licensed by the state, and as such are held (or at least should be held) to certain standards. I think there’s a difference between a grocery store refusing to carry Horizon Organic dairy products because Horizon has objectionable ethical practices and a pharmacy, especially the only one in a tiny little town in the middle of nowhere, refusing to carry standard, legal, approved prescription medicines for religious reasons. If that makes any sense.
Also, I’m lucky to live in Montana for many reasons. 😀
February 10, 2009 at 15:58
And now we come to crux of the situation–who’s rights do we violate, common sense dictates the minority,and should do it right? So now we have to depend on our law makers to make the best possible and then we watch the lawyers try to take it apart again…well argued and I agree.
June 11, 2009 at 12:14
I do not think that pharmacists should have the right to deny someone of a perscription, especially something like birth control to anyone. Especially because of their religious beliefs. They should not be able to bring religious beliefs into their place of work and use them to make decisions for other people’s lives. It is a choice that should only be made by the woman whos life will be affected.
June 11, 2009 at 14:38
This is another case of science and religion not mixing. A pharmacist must take an oath, just like doctors, to help and not harm the patient. A professional work environment has no room for religion.
June 11, 2009 at 19:26
I have mixed feelings about this, I know that in order to get birth control you must visit a doctor and they only right them for a year because that is when youre next pap smear is supposed to be and they want eveyone to be healthy. But if some one refuses because of religion that is unethical. All should be for the patient
June 11, 2009 at 20:07
I disagree, I think that religion and a professional work environment should go hand in hand. I wish that stores were closed on sundays and holidays so that people can spend that time with their families. I also think that women should be allowed birth control at anytime though. Maybe religious pharmacists would allow the free flow of birth control if they knew that the person getting it fully knew it’s consequences, uses, directions, and could justify their reason for using it.
June 12, 2009 at 11:09
I just wanted to take a moment to point out that not all religions agree, and that not all of us are religious. Forcing your religiously based “morals” on me is not acceptable.
June 11, 2009 at 21:59
To be truly fair I think the doctor should have just as much right to refuse to write prescriptions for birth control as the woman is to take birth control. If that pharmacist does not believe in birth control that is his right and she should find a different pharmacist.