For any of you interested in the CI-102 petition, Montana Cowgirl over at Left In the West has posted some very interesting and potentially disturbing info about the folks behind CI-102.  Please check out her post.

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.