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Pharmacy Rights Battleground: Washington State

By June 7, 2006

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Update 7 June
The Washington State Board of Pharmacy has issued a draft rule which would allow pharmacists to refuse to fill prescriptions; a public hearing is set for the rule is set to take effect on 31 August. The rule would amend WAC 246-863-095, Pharmacist’s professional responsibilities and is referred to as a "conscience clause" by anti-abortion advocates and a "refusal clause by women's rights groups. (Draft Rule - PDF).

Ironically, the state (and it's not alone in this mandate) requires that pharmacies stock drugs -- so even Wal-Mart must carry emergency contraception as well as, for example, AZT (for HIV-positive patients). And reportedly the pharmacist license "require[s] that patients' needs come first."

For those of you tuning in late, the issue is this: do pharmacists have a duty to fill lawful prescriptions, so long as there are no possible negative interactions? Or do pharmacists have the right to refuse to fill prescriptions if they think the drug will be used in a manner contrary to the pharmacist's beliefs?

A Mistake
Reaction has been swift. Governor Gregoire called the rule a mistake. She also pointed out that the legislature has not formally confirmed the board members. [The news story provides no details on this anomoly.]

Four states -- Arkansas, Georgia, Mississippi, and South Dakota -- side with the pharmacist. But in Illinois, poll data show citizens siding with patients.

Last year, Governor Rod Blagojevich (D) pushed through rules that "[guarantee] a woman's right to prescription contraceptives with 'no delays, no hassles, no lecture'." The public supported the measure: 66 percent did not believe pharmacists should be able to refuse to fill emergency contraception. Only 26 percent supported a conscience clause.

Editorial Response
The Everett Herald writes:

The proposal gives pharmacists the right to decline prescriptions that are in conflict with their beliefs.

"The language they're considering adopting is so vague, that to me it opens the door for any pharmacist to (decline) to fill any prescription for any reason," said Rep. Shay Schual-Berke, D-Normandy Park, who is a physician.

Where does it stop? Objection to dispensing birth control pills? Viagra? Ritalin? The state board, which has been deluged with nearly 7,000 comments from citizens around the state, according the Associated Press, would be smart to take Gregoire's advice and end this ordeal now, rather than waiting for the state to overturn the ruling.
Susan Paynter, writing in the Seattle P-I, makes the point that this is bigger than contraception:
What if it's a pharmacist who may or may not be Tom Cruising spiritual waters aboard the SS Scientology? Say he's opposed to filling prescriptions for antidepressants? Couldn't happen? It recently did right here in this state.

And, at a pharmacy in Seattle, a woman's prescription for a cervix-dilating medication was refused by a pharmacist who suspected she was on her way to have an abortion. Not that it ought to matter, but the woman's physician prescribed the drug because she was about to have surgery for uterine fibroids.

And, in Yakima, a pharmacist refused to dispense syringes to a diabetic, assuming he was an IV drug user. And there are more infuriating scenarios, says Nancy Sapiro of the Northwest Women's Law Center.

Even conservative Yakima is opposed:

[I]f the pharmacy board proceeds with this ill-advised rule, it will be challenged, as it should be.

It would be far better if the panel backed off and dropped the conscience clause approach. Members should adopt a rule that recognizes filling lawful prescriptions is a market-driven, patient-need activity and not one to be dictated by personal moral codes of pharmacists.

Rule Overview
I'm scratching my head on this one: the rule says that a pharamacist shall not delegate the professional reponsibility: "[d]ecision to not dispense prescriptions for any reason." Leave the handwriting jokes aside -- I don't think a lawyer could have made something any less clear than this. Well, except for the new preamble (emphasis added):

Pharmacists and pharmacy ancillary personnel shall not obstruct a patient in obtaining a lawfully prescribed drug or device. If a pharmacist cannot dispense a lawfully prescribed drug or device, then the pharmacist must provide timely alternatives for the patient to obtain treatment.

First, the pharmacist "shall not obstruct" .... to this lay person, this sounds like the pharmacist has to fill the script.

Second, "cannot dispense" sounds like the pharmacy doesn't have the drug in stock. It is not the same thing as "will not" dispense ... that is, not until you get to that "decide not to dispense for any reason" bit, which comes later in the rule.

Washington State is not alone. According to a March article in Salon, "at least 15 states have legislation pending that would allow not just pharmacists to refuse to dispense prescriptions, but would also protect cashiers who refused to ring them up."

Forty Years of Legal Contraception At Risk?
The political war on morning after or emergency contraception has morphed into a war on all contraception, according to some critics. Cristina Page, writing for TomPaine.com asserts that all anti-abortion groups in the US also oppose the use of contraception. Some oppose the use of condoms in Africa, the home of AIDs. She writes:

The American Life League explained, "We have been working to prove that prescription contraceptives have nothing to do with woman’s health and well-being but are recreational drugs that prevent fertilization and abort children."

A 7 May article in The New York Times magazine reminds us that the precursor to Roe v Wade was 1965's Griswold v. Connecticut, which legalized contraception.

''We see a direct connection between the practice of contraception and the practice of abortion,'' says Judie Brown, president of the American Life League, an organization that has battled abortion for 27 years but that, like others, now has a larger mission. ''The mind-set that invites a couple to use contraception is an antichild mind-set,'' she told me. ''So when a baby is conceived accidentally, the couple already have this negative attitude toward the child. Therefore seeking an abortion is a natural outcome. We oppose all forms of contraception.''
The article continues:
R. Albert Mohler Jr., president of the Southern Baptist Theological Seminary, is considered one of the leading intellectual figures of evangelical Christianity in the U.S. In a December 2005 column in The Christian Post titled ''Can Christians Use Birth Control?'' he wrote: ''The effective separation of sex from procreation may be one of the most important defining marks of our age -- and one of the most ominous. This awareness is spreading among American evangelicals, and it threatens to set loose a firestorm.. . .A growing number of evangelicals are rethinking the issue of birth control -- and facing the hard questions posed by reproductive technologies.''

Culture War Takes Headlines
Like the same-sex marriage issue, this battle is part of something called the "culture war." Rather than focus on issues of substance -- ie, those affecting the nation's solvency -- these folks prefer to focus on issues of individual behavior. Whatever happened to "Your rights end where my nose begins?"

First Posted: Friday June 2, 2006

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June 8, 2006 at 6:24 am
(1) Progressive says:

NARAL has a petition going to enact legislation protecting citizens by ensuring they can get whatever prescription they need filled, whereever they need to fill it. Please take action today to support the bipartisan Access to Legal Pharmaceuticals Act.

http://prochoiceaction.org/campaign/98_griswold?rk=R1L3AaE1UmZmE

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