Washington State Moves to Allow Pharmacies to Refuse to Dispense EC


In Washington State, a small group of pharmacists are putting on the pressure to allow pharmacies to refuse to dispense medication to which they object – and the State Board  of Pharmacy seems to be bending over backwards to do all they can to help them do so.

The Washington State Board of Pharmacy has voted 3-2, according to the News Tribune, to move ahead with a reversal of a 2007 rule that prevented pharmacies from refusing to dispense certain legal medication – including emergency contraception (EC) for the women of Washington State.

When the rule was first implemented (with the support of the state’s Governor Christine Gregoire) – to ensure that anyone who needed timely access to legal medication from a pharmacy could get it -  owners of a grocery store, Ralph’s Thriftway in Olympia, WA, responded with a lawsuit. The owners of the store refuse to carry Plan B (the brand name under which emergency contraception is sold) out of “moral opposition” to the drug. While the majority of pharmacists don’t have a problem with dispensing emergency contraception, there are some who seem to feel that that the medical community’s “evidence” that EC is actually contraception gets in the way of their personal opinion that it’s actually an abortifacient. Further, they feel that regardless of the safety, legality and FDA approval (PDF), women simply don’t deserve access to this medication.

The issue has been dragging on for years with public support firmly on the side of ensuring access to Plan B at pharmacies in the state, and a 2009 Ninth Circuit Court of Appeals decision in regards to an injunction against the rules, which held that the rules “do not aim to suppress, target, or single out in any way the practice of religion, but, rather, their objective was to increase access to all lawfully prescribed medications.”

But instead of allowing the case to go to court, where this small group of pharmacists attempting to stand in the way of women’s access to Plan B was likely to have lost, the state Attorney General stepped in to negotiate a settlement. The AG said that pharmacists should be able to “conscientiously object” to dispensing emergency contraception and refer women elsewhere. Yeah, it didn’t work for most of the residents of Washington State either.

What was at first a unanimous decision, on the part of the Washington State Pharmacy Board, to go ahead with the settlement has turned into an extremely divisive issue after thousands voiced their opposition to the Board’s consideration of changing the rule to meet the AG’s suggestion. The Board has received, so far, a total of 5,350 comments on the proposed rule change; 4,448 are in support of leaving the rule in place. An overwhelming number of those who have commented believe pharmacies should not be allowed to “opt out” of dispensing legal medication. 

To be clear, the existing rule already allows individual pharmacists to express their “moral opposition” by essentially passing a customer on to a co-worker, as long as the pharmacy fills the prescription by someone.  But a small group of pharmacists, led by Ralph’s Thriftway, aren’t satisfied. They want to be able to have an entire pharmacy say no to women in need of emergency contraception. It doesn’t stop there, of course. If they get their way, what would stop a pharmacist from deciding to opt out of providing a gay person with access to HIV medication, if they so chose? Or a diabetic person access to life-saving treatment?

The Pharmacy Board is now split with, interestingly, two of the three women on the board in support of keeping the rule as is (ie, ensuring that pharmacies cannot refuse to dispense medication) and three of the four men in support of changing it to allow pharmacies to refer women elsewhere. The third woman on the board was not present at the most recent meeting.

The one man on the board who does not support changing the rule is the Board chair, Gary Harris, who asks “What if a pharmacist believes “marriage is one man, one woman, and I have some gay men that come in.  (What if) I were to say ‘Gee, it’s against my religious background. You’ve brought this on yourself.’” Harris, however, does not have a vote unless there is a tie.

The rule-changing process is far from over. The public can comment on the proposed rule changes until November 30th, notes Planned Parenthood Votes! WA. When the board drafts final rules language, the public will then have another extended period in which to register comments and feedback. It should go without saying that a small group of pharmacists who have registered opposition to EC because they believe it “kills a fertilized egg,” as one pharmacist puts it, should not have the ability to enact barriers to safe, legal medication for the women of Washington State. If the rule change is allowed to go into effect, though, it means those pharmacists’ personal opinions about certain medications; patient populations; or individual choices, will take precedence over accessing timely, needed care. 

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  • prochoiceferret

    If Ralph doesn’t want to run a pharmacy, why doesn’t he just close it down? Lots of grocery stores do perfectly well without a pharmacy.

  • reproductivefreedomfighter

    Ridiculous!  Already in Washington we’re facing cuts like the Take Charge Program.  Isn’t it enough that a pharmacist can refuse to fill a prescription?!  That’s bad enough, considering the implications for rural pharmacies where there may only be one pharmacy in town.  I’m a NARAL intern this year and we are going to be very vocal about this in the next month.  I wonder how many cases of pharmacists refusing to hand out Viagra have been noted.  These decisions are subjective.   Women shouldn’t have to get their birth control pills elsewhere, or their emergency contraception, or condoms.  PERIOD.

  • waterjoe

    Mandating pharmacies to distribute every medication only makes sense if the pharmacies were government-owned.  If individuals have a right to not fill a prescription, why would the individuals that own the pharmacy not have that right?  If you take away the right to refuse from one, be consistent and take it away from all.  If you go down that route, you might as well “nationalize” the pharmacies, since the only basis for taking away a person’s religious liberties would be if this was a state action.

     

    Like most states Washington probably requires special licenses for bus drivers, whether they drive public city busses or private school or church busses.  It is a safety issue.  However, does issuance of a license mean that the driver of a church bus must transport anyone for any reason?  Would the state force the driver from a traditional African-American church to transport a group of klansmen to a white supremacy rally?

     

    The gay man/HIV drugs scenario is a red herring.  The conscience rules protect individuals with an objection to an act, not to a person or his or her behavior.

     

  • amie-newman

    The gay man/HIV drugs scenario is a red herring. The conscience rules protect individuals with an objection to an act, not to a person or his or her behavior.

    If the conscience rules (which, by the way, do NOT apply here. As I mentioned, right now, the rules state that pharmacies must dispense safe, legal medication that is requested. Pharmacists DO have the right to refuse) “protect individuals with an objection to an act” then, by extension, they protect individuals with an objection to a person or his or her behavior. There is NO red herring here. If a pharmacy is allowed to refuse to dispense medication because of “moral opposition” then there is absolutely nothing to prevent them from deciding they don’t want to provide HIV medication because they don’t like why it’s being used, or diabetes medication because they don’t believe those with diabetes are taking proper care of themselves, for example.

    Your example – of an African-American bus driver being forced to drive a bus filled with klansmen to a rally is an entirely inappropriate comparison. First of all, as I stated in the piece, the policy DOES right now allow for individual pharmacists to refer patients to another pharmacist as long as the pharmacy dispenses the medication. If this bus driver had an objection, he or she could very well “refuse” if there were a similar policy. Second of all, emergency contraception is a legal form of contraception – I’m sorry if some people don’t like it but it is medically contraception which is LEGAL. If a pharmacy has an issue with dispensing medication which is FDA approved and legal, than the pharmacy should not be in the business of dispensing medication! Pharmacists, under this policy, can ask a fellow pharmacist to dispense medication if they don’t “agree” that the woman should take it (because this is what it comes down to, no?) however, “feeling” that EC is “killing a fertilized egg” when the woman herself and the medical community do not agree is placing a pharmacists personal feelings above the woman’s right to access timely medication. Not unsurprisingly, I have never heard of a problem where a pharmacist has refused to dispense medication except to women needing EC. It’s for this reason that I also believe this is discrimination against women plain and simple.

    I’m sorry but your reasoning does not hold up, in my opinion. If the owners of Ralph’s hold a personal opinion that emergency contraception = murder than they should likely get out of the pharmacy business.

  • joan

    It is just plain wrong for a pharmacy to decide whether or not a woman should become pregnant. A woman who seeks Plan B is trying to prevent pregnancy, but a pharmacy that withholds or denies Plan B is saying they know better than the woman, that they want to force her to become pregnant. Compulsory pregnancy, determined by the pharmacist. wow. I urge you to write your comments to the WA BOP before the Nov 30, 2010 deadline. https://fortress.wa.gov/doh/policyreview/AddComment.aspx?ID=647

  • waterjoe

    Amie:  You did not respond to any of my points.  Why should the pharmacist have rights but not the pharmacy?  Why does the fact that the medication is legal make a difference?  White supremacy rallies are legal.  And why can’t the rules distinguish between the act and the user?  It happens all the time in the law.  Lastly, where is this “right to access timely medication?”  And, if it exists how does it trump individual conscience?  The threshold is pretty high.

     

    The argument that one should not become a pharmacist unless she is willing to fill every prescription does not work since it would, logically, only apply to those who became pharmacists after the development of a particular medication.

     

    “Not unsurprisingly, I have never heard of a problem where a pharmacist has refused to dispense medication except to women needing EC. It’s for this reason that I also believe this is discrimination against women plain and simple.” — bad logic.  A person cannot discriminate against women unless the act involves both men and women and the person applies one set of policies to women only.

  • prochoiceferret

    Since Mad Men is pretty popular these days, I thought I’d give waterjoe’s argument a retro-’60s remix:

     

    Mandating businesses to serve every race only makes sense if the businesses were government-owned.  If individuals have a right to not serve a customer, why would the individuals that own the business not have that right?  If you take away the right to refuse to serve one, be consistent and take it away from all.  If you go down that route, you might as well “nationalize” the businesses, since the only basis for taking away a person’s discriminatory liberties would be if this was a state action.

     

    You can throw in some old audio clips of George Wallace for effect!

  • silphium

    I live in a conservative part of Washington, and this genuinely worries me.  I added my piece to the WA legislative feedback site objecting to pharmacist referrals and refusals, and hope to get friends to do the same.  Anyone else in WA experienced pharmacist refusal before Chris Gregoire’s legislation?  Not only is it inconvenient, it’s mortifying.  Let’s keep humiliation of people trying to get legally available contraception rare.

  • ack

    While the majority of pharmacists don’t have a problem with dispensing emergency contraception, there are some who seem to feel that that the medical community’s “evidence” that EC is actually contraception gets in the way of their personal opinion that it’s actually an abortifacient.

     

    This made me laugh.

  • squirrely-girl

    Mandating pharmacies to distribute every medication only makes sense if the pharmacies were government-owned.

    This would make sense if government didn’t regulate things like drugs in the first place. But we do. It’s also fairly standard to require pharmacies that take Medicare and Medicaid scripts to keep on hand and distribute all medications covered by those plans. What, are you in favor of letting drugstores just do what they want and dispense as they see fit? Because that’s not exactly a safe measure. 

    The gay man/HIV drugs scenario is a red herring.  The conscience rules protect individuals with an objection to an act, not to a person or his or her behavior.

    I think you’re actually arguing against yourself here. Actions are behaviors. If the pharmacist’s issue is emergency contraception, which chemically, as a concentrated dose of regular birth control, has REPEATEDLY BEEN SHOWN to prevent ovulation NOT disrupt implantation, the issue would appear to be the act of women having sex and not wanting to be pregnant. In other words, the pharmacist’s IGNORANT REFUSAL to accept medical science while professing non-science (abortifacient) is the red herring. The gay man/HIV drug scenario could be just as much of an issue if the pharmacist thinks the act of “gay sex” is responsible for the condition much like thinking the act of sex is responsible for the pregnancy condition. Which would suggest pharmacists could also take issue with unmarried women obtaining birth control, or with dispensing any birth control altogether. For that matter, what about pharmacists who don’t want to dispense Viagra?

  • amie-newman

    you tried to contact Legal Voice? They are a women’s legal rights organization in Washington State (where I live as well) and are involved in the pharmacy refusal fight. They may (?) be collecting stories to use – stories of women who have been refused EC at the pharmacy counter. If you feel comfortable, you may consider contacting them and sharing:

    http://www.nwwlc.org/focus/health/refusals.html

  • amie-newman

    a pharmacy can refuse to dispense any legal, safe, FDA approved medication for any reason. A pharmacist becomes a pharmacist after the advent of HIV medication. He or she says, you know, I really don’t believe gay people should have the right to HIV medication because I think it inhibits an infection which strikes gay people, in particular, for a reason. By your logic, a pharmacy would be able to simply opt out of providing said medication. This is medication we’re talking about – not chewing gum. Not toothpaste. You don’t get to decide for those for whom you’re providing needed medication what is “morally correct” and what’s not.

    And, undoubtedly, this could be construed as discrimination against women. It is ONLY women who utilize EC. If a pharmacy decided to selectively refuse to dispense Viagra, would this not be discrimination against men? Do you honestly think men wouldn’t protest this as discrimination?

    As well, for what it’s worth, I don’t agree that a pharmacist should have the “right” to refuse to dispense emergency contraception – nor do I believe the pharmacy should have the “right” to refuse to stock it. If a customer is in need of safe, legal medication the pharmacy and pharmacists working should provide it. This false notion of this somehow impinging on the “freedom” of the pharmacist or pharmacy by saying you need to dispense medication because it’s your job is absurd. No one is saying the pharmacist or pharmacy owner needs to use the medication. This is contraception – it’s one of many forms of medication human beings use! If you do not believe women should be using contraception which requires a prescription or OTC purchase, find another line of work.

  • squirrely-girl

    A person cannot discriminate against women unless the act involves both men and women and the person applies one set of policies to women only.

    This makes very little sense. Are you therefore suggesting that I couldn’t be discriminatory against black people unless there were white people around as well? There is no comparable medication available for men given that pregnancy is a strictly female condition, so yes, this would be a case of discrimination.

    Lastly, where is this “right to access timely medication?”  And, if it exists how does it trump individual conscience?  The threshold is pretty high.

    Issues of time sensistive medications and refusals are generally covered by licensing and regulatory agencies (i.e., individual state governments) as well as organizational/accrediting boards for specific specialties. So if you’re truly interested in learning more, I would suggest starting with your particular state. However, most states allow/require a pharmacist to refuse to fill a prescription if it will interact with a drug the patient is already taking, if the script has been forged, if there is an error in dosage or if there is a reason to believe the drug is being abused. ”Individual conscience” rarely trumps medical science… if the individual pharmacist doesn’t wish to take the drug themselves they have that right but it’s an awfully slippery slope to allow pharmacists (seriously? grow the f*%& up already douchebag) to refuse to do their jobs because of moral conflicts… again, where do the objections end? This isn’t a particularly high threshold unless you’re a fundie. :/

     

     

  • waterjoe

    There is no comparable medication available for men given that pregnancy is a strictly female condition, so yes, this would be a case of discrimination.

    The very fact that it is strictly a female condition means that it cannot be a case of discrimination.  Discrimination means that disparate treatment is given between otherwise comparable groups.  In this case, there is no other gender group.  It may be wrong to allow pharmacists and pharmacies to refuse to dispense EC, but if it is wrong, it is wrong for one of the other reasons mentioned, not because it is gender discrimination.

     

  • carolyninthecity

    I was going to make that same point that obviously if a pharmacist suspects drug abuse or dosage error etc.. then of course they should have the right to refuse out of concern for the patient’s safety and their own job. BUT there is a very clear difference between these scenarios and a pharmacist who refuses to dispence medication because of their own personal belief or opinion. I can respect religious conviction only so far as it does not interfere with other people’s lives. When you are a pharmacist/doctor/nurse, it is not about you. It is not about your beliefs, it is about your patient and their needs. 

    And for waterjoe, this has been addressed, but for emphasis I want to stress OF COURSE the right to timely medication trumps individual conscience. At least, it should. If we don’t have that right then what’s the point of health care? 

     

    I’m very grateful to live in Ontario where the EC is on the shelf next to the condoms and lube, no pharmacist needed :)

  • crowepps

    It should go without saying that a small group of pharmacists who have registered opposition to EC because they believe it “kills a fertilized egg,” as one pharmacist puts it,

    There is absolutely NO evidence at all that EC does any such thing, and having pharmacists dispensing medications when they have this little understanding of how the medication works is alarming.  How are women supposed to get accurate scientific information if the health professional instead passes on myths/rumors he’s heard from his priest/pastor?

  • forced-birth-rape

    “I’m very grateful to live in Ontario where the EC is on the shelf next to the condoms and lube, no pharmacist needed :)”

    ~ Ontario and Canada ROCK! If only our rube nation was so enlightened. ~

  • crowepps

    The very fact that it is strictly a female condition means that it cannot be a case of discrimination.  Discrimination means that disparate treatment is given between otherwise comparable groups. 

    Since women and men are both ‘humans’, it is indeed discrimination to divide them into a male group that has full rights all the time, and a female group that only has full rights while virginity lasts and after menopause, but has only provisional rights during the 30 to 35 reproductive years because any time they have or are forced to have sex their rights blink off and disappear for a week or two while all the rights are vested in possible ZBEFs.

     

    It is always “gender discrimination” to use a condition peculiar to one sex to make that group inferior before the law.

     

    Men have a right to receive their prescriptions without their privacy being invaded or their morals being questioned.  Women, however, have to surrender their medical privacy, ‘explain’ their personal circumstances and ‘get permission’ from the pharmacist.  The conception rate after rape is less than 20%.  That means 80% of the women with prescriptions for EC are not even at RISK for pregnancy, but instead want to take it for their peace of mind.  What justification is there for the pharmacist violating the privacy of those women and making their experience worse?

  • plume-assassine

    I refuse to believe that certain pharmacists think EC is an abortafacient. There’s tons of research out there showing that it is not. They pretend like their goal is to keep women from aborting, but when they deny women emergency contraception to prevent pregnancy… what do they think is going to happen?! She is going find a clinic and get a real abortion! These pharmacists are hiding behind false religious beliefs about pregnancy in order to punish women for having unprotected sex. They are punished even further by having to fund an expensive procedure (abortion) when they could’ve gotten EC for cheap to prevent pregnancy in the first place.

  • arekushieru

    …I don’t think that even this policy should be used.  It seems to me to be discriminatory in that it allows individuals in government-regulated businesses to refuse service due to certain behaviours that one doesn’t accept while disallowing individuals in non-government-regulated organizations the same options.  In fact, I think government-regulated services and the individuals *should* be held to higher standards than the latter.  

  • catseye71352

    And then a flash-forward to Aqua Buddha Racist Rand Paul.

  • arthur-frederick

    A fertilized egg is not synonymous with a baby. Most fertilized eggs are washed out of the uterus naturally. Others do not definitively attach to the uterus and many die within seconds.

    A woman who is raped may have an egg fertilized by the rapist–but it is her choice not to see the product of rape if it should survive, grow, and ultimately be born. No man–nor any other woman–only the woman who wishes to rid herself of a potentially fertilized egg (the morning after) has the right to chose whether or not to take the product to assure herself of not being pregnant. Sperm is not sacred any more than an egg.

    If a man could get pregnant, abortion would be a sacrament.

  • beenthere72

    If a man could get pregnant, abortion would be a sacrament.

     

    Amen to that!

  • therealistmom

    .. I’m sad and scared. Patty Murray barely beat the insanely anti-choice Dino Rossi in the eelction, and now this. Looking at a state map pretty much everywhere is red (including my county) except the urban regions in the Puget Sound. For now, the Seattle/ Tacoma vote still outdoes the rest of the state, but the more conservative regions are growing in population in leaps and bounds. I was proud and pleased our state was among the first to legalize pharmacy-based dispensing of Plan B, and was incredibly grateful that it was covered by Medicaid on the occasion I needed to buy it.

     

    I hate to see a slow march backwards in the progressive nature of our state, and what it could mean to women. As a teen, I was able to get an abortion because of the lack of restrictions on women. Now the creeping in of anti-woman values is rearing its ugly head.

  • amie-newman

    The legal definition of discrimination:

    Discrimination refers to the treatment or consideration of, or making a distinction in favor of or against, a person or thing based on the group, class, or category to which that person or thing belongs rather than on individual merit.

    If you wholesale refuse to dispense a type of medication to women – not to an individual woman because you feel that the medication is contraindicated, for example – but you refuse because you are making a distinction that this medication should not be used BY WOMEN, then it is legally discrimination (in my opinion, of course. I don’t know if a judge would agree!).

    However, as you stated, there are myriad reasons why refusing to dispense contraception to women is wrong. This is simply one of them.

  • waterjoe

    But the objection is the particular prescription.  If it wasn’t the pharmacists would object to any prescription that might help women. The distinction is important. 

  • rebellious-grrl

    No man–nor any other woman–only the woman who wishes to rid herself of a potentially fertilized egg (the morning after) has the right to chose whether or not to take the product to assure herself of not being pregnant. Sperm is not sacred any more than an egg.

    If a man could get pregnant, abortion would be a sacrament.

     

    Heck yes to that! The world would certainly be a lot different if men could get pregnant.

     

  • rebellious-grrl

    No man–nor any other woman–only the woman who wishes to rid herself of a potentially fertilized egg (the morning after) has the right to chose whether or not to take the product to assure herself of not being pregnant. Sperm is not sacred any more than an egg.

    If a man could get pregnant, abortion would be a sacrament.

     

    Heck yes to that! The world would certainly be a lot different if men could get pregnant.

     

  • crowepps

    The pharmacist is objecting to any prescription which might help women AVOID pregnancy on what basis?

     

    Women who are raped or who choose to have sex are “supposed to” get pregnant because that’s the “appropriate consequence”?

     

    I think you’re insisting a distinction is important when the belief underlying the distinction is ALSO bigoted.

     

    Particularly considering that there is ABSOLUTELY NO evidence whatsoever that hormonal birth control works in any other way except to PREVENT OVULATION which means NO EGG IS EVER FERTILIZED.  Pharmacists who do not understand the mechanism of action of a common medication are incompetent and should find another career.

  • forced-birth-rape

    ~ One of the many reasons I quit christianity is because they “want” a raped female to become pregnant, from rape! No thank you. ~

  • crowepps

    only the woman who wishes to rid herself of a potentially fertilized egg (the morning after)

    It takes an average of 36 HOURS before the sperm fertilizes the egg.  It does NOT happen instantaneously.  If a woman shows up at the pharmacy the morning after, she is NOT yet pregnant.  And if MAP could get rid of a “potentially fertilized egg” the morning after, it wouldn’t have a 15% failure rate.  It only works if a fertile egg has not yet been released.

  • squirrely-girl

    The very fact that it is strictly a female condition means that it cannot be a case of discrimination. 

    So would you consider it sex based discrimination if they didn’t provide meds for erectile dysfunction?

     

    By the way, I’m taking it a little easy on you regarding your “definition” of discrimination because I’m assuming you’ve never had any classes or education on the topic. Otherwise you would know that definition just wasn’t true.

  • squirrely-girl

    I could object to educating women but provide services to save their lives and still be considered the biggest bigot on the face of the planet. I could make an exception for the life of the mother with abortion but still think any and all other cases are just desserts for dirty whores and still be considered the biggest misogynist on the face of the planet.

     

    You’re right, distinctions are important, but you’re not making a very solid case for why EC would be an appropriate “distinction.”

  • squirrely-girl

    How are women supposed to get accurate scientific information if the health professional instead passes on myths/rumors he’s heard from his priest/pastor?

    Screwed up thing here is that even the Catholic Health Association acknowledges that Plan B works by preventing ovulation. 

     

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