PDFThe Tip of the Spear: Defending Pharmacists' Rights of Conscience

By Elizabeth Rose

AUL 2006 Summer Fellow

 

In recent years, pharmacists have faced an increasingly strident and public attack on their rights of conscience.1 Not surprisingly, this attack directly relates to the ongoing battle over abortion. Following Roe v. Wade,2 the issue of healthcare rights of conscience focused on the freedom of doctors, nurses, and other healthcare professionals to abstain from participating in surgical abortions. Although this freedom is generally accepted by society, in the past decade pro-abortion groups have expanded their attacks on conscience, especially with regard to pharmacists' role in dispensing Plan B, the so-called "morning-after pill,"3 the abortifacient RU-486, and oral contraceptives. The growing trend is to demand access to these drugs for patients at the expense of the freedom of conscience of healthcare professionals.4 Heated political battles are taking place in state legislatures across the country as politicians attempt to pass laws either to protect pharmacists' right to abstain from participating in morally objectionable practices or to force them to carry out their duties in violation of their consciences.

 

Freedom of conscience is a long-respected tradition in our nation, particularly for medical professionals. In fact, our nation's founding fathers recognized that rights of conscience and the free exercise of religion were essential to the foundation of a democratic nation. As James Madison stated:

The Religion then of every man must be left to the conviction and conscience of every man; and it is the right of every man to exercise it as these may dictate . . . . It is the duty of every man to render to the Creator such homage, and such only, as he believes to be acceptable to him.5

Unfortunately, most commentators have slipped into the habit of using the language of tolerance and accommodation rather than framing this debate for what it truly is -- a struggle to validate and protect the rights of conscience of individuals. In the words of the American Pharmacists Association: "We don't have a profession of robots. We have a profession of humans. We have to acknowledge that pharmacists have individual beliefs."6 Nonetheless, instead of having their individual beliefs acknowledged, pharmacists are increasingly faced with societal demands to go along with dispensing chemicals and devices that they know will be used to destroy human life at its earliest stages.

 

Proponents of abortion recognize the paramount importance of the issue of conscience generally and pharmacists' rights of conscience specifically. NARAL Pro-Choice America (NARAL) and its allies are presently engaged in a campaign to enact legislation that would force pharmacists to fill prescriptions for birth control and abortifacients regardless of an individual pharmacist's conscientious objection. NARAL has characterized these conscientious objectors as "renegade pharmacists . . . refusing to fill safe, legal prescriptions for birth control" and insists that "pharmacies have a duty to dispense and have an ethical obligation not to endanger their patients [sic] health by withholding basic healthcare."7 These misrepresentations must be confronted, and an accurate understanding of this national crisis of conscience must be brought to the forefront.

 

As the pressure mounts on pharmacists to conform to societal demands, certain individuals face the distressing decision of whether to abandon their careers or their convictions. Pharmacists often risk dismissal or other disciplinary action for standing up for their beliefs. Luke Vander Bleek, a pharmacist and pharmacy owner, faced exactly this situation. In 1997, Vander Bleek, with his wife Joan, became the owner of a small town pharmacy in Morrison, Illinois. Over the next seven years, Vander Bleek opened or acquired three other pharmacies in small Illinois communities, providing pharmaceutical services that would otherwise not be available in these underserved markets. Vander Bleek established himself as a well-known, well-respected businessman who never dispensed Plan B because of his conscience and religious faith.

 

In April 2005, Illinois Governor Rod Blagojevich jeopardized Vander Bleek's ability to continue offering his services in these small towns. Blagojevich, through executive fiat and without legislative approval, issued an emergency executive rule that required community pharmacies licensed in Illinois to procure and dispense all forms of contraceptives "without delay."8 The emergency rule -- made permanent on August 16, 2005 -- directly contradicted an existing law, the Illinois Health Care Right of Conscience Act,9 which was passed to afford broad protection for healthcare workers in all healthcare settings. Vander Bleek recognized that he could not, in good conscience, follow the Governor's order and would be forced to leave his life-long profession as a pharmacist rather than "stock and dispense products that [I] believe to be harmful to human life." Risking his livelihood and his reputation, Vander Bleek made the laudable decision to take a stand against the Governor's coercive order and, on June 8, 2005, filed suit on behalf of Luke and Joan Vander Bleek against Governor Blagojevich.10

 

Luke Vander Bleek is just one of thousands of individuals who have been forced to make similar decisions between following their consciences and keeping their jobs. Many pharmacists view their profession as one of healing and oppose the use of medication to end human life. In Vander Bleek's own words: "I have spent my entire profession in pharmacy committed to easing suffering, curing, and diagnosing disease, and improving the quality of human life . . . . I will not practice in an environment, [in] which we are legally obliged to be involved in the destruction of human life."11 Especially when society cannot reach a consensus about the morality of a procedure, the law must protect pharmacists whose deep moral convictions dictate that they cannot participate in behavior that is harmful to human life. For the conscientious objector, his moral, ethical, and religious convictions are not instruments for solving problems but form part of his identity and his very self. His personal ethics cannot be bifurcated from his professional ethics. Any law that forces pharmacists to act contrary to their convictions and to suppress their consciences imposes one set of value judgments over another.

 

Opponents of freedom of conscience contend that a pharmacist's right to conscientious objection must be subordinated to the needs of patients; however, conscientious objection does not prevent patients from obtaining contraceptives from other sources. Just as the exercise of freedom of speech does not force others to agree with the speaker, the exercise of freedom of conscience does not force others to agree with an objector. Objectors act primarily to preserve their own moral integrity, not to block access to services or to punish or control patients.12 Their main concern is to avoid being implicated in what they understand to be an immoral act and, under most circumstances, a patient who is denied a prescription from one pharmacist or pharmacy can conveniently obtain it elsewhere. It is inappropriate to reduce human persons to the status of tools or things under any circumstance, but it is particularly reprehensible in the healthcare setting where healthcare professionals are so valuable because of their knowledge and judgment. To demand the sacrifice of individual religious and personal rights of conscience in favor of patient convenience not only demeans an individual pharmacist but also the medical profession as a whole.

 

In order to protect the priceless rights of conscience of pharmacists, state legislatures must become proactive in passing meaningful legislation. Although 47 states allow doctors and other healthcare providers to refuse to perform abortions on personal grounds,13 this same protection is not widely granted to pharmacists and pharmacy owners. Although seven states currently have a law that protects pharmacists' rights of conscience to some degree,14 opponents of rights of conscience continue to agitate for laws that would force a pharmacist to dispense prescriptions despite his or her conscientious objection. Some states offer protection for healthcare rights of conscience to public employees. These provisions explicitly provide that state or other public employees cannot be required to participate in family planning or birth control services.15 In these states, lawmakers only need to extend the protection given to public employees to pharmacists who do not have the backing of state government. To adequately protect pharmacists and pharmacy owners, it is essential that every state enact comprehensive rights of conscience legislation.

 

In 2007, a number of states introduced bills in one or both houses of legislature pertaining to pharmacists' rights of conscience; however, of those bills introduced, more than half purported to force pharmacists to fill prescriptions rather than protect their rights of conscience.16

 

As this national debate over the role and rights of pharmacists becomes more salient among state legislatures, it is of paramount importance that state legislators and public policy groups are apprised of the need to enact comprehensive legislation that respects pharmacists' freedom and right of conscience and protects them from coercive action that contradicts their sincerely-held moral and religious beliefs. 

 

Endnotes

 

1. For an example of a pharmacists' conscience objection resulting in the loss of employment, see Jo Mannies, "'Pill' Dispute Here Costs Pharmacist Her Job," St. Louis Post-Dispatch, Jan. 27, 2006, A1. 

 

2. 410 U.S. 113 (1973). 

 

3. Although Plan B is commonly referred to as the "morning after pill," such a description is misleading because the drug actually functions as an abortifacient. 

 

4. "Access" is the frame promoted by pro-abortion groups. "Illinois Rules on Access," Planned Parenthood of America, available at: http://www.plannedparenthood.org/pp2/portal/files/portal/media/pressreleases/pr-050816-pharmacist.xml 16 August 2005. 

 

5. James Madison, Memorial and Remonstrance Against Religious Assessments, ¶ 15, reprinted in Everson v. Bd. of Ed., 330 U.S. 1, 65-66 (Rutledge, J., dissenting). 

 

6. Susan C. Winckler, American Pharmacists Association, Vice President for Policy Communications 

 

7. Statements available at http://www.prochoiceamerica.org/assets/files/Birth-Control-Pharmacy-Access.pdf   

 

8. 68 Ill. Admin. Code § 1330.91 (2005) 

 

9. 745 Ill. Comp. Stat. Ann. 70/1 et seq. (2005) 

 

10. The District Court granted summary judgment in favor of the State of Illinois, essentially stating that the suit was not ripe for adjudication. The appellate court affirmed and the matter is currently pending before the Illinois Supreme Court.

 

11. Statements made before the United States House of Representatives' Small Business Committee on July 25, 2005, available at: http://wwwc.house.gov/smbiz/hearings/databaseDriven-HearingsSystem/displayTestimony.asp?hearingIdDateFormat=050725&testimonyId=377

 

12. For an exploration of some of the pharmacists' motivation, see Doug Moore, "Illinois Druggists Pledge to Defy Rule," St. Louis Post-Dispatch, Aug. 21, 2005, B1. 

 

13. Alabama, New Hampshire, and Vermont offer no protection for health care rights of conscience. 

 

14. Arkansas, California, Georgia, Kansas, Maine, North Carolina, and South Dakota in some way protect pharmacists' conscientious objections. 

 

15. Colorado, Georgia, Oregon, West Virginia, Wisconsin, and Wyoming explicitly offer protection to a public employee who wishes to abstain from distributing contraception and/or family planning services. Colorado extends this protection only to city and county employees, while Oregon limits it to those who are employees of the Oregon Department of Human Services. 

 

16. Specifically, at least five states including Indiana, Missouri, North Carolina, Texas, and Virginia considered measures to protect the conscience rights of individual pharmacists and pharmacies, while at least ten states including Arizona, Missouri, New Jersey, New York, Oklahoma, Pennsylvania, Texas, Virginia, West Virginia, and Wisconsin considered measures to compel pharmacists and/or pharmacies to dispense contraception or emergency contraception without regard for conscientious objections. Measures considered in at least six states (Arizona, New Jersey, New York, Pennsylvania, Texas, Virginia, and West Virginia) would have required pharmacies to fill all "valid prescriptions." On a similar note, the Washington Board of Pharmacy adopted a rule stating pharmacies have a duty to deliver all prescriptions. Meanwhile, measures in four states (Arizona, Missouri, Oklahoma, and Wisconsin) dealt with only contraceptives.