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When a Pharmacist Refuses To Fill a Prescription


In several highly publicized incidents in Texas and Wisconsin, pharmacists refused to fill prescriptions for the “morning-after” pill based on religious or ethical beliefs. The Texas pharmacists lost their jobs, and the Wisconsin pharmacist was sued. Though such severe consequences are rare, these cases have generated a lot of controversy, and state and federal legislation.

Four states—Arkansas, Georgia, Mississippi and South Dakota—have passed laws allowing pharmacists to "opt out" of filling prescriptions they find morally objectionable, and at least 13 others are considering doing so.1 The governor of Illinois, on the other hand, introduced legislation to compel pharmacies that carry contraceptives to fill all prescriptions for birth control. At least four other states are considering legislation that would require pharmacists to fill all prescriptions presented to them.

Arguing that no one has a right to come between doctors and their patients, Sen. Frank Lautenberg (D-NJ) introduced in April 2005 the Access to Legal Pharmaceuticals Act. The legislation would ensure that retail pharmacies fill all prescriptions. If an individual pharmacist refuses, the prescription would be given to another practitioner in the pharmacy. Also, at the patient's request, a pharmacy would be required to order prescription birth control not usually stocked if it stocks other prescription contraception. Delays in providing the requested contraception could result in a fine.

The debate has sparked interest throughout the healthcare community as well. In a Medscape survey conducted in July 2005, 77% of the healthcare respondents said pharmacists should not refuse to fill prescriptions that conflict with their personal beliefs. Because of how respondents were classified, it is not clear how many pharmacists responded to the survey. (To take the HPSO Web survey on this issue, go to www.hpso.com/rxsurvey.)

The current controversy centers largely on the morning-after pill and oral contraceptives. But a pharmacist could object to filling other types of prescriptions for many reasons. A pharmacist who opposes assisted suicide, for example, may not want to fill a morphine prescription for a patient who has a painful terminal illness and has expressed a wish to end his life.

The American Pharmacists Association (APhA) is inclined to recognize pharmacists' right not to fill a prescription as long as the patient's needs can be met by others, according to Susan Winckler, RPh, JD, vice president of policy and communications and staff counsel. The APhA suggests that in addition to referring patients to another pharmacist or drugstore, concerned pharmacists also consider practice settings where this issue is less likely to arise, or working with physicians or other pharmacists to establish alternative dispensing methods. A pharmacist in a rural community, for example, might let physicians know what prescriptions he will not fill and suggest that they dispense the drugs themselves, if their state allows it. Or, he could refer patients to another pharmacist.

The APhA, the Academy of Managed Care Pharmacy, the American College of Clinical Pharmacy and the American Society of Health-System Pharmacists noted in a letter in the Legal Times that "pharmacists, like physicians and nurses, should not be required to engage in an activity to which they object." That said, Winckler emphasized that the APhA opposes obstruction: “A pharmacist may step away from a prescription but shouldn't step in the way.”

Francis Manion, JD, of the American Center for Law and Justice, believes that pharmacists with ethical objections to filling certain prescriptions have some legal protections and defenses but that the courts are unlikely to rule on this issue any time soon. In the meantime, Manion says, “Pharmacists need to be proactive” and let their employers know from the outset where they stand so accommodations can be made. It's important, too, that each pharmacist knows the law on refusing to fill a prescription on moral grounds in the state where he or she practices.

You and your employer need to be aware of the “refusal issue” and be prepared to handle it properly so as to avoid a lawsuit.

1. Pharmacist Conscience Clauses: Laws and Legislation. Updated June2005.

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