Saturday, April 02, 2005

The New "Separate But Equal"

As the tales have spread of women seeking birth control at pharmacies only to be refused, the American Pharmacists Association has stepped up to the plate and reassured the public that so long as patients can be served elsewhere, this is not a problem. This is uncomfortably close to the reasoning used by the Supreme Court in its famous Plessy v Ferguson decision that led to generations of Jim Crow laws: as long as the Negroes can get their (food, drinking water, bathroom needs, education) someplace else, whites need not fret about having to rub elbows with them. And it worked out spledidly for them, didn't it?

Well, for once (at least it feels like "for once") a state government chooses to legislate against an inequity, instead of codifying it. In the NYTimes today I see that:

"With a growing number of reports of pharmacists around the country refusing to fill prescriptions for birth control and emergency contraception, Gov. Rod R. Blagojevich on Friday filed a rule requiring Illinois pharmacies to accept and dispense all such prescriptions promptly.
"Our regulation says that if a woman goes to a pharmacy with a prescription for birth control, the pharmacy or the pharmacist is not allowed to discriminate or to choose who he sells it to or who he doesn't sell it to," Mr. Blagojevich, a Democrat, said. "No delays. No hassles. No lectures."
Chalk one up for the Democrats! This was in response to a couple of incidents recently where women seeking to get birth control at an Osco in downtown Chicago were refused service. Osco, bless its wizened little corporate heart, didn't bother to comment. But Susan Winckler of the American Pharmacists Association did, invoking that time-hornored straw man of conservatives everywhere, the "slippery slope":

"The association, she said, believes that pharmacists should be allowed to "step away" in cases where they feel uncomfortable dispensing a particular drug - so long as their customers can still get their drugs from alternative sources.
Ms. Winckler said she also worried that Governor Blagojevich's new rule might reach beyond the question of a pharmacist's own moral sensibilities, and require pharmacists to dispense all prescriptions, even those that were "clinically inappropriate" for patients. Such cases might include ones in which a pharmacist discovered a customer's allergy or a potential drug interaction that a prescribing doctor had missed."
Even a grade schooler could be made to understand the difference between refusing a legal prescription on grounds that have nothing to do with a patient's welfare, and warning a patient about a potentially lethal drug allergy or interaction. I'd guess the adult world could be expected to grasp it as well.

This an important issue, one that can have even more wide-reaching effects than the end-of-life issues arising out of the Terri Schiavo madness, because so many women use birth control pills or other prescription contraceptives. Worse, the number using them has actually decreased, in part due to cost and lack of availability. So this growing phenomenon threatens to exacerbate the problem, and what happens when more and more women become accidentally pregnant? Abortion goes up.

Many of the recent denials of service have been made because of emergency contraception. The ethical arguments against pharmacists denying service on grounds of conscience are made persuasively here, in a New England Journal of Medicine aricle that looks at both sides of the debate, "The Limits of Conscientious Objection--May Pharmacists Refuse to Fill Prescriptions For Emergency Contraception". Among the points it makes are:

  1. Pharmacists have fiduciary responsibilities--they voluntarily enter the field and adopt its corresponding obligations, including that if their objections directly and detrimetally affect a patient's health, the patient should come first.
  2. Emergency contraception is not abortifacient--it does not affect an establsihed pregnancy, and acts by more than one mechanism,; thus the Catholic Health Association could reconcile itself to a mandate in Washington state to provide such contraception to rape victims.
  3. Religious and moral objections should yield when they detrimentally affect a patient's ability to obtain timely medical treatment--such refusal could place a disproportionately heavy burden on the poor and rural.
  4. Refusal has great potential for discrimination and abuse--pharmacists with moral objections can choose from an ever-greater number of drugs for refusal based on their perceptions of the kinds of people using them and the reason for use (i.e., HIV drugs for someone perceived as immoral or suffering "God's judgement").
Because I feel this is such a crucial issue for examination and dialogue, I am re-posting below 3 related pieces I've done on this subject. I'd be interested in seeing this get a wider audience, and feedback from readers and bloggers alike.

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