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Culture war hits local pharmacy

Many druggists across the country refuse to give out morning-after pills. Legislators weigh in.

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But many pharmacists believe it's possible to accommodate their consciences and still ensure a patient gets her prescription. "We support the pharmacist stepping away, but we don't support them stepping in the way," explains Susan Winckler of the American Pharmacists Association, which adopted a policy calling for conscience protections, as long as the pharmacy had an alternative system in place - another pharmacist on duty, for instance, or an agreement with a neighboring pharmacy. The issue first arose not because of contraceptives, she says, but over pharmacists in Oregon concerned about taking part in assisted suicide.

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Ms. Winckler is concerned about the order in Illinois, which she says has caused many drugstores to reverse their policies and doesn't take into account that pharmacists may refuse to fill a prescription due to health concerns as well as moral objections. She's also worried about proposed laws that give too much weight to either the pharmacist's rights or the patient's rights, instead of considering them both.

Still, in a conflict, the patient's rights should win, say some medical ethicists. "For the past few years now, pharmacists have wanted to model their relationship with the patient on the physician-patient relationship, which is not really appropriate," says Evelyne Shuster, a medical ethicist at the University of Pennsylvania.

Others wonder about the implications down the road: A pharmacist only agreeing to give contraceptives to married clients, for instance. Defenders of the conscience clause dismiss such fears as ridiculous, and contend that pharmacists - who have an obligation to look out for their clients' interests when it comes to, say, adverse side effects or potential allergies - are healthcare professionals who should have the same protections as doctors do.

"We intervene and stop prescriptions and make doctors change prescriptions," says Karen Brauer, a pharmacist in Lawrenceburg, Ind. The pharmacy she works at refuses to stock contraceptives - a fact she explains if people come in looking for them - but she feels that workers at any pharmacy need to be able to follow their conscience.

Ms. Brauer, along with some other pharmacists, has a particular problem with emergency contraceptives because they work by inhibiting ovulation, fertilization, or implantation. While most medical professionals define pregnancy as beginning with implantation in the uterus, she and some others consider a fertilized egg, even before implantation, to be human. "We should be free to opt out of killing humans at any stage of development," she says. "If women really want this drug, they are going to have to find a willing provider."

Others voice more tempered views, but still feel that allowing a right of conscience shouldn't have to keep a patient from being serviced. "We don't force doctors to perform abortions, and we shouldn't force pharmacists to dispense contraceptives," says Steven Aden of the Center for Law and Religious Freedom.

He doesn't buy the argument that referring a client elsewhere can be too burdensome or cause delays that threaten the effectiveness of the morning-after pill. "You don't force somebody to do something they think is morally wrong because somebody can't get into a car or a bus and access healthcare."

Reproductive-rights advocates note that keeping a woman from the morning-after pill can cause more unwanted pregnancies - and potentially abortions - than making it available. But above all, they say the issue comes down to discrimination that no woman should have to face at the pharmacy. "A pharmacist's job is to dispense medication," says Steve Trombley, president of Planned Parenthood Chicago. "Not moral judgment."