Essential Estrogen

As you drive through rural Iowa, you decide to stop and eat at a local restaurant. The place looks and smells wonderful. You have a seat and the waiter brings you a big glass of water with a slice of lemon on the side and asks if you're ready to order. You're really hungry and decide on the ribeye plate and ask for cottage cheese in place of the green beans. The waiter's face goes red and he begins to explain that he will not serve orders containing both meat and dairy as this contradicts his religious belief and Kosher practices. Although you are not sure why his religious beliefs should dictate what you (the customer) do, you leave and eat at another restaurant. Unfortunately, this is the only restaurant in town and you'll have to drive another 59 miles for another.

You manage a group of road workers and need to ensure a proper number of active workers on each day. As you move individuals to various teams and send them out on jobs, you get word of severe traffic delays at one particular work site. Upon arrival at the location, you discover one of the workers assigned to assist with narrowed traffic flow is a Muslim and requires several breaks each day to pray.

A local boy asks your permission to date your 15-year-old daughter. Impressed with his respect for you and your family, you agree, but only if you are allowed to chaperone. When the first big night arrives, the group travels to the local theater for a movie. The orthodox Mormon at the ticket counter, however, refuses to sell tickets to young couples on dates since his religious beliefs dictate teens should not date until they are 16.

Back in mid-January, the Iowa Pharmacy Examiners Board approved a series of amendments which affect how pharmacies and pharmacists in our state implement and maintain services. These approved amendments (PDF) are set to be incorporated into existing law unless interested persons object.

While the amendments cover a wide variety of subjects, we'd like to concentrate on a new rule (located on page 2 of the PDF), 657--8.10(147,155a), and in particular the second clause of that new section.

657—8.10(147,155A) Refusal to fill prescription or dispense drug. Pharmacy personnel shall assist a patient requesting an unavailable drug, or a patient requesting a drug not provided based on the pharmacist’s conscientious objection or refusal, to identify another pharmacy or other legal source that may be able to provide the drug.

8.10(1) Discretionary refusal. A pharmacist may exercise discretion and refuse to fill any prescription or dispense any drug based on any of the following factors:

a. The pharmacist is unsatisfied as to the legitimacy or appropriateness of the prescription presented.

b. The pharmacist is unsatisfied as to the validity of any photographic identification.

c. The pharmacist is unsatisfied as to the identity of the patient presenting a prescription or of any person acting on behalf of the patient.

8.10(2) Conscientious objection and refusal. A pharmacist may refuse to fill any prescription based on the pharmacist’s ethical or moral beliefs. The pharmacist shall notify the pharmacist’s employer prior to invoking a conscientious objection to the dispensing of any drug or class of drugs.

This new section allows pharmacists to refuse to provide medications to anyone, regardless of the presence of a doctor's prescription or urgency of need. While pharmacist conscientious objection has typically been an issue only in terms of emergency contraceptives and more traditional birth control, the proposed change is not limited to reproductive-related medications. This has led other groups to wonder if their medications might be next.

Such a policy (as outlined in the hypothetical situations at the top) is impractical, especially late at night in emergency situations where medications must be taken within a certain time period. Even outside of those urgent cases, however, working class and poor women have a difficult time getting enough time off work or money to travel from one pharmacy to another. Young women, who are often frightened and unsure of themselves, may simply give up when confronted by a judgmental pharmacist.

Finally, pharmacists, although aware of the medication being prescribed, may not be aware of the conditions prompting the prescription. Two years ago, my then 13-year-old daughter was diagnosed with polycystic ovarian syndrome (PCOS). As one portion of treatment, her doctor prescribed birth control pills (regulate menstrual cycles, inhibit increased hair growth and help with skin problem). She and I took the prescription into the pharmacy our family had used for years and presented it to the pharmacist. Once the pharmacist realized who the prescription was for, he refused to fill it, citing religious objection.

Without consideration as to my daughter's diagnosis, this so-called professional attempted to make a medical decision based on his religious beliefs?!

Needless to say, we no longer use that pharmacy and never will again. Fortunately, we live in a metro area with several pharmaceutical choices and the prescription was not an urgent need.

If you see distinction between abortion and contraception; between what a physician does and what a pharmacist does; or between performing a medical procedure and dispensing medication the Iowa Pharmacy Board needs to hear your voice.

If you believe the Fifth Amendment prohibits deprivation of personal liberty without due process, then the Iowa Pharmacy Board needs to hear from you before 4:30 p.m. on Friday.

Correspondence on this matter should be sent in writing to Terry Witkowski, Executive Officer, Iowa Board of Pharmacy.

Postal address:
400 SW 8th Street, Suite E, Des Moines, IA 50309-4688

Email:
terry.witkowski@ibpe.state.ia.us

Fax:
(515) 281-4609

In the end it boils down to burden and, when the choice arises, the burden must fall on the pharmacist (who knows in advance of his/her own moral reservations) and his/her employer (who should also know in advance the self-imposed obligations of employees). The customer who may well be pregnant, frantic, poor and short on time cannot have expectations of timely, professional service undermined by another person's religious belief. Nor should the physician who wrote a medical prescription in good faith and after patient consultation be undermined by another individual outside the scope of medical decisions.