They're called "conscience" or "refusal" clauses, and they allow health care providers to refuse to provide certain services or information against their own narrow belief system. Most often, pharmacists use refusal clauses to justify refusing to fill women's birth-control pill prescriptions. But a new federal version is working its way toward a House-Senate conference committee, and it would allow all health care entitities to refuse to even provide information about abortion to women who ask.
Gloria Feldt is president of Planned Parenthood Federation of America , and author of The War on Choice: The Right-Wing Attack on Women’s Rights and How to Fight Back (Bantam, 2004).
Julee Lacey, a married first-grade teacher with two children, would always go to her neighborhood CVS drug store in North Richland Hills, Texas, whenever she needed a prescription filled. And she never had a problem, until March 25, when the pharmacist on duty refused to fill Lacey’s prescription for birth-control pills, telling Lacey she did not “personally believe in birth control.” When Lacey’s husband went back to the CVS shortly thereafter to try again, the pharmacist told him, according to the Associated Press, that birth control “was not right,” and, erroneously, that “the pills cause cancer.”
A month earlier, a rape survivor in Denton, Texas, obtained a prescription for Emergency Contraception Pills (ECPs) from a hospital. The first pharmacy she went to didn’t stock them. Neither did the second. When she found an Eckerd pharmacy that did keep the medication in stock, all three pharmacists in the store refused to fill the prescription purely because of their ideological beliefs. ECPs, they said, violated their “consciences."
Wait a minute. Whose conscience counts here: the pharmacist’s or the conscience of—indeed, the basic human rights of—these women?
Though both of these cases happened in Texas, this is more than a local phenomenon. This is a national trend, and it’s spreading fast. Refusal clauses allow pharmacists or other health care providers to deny patients basic health care on the grounds of their own narrow, personal ideologies. Denying women access to basic reproductive health care like contraception on the grounds of the pharmacist’s own retrograde beliefs has become the latest strategy in the battle to restrict women’s freedoms and to limit our right to choose.
During the past legislative session, 13 states introduced or considered refusal clauses that would allow pharmacists to refuse to dispense certain prescriptions based on personal “moral” objections. The majority of those bills would permit a pharmacist to refuse to fill a prescription for simple contraception. South Dakota, Arkansas and Mississippi already have refusal clauses on the books. The South Dakota law goes so far as to specify that pharmacists may refuse to fill prescriptions for any medication they think will cause an abortion, regardless of the scientific facts. Never mind that birth-control pills and emergency contraception both work to prevent pregnancy from occurring in the first place and do not interfere with existing pregnancies, and thus by definition cannot cause abortions. Anti-choice extremists have intimidated states into ignoring the medical definition of pregnancy in favor of inaccurate ideological dogma.
And now some Republicans in Washington are getting into the act. Rep. Dave Weldon, R-Fla., is planning to tack on an amendment to the government's budget process which would encode these discriminatory policies into federal law. Weldon's “Conscience Protection Amendment”—also being pushed by the U.S. Conference of Catholic Bishops—would allow health care entities to refuse to comply with existing federal, state and local laws and regulations pertaining to abortion services. As such, it would override federal Title X guidelines that ensure women receive full information, strip states of their autonomy, and deny low-income women key information about, and referrals for, abortion services.
As you’d expect, these dangerous laws and policies can have disastrous results for women who are trying to prevent unintended pregnancy or preserve their health. This is especially true in the case of women who need ECPs, which must be administered within 120 hours of unprotected intercourse in order to be effective.
Unfortunately, some pharmacies seem more willing to accommodate the pharmacist than the woman customer. Though Eckerd fired the Denton pharmacists for violating store policy, the pharmacist at CVS faced no severe reprimand. CVS and other pharmacies have “refuse and refer” policies that allow pharmacists to refer patients to another store. These policies are far from adequate. In many parts of the country, the nearest pharmacy can be many miles away. For rural or low-income women, this sort of barrier can be overwhelming, especially when urgently seeking emergency contraception.
Not to be overlooked is the shame and humiliation that a pharmacist’s refusal casts upon a woman. Kathryn Cowburn, a self-described “responsible, married woman whose husband’s condom broke,” had to beg her physician to prescribe emergency contraception. “I ultimately received the emergency birth control, but not before I was made to feel like a moral outcast,” she told Planned Parenthood. Angela, another woman who desperately needed access to emergency contraception after her boyfriend’s condom broke, wrote to Planned Parenthood about her frustration after her pleas were rejected by two pharmacies and two hospitals. “I’ll never forget how uncaring and nonchalant the pharmacists at those stores were…. [I felt] like my country hated me, and viewed me like a baby machine.”
It is an outrage for any woman to walk away from her pharmacy with the feeling that her conscience, her human rights, are trumped by a particular pharmacist.
Julee Lacey told the Dallas Morning News: “I think my doctor should make these decisions. If they’re going to decide not to do birth-control pills, where are they going to draw the line?”
This is a question we should all be asking, and more importantly, asking of our pharmacists. You deserve to know whether your pharmacy will indulge or oppose this dangerous trend. In either case, take action: Write to the pharmacy and its parent to express your opinion. And if your pharmacy makes women’s health and women’s consciences the priority, thank them. If they don’t, ask them now: Whose conscience counts?
