Where I live (that would be Chicago) all pharmacists are required by law to fill all legal prescriptions. They cannot turn anyone away and can be fined or disciplined if they try. Using a religious objection to refuse to sell a drug just won't fly here.

It is also a requirement that all pharmacies post a sign in a visible area outlining this law and explaining the rights of patients.

I wonder, if the seven pharmacies who refuse to dispense birth control had said they wouldn't sell insulin instead of contraception, would you be so cavalier about dismissing people's concerns?

What's the moral objection to insulin? And how do conditions treated by insulin differ from other conditions?

I agree that a woman could just go elsewhere for her contraception, but I worry what precedent this sets. What if an animal loving pharmacist refuses to sell drugs that were tested on chimps? What if a pharmacist decides that giving HIV drugs to gay men is immoral?

In the Republic of Ireland, not so long ago, women had to travel to Northern Ireland to get contraception (even condoms). The Government ruled, and rightly so in my view, that this put an undue burden on women and violated their human rights. Now all pharmacists must fill the prescriptions they are handed -- end of story. Mr. Saletan seems to suggest that legislation such as this will lead to further problems, but it hasn't happened in Ireland. So, what problems does he anticipate?

I think there are two serious concerns with pharmacists who won't fill prescriptions for birth control pills. First, I doubt that very many of these pharmacists are making available any information about where a woman can get her prescription filled. As Saletan pointed out, if we're going to allow pharmacists to refuse to fill prescriptions, they must be required to prominently post information telling patients how they can find a pharmacy that will fill their prescription. (Which leads to the question of who should pay to operate a toll-free number and database of pharmacies.)

But more importantly, there are rural areas of this country where there are very few pharmacists. A refusal by a pharmacist to sell contraception in such an area could have the effect of making it extremely difficult for a woman to obtain emergency contraception. There may not be entire regions of the nation where this will happen, but it's easy to imagine several-hundred-square-mile areas of Texas or Utah (or other western, sparsely populated states) in which the decision by a couple of pharmacists to stop selling contraception could impose an enormous burden on women in those areas. That is a problem that must be addressed.

Good points, Jonboy. What happens if we take point #2 one step further? If, as Saletan argues, it's fine for some pharmacies to decide not to sell birth control, is it also ok if most choose not to sell it? Or all? Unlikely, I know, but there is apparently nothing legally preventing it from happening, and Saletan seems to think that's fine. Surely at some point the scarcity and long travel distances would become an undue burden for women (like the Ireland example above).

Don't forget that slippery slopes usually run both ways. Should a women's health provider be legally required to offer abortions? You can make a much better argument for that (compared to birth control) based on geographic deprivation.

We're talking about pharmacists here, not doctors. There is a big difference. We are talking about a pharmacist overriding a doctor's decision on what is best for a patient's health and well being. If you are going to the trouble of posting on here, why don't you actually address the undue burden issue with pharmacies, which is what we are actually discussing. You're just changing the subject.

Certainly not. But I also don't expect a gastroenterologist to do brain surgery, or a GP to provide chemotherapy. Physicians chose from a wide variety of specialties to practice the type of medicine that interests and best suits them. Pharmacists are not specialists. They provide medications of all types, for all diseases and conditions (and to prevent diseases and conditions). Picking and choosing which patients get which medicines is the function of a physician (and his/her patient), not a pharmacist.

I DO expect, however, that if an OB/GYN does not perform abortions, that s/he will refer the patient to a practitioner that will (or, at the very least, to a resource that will direct the patient to an abortion provider). Just as I would expect my GP to refer me to a gynecologist to perform a pelvic exam if s/he does not. Or an oncologist who believes that further treatment of cancer would not be useful to another oncologist for a second opinion. I don't think that is a slippery slope. I think it's common sense.

I'm sorry, but your argument that is pointless to worry because not enough pharmacies are banning contraceptives is ridiculous and dangerous.

If only one public school refuses to admit African Americans would you feel the same way. We have seen our right to choose eroded over the past 20 years and each time, someone, (usually a man) says, "Don't worry. It's not that big a change. We're only banning one procedure. We're only requiring a little more information. We're only requiring parental consent." And now we're seeing that argument extend to contreception.

Some women remember the days when a single moment of weakness could result in a pregnancy with no other options than to give birth or seek the services of an illegal abortionist. The consequences of unwanted pregnancies are heavily weighed against females more than males. And now attacks on sexual freedom and reproductive control are once more wieghted against women.

You don't have to be a feminist to see the danger and sexism here.

As for your question about whether healthcare providers should be forced to perform abortions?

I think they should. If they provide other comparable ob/gyn services, then there is no reason they shouldn't be made to offer a legitimate medical procedure like abortion. If they object on moral grounds, then they should be forced to refer you to someone who will.

Should a woman's health care provider have to offer abortions? Yes, yes and yes.

Sorry to bring up Ireland again, but it seems to fit the discussion. In the ROI, it's contraception (emergency or otherwise) -- OK, abortion -- NoWay. Contraception is cheap and easily available. The idea is that more and better contraception leads to fewer abortions. It appears to be working.

However (isn't there always a BUT). Recently, a young colleague of mine found herself pregnant. She knew she would have to travel to the UK for an abortion but she didn't have enough money and couldn't turn to her family or the father for help. The cost of the flight, somewhere to stay, and the cost of the procedure was well in the thousands of Euros. By the time she begged and borrowed from her friends, she was nearing 20 weeks into her pregnancy. Not a nice scenario and very traumatic for her.

If abortion had been available in the ROI, she would have been spared this trauma and the embryo would not have reached such a late stage.

Now, you might say, Boo Hoo, she shouldn't have gotten pregnant. But no matter how good our intentions, accidental pregnancies are not going to be eliminated completely. So let's make it all safe and legal and easily available. And no health professional should be allowed to interfere. Their job is to ensure public health and wellbeing. Let them keep their religious views to themselves.

Saletan:

What's the moral objection to insulin? And how do conditions treated by insulin differ from other conditions?

Many vegetarians & vegans find the production of insulin to be morally repugnant, as it at least used to use the pancreases of dead mammals, usually pigs & cattle. There are now other ways to synthesize it, but most of them require some animal tissue in the process.

Another example: the production of estrogen to treat the symptoms of menopause begins by forcing brood mares to reproduce and destroying the foals. You can google "Premarin foals" to see why many people find it morally repugnant.

Would you allow a pharmacist to refuse to dispense insulin based on those objections? What about estrogen? If not, why would you allow a pharmacist to refuse to dispense contraception?

Saletan:

What's the moral objection to insulin? And how do conditions treated by insulin differ from other conditions?

The moral objection to insulin is the same as any moral objection to anything; it is whatever the objector wants it to be. How rational does a pharmacist's moral objection need to be before we allow him/her to refuse a patient's script?

You appear ready to accept the argument that "contraception is murder" to justify refusing such services. If this debate were happening in the past, when much insulin was produced from pigs, would you accept the argument that "products from pigs are unclean" as justification for refusing to give insulin to a diabetic? What if the pharmacist honestly believed that giving a pig product taited the user's soul, and that death with a clean soul was preferrable?

What about blood transfusions? Some religious belive that the bible forbids transfusing blood. May a nurse or doctor refuse to give blood to a patient because they believe its wrong?

I didn't know about the animal rights objection to insulin. Interesting.

Your second point is outdated nonsense, though. Premarin has been synthesized in factories for over 30 years now.

You and I both know that there are reasons for taking the birth control pill that have little to do with contraception.

How arrogant and short-sighted is it for an anti-choice pharmacist to deny birth control to a woman with fibroid tumors or endometriosis? These women take the drug to forestall the inevitable result of these conditions, a hysterectomy, and PRESERVE their fertility until they are ready to have a baby. Frequently they only get one chance at a pregnancy even if they do go that route.

The point is that a pharmacist is not a physician. Pharmacists cannot and should not presume to make medical decisions. Only a physician is qualified to make a decision as to what drug a patient needs and for what reason. In this sense, the pharmacist is only a service provider and should therefore only question a prescription if there's a chance of a drug interaction.

I have a question for you, though. How many of the pharmacists that are refusing women the right to control their fertility are women?

jascob:

Saletan:

What's the moral objection to insulin? And how do conditions treated by insulin differ from other conditions?

The moral objection to insulin is the same as any moral objection to anything; it is whatever the objector wants it to be. How rational does a pharmacist's moral objection need to be before we allow him/her to refuse a patient's script?

I would allow the pharmacist to refuse any prescription, for any reason. Forcing a pharmacist to violate his own moral code would violate my moral code.

Taking away the legal option to refuse to sell objectionable products, whatever their nature, also has unintended consequences. The most obvious is that the pharamacist may decide to close up shop rather than supply contraceptives. Are you going to force him to stay in business? How?

jascob:

What if the pharmacist honestly believed that giving a pig product taited the user's soul, and that death with a clean soul was preferrable?

What about blood transfusions? Some religious belive that the bible forbids transfusing blood. May a nurse or doctor refuse to give blood to a patient because they believe its wrong?

Absolutely, they may object. To be fair, the objection should be made clear prior to any procedure being agreed upon. Those who object to transfusions should not, for instance, work in emergency rooms. Saletan's suggestion of clear notification would cover this as well.

Someone proposed a theoretical "gay gene" test that some pharmacists might object to. That makes a better moral comparison, since it violates a more widely held but still controversial principle.

Here's a real-life example, from my wife's labor & delivery floor: an African woman has her vagina sewn shut. The stitches are removed for the birth. Afterward, she wants them replaced. The procedure leaves a tiny opening that allows menstrual flow, but makes sexual intercourse excruciatingly painful. Should the doctor be required to stitch her vagina closed?

Analogies are always imperfect, but think of something you might morally object to doing, and imagine being forced to do it. It doesn't really matter what it is. It's the fact that you're being forced against your will that is morally repugnant.