Pharmacists' refusal to provide contraception is a valid exercise of professional discretion.

I don't think you can oppose these guys very strongly or make any serious argument that they should not be permitted to operate, while supporting abortion rights. It’s worth keeping in mind that the underpinning theory of Roe v. Wade is that the government should not interfere in the exercise of discretion by medical professionals to determine what procedures are approriate to the individual circumstances of each patient.

If you believe that the government should not interfere in a doctor’s decision that abortion is the best treatment option for a patient, then I can’t see how you could simultaneously believe the government should compel these pharmacists to provide a treatment they object to as a matter of professional conscience, even if you disagree with their objection. The professional freedom of a doctor to provide abortion is exactly the same as the professional freedom of a pharmacist to refuse to stock or distribute a particular treatment. You can support one use of the freedom and disagree with the other, but you can’t reasonably argue that one should be regulated and the other should be protected from regulation.

Pharmacists are professionals. These guys aren’t just desk clerks who hand out pills. The entry to the profession requires six years of higher ed and it’s considered a highly specialized job. The reason for this is, in large part, because the pharmacist faces issues of professional ethics and is expected to be able to make important decisions in the course of his business. These guys are highly-educated and well-paid to be a check on lying, drug-seeking patients and unethical doctors, and to catch medical mistakes that could endanger patients’ lives.

One common and extremely important example of a pharmacist using this discretion is if the same patient presents scrips from different doctors, and the pharmacist believes the doctors have not consulted with each other, may be unaware of the other meds, or that prescribed medications will have some dangerous interactions. In this case, the pharmacist should refuse to fill the scrips. Similarly, if the pharmacist is getting a lot of scrips from the same doc for a powerful narcotic painkiller like Oxycontin, and he believes the doc is handing out the drug to people who don’t need it and should not be getting it, the pharmacist might refuse to fill the scrips.

Similarly, if patients who are not dangerously overweight are given a powerful prescription weight-loss drug, like the phen-fen/redux combo that was widely handed out in the 90's and turned out to be incredibly dangerous, the pharmacist might exercise his discretion and refuse to fill the scrips.

If pharmacists were paid to unquestionably fill prescriptions, the job could be done by a technician with a two-year associate's degree instead of a pharmacist with a six-year doctorate.

The central purpose of a pharmacist's job is the exercise of discretion, and while some may disagree with his use of it, his obligation is to his conscience and not to someone else's political agenda.

Saletan is right that the harm being done by a handful of pharmacists refusing to stock contraception does not warrant an intrusion on professional autonomy, because that intrusion would set a dire precedent that could be used to attack physician autonomy and, therefore abortion rights, as well as other beneficial exercises of autonomy by professionals.

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While I agree that a pharmacist does more than just fill orders, I think you're also overstating their role and decision-making a power. If a pharmacist sees something amiss with a prescription (either a drug-interaction or a high dose of painkillers) they don't simply refuse to fill it and leave the situation there. They will consult the doctor to find out if they were aware of the interaction in the first case or if they doctor did indeed prescribe such a high dose. In the case where the pharmacist suspects the doctor him/herself is involved in illegally overprescribing certain medications, the pharmacist can contact the DEA. In no situation that I'm aware of is it considered good practice for a pharmacist to override a physician's judgment about medical care without consulting the physician and having the physician sign off on whatever course of treatment they agree on. I have never heard of a pharmacist deciding on his/her own that the doctor was prescribing a dangerous drug and consequently advising the patient against it. Considering there are a myriad of reasons why any drug might be prescribed and a pharmacist certainly has neither the full patient history nor the medical training to make such decisions, to do so would be extremely irresponsible and unprofessional.

I point this out not b/c I don't agree that there aren't some sticky questions here, but because to discuss them I do think it's important to clarify a pharmacists role. A pharmacist does not have the right to unilaterally prescribe a drug, and by the same token they do not have the right to unilaterally advise against a drug if a doctor has prescribed it. Whether they are obligated to fill the prescription themselves or they can simply refer the customer to another pharmacy is a separate matter. The sticking issue, as I see it, is the fact that in certain areas the refusal of a pharmacy to provide a drug will effectively mean the pharmacist is making the decision that a patient can't/shouldn't have a drug b/c there are no other options. This is, I believe, the only legal grounds for any objection. The moral and ethical questions are certainly up for debate.

No, the pharmacist does not have the right to advise a patient against the drug, but he doesn't have an obligation to fill the prescription either.

If he believes a patient's prescriptions will cause a dangerous interaction, and he can't reach the physician to clear it up, he will refuse to fill the prescription.

If he believes the dose of painkillers is unusual and he can't reach the doc, or believes the doc is behaving improperly, he may contact the authorities, but he will also refuse to fill the prescription.

The pharmacist is not in charge of the patient's health care, but he is in charge of the drugs he makes available. I agree that it would be totally inappropriate for a pharmacist to confiscate a patient's prescription for birth control, thus preventing her from seeking it elsewhere.

But where she is free to go to another pharmacy, her right to obtain the medication properly prescribed by her doctor and his right not to supply any medication he objects to on moral grounds are not in conflict.

Every example you cite is based on concerns that relate to the pharmacist's professional role - avoiding harmful drug interactions, checking dosages to make sure they're correct, ensuring that prescriptions are valid or ensuring that they're properly authorized by the doctor. None of them are based on morality.

In fact, outside of the realm of contraception, I've never heard of a pharmacist refusing to fill a prescription on moral grounds. I'm not a fan of the Viagra comparisons that have been used repeatedly in this forum, but there are plenty of single men with ED prescriptions, and I've never heard of a pharmacist saying he won't dispense that kind of medication except to married men so as to prevent adultery or fornication. It does smack of hypocrisy to say that it's okay to make a supposedly moral decision as to one drug while not making the equivalent decision as to another.

And, in any event, pharmacists often don't know why a drug is prescribed. I'm not interested in having a pharmacist pass judgment on my reasons for taking something unless there's a question about the validity of the prescription or a drug interaction; that's the doctor's job, not the pharmacist's.

This still doesn't prove your point. In these instances, the pharmacist isn't refusing to fill a prescription outright for all time. S/he is saying (based on professional, not moral opinion) that there is a potential risk associated with the drug, and so s/he needs to contact the physician before filling it. This is entirely different than saying they will never fill it b/c they personally and professionally have decided it is harmful or unnecessary which is what your OP implied.

While in theory I don't disagree with your point about a personal right to refuse to provide a drug, I also don't see how your "reasonable standard" of "where she is free to go to another pharmacy" can be enforced. How far does the closest pharmacy have to be? What if she only has a 20 minute break from work? What if they don't accept her insurance? this is where the conflict arises. and given that it's a very real conflict between the rights of the patient and that of the pharmacist, it's a sticky one. (although, I more or less agree with randy-khan in the next post that most of these decisions seem laced with hypocrisy and sexism.)

randy-khan:

Every example you cite is based on concerns that relate to the pharmacist's professional role - avoiding harmful drug interactions, checking dosages to make sure they're correct, ensuring that prescriptions are valid or ensuring that they're properly authorized by the doctor. None of them are based on morality.

It's based on the anticipation of harm from the use of the drugs. If they believe birth control pills are harmful in all cases, not stocking them is their prerogative.

If the individual pharmacist's decision to do this created a material risk that people would be rendered unable to obtain the birth control pills, then there might be a clash of rights here, and I would tend to agree that the patient's right to the medication would prevail.

However, such a scenario is entirely counterfactual. She can get her pills elsewhere, and the pharmacist can avoid his perceived dilemma. I would support impinging on professional discretion where the pharmacist's refusal to participate in a medically sanctioned treatment blocked the patient's ability to obtain it. But that isn't the case here.

Crawford:

It's based on the anticipation of harm from the use of the drugs. If they believe birth control pills are harmful in all cases, not stocking them is their prerogative.

If that's what they believe, then they shouldn't be pharmacists.

I'm not being churlish here (well, at least not entirely). Birth control pills are prescribed for many reasons that have nothing to do with birth control. Heck, there are cases where birth control pills are prescribed precisely to prevent pregnancy because pregnancy would be hazardous to the patient (and my recollection is that only the fringe of the fringe of the pro-life movement opposes abortion to preserve the life of the pregnant woman). Any pharmacist who is trained properly presumably knows this, and any pharmacist who fails to acknowledge it is incompetent or unwilling to fulfill his or her professional duties.

To be frank, no matter how much training a pharmacist has, it boggles my mind to think that it's appropriate to substitute the pharmacist's judgment about the harmfulness of a drug that is lawfully prescribed for the specific purpose for which it was approved by the FDA for that of the prescribing doctor in a case where there is no question about fraud, drug interaction or any similar kind of issue. Honestly, if someone can't get his or her mind around doing the job the right way, then he or she shouldn't be a pharmacist. It's like saying you want to be a lawyer, but don't want to be bound by the ethics rules. Sorry, but that's the price you pay for being in the profession.

Crawford, I have questions for you on this whole 'professional discretion" issue. I can accept that pharmacists have the right to refuse medication if he or she thinks it may harm the patient. But what, exactly, can be considered universally harmful about oral contraceptives? There is a warning on some packages that smokers over the age of 35 should refrain from taking the pill. Other than that, what is the justification? Is there a valid one? As a pharmacist, you can't just say you 'believe' BCP's are harmful to all women; you have to have a reason. As in, facts, supporting evidence, and so on. You can't just make shit up, or offer no reason at all. To do so is wildly unprofessional and improper, based on the very rules you described, Crawford. And if a pharmacist actually has a moral problem with birth control, and disguises it as a medical concern to appear 'professional', then he or she is a liar, and also extremely unprofessional. So unless there is a serious, universal danger associated with oral contraceptives, your entire argument is irrelevant. Also, you seem certain that every woman denied birth control at one pharmacy can just go to another one. What if the next pharmacy is 30 miles away? This is certainly the case in many parts of rural America. At what point is it an undue burden on the woman?