Pharmacist right to refuse dispense medication to a patient.



Background

• A registered pharmacist is trained to formulate and dispense drugs or medications through completion of an accredited university program in pharmacy. The responsibilities include instructing patients on the use, hazards, interactions, and side effects of any drug dispensed. Licensure is required upon completion of the program and prior to serving the public as a pharmacist.
• Pharmacy is one of the most regulated professions in the country. Like any other professions, Pharmacists are invested with the responsibility to adhere to the standards of ethical practice and conduct set by the profession.
• State boards of pharmacy regulate, administer and influence every phase of pharmacy practice, including the requirements and testing to become a licensed pharmacist. The mission of the state pharmacy boards is to set regulations, standards, and parameters within which pharmacists practice.
• The rights of pharmacists to refuse to dispense certain prescriptions vary widely from state to state. The legal obligations and protections of pharmacists and pharmacies are specific in some states but generally not defined. This various regulations raise questions to consumers and debate in legislature. Uniform regulations or legislatures are not forthcoming in near future.

Conscience Clause

Numerous states have specified that it is the pharmacist's duty to refuse to dispense based on professional judgment. This is supported by the Drug Enforcement Administration rule in the Code of Federal Regulations that states that a pharmacist has violated the law if a prescription is filled that is for a use that is not in the ordinary course of treatment. The regulations, however, do not address the pharmacist professional judgment. Such laws are sometimes referred to as "conscience clause" laws because they allow medical providers to refuse to provide services to which they have religious or moral objections Supporters of such laws argue that pharmacists should not be forced to engage in activity that violates their personal beliefs, while opponents contend that women have the right to receive the medical treatment legally prescribed by authorized health practitors.

Individual states legislatures

At least four states have laws that specifically permit pharmacists to refuse to fill valid prescriptions have a conscience clause that allows pharmacists to refuse to fill or refill certain prescriptions which they find morally objectionable:

1. Arkansas ,
2. Georgia,
3. Mississippi,
4. and South Dakota.

In contrast, four states;

1. Illinois,
2. Massachusetts,
3. North Carolinaand
4. Pennsylvania

Have an emergency rule or regulation that states or implies that all legal and binding prescriptions must be dispensed or transferred. Clearly, pharmacy conscience clause laws vary widely from state to state. While only a small number of states have laws that specifically authorize or deny a pharmacist's right to refuse to fill valid prescriptions for reasons of personal belief, a number of states are considering such law.

Exceptions

• South Dakota is the only state that has adopted a conscience clause in its pharmacy act. Presumably, only pharmacists in South Dakota who refuse to dispense based on personal beliefs will be protected by law. South Dakota, pharmacists are not required to dispense medication if there is reason to believe that the medication would be used to destroy an unborn child.
• On the other hand, Wisconsin have laws that govern the professional conduct of pharmacists or that generally require the dispensation of drugs pursuant to a valid prescription, or transfer prescriptions for contraceptives.
• However, there are no states that have mandated that a pharmacist must dispense a prescription. Generally, as long as a pharmacist acts in good faith and people who need medications get them, they will not face disciplinary actions.
• This means that if a pharmacist does not morally agree with the course of treatment, there is a need to refer the patient to another pharmacist. There may be pharmacists that feel that the act of referring makes them a participant in a procedure that they are morally against. It would appear that this is where a patient or employer would have the most leverage legally. Pharmacists have a duty to provide access to drugs to people who need them. If there is a technical problem with a prescription, or if the pharmacist must make a professional judgment to refuse to dispense, it is the expectation that the physician be contacted.
• The same applies when a pharmacist is faced with making a moral decision. If nothing else, the physician should be contacted; preferably, the pharmacist will refer the patient to another pharmacist.

Local Jurisdiction

In addition to states, local jurisdictions may enact laws as well.

• Moreover, individual stores and pharmacy chains have their own employment policies that govern such situations in the absence of state laws on the subject, and many of these policies appear either to require pharmacists to fill valid prescriptions or to allow their employees to refuse to fill prescriptions only if the employee transfers the prescription to another pharmacist or pharmacy.
• Walgreens, for example, has a policy that requires pharmacists who object to filling certain prescriptions to refer those prescriptions to another pharmacist or pharmacy.
• Pharmacists should assume responsibility for reducing the severity of the implications of this issue by taking a proactive approach by considering the impact of these and other moral dilemmas before they are presented in the workplace.
• Pharmacists should establish relationships with physicians, and encourage frank discussion between co-workers, employees, and employers.
• Each state, employer, pharmaceutical organization, and individual pharmacist develop, communicate, and implement a conscience clause that protects the pharmacist' rights without denying the patient access to treatment. This will in fact let the pharmacist know of the legality of working and consequences of certain actions.

Pro Choice

American Pharmaceutical Association "recognizes the individual pharmacist's right to exercise conscientious refusal and supports the establishment of systems to ensure patients' access to legally prescribed therapy without compromising the pharmacist's right of conscientious refusal. Although most states have laws that explicitly allow physicians to refuse to provide certain medical services, the policies pertaining to pharmacists are less clear. Regardless of any statues or regulations to set forth, the issue of whether or not pharmacists should be allowed to refuse to fill valid prescriptions for contraception is likely to continue to generate a great deal of legislative debate along with pro choice debate as long as the constitution of United States is supreme law and protects civil liberty.

Latest Ruling - Caution For Pharmacist

Tue, 25 Mar 2008 22:14:46 GMT WAUSAU, Wis. - A state appeals court upheld sanctions Tuesday against a pharmacist who refused to dispense birth control pills to a woman and wouldn't transfer her prescription elsewhere. The 3rd District Court of Appeals ruled that the punishment the state Pharmacy Examining Board handed down against pharmacist Neil Noesen did not violate his state constitutional rights, specifically his "right of conscience" to religiously oppose birth control."Noesen abandoned even the steps necessary to perform in a minimally competent manner under any standard of care," the three-judge panel said. The decision upheld a ruling by Barron County Circuit Judge James Babler.Planned Parenthood of Wisconsin praised the ruling as important for women's access to reproductive health care. Several states have been wrestling with the issue of pharmacists who refuse on religious grounds to dispense birth control or "morning-after" pills.Noessen's attorney Paul Linton said that he was disappointed but that no decision had been made on whether to appeal.The ruling "can curtail the religious rights of pharmacists and perhaps other health care professionals," Linton said.According to court records, Noesen was working as a substitute pharmacist at a Menomonie Kmart in 2002 when a University of Wisconsin-Stout student sought to refill her birth control prescription.Noesen testified he advised the woman of his objection to the use of contraception and refused to fill the prescription or tell her how or where she could get it refilled.The woman was able to get the prescription filled two days later but missed the first dose of the medication, court records said. She filed a complaint with the state Department of Regulation and Licensing.Noesen, 34, of St. Paul, Minn., told regulators that he is a devout Roman Catholic and refused to refill the prescription or release it to another pharmacy because he didn't want to commit a sin by "impairing the fertility of a human being."The Pharmacy Examining Board ruled in 2005 that Noesen failed to carry out his professional responsibility to get the woman's prescription to someone else if he wouldn't fill it himself.The board reprimanded Noesen and ordered him to attend ethics classes. He was allowed to keep his license as long as he informs all future employers in writing that he won't dispense birth control pills and outlines steps he will take to make sure a patient has access to medication.The board also found Noesen liable for the cost of the proceedings against him — about $20,000 — but the appeals court ordered the board to reconsider that decision.Larry Dupuis, legal director for the American Civil Liberties Union of Wisconsin, which like Planned Parenthood participated in the appeal, said the ruling struck the proper balance between patients' and pharmacists' rights.A pharmacy should accommodate its pharmacists' religious beliefs but it can't leave "a patient high and dry," Dupuis said.Noesen said the discipline "critically devastated" his business as a traveling pharmacist because some pharmacies refused to hire him and he lost his liability insurance, court records said.

Frequently Asked Questions¹

• Does a pharmacy or pharmacist violate a woman's federal constitutional rights by refusing to satisfy her request to purchase birth control?

No. A pharmacy's or pharmacist's refusal to sell birth control does not violate a woman's federal constitutional rights. The U.S. Constitution imposes no limitations on non-governmental institutions like privately owned pharmacies. Even if the refusal takes place in a state-owned pharmacy, a woman has no federal constitutional right to receive contraception. Although the Constitution protects a woman's right to contraception, it does not ensure that women can access reproductive health services.

Reference

¹ACLU

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