The New Drug War 

Whose rights take precedent -- the patient's or the pharmacist's?

After a 20-year-old Tucson woman was raped, she spent three days searching for a pharmacy that stocked the "morning after" pill, each day of her search reducing the chances of the drug working. "When she finally did find a pharmacy with it," reports the Arizona Daily Star, "she said she was told the pharmacist on duty would not dispense it because of religious and moral objections." In Fort Worth, a CVS pharmacist told customer Julee Lacey that she did not "believe in birth control" and that Lacey would have to get her refill elsewhere. A San Diego County fertility clinic turned down a lesbian couple's request for artificial insemination not, the doctors say, because of their sexual orientation, but because they were not married. But gay marriage is illegal in California.

The American Pharmacists Association allows its members to refuse to fill prescriptions on moral grounds, as long as they refer their customers to a more open-minded colleague. But 13 states have proposed or passed laws that would eliminate the referral requirement, and the trend is accelerating. Last year the Michigan House of Representatives overwhelmingly passed the "Conscientious Objector Policy Act," a statute that would allow doctors, emergency service technicians, and pharmacists to refuse to treat patients or fill prescriptions on moral, ethical, and religious grounds.

"The explosion in the number of legislative initiatives and the number of individuals who are just saying, 'We're not going to fill that prescription for you because we don't believe in it' is astonishing," said Gloria Feldt, president of the Planned Parenthood Federation of America.

When a soldier refuses an order to shoot someone, it's virtually impossible for him to obtain "conscientious objector" status. A soldier who refuses to kill faces a court martial and possible prison sentence. But when a pharmacist refuses to dispense a drug that would prevent a woman from becoming pregnant with her rapist's child, he's merely "following his principles" and enjoys the support of his state legislature.

Luke Vander Bleek, an Illinois pharmacist who says his Catholic faith led him to fight an Illinois rule that requires him to fill all prescriptions, including those for birth control, said: "I've always stopped short of dispensing any sort of product that I think endangers human life or puts the human embryo at risk."

But Illinois governor Rod Blagojevich takes the side of patients: "It's not the job of a drugstore or a pharmacist or someone who works in a drugstore to make those decisions or to pick and choose who gets birth control and who doesn't."

How can society reconcile these two competing, yet equally compelling interests? Surely a medical professional should not be forced to perform procedures or dole out drugs that violate his or her personal beliefs. I consider optional cosmetic surgery -- face lifts, tummy tucks, boob jobs -- degrading and obscene, symptoms of a shallow society's contempt for natural beauty and aging. If I were a doctor, I would refuse to perform these operations or refer patients to a physician who did. On the other hand, people should be able to walk into a fertility clinic with the reasonable expectation of getting help to conceive a baby -- whether they're straight, gay, single, or married.

Truthful advertising may prove more effective, and certainly more ethically sound, than a sweeping ban on discretion among health-care professionals. For example, the Target store in Fenton, Missouri, that refuses to fill birth control prescriptions should be forced to post a large sign outside its store to save would-be birth-controllers the trouble of looking for parking. "No birth control," the sign could read, or perhaps "Sluts stay away!" Similarly the St. Louis-area Walgreen's that recently suspended its pharmacist-refuseniks for violating Illinois' "Don't ask. Must fill" rule could post the chain's support of reproductive rights out front.

Even if Americans embrace my proposal that stores and physicians be required to publicize their moral scruples, the red-blue divide will remain the biggest obstacle to peace in the ongoing war over Americans' genitals. The rape victim who spent three days tracking down the "morning after" pill in Tucson, after all, would have had no trouble at all had she lived in Los Angeles.

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