Conscience Clauses Stir Debate Among Scholars

By Jeff Miller

Rights and responsibilities are at the heart of the conscience clause debate, which in recent months has crystallized around two questions: Should pharmacists be required to dispense emergency contraception (the so-called "morning after" pill) to those patients requesting it? Or should pharmacists opposed to the practice for ethical, moral or religious grounds, be allowed to refuse and be legally protected for doing so? In a Tuesday evening face off between UCSF pharmacy doctoral students Steve Aucello and Deanna Spounias at the University of San Francisco Law School, no easy answers emerged. Indeed, the nuances of various state laws, statutes, regulations and professional codes of conduct, discussed by Hastings Law School professor Marsha Cohen and UCSF School of Pharmacy law and ethics expert Lorie Rice, have created a crazy quilt of good intentions and unintended consequences. One surprise for many in the audience: Conscience clauses are not new. Some already exist to protect against drug abuse or misuse. "A number of states now protect the pharmacist from refusing to fill a prescription if there seems to be a danger of euthanasia, suicide or drug interactions," explained Rice. Aucello agreed that such protection is an important part of the pharmacist's responsibility to the patient, but argued that denying emergency contraception was not deserving of a similar shield. Instead, it is a violation of the pharmacist's oath, a dangerous precedent and "an affront to women and the poor." "Even if I am opposed to contraception on religious grounds, my personal values shouldn't matter. I'm not leaving my ethics behind. I'm just honoring my oath," Aucello said. Spounias found this argument disingenuous. "Personal principles and ethics should not and can not be divorced from professional practice. Isn't arguing otherwise a little absurd?" Lawmakers seeking a compromise have rallied around rules that would allow a pharmacist to refuse to dispense emergency contraception in return for arranging a referral, or alerting the employer in advance so a common sense referral plan can be crafted. Spounias supported this approach as one that preserves the "balance of care." Aucello disagreed. "What if you live in a rural area and there isn't another pharmacy close by? The powerful will always have access. The poor will not." In the opening presentation, Shareen El-Ibiary, a School of Pharmacy women's health expert, explained what activists on both sides of the debate sometimes ignore. The morning-after pill))"interferes with fertilization and inhibits the egg's implantation in the uterus." What's the significance? If the egg has already implanted, emergency contraception will not alter that physiological fact. Put simply, El-Ibiary stated,"Emergency contraception does not cause an abortion." Source: Jeff Miller

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Boxer Eyes Prescription Protection (SF Chronicle) NPR Weekend Edition: Interview -- Lorie Rice discusses ethics questions facing pharmacists