The Ethics of Dispensing Medication Against Moral Beliefs

When most of us bring a doctor’s prescription to our local pharmacy, we expect to pay our money (or show our insurance card) and walk away with the medication we asked for. In most U.S. states, however, there’s no legal guarantee that this simple transaction will happen. Pharmacists may turn away customers seeking to buy medication that the pharmacist finds morally objectionable. Primarily, those are birth control medications.

In 1994, the American Pharmaceutical Association adopted an oath that laid out several principles for the profession: pharmacists must avoid causing harm; they must actively prevent harm and promote benefit to patients; they must respect the autonomy and dignity of each patient and they must exercise justice in allocating medicine. The oath allows pharmacists to turn down a patient’s prescription if, for example, they determine that a medicine would endanger a patient’s safety. Whether the oath includes refusing based on their own personal morals, however, is much less clear.

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The type of drugs most often cited in reported cases of pharmacist refusal are emergency contraceptives. The argument for refusal is that the drugs cause embryos to abort. A pharmacist could argue that he is guarding the health of the unborn child, which is consistent with the professional oath. Recent studies have shown, however, that the drugs work by preventing ovulation, not by causing abortion. But some pharmacists have objected to routine birth control as well, citing deeply held Catholic religious beliefs.

According to pharmacist Catherine Quinn, moral objections to dispensing birth control come “at the expense of the patient’s autonomy.” Under the oath, the right of a patient to decide what’s best for herself overrides the pharmacist’s personal beliefs. When pharmacists accompany their refusal of birth control with a lecture, even insulting the patient, as has occurred in some documented instances, they violate both the patient’s autonomy and confidentiality. In most cases, pharmacies that have refused birth control to women will sell condoms, with no prescription required, to men. This would appear to be unjust, another violation of the professional oath.

The controversy extends beyond individual pharmacists. Under the 2010 Affordable Care Act, popularly referred to as Obamacare, employers’ insurance programs and health insurance companies are required to cover birth control medication without any co-payments. The act allows exemptions for “religious employers” who can show that their purpose is to inculcate religious beliefs and their employees share those beliefs. The exemption does not apply to religiously affiliated colleges or private employers operated by religious individuals. More than 60 lawsuits were filed in the first months after the act was passed saying that the “contraception mandate,” violates First Amendment religious freedom rights.