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Emergency Contraception and Moral Misgivings

FDA ruling puts pharmacists in crossfire

by Daniel C. Vock,

The latest fireworks over the “morning-after pill” weren’t in Congress, or at the U.S. Food and Drug Administration, but in Kent, Wash., at last week’s meeting of the normally obscure state Board of Pharmacy.

After months of controversy and a flood of 16,000 comments, the board followed Gov. Christine Gregoire’s (D) suggestions and refused to give legal protections to pharmacists who for moral reasons object to dispensing the high-dose birth control pill.

The action, though, doesn’t end the tempest in Washington state. Druggists already are raising objections to the board’s proposed rule, which still needs final adoption. And birth control advocates are calling for the board to investigate at least four drug stores that refuse to stock the emergency contraceptive pill, known as Plan B.

As Washington’s case shows, the FDA’s decision last month to let women over age 18 buy the morning-after pill without a doctor’s prescription won’t end heated disputes in state capitols over emergency contraception. Instead, the FDA action thrusts pharmacists – more than ever – into the middle of the fray and presents additional issues that may land in state policy-makers’ laps.

“What this does is shift the burden from doctors with prescribing rights and privileges to pharmacists,” said Deirdre McQuade, the U.S. Conference of Catholic Bishops’ spokeswoman on birth control matters.

Emergency contraception is controversial because it poses moral questions similar to those raised in the abortion debate. The Catholic bishops and others who believe life begins at conception object to Plan B because of the possibility that it may prevent a fertilized egg from implanting on the uterine wall.

But those who want greater access to the morning-after pill argue that the drug works the same as standard oral contraceptives, primarily by preventing fertilization of a woman’s egg. Taken within 72 hours of unprotected sex, the pill can prevent 89 percent of pregnancies, according to Plan B’s manufacturer, Duramed, a subsidiary of Barr Pharmaceuticals Inc.

Like Washington’s pharmacy board, states have been struggling with how to balance the rights of patients to get access to Plan B and the rights of health care providers to follow their religious or moral convictions.

Pharmacists have lost their jobs in Illinois, Texas and Wisconsin for their unwillingness to dispense emergency contraception. Wal-Mart, the nation’s largest retailer, reversed policy and began stocking the morning-after pill nationwide in March after state regulators in Illinois and Massachusetts ordered all pharmacies to carry the drug.

Massachusetts Gov. Mitt Romney (R), a possible presidential contender for 2008, touched off a furor last year when his administration suggested that Catholic hospitals would not be subject to a law mandating that emergency rooms offer emergency contraception to rape victims. He quickly reversed that stance.

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