Posted Tuesday, June 17, 2008, at 7:56 AM
The movement to stamp out birth control appears to have taken an ominous turn. Until now, women with contraceptive prescriptions were just being turned down by individual pharmacists. Now they're being turned down by whole pharmacies. Refusals from individuals behind the counter have "resulted in pharmacists being fired, fined or reprimanded," reports Rob Stein in Monday's Washington Post . "In response, some pharmacists have stopped carrying the products or have opened pharmacies that do not stock any." Pharmacists for Life International names seven pharmacies that have signed a "pro-life" pledge and says others are doing the same.
It's not clear how many of these proprietors object to birth control per se and how many are abstaining because they think emergency contraception is abortion. Stein points out that in some states, the only legal way to refuse a prescription for emergency contraception is to abstain from offering contraceptives generally.
What's the reaction from pro-choicers and bioethicists? Here are excerpts from the Post story:
1) "I'm very, very troubled by this," said Marcia Greenberger of the National Women's Law Center, a Washington advocacy group. "Contraception is essential for women's health. A pharmacy like this is walling off an essential part of health care. That could endanger women's health."
2) "Why do you care about the sexual health of men but not women?" asked Anita L. Nelson, a professor of obstetrics and gynecology at the David Geffen School of Medicine at UCLA. "If he gets his Viagra, why can't she get her contraception?"
3) "If you are a health-care professional, you are bound by professional obligations," said Nancy Berlinger, deputy director of the Hastings Center, a bioethics think tank in Garrison, N.Y. "You can't say you won't do part of that profession."
4) Critics also worry that women might unsuspectingly seek contraceptives at such a store and be humiliated, or that women needing the morning-after pill, which is most effective when used quickly, may waste precious time. "Rape victims could end up in a pharmacy not understanding this pharmacy will not meet their needs," Greenberger said.
5) "We may find ourselves with whole regions of the country where virtually every pharmacy follows these limiting, discriminatory policies and women are unable to access legal, physician-prescribed medications," said R. Alta Charo, a University of Wisconsin lawyer and bioethicist. "We're talking about creating a separate universe of pharmacies that puts women at a disadvantage."
Let's take these objections one at a time.
First: "Walling off" women's health care? Beware dramatic metaphors from lawyers. There is no wall. You bring your scrip to the pharmacy, and the guy at the counter says, "Sorry, we don't stock contraceptives." That's annoying and, in my view, stupid . But nobody's walling you in. Your burden consists of finding another pharmacy.
Second: Why Viagra and not contraception? Because some pro-lifers view hormonal contraception as potentially lethal . I don't share their anxiety about this theoretical risk to an early embryo, particularly when the alternative, in the event of pregnancy, is a high likelihood of fetal killing . But you can't blow off the argument by assuming that contraception should be covered because it's more important than Viagra. The whole point of the argument is that you're looking at it backward: The fact that contraception is more consequential than Viagra is a reason to be more wary, not less, of distributing it.
Third: "Professional obligations" to provide all health care? Actually, doctors and hospitals draw moral lines around their practices all the time. This doctor won't pull the plug; that one won't do abortions; this other one can't in good conscience collaborate in your faith-based treatment plan.
Fourth: Humiliation? Sorry, but part of true equality is brushing off people who don't respect you. If the guy behind the counter won't sell birth control, he's the one who should be embarrassed, not you. Walk out, and don't come back.
Fifth: Whole regions where pharmacies won't stock contraceptives? Come on. Only seven have even signed the "pro-life" pledge. It's true that abortions have been driven out of rural counties. But politically, the resistance to birth control is nothing like the resistance to abortion. A pharmacy that won't stock contraceptives looks pretty silly.
Greenberger does make a good point about wasting women's time when, as in the case of morning-after pills, speed is essential. And Stein's reporting suggests the abstaining pharmacies aren't making their policies clear enough. If they won't do this voluntarily—by posting them, for instance—the law should make them do it. If I were writing the regulations, I'd draw up a big, fat, standardized "We don't stock birth control" notice, complete with a 24-hour toll-free number that will direct you to the nearest pharmacy that has what you need.
But I wouldn't force pharmacies to sell birth control if they don't want to. In particular, I dread Charo's suggestion that providers should be compelled to offer "legal" drugs. One of this country's greatest achievements is its separation of legality from morality, so that individuals can hold themselves to a higher standard, as they see it, without forcing it on everyone else. This is the principle many pro-lifers have rejected as they press for abortion bans to " teach " the immorality of killing fetuses. Happily, some have shifted their energy from attacking abortion clinics to setting up "alternative" pregnancy centers. It's a shift from violence and harassment to exhortation and, at worst, deceit.
So, please, don't tell moralists they have to do or sell whatever's legal. If you do, you won't like what happens to the law.