Right to refuse vs. easy access.

Two pharmacists at a drugstore in Texas refused to fill a prescription for an emergency contraceptive known as the "morning after pill" for a woman said to be a rape victim. They were later fired.

In Wisconsin, a judge reprimanded a pharmacist for not only refusing to fill a college student's prescription for birth-control pills, but also for not wanting to transfer the prescription to a pharmacist who would fill it.

An Illinois pharmacist who refused giving emergency contraception to two Chicago women received a response from Illinois Governor Rod Blagojevich, who declared a statewide "emergency rule" requiring pharmacists to provide emergency contraception and birth control without delay.

Wal-Mart has received attention for not stocking the emergency contraception pill. Other chains such as Walgreen's and Rite-Aid carry the drug, but allow pharmacists to pass on dispensing it, although they must help customers find a druggist who will fill the prescription. This can be a problem for rural women, where often only one pharmacy is nearby.

Legislators in many states are debating refusal clauses. Sometimes referred to as "conscience clauses," refusal clauses were first enacted in response to the U.S. Supreme Court's 1973 Roe v. Wade decision. The policies were designed to allow doctors and other health care providers to refuse to per form or assist in an abortion, and hospitals to refuse to allow abortion on their premises. Today, some pharmacists want the right to refuse to fill orders for emergency contraception or any kind of contraception based on their personal beliefs.

Most of the debate revolves around a pharmacist dispensing emergency contraception. When taken within 72 hours after sexual intercourse, emergency contraception inhibits fertilization or prevents implantation of a fertilized egg. It is controversial. Some insist that it is a form of abortion because it affects fertilized eggs. Others oppose contraception altogether. Emergency contraception, which administers a high dose of birth control pills, is not the same thing as Mifeprex or RU-486, used in place of a non-surgical abortion. Pharmacists do not play a role in administering these medications as doctors must get the medication directly from the manufacturer.

On the other hand, pharmacists are taking on more responsibilities and bold considerable power over medical decisions. In 1998, Washington became the first state to allow women to obtain emergency contraception directly through a pharmacist. From February 1998 until June 2001, Washington pharmacists filled nearly 35,600 prescriptions for emergency contraception. Currently, Alaska, California, Hawaii, Maine, New Mexico and Washington allow pharmacists to dispense emergency contraception without a doctor's prescription under certain conditions.

Should pharmacists who object to the use of certain reproductive medications be allowed to remain true to their beliefs and conscience within the realm of their daily work? Should female patients who are seeking these medications he allowed free and open access to them? Hearing arguments from both sides state legislators are stepping in to settle the questions.

Arkansas Georgia, Mississippi and South Dakota have existing laws that allow pharmacists to refuse to dispense emergency contraception drags. North Carolina and Massachusetts--and now Illinois--require pharmacies to ensure that valid prescriptions are filled.

For up-to-date information on conscience clauses check NCSL's Web page at www.ncsl.org/programs/health/conscienceclauses.htm

REFUSAL CLAUSES AND PHARMACISTS REQUIREMENTS

Seven state have laws or policies on whether or not pharmacists can refuse to fill prescription orders for emergency contraception. This session, there were 19 bills on both sides of the issue, but none have become law.