Last Thursday the Ninth Circuit Court of Appeals upheld a suspension of a Washington State law that prevents pharmacies from refusing to dispense medication. Emergency contraception has been at the heart of the law, but pharmacy refusals have happened for other drugs as well: anti-retroviral drugs, for instance, or insulin (because pharmacists though the patients “looked like junkies”). The federal court argued that women who may be denied the medication would not suffer irreparable harm, at least until June 3, when the appeal to the suspension will be heard. So currently a customer may be denied access to emergency contraception for “religious reasons.”

Translation: if your pharmacist happens to believe, unlike everyone else in the medical profession, that emergency contraception is abortion, s/he can deny you medication that may prevent an unintended pregnancy (and possibly an actual abortion). You must deal with the repercussions of this possibility – the added hassle of going to another pharmacy, the shaming from the pharmacist, loss of precious hours to prevent ovulation – for another year because those potential costs are not, in fact, burdensome (a panel of old men has decided). As long as your pharmacist points the finger at God, you have to give up your right to healthcare because someone else’s expression of faith trumps your right to control your body.

The primary question this ruling (among others) brings up for me is why pharmacists get to be exceptions. I know part of the answer: the judges that ruled in favor of upholding the injunction were appointed by the Bush Administration. The judge that dissented was not. It is a matter of timing.

But really, why do pharmacists get to whip out their first amendment rights to religious practices when it harms someone else’s health? This question seems foolish at best – because that’s the way the founding fathers set it up, duh! – until this freedom is put in context.

(I’m going to beat on pharmacists for a bit – bear with me. Most of them are honest, ethical people who do their jobs. This is a rant against the crazy ones.)

Pharmacists choose their occupations freely. They spend a few years getting trained and they earn a certificate which verifies that yes, indeed, this person is now a member of the medical profession. The healthcare industry is one of the most regulated, and rightly so: the entire health of the nation depends on all the parts working together. Pharmacies are required to stock some kinds of drugs all the time, certain drugs may only be dispensed by trained professionals (pharmacists), patient confidentiality must be protected, etc. Pharmacists know they will operate under these restrictions when they enter the industry. To the extent that the greater public interest is protected, then, the benefits of choosing to run one’s business as one sees fit are limited.

So much for the “just let them run their businesses! Pharmacists aren’t pill dispensers!” argument. Actually yes, in fact, they are pill dispensers for the public in some cases. It’s not a secret.

Also the Washington State law specifies that pharmacies, not pharmacists, must dispense the medication. So no individual can be forced to sell anything, but the customer cannot know the difference. The business, the pharmacy, must provide. No one in Washington has been fired because of this law. In fact the law bends over backwards to prevent pharmacists who won’t do their jobs from being fired. ‘Cause, you know, God told them to be shitty workers.

So pharmacists freely enter into an industry they know will constrain some of their freedoms. Likewise members of the military enter a profession that places restrictions on their freedom of speech for the greater public good (national security). In order to prevent conflict of interests judges give up their right to participate in much of civil society. Businesspeople give up their right to freely speak about their work, not because the greater public interest is necessarily served, but because companies do not want their employees to sell secrets to the competition. (Some people argue that private profits are in the public interest. I do not agree.) Teachers give up their right to carry guns at their workplaces. Food service workers give up their right to control their bodies, insofar as they must wash their hands at work. And pharmacists give up their right to…wait, I don’t think this even works. There’s no faith that I know of where basic tenets of the faith depend upon preventing someone from taking emergency contraception. So pharmacists don’t have to give up their right to practice every aspect of their religion at all!

They justify this as a religious question by invoking the specter of abortion, and their religion prevents them from helping to end a pregnancy. This is bullshit.

Emergency contraception – in the United States, Plan B is the only brand currently available – is basically a large dose of the same hormones in birth control pills, which occur naturally in the body. Specifically EC is a greater dose of levonorgestrel, a progestin. Other kinds of EC available in other nations may include mixtures of estrogen and progestin. EC’s primary mechanism for preventing pregnancy is preventing ovulation. Yet a certain proportion of the women who take it will have already ovulated, so we would expect more of them to become pregnant. In other words, EC reduces unintended pregnancy too much to work solely by the delayed ovulation mechanism. However, there has been little research done on how it prevents pregnancies in other ways. Possibilities include altering the uterine lining to become less receptive to implantation, altering/hindering the way fallopian tubes transport sperm/eggs/both, thickening cervical mucous to hinder sperm, alkalinizing the uterus to immobilize sperm, and actually interfering with fertilization somehow. No one knows.

What Plan B does NOT do is end a pregnancy. If the fertilized egg has already implanted in the uterus – the medical definition of pregnancy, a definition the medical industry uses – taking the pill does nothing to harm the cells. It will not harm a developing fetus. There is no evidence that taking birth control or EC during pregnancy ever harmed a fetus before or after birth.

Pro-lifers claim that life begins at fertilization, and thus if EC actually did harm a fertilized egg or even prevented it from implanting that counts as “abortion.” This is absolute rubbish. There is no medical basis for it, only batshit religious supposition. And, um, some legal basis.

Last year some of you may remember that the Supreme Court upheld a law banning late-term abortions via the extraction and dilation method. The basis for the ruling was NOT fetal viability – that is, potential of the fetus to survive outside the uterus – but arbitrarily chosen bodily “landmarks” on the fetus, which if taken past the cervix would sudden qualify it as a person. Abortions by this method are allowed to save the life, not the health, of the mother. In her dissenting opinion, Justice Ginsburg angrily pointed out that using “landmarks” instead of “viability” as the criteria for personhood goes against past precedent and is detrimental to women’s health. It sets a slippery slope for definitions of landmarks. In theory even a fertilized egg could eventually legally become a person, even if it was non-viable. Often the body makes mistakes, like having an egg implant outside the uterus (ectopic pregnancy) or getting a fertilized egg with deadly mutations or missing essential chromosomes. These unhealthy cells can be ejected by the body, but they may need some outside assistance for the health of the mother. Yet the law may in the future consider these non-viable fertilized eggs just as important as an actual person.

So coming back to the pharmacists: some of them use this uncertainty and societal disagreements about the start of life to say that EC is definitely abortion, even though they freely enter an industry that says EC is definitely not. Then they go to the courts, who through activist judges declare that their religious suppositions have an actual basis in medical fact, which they do not, and the courts uphold the “right” of the pharmacists to deny healthcare to women; to, essentially, force their religious practices upon another person. Which is a violation of that patient’s civil rights as well as a violation of public trust.

Again I ask: why are pharmacists the exception, when people in other professions give up their rights all the time?

This entry was posted on Tuesday, May 6th, 2008 at 9:25 pm and is filed under Sex, Washington State. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.