Carolyn Gardner
Christian Science Monitor

When pharmacist Neil Noesen refused to fill a customer's prescription for birth-control pills at a Kmart in Menomonie, Wis., he did so on the basis of his religious beliefs. But when he also refused to transfer the woman's prescription to another pharmacy, she went to the police.

Next week, on May 4, Mr. Noesen will appear before a court commissioner in Madison, Wis., to face a disciplinary hearing on charges of unprofessional conduct. The Wisconsin Department of Regulation and Licensing could fine him or revoke his license.

Noesen's case mirrors two incidents in Texas that are pitting a woman's legal right to contraceptives against a pharmacist's right to follow his or her conscience. In Denton, Texas, a pharmacist at an Eckerd pharmacy lost his job in January after turning away a rape victim who wanted to fill a prescription for a morning-after contraceptive. And in suburban Dallas last month, a CVS pharmacist refused to fill a prescription for birth-control pills for a married mother of two. CVS says it is "addressing the situation" with the pharmacist.

Referring to cases like these, Lisa Boyce, vice president of public affairs for Planned Parenthood of Wisconsin, says, "It's certainly not an epidemic, but it's noteworthy." She and other activists express concern that women's access to birth control could be threatened by such refusals.

"No woman should have to shop around until she finds a pharmacist who will dispense her doctor- prescribed birth-control prescription," she says.

Noesen's attorney, Krystal Williams-Oby of Madison, explains his actions on July 6, 2002, when a university student handed him her prescription. "My client was not judging the patient," she says. "He was judging his own heart. He sincerely believes he would be committing an act of sin to dispense [birth control], and to call someone else to dispense it." She sees this as a religious liberty issue.

The American Pharmacists Association maintains a two-part policy. "The pharmacist has the right to conscience, and the patient has the right to legally prescribed medication," says spokesman Michael Stewart. A pharmacist who objects to dispensing a particular medication must tell an employer. If one pharmacist refuses to fill a prescription on grounds of conscience, another pharmacist must do it. Some customers may be referred to another pharmacy. Other prescriptions may be delivered by mail.

"In the great majority of cases, the pharmacist's right to conscience is exercised appropriately and seamlessly, so the patient is not even aware that the pharmacist has exercised that right," Mr. Stewart says. "A pharmacist can say, 'Let me get Bob for you, ma'am,' and that's the end of that."

Two states - South Dakota and Arkansas - already have laws protecting pharmacists who refuse to fill birth-control prescriptions on moral or religious grounds. Ten other states, including Wisconsin, are considering such legislation - Indiana, Michigan, Minnesota, Mississippi, Missouri, Ohio, Rhode Island, Vermont, and Washington.

Karen Brauer, president of Pharmacists for Life International, believes that states without protection for pharmacists will eventually face a pharmacists' shortage. She was fired by Kmart in 1999 for refusing to fill a contraceptive prescription.

Store policies differ. CVS states that its pharmacists must ensure that "customers promptly receive all medications for which they have a lawfully written prescription."

At Wal-Mart, pharmacists do not stock the morning-after pill. Danette Thompson, a spokeswoman, calls the policy a business decision. "When we look at the number of prescriptions filled for a given drug and the frequency with which that's requested by a customer, those kinds of things are taken into consideration," she says.

Critics counter that Wal-Mart's dominance in rural areas leaves many women with few alternatives if they need emergency contraception in cases of rape or incest.

Also, "many rural communities only have one pharmacy," says Ms. Boyce, "so you have only one pharmacist. Or the next pharmacy is miles away.

Calling the recent refusals by pharmacists "very troubling," Kelda Helen Roys, executive director of NARAL Pro-Choice Wisconsin, says, "If we let pharmacists pick and choose which prescriptions they're going to honor, you basically invalidate that healthcare for large numbers of people in the state." More than 90 percent of women will use birth control at some point in their lives, according to Planned Parenthood.

Others see the issue differently. "This is a situation where certain people of certain faiths seem to be fair game for discrimination, which is egregious," says Peggy Hamill, director of Pro-Life Wisconsin in Brookfield. She tells of pharmacists who refused to fill prescriptions and have had to move from one place to another. Others have taken jobs in nursing homes.

Contraceptives are not the only moral and ethical issue some pharmacists face. Mr. Stewart says that in Oregon, where assisted suicide is legal, the American Pharmacists Association policy would support a pharmacist who does not want to dispense medication that would facilitate assisted suicide. And in other states, he adds, "Our policy supports pharmacists who do not want to dispense lethal injections as capital punishment."

As pharmacists and women's groups await the results of Noesen's hearing, some ethicists are considering the ramifications as well. Linda Rankin, a medical ethicist and philosophy professor at the University of Tennessee in Knoxville, calls this a complex issue.

"It's clearly legal that women are entitled to get morning-after pills," she says. "Morality is a lot slipperier. If we don't protect personal integrity, we would go down a dangerous avenue. By taking a professional license, you do in fact step out of your personal morality. You have taken on an additional responsibility, but that does not mean you have given up your integrity as a person.

"When people take on the life of a pharmacist, they have to realize what might be asked of them," Professor Rankin continues. "Would they be able to fill these prescriptions? If they can't, then they have a moral obligation not to practice at a place where they are the only pharmacist, and where not to do this would cause serious harm to other people."
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Something tells me that, if one of these o-so-righteous pharmacist's daughters was raped, they'd be the first in line to obtain the 'morning after' pill, and the most vocal if it was not made available.

This ethical and moral situation has started with the pro-life/pro-choice dilemma, but its affects could be far reaching.

First of all, what gives a pharmacist the right to make moral judgment on the medical needs of someone else? Medical advances today make stem-cell research a positive step forward in the treatment and cure of many diseases. If a pharmacist does not agree with this research, can he/she refuse to fill prescriptions for after-care or maintenance of a stem-cell patient?

Will a pharmacist refuse to fill prescriptions from a particular manufacturer if that company tests products on animals and the pharmacist is a member of PETA?

If a pharmacist has strong moral or ethical problems about some of the medication they dispense, they are in the wrong line of work. They should consider the clergy, running for public office or become a lobbyist. Otherwise, they should do what they ere trained to do - prepare medication from legally authorized prescriptions requested by licensed professionals - and keep their personal opinions to themselves.

Are we supposed to comment on this ?? If so, I agree with the pharmacist who refuses to fill the prescription. He or she has a right to refuse.

Perhaps these people ought to have researched the requirements of the job before training to become pharmacists. What about women who are prescribed the pill for reasons other than contraception, are they to be refused the drug too? I think they ought to dispense what is required of them.

What next, will we be getting checkout staff refusing to let customers purchase condoms? Certainly in Britain such things are sold in supermarkets so it is likely that checkout staff will have to pass the items through a scan.

Are vegetarian checkout operators going to stop customers buying meat products?

In my opinion if you take any job you should be prepared to do it as required, not pick and chose which parts you will or will not do.

I can accept that some people will not want to be involved in actual termination of pregnancies, I accept that they ought to be able to opt out of such cases but to refuse contraception, definitely not.

I think if there is another option such as another pharmacist to fill the prescription it would be OK to refuse. In an instance where that is not possible or it would be a risk to someones health I would agree that it should be filled.

I find it interesting how people are willing to force other people to do things against their will if it pertains to a religious belief. Easy to say" He or she chose the wrong profession " Maybe when some of these people chose their profession this was not an issue.

Since the article was specifically about the contraceptive pill, even though this is used also for other 'female problems' other than contraception, let us just talk about that. It has been on the market since the early 1960s, now that means that a person unaware that they would be asked to dispense it would now be rather old and probably retired. Anyone deciding to become a pharmacist since the early 1960s would know they would be asked to dispense it.

Bottom line. The courts will decide.

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I find it interesting how people are willing to force other people to do things against their will if it pertains to a religious belief.

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What's this? Who's trying to force whom to do what? Assuming that the "pill" was prescribed as a contracepttive, isn't the pharmacist is trying to force the woman to risk having a baby she doesn't want or to use an "approved" method of birth control?

We discussed this last year sometime, but I'm still socked when I read the articles. I talked to my very religious friend who is studying pharmacy and he said "I know I'll have to dispense pills I may not agree with, but it's my job." If I refused to do part of my job, I'd be fired.

In my opinion, the pharmacists are wrong. They are claiming some knowledge of the intimate lives of these women and they don't. "The pill" is used for more than contraceptive purposes. The morning after pill is used by victims of sexual assault. Should we make a rape victim suffer again? No, we clearly should not. It's not the job of the pharmacist to judge, his or her job is to dispense medication once it has been prescribed by a doctor. If their own moral views keep them from doing so, they should find another line of work.

I don't know what all the fuss is about. If a pharmacist won't fill the prescription go elsewhere. I am sure you can find many pharmacists who will be happy to fill the prescription.

Or is the real issue the fact that you don't care for the pharmacists position and that he or she may be pro-lfe. ?? And of course, we can't let that go unpunished. By all means fire them .

Hmmm, I wonder what I'd do if I struck a Scientologist pharmacist who refused to hand over my psychotropics? Probably just that, actually, strike the pharmacist...I go back to what was said in the article about 'getting Bob' to fill the script without making an issue of it. I've worked in Customer Service, I've palmed people I didn't want to deal with for various reasons off onto colleagues, and taken over situations for colleagues. But I've also dealt with people/requests I didn't want to when such options weren't open to me. I do think it's a little rich to refuse to do part of a job you have signed on to do, and it's also a form of mis-representation --->

A situation in Australia was uncovered last year whereby the only service listed under "Unplanned Pregnancy" in many phone-books was a toll-free national number for a what sounded like a government agency. In many instances the phone counsellor would offer to send follow-up literature, and some people became suspicious when they noticed the material covered all options except for termination of the pregnancy. Turns out the service was actually run by a Right-to-Life group who took advantage of people in particularly vulnerable situations. Now, absolutely this group should be allowed to exist, to offer telephone counselling, as many leaflets as they can print. But there is no defence for them not making it plain who they are and what their agenda is.

Same with the pharmacists. I'd like it to be advertised, to know ahead of time should I (knock wood) ever find myself needing to get a prescription for anything in a hurry that I might be refused service.

Mikey, I bet you live in the city, or in a well populated rural area. "go elsewhere" is not really an option for thousands of people.
To me, it's simple. Don't take a job that requires you to go against your conscience. PETA members don't work at meat packing plants. Environmentalists don't work for clear cut loggers. (and in parts of northern Canada, that means they don't work at all) Standing up for what you believe in sometimes means paying a price. It doesn't mean asking other people to pay the price for you.

Well, I see we have now gotten as far as possibly striking a pharmacist who won't do what he or she objects to doing. Simple answer to that, you strike anyone, you should be arrested.

Before this gets too heated just bear in mind that we don't have a Controversial Issues forum here anymore. Let's keep it friendly.

I can understand and even accept a pharmacist's right to decide he or she will not dispense certain drugs. (Even if I think it is morally absurd.) However, while it may be the prerogative of the pharmacist which drugs he or she will or will not give out, it is NOT the prerogative of the pharmicist whether or not the person WITH the prescription should or should not be given the drugs.

A pharmacist who makes the decision not to give out birth control can do so, as far as I'm concerned, though I agree that perhaps a person who knows they will not be able to do the entire job should not have that job to begin with. But the point at which they effectively stop another person from obtaining legal and prescribed medication JUST because of their own moral limits is the point at which they've gone too far and should be stopped. If it is legal for a pharmacist to abstain from filling certain prescriptions because doing otherwise would "force" others' beliefs upon them, then surely it should NOT be legal for a pharmacist to effectively block another person from having a legal prescription filled for the same exact reasons.

To me, the real discussion isn't even one of pro-choice / pro-life, even if that is how it began. I may think that a pharmacist who refuses to dispense birth control pills maybe didn't find the right calling in life, I may think he is a bit of a looney, I may even think he is self-righteous and holier than thou in a way that makes his so-called moral high ground really just a wallow in the mud. But I have no right to MAKE him get another job. He may think that the woman buying contraceptive pills is loose, a floozy, a sinner, he may even go so far as to concider her a murderer if he's really that far down that particular road, but he has no right to disallow that woman from obtaining the pills she has a legal right to obtain.

In the UK although a pharmacist may refuse to dispense drugs because of views held they are obliged to tell the person where they can obtain the drugs they need. I understand that in the US some pharmacists will not even return the prescription to the woman to enable her to go elsewhere - now that is definitely wrong, it is stealing the prescription if nothing else.

Agreed, ing. If a pharmacy is run by people who take it on themselves to "overrule" prescriptions the very least they must do is warn the public before they enter the place. There ought to be a warning along the lines "Strictly moral pharmacy. The immoral must go elsewhere" - or something like that. (The report says the pharmacist refused to transfer the matter to another pharmacist or pharmacy, which suggests, anyway, that he didn't even return the prescription to the woman).

"What's all the fuss?" asks one poster, having previously suggested that Christians are persecuted in America.

Obviously, one shouldn't expect pharmacists to be zombies, mechanically making up prescriptions, without further ado. (An acquaintance who is a pharmacist told me of a case where the dose on a prescription struck him as dangerously high. He phoned the doctor who'd issued the prescription. It turned out that there had been a genuine error and the prescription was revised and the dose brought down to a level within the normal range.

However, one doesn't expect pharmacists to misuse their position, either. One doesn't expect them to appoint themselves furtively as members of some self-appointed "moral police".

Just because you are in the minority doesn't mean you aren't welcome to participate. But we sometimes do expect honest discussion. No offense meant, of course, because obviously we disagree, and that's just fine, but picking out single statements and waggling your finger at them without actually participating in the conversation going on is usually not met with a lot of friendliness. Things like picking out the statement about striking a pharmacist and chastising over it and yet not addressing any of the salient points in the rest of that post or the next doesn't seem very friendly.

If a doctor sees fit to prescribe it then a pharmasist should see fit to fill it.

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Bottom line. The courts will decide.

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THe courts will be deciding what I have for lunch soon.

Perhaps they will say you cannot eat lamb.

More likely the courts will be telling everyone to eat crow.

I'm just wondering if someone of the religion that believes you shouldn't go to the doctor or take medicine would become a pharmacist then just not fill prescriptions. Would they be able to cry 'freedom of religion' and sue if they were fired?

I'm sure that very subject is why the article Vendome posted is from the "Christian Science Monitor" since the Christian Scientists are the ones (or one of those) who do not believe in medicine. I'm sure it is of interest to them that pharmacists are being "persecuted" for their religious beliefs. I wondered myself if there aren't people who have become pharmacists knowing they would specifically not fill prescriptions for certain things, and even becoming a pharmacist specifically because they would then be able to expound on the morality of those things by not filling the prescriptions and then, presumably, having to explain themselves, being able to deliver a sermon in the process.

If the pharmacist owns the shop he/she should of course have the right to stock the items he/she prefers to sell in their shop. Saying that a person must stock what we want them to stock is forcing another to do something against their wishes and that isn`t what freedom is about, as a matter of fact it reminds me of how people live in places like Iran and Afghanistan.
If the pharmacist works for another person/company and are employed to sell that parties items and they refuse outright to sell those items they should be sacked without having any recourse to sue their employer.
It`s as simple as that to me. Everyday I`m faced with decisions about buying from this shop or that because one shop doesn`t sell what I want, I don`t buy from several shops because they have limited stock and I certainly don`t go runnning to the courts or the police because my local hardware retailer wont sell wooden handled hammers because of environmental reasons.
If you are living in an area that has no shops that sell the items you want....... move.

Taking the 'I have a religious issue with dispensing birth control and will not do it' stance is one issue. I may not agree with it, but I can see valid arguments for both sides.
However saying 'I will not transfer the prescription to another pharmacy', or worse, refusing to give the prescription back, would be forcing his religious belief on the customer, and I cannot see any valid arguments for that.
Whether or not they should have taken the position in the first place is a whole other issue.
Would you like to have a doctor working E.R. who refused to perform transfusions, or a police officer who refused to carry a gun or use any kind of force to subdue the bad guys?