Preserving Patients’ Access to Care and Pharmacists’ Conscientious Objection

Patient access to prescribed medications has been limited in some cases by pharmacists' refusal to fill prescriptions, sparking a national debate and various state legislative proposals. In some cases, pharmacists have even confiscated the woman's prescription. House Bill 16, introduced but not passed during the 79th Texas Legislature, proposed to define a right of pharmacists and pharmacies to refuse to dispense emergency contraception.

The Committee on Maternal and Perinatal Health believes that legislation giving pharmacists an unfettered right to refuse to fill prescriptions (1) erodes the primacy of the patient-physician relationship; (2) creates barriers to care; (3) creates vulnerability to charges of patient abandonment and discrimination; and (4) could be construed as an expansion of pharmacists' scope of practice.

Emergency hormonal contraceptives, such as Plan B, work primarily by affecting ovulation and sperm function but occasionally may prevent implantation. Emergency contraception does NOT affect an established, implanted pregnancy. To be effective, emergency contraception must be taken within 72 hours of unprotected sex. The sooner it is taken, the more effective it is. A pharmacist's refusal to fill this prescription may delay the patient's taking it, making it ineffective, particularly in rural areas or when transportation is difficult. Such a refusal may lead to more abortions and/or unwanted babies.

While the committee recognizes a need to reasonably accommodate a professional's moral and religious beliefs, the committee holds the patient's right of access to legally prescribed medication to be paramount. Pharmacies and pharmacists should set up systems that guarantee patient access to legal pharmaceuticals without undue delay or interference.

In June 2005, the American Medical Association combined resolutions from the American Academy of Family Physicians, the American College of Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and others, adopting a policy that directs AMA to (1) work with state medical societies to support such legislation; (2) work with relevant associations to guarantee a patient's right to obtain legal prescriptions; and (3) in the absence of all other remedies, to work with state medical societies to adopt state legislation that will allow physicians to dispense medication to their own patients when there is no pharmacist within a 30 mile radius who is able and willing to dispense that medication.

Recommendation : That the Texas Medical Association, while agreeing to reasonable accommodation of a pharmacist's right of conscientious objection, support governmental policies that safeguard the patient-physician relationship and protect patients' right to obtain legally prescribed and medically indicated treatments in a clinically timely manner. TMA will (1) enter into discussions with relevant associations (including but not limited to the Texas Hospital Association and state pharmacy associations) to guarantee that if an individual pharmacist exercises a conscientious refusal to dispense a legal prescription, a patient's right to obtain legal prescriptions will be protected by immediate referral to an appropriate dispensing pharmacy; (2) in the absence of all other remedies, support state legislation that will allow physicians to dispense medication to their own patients when there is no pharmacist within a medically reasonable distance who is able and willing to dispense that medication; and (3) help educate physicians and the public concerning the mechanism of action of emergency contraception.

TMA House of Delegates: TexMed 2006