There’s an interesting case going to the 9th Circuit Court of Appeals today. Attorneys for an Olympia, Washington grocery store chain and two pharmacists will be back in court trying to maintain a preliminary injunction imposed by a judge last fall. The injunction prevents a set of Washington State Pharmacy Board rules from taking effect in that state.

Why do a couple of pharmacists want to prevent the establishment of new rules from their profession’s governing body? Because the new rules would actually require pharmacists to fill prescriptions. I know that may seem draconian, but bear with me.

The crux of the conflict is the so-called “Morning After” pill, otherwise known as Plan B. Plan B is an emergency contraceptive intended for use after a contraceptive failure, unprotected sex, or a sexual assault. Plan B is not Ru-486. Plan B will not effect an existing pregnancy. Instead, Plan B prevents pregnancy by either interfering with the transport of sperm or the ova, or by inhibiting the ability of a fertilized egg to implant in the endometrium of the uterus.

Although ethicists and theologians can tapdance on the head of a pin with respect to the question of “when life begins”, I would place this under the category of “preventing pregnancy” rather than “terminating pregnancy”. But I am not a pharmacist. And more importantly, I am not the Stormans family grocery store chain. Their position is that the new rules do not permit a religious exemption for those who believe that providing Plan B is participating in destroying a human life.

I will also leave it to the ethicists and theologians to debate whether or not preventing a pregnancy is the same as destroying life.

Why not just refer the customer to another pharmacy that does stock Plan B? Well, that’s what the Stormans pharmacies were originally doing. The owners of Stormans instructed their pharmacists to refer customers seeking Plan B to one of the other “33 pharmacies within a five-mile radius” of their store. After a number of women were turned away, however, they started receiving angry calls, then Planned Parenthood started picketing the store and organized a boycott. After an investigation, Washington State passed a law stating that “pharmacies have a duty to deliver lawfully prescribed drugs or devices to patients … in a timely manner consistent with reasonable expectations for filling the prescription.”

Knowing that this was aimed directly at them, Stormans and two other pharmacists requested a preliminary injunction preventing the law from being enforced. As long as that injunction remains in place, the new rules do not go into effect, and customers of pharmacies in Washington State (hello, Vancouver!) have no guarantee that they will be able to obtain Plan B if it is needed. And bear in mind, if it’s needed, it’s needed urgently. The organizations Planned Parenthood and the Northwest Women’s Law Center say the injunction affects the rights of the patient. They want the 9th Circuit Court of Appeals to lift the injunction until next April, when a judge will hold a trial to decide if the Pharmacy Board’s new rules are constitutional.

How do you balance the rights of a business owner against the rights of their customers? If this was a decision on what kind of cereal to stock, or what brand of carpet shampoo, I think it would be a non-issue. But it isn’t. It’s about the availability of medical care.

A pharmacist is an important link in the chain of health care that exists between the doctor and the patient. Pharmacists are obligated to safeguard the health of their patients. They are also obligated to follow the directions of the prescribing physician, except when that action represents an actual danger to the patient. Allowing personal philosophy to dictate whether or not you choose to fill a prescription breaks that chain, and interferes with the treatment of the patient by their doctor. It compromises the medical care of the patient, and it should not be allowed. If you cannot in good conscience fill every prescription that comes in the door, then you should not be working in a pharmacy.

Furthermore, although you might find 33 Plan B-friendly pharmacies in Olympia, there are parts of this country where popular opinion might keep Plan B from being stocked at any locally available pharmacy, effectively cutting off access to the drug despite the doctor’s prescription. It’s a tough question, one that will hopefully be addressed when the constitutionality of the law will be considered.

To me, however, the situation raises a series of fascinating questions. To what degree is an employer obligated to honor their employee’s religious convictions? Clearly if a Jewish employee wished to take Yom Kippur as a holiday, I think that should be permitted. On the other hand, say, if you work in a shoe store and are a devout Hindu, I don’t think you have the right to refuse to sell leather shoes. If that was going to be a problem for you, you shouldn’t have gotten that degree in shoe sales. I am seized by the image of a pharmacist who is a militant Christian Scientist. Would they believe that filling any prescription would be wrong? What then? Stand around selling mouthwash all day? I’m just saying…

For the record, I don’t think anyone should be forced to fill a prescription that they so obviously disagree with. The clear and obvious answer is that such people should no longer be pharmacists. That way, patients can get the care they are entitled to, and the (former) pharmacist can move on without being forced to compromise their morals. This seems like such an obvious answer, I don’t know why someone else hasn’t thought of it.

Unfortunately, it can’t be that simple. There will always be a minority that feels that their moral convictions trump everyone else’s moral convictions. For those people, this issue really isn’t about health care or patient rights at all; this is merely one more battle in the war against moral decay, a battle being fought with all the tenacity that your average fire-breathing zealot can bring to bear.

I guess it just goes to show that the value of a human life is inestimable, and that for the truly devout, any action is justified in avoiding the taking of a human life, either directly or indirectly.

By the way, to date the invasion of Iraq by our nation’s citizen-soldiers has resulted in the deaths of between 85,000 and 93,000 Iraqi civilians. Don’t know why that popped into my head just now. Funny.

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