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Pharmacist's Beliefs Vs. Patient's Wishes

Medicine: She tried to get her prescription for morning-after pills filled but was refused. Her case illustrates a dilemma for some behind the counter.


Fearing that she would become pregnant after a romantic night with her husband, Michelle Crider asked for help.

Instead, she got a deadlock--with pharmacist John Boling.

When her doctor, Myron Schonbrun, asked Boling to supply Crider, 28, with Ovral birth control pills--take two pills immediately, then two more within 12 hours--the pharmacy manager at Longs Drug Store in Temecula refused.

"I kind of understood immediately," Schonbrun recalled. At that dosage, Ovral is a morning-after pill, meant to prevent a fertilized egg from implanting in the uterus, and Boling disapproved.

But Schonbrun knew that although Crider, the mother of a 2-year-old girl, deeply wanted another child, a pregnancy would make her deathly ill. So the doctor tried to finesse the problem. He asked Boling to provide a month's supply of Ovral, to be taken one a day, like any contraceptive.

Boling again refused. He said he "knew what it was going to be given for," Schonbrun recalled.


Boling's revolt is just the beginning. With the Food and Drug Administration's recent proclamation that morning-after pills are safe and effective, druggists across the nation increasingly may find themselves in the middle of conflicts that pit personal beliefs against the rights of patients.

And pharmacists will face even more serious challenges in coming years, when the RU-486 abortion pill is approved--and if other states follow Oregon in legalizing drugs for physician-assisted suicide.

The pharmacists are caught in a Catch-22. The American Pharmaceutical Assn. supports a pharmacist's right of refusal, but the 48,000-member organization says that right must not override a patient's right to treatment.

In other words, pharmacists must find a way to accommodate their beliefs as well as those of the patient. That could mean referring a prescription to another pharmacist--a prospect that might satisfy neither the scruples nor the competitive fires of the dissenting druggist.

"Ethics demands that it's what you ought to do for the patient, not for yourself," said Richard Abood, a professor of pharmacy practice at University of the Pacific School of Pharmacy in Stockton.

"The pharmacist might be a little repulsed to give it to another pharmacist, but . . . sometimes you've got to do things that are uncomfortable."

In fact, Crider eventually got her prescription from a nearby Vons supermarket pharmacy.

"I'm still very angry," she said. "Without knowing my situation, he could have affected a huge part of my life. What if there had been no other pharmacy to go to?"

The process was demeaning, Crider said.

Boling, whose behavior brought a reprimand from Longs, declined to be interviewed for this story, citing instructions to refer all queries to the company's headquarters in Walnut Creek, Calif.

"Failure to serve a customer is the issue here," said Clay Selland, treasurer and spokesman for the 339-store chain.

"He was disciplined because he should have offered another option to the doctor. Our policy is that . . . he needs to send it along to another pharmacist that's on duty, to another Longs store . . . or refer it on to a competing pharmacy."

Still, Longs officials acknowledge that there is no written policy, and pharmacists and women's advocates complain that corporations are not making their policies clear to the men and women who actually fill prescriptions.


Crider is not the first woman to encounter a pharmacist or institution unwilling to furnish morning-after pills.

At the University of Florida in Gainesville in 1989, a university pharmacist declined to fill a student's morning-after prescription. He left the public university after it could not accommodate his 1st Amendment rights to a religious objection without the considerable expense of hiring additional pharmacists.

In 1991, the mother of a rape victim taken to Daniel Freeman Marina Hospital in Marina del Rey requested information about a morning-after pill, but the Catholic facility declined.

An appeals court found the hospital had an obligation to inform the victim about the method and where to obtain it.

Spurred by antiabortion forces, pharmacists' groups in California, Louisiana, Puerto Rico and Alberta, Canada, have adopted policies that affirm the right of a druggist to claim conscientious objection on religious, moral or ethical grounds.


Similar proposals are under consideration in a dozen more states, said Bo Kuhar, executive director of Ohio-based Pharmacists for Life International. Kuhar said a morning-after referral would conflict with his antiabortion beliefs.

A pharmacist now "has to decide which is more important--his principles or the threat of a reprimand or a dismissal," he added.

But Mary Ellen Hamilton, Planned Parenthood public affairs vice president for Riverside and San Diego counties, said no third party has the right to intervene in a personal decision made between a woman and her doctor.

"It's scary and disturbing," she said.

Meanwhile, the lives of pharmacists will probably become even more complicated. In February, the 5,500-member California Pharmacists Assn. passed a resolution supporting pharmacy participation in the legal distribution of medicinal marijuana.

Richard E. Kane, the owner and sole pharmacist of the Oakdale Pharmacy in Encino, said he would handle legalized marijuana or RU-486 despite the specter of protest.

"As an independent pharmacist, you do things above and beyond what a chain would do," he said. "You make the same kind of commitment to how you handle these [controversial] prescriptions. . . . You believe the patient comes first."

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