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Monday, December 10, 2007

Plan B Plan B

posted by on December 10 at 17:21 PM

I’ve linked the press release below, but here’s the basic news: The Northwest Women’s Law Center, Planned Parenthood, and the ACLU are appealing last month’s District Court injunction which prevents patients from getting Plan B if a pharmacist or pharmacy doesn’t feel like filling the prescription.

The legal logistics are a little confusing, but in short: State rules passed earlier this year mandated that if a pharmacist felt they couldn’t fill a Plan B prescription for religious reasons, the pharmacy had to figure out another way to accommodate the patient—have another pharmacist fill the prescription, for example.

Stormen’s Inc. and two individual pharmacists sued in July and the District Judge said last month that the rules were void until his official decision came down (after a trial). With that, the judge also offered a preliminary analysis indicating he would ultimately throw the rules out altogether after the trial.

Today’s appeal from the Northwest Women’s Law Center does two things. 1. It says: We don’t want to wait for the official decision. We want to take the issue to the U.S. Court of Appeals (the 9th Circuit in San Francisco.) now. And 2. In the mean time, toss the injunction.

As it stands right now, if a pharmacist doesn’t want to fill your Plan B prescription, you’re SOL.

So, today’s appeal is cool. But something has come to my attention in all this. Previous rules—also (inadvertently) upended by District judge—mandate that pharmacies (not pharmaicsts), pharmacies must stock Plan B, or any drug that the community demands.

That seems weird to me. Should the state be able to tell a private business that it must sell a certain item. I agree that the state should be able to tell certain manufacturers how to build products so they’re safe and the state should be able to mandate safety and non-discrimination rules in the workplace, but dictating what products go on shelves?

Yes, if a pharmacy carries Plan B, I believe a dissident pharmacist shouldn’t be able to prevent a patient from getting her prescription filled. But I don’t think a pharmacy should have to carry Plan B if the owner doesn’t want to.

Ruling Limiting Access to Medicine Is Appealed
Health Group Leaders Applaud Appeal of
Injunction Blocking Pharmacy Board Rules

The American Civil Liberties Union, the Northwest Women’s Law Center and Planned Parenthood of Western Washington today announced they are appealing a court ruling that blocks enforcement of Washington Pharmacy Board rules ensuring access to medications. The organizations, along with the firm Heller Ehrman LLP, are representing seven concerned citizens from around the state who have been allowed to intervene in the case.

The organizations say the lower court ruling misconstrues well-established legal precedent, and are confident that the regulations will be upheld and fully reinstated on appeal. The U.S. Court of Appeals for the Ninth Circuit will hear the appeal.

The intervenors also are asking the lower court to stay the injunction and not to move forward toward a trial until the appeal has been resolved.

Leaders of health care groups are backing the action. “We applaud the decision to appeal the court’s order blocking enforcement of the pharmacy board rules,” said Ania Beszterda, Lead Policy and Community Advocate for Lifelong AIDS Alliance. “People across the state need to know that they can get their prescriptions filled without discrimination or difficulty.”

“In rural communities, especially, a pharmacy refusing to dispense creates a real barrier to care. There are fewer pharmacies, so patients have less choice. It’s unacceptable to expect people to drive another 30 or 40 miles in hopes of finding a pharmacy that will fill their prescription,” said Dian Cooper, executive director of the Cowlitz Family Health Center, a community health clinic in Longview.

On Nov. 8, U. S. District Court Judge Ronald B. Leighton issued a preliminary injunction putting on hold rules enacted by the Washington State Board of Pharmacy in April 2007.
The rules (WAC 246-869-010 and WAC 246-863-095) were adopted after a lengthy rule-making process, including numerous public hearings, to protect patients’ access to lawful prescription medications and medications with restricted distribution without discrimination or delay.

Under these rules, if a pharmacist objects to dispensing a particular medication for personal, moral, or religious reasons, the pharmacy can accommodate the objecting pharmacist. But in all cases, the pharmacy must fill the prescription in a timely manner.

When the rules took effect in July, two individual pharmacists and a pharmacy owner (Stormans, Inc.) sued the State of Washington, challenging the new rules. The plaintiffs want pharmacies to be allowed to refuse to fill customers’ requests for valid prescriptions that conflict with personal beliefs. In court papers filed in August, the intervenors asserted public health concerns, saying patients should be allowed to promptly obtain needed medications.

The Washington State Pharmacy Association, which represents the pharmacy profession, participated in the rule-making and supported the challenged rules during the rule-making process. More than 70 organizations, including Senior Services of Seattle/King County, the American Academy of Pediatrics - Washington Chapter, and the Washington Coalition of Sexual Assault Programs also support the rules.

Handling the case for the intervenors are Rima Alaily, Molly Terwilliger and Matthew Carvalho of the firm Heller Ehrman LLP; Sarah Dunne and Aaron Caplan of the ACLU of Washington; Nancy Sapiro of the Northwest Women’s Law Center; and Kelly Reese of Planned Parenthood of Western Washington.

RSS icon Comments


A pharmacy is like an electrical utility monopoly.

I think that in the pharmacy's case, the license and training gives them special rights, not possessed by others, to sell the public necessity, but in return they are obliged to stock medicines that allow them to serve all members of the community. If they don't want to serve all members of the community with prescribed medication then they shouldn't have gotten into this business that obliges them to do so.

Are you suggesting pharmacists should have the right to refuse to stock medication for treating sickle cell anemia, or lactose intolerance, or AIDS drugs?

Posted by mirror | December 10, 2007 5:40 PM

I agree with your statement that the government shouldn't be able to tell private businesses that they *must* carry an item in their stores.
The real issue, however, is that it shouldn't be left up to private pharmacies or Planned Parenthood to dispense life saving drugs like Plan B (and if anyone has ever faced the prospect of an unwanted child they know what I mean when I say "life saving").
Plan B and regular birth control should be provided free of charge to anyone who wants it in this country, by schools, health clinics, hell, vending machines! OK maybe dispensing it alongside Pepsi wouldn't work, but the point is that the best way to save people's lives from misery, abuse and poverty is to help them not have unwanted children and to make sure that children who are born were conceived on purpose!

Posted by Sara | December 10, 2007 5:43 PM

oooooooor, you could just stop have sex! GEEEEZ.

Posted by konstantConsumer | December 10, 2007 5:45 PM

What happens if a Jahoveh's Witness becomes a pharmacist? Can they refuse to dispense anything they want?

I'm tempted to become a pharmacist and then claim that my religion prohibits any and all medications. And then they can't fire me because its religious discrimination! .... all this just to prove a point and get them to change that stupid law.

Posted by hmm | December 10, 2007 5:49 PM

But seriously, can you point us to a petition to sign or something? Although, since I'm not a resident of washington state I don't know if I count for anything in this one... National petition?

Posted by hmm | December 10, 2007 5:56 PM

Are you kidding? Where are citizens supposed to get the medications their doctors prescribe if not at a pharmacy? Furthermore, the state has a special responsibility to ensure the accessibility of medical treatment that ensures sexual equality. (And, yes, I get it, this is not a widely held view.)

Posted by les | December 10, 2007 5:58 PM

Yes, if a pharmacy carries Plan B, I believe a dissident pharmacist shouldn’t be able to prevent a patient from getting her prescription filled. But I don’t think a pharmacy should have to carry Plan B if the owner doesn’t want to.
So a pharmacy should have the freedom to carry an object for sale, but not have the freedom to allow its employees to sell it or don't? If a pharmacist wants to sell it, and stocks it, any employee he hires must do so as well? Weird place to cut off the freedom of a private business.

Posted by torrentprime | December 10, 2007 6:00 PM

Let's say there's a pharmacy run by Seventh Day Adventists, or even Mormons.

Let's say it's in the boonies.

Should they be able to deny people prescribed medications containing caffeine?


Sorry, if you want to be a licensed pharmacy in this state, you have to dispense medications - as opposed to not advertising them (your choice).

Licenses entail responsibilities.

Posted by Will in Seattle | December 10, 2007 6:03 PM

What about Scientologists? They don't believe in psychiatric medicine.

Should they be able to deny meds for depression, schizophrenia, etc.?

Posted by Really Silly | December 10, 2007 6:15 PM

You're wrong, Josh.

The state doesn't allow doctors to sell you drugs directly. The state requires that doctors prescribe drugs, and you have to buy them at a pharmacy.

Therefore, since citizens MUST go to a pharmacy to obtain prescription drugs, pharmacies should be required to carry all medications that any doctor in their vicinity might prescribe. The state licenses pharmacies, and can issue any rules it wants for issuing said licenses. If someone doesn't like the rules, they are free to run some other kind of business that doesn't have such strict rules.

A doctor's prescription is a useless piece of paper without some place that will dispense the necessary drugs.

Unless the state allows other businesses to sell prescription drugs, then yes, pharmacies should be required to stock all drugs, whether they like it or not.

Posted by SDA in SEA | December 10, 2007 6:17 PM

I think that Mirror is on the right track; and after all we tell pharmacies what they can't sell - e.g. heroin -- so why not be able to tell them what they must make available?

Posted by David Sucher | December 10, 2007 6:17 PM

Where is the mythical town with only one pharmacy within a day's drive? Is a doctor in that same town willing to prescribe Plan B but unwilling to tell her patient how to take multiple birth-control pills to get the same result?

A pharmacy is not a monopolized public utility.

A carpenter's special training and license does not require him to build whatever structures you demand.

If some nut-job pharmacist wants to get selectively religious and promote unwanted pregnancies, what do you care? He can join the lamp-lighters union and complain from the shadows of history. Washington State shouldn't be in the business of legislating morality.

Posted by six shooter | December 10, 2007 6:30 PM

Absolutely, pharmacies should be compelled to stock everything. I totally agree with you in general terms - there was a tempest in a teapot up here in Canada a few years ago when the privately-owned Chapters-Indigo chain declined to carry Mein Kampf for personal/ethical reasons (and I supported the chain's ownership on that), but pharmacies aren't just private businesses - they are state-sanctioned pushers burdened with ensuring the populace has access to a fundamental aspect of health (or sick) care.

There are lots of hysterical examples above - Scientologists refusing to stock lithium or Prozac, etc etc, but notwithstanding the morality/reliosity issue, the rule is in place to prevent pharmacies from only stocking the drugs with the highest markup, or the smallest storage requirements, or the least security risk. If the government didn't require pharmacies to stock everything, then they'd have to take over drug dispensation entirely themselves, and wouldn't that be fun??!!

Posted by Natalie | December 10, 2007 6:31 PM

How is killing a flu virus with antibiotics anymore less inumane by their logic?

Posted by Just Askin' | December 10, 2007 6:36 PM

@13 -- The law doesn't require pharmacies to stock everything.

@10 -- My doctor hands out free samples like, well, free samples. I also buy drugs from online pharmacies. (Some of these pharmacies aren't even licensed in the State.) The last time I went to the hospital, a doctor administered to me a drug without involving a pharmacist.

Find the mythical town and you've got a case. Otherwise you're just sacrificing the real pharmacist for the theoretical patient's rights.

Posted by six shooter | December 10, 2007 6:39 PM

It is perhaps an insult to Capitalism to tell a private business what to do. It is likely that Free Enterprise is besmirched by such tyranny. But so what?

I know a lot of people think that's just not allowed, but where are they getting that idea? Nowhere but their own imaginations.

We should go right ahead and regulate whatever we like if that's what it takes to make our society run the way we need it to run. Why get hung up on one particular ideology that was never enshrined in our law? What elevates the free marketer's ideology any other?

Posted by elenchos | December 10, 2007 6:45 PM

Josh, if pharmacies weren't required to stock drugs as requested by the community, I bet tons of pharmacies would stop selling affordable generic medicines. I recently filled two generic prescriptions for $11.99 each, and I'm pretty sure the pharmacy would have preferred to sell me the name brands for much more.

Posted by yes to medicine | December 10, 2007 6:48 PM

Hi, pharmacies? It's us, the people. We have granted you the special privilege of profiting from the trade of certain controlled substances -- those for which we believe there is a medical need. We allow you to do this based on our rules about which substances may be bought and sold and under what circumstances it may happen. This seems to have worked out pretty well for us for a long time, but if you'd like to start setting your own rules about what you will dispense for us, then we'll just buy and sell those substances on our own at state-run pharmacies. You can take care of the over-the-counter drugs, cotton swabs, and foot powders, restricting their sale based on any crazy mythology you like. Thanks for all the good times.

Posted by Phil M | December 10, 2007 6:50 PM

Also, I'm awfully glad when I get sick and am prescribed a medication, I can go to the nearest drugstore with reasonable certainty that they will have what I need (instead of going home and calling around to find out which pharmacy carries it, or whatever).

Posted by yes to more medicine | December 10, 2007 6:56 PM

Of course they should be forced to in order to qualify as a pharmacy. Letting them just pick and choose endangers the health and well being of everyone. "I'm sorry, the profit margin on generics just isn't good enough for us. Please shell out an additional $80 if you want to get well." If one were allowed to do it, they all would, and we'd be even more fucked healthcarewise than we already are.

Posted by Gitai | December 10, 2007 7:00 PM

>Find the mythical town and you've got a case. Otherwise you're just sacrificing the real pharmacist for the theoretical patient's rights.

There have not only been real patients, but real rape victims, who have been denied the morning after pill by pharmacists and been unable to get to another pharmacy that same day. Not everyone has a car.

Posted by hmmm | December 10, 2007 7:13 PM

along with all the other posters I agree, it's all about the licensing which is given in exchange for certain assurances, such as giving the public access to controlled substances, to say nothing of the training and ethos of becoming a pharmacist. now there may be an argument that others should be allowed to sell or not sell certain drugs. However, these others simply would not be allowed to be called pharmacists or pharmacies.

check out the pharmacist oath and code of ethics.

"VII. A pharmacist serves individual, community, andsocietal needs."

Posted by MSW | December 10, 2007 7:20 PM

Pharmacies are not government-protected monopolists like the utilities, true, but they are government-protected oligopolists, like the schools and the airlines. You don't have to be a pharmacy or a pharmacist if you don't want to, but if you want the special license to possess and distribute controlled substance, it is not unreasonable to expect you to take it on the condition that you stock and sell some minimum set of products.

A school cannot decide not to offer any education in (e.g.) reading and math while receiving the special treatment that schools receive, an airline cannot decide not to transport (e.g.) black folk while receiving the special treatment it receives, and a pharmacy should not be permitted to decide not to fill certain legal prescriptions while receiving the special treatment it receives. Pharmacies that don't like it can become convenience stores, and pharmacists who don't like it can become accidentally pregnant.

Posted by A. | December 10, 2007 7:26 PM

Josh are you nuts????

The state can regulate commerce.

This includes:
banning certain things
banning YOU from working for $1 an hour
(employer can't "stock" a $1 an hour job or "offer" that "product" on its "shelf");
requiring taxes
requiring you to do the bookkeepping for the taxes
defining sizes shapes products labelling
WHATEVER the majority wants.

There is no general "freedom to be free" of state regulation.

WE can pass all these laws validly. We can pass laws requiring MS to offer a browser -- or stop offering a browser -- with an operating system.

This whole issue was resolved in several decades of legal wrangling in which the Supreme Court finally agreed there is no generic freedom of contract, therefore the state can regulate wages and hours.

Without this ruling, no minimum wage, no minimum hours legislation, no unions, none of the array of social legislation we now have.

If you're in business you must pay the minimum wage; the state tells you what contracts you may offer.

If you are a pharmcy or pharmacist the State can tell you you must offer certain things.

It's the same principle. Majority rule trumps generic "freedom" in commercial matters.

Posted by unPC | December 10, 2007 7:47 PM

@21 -- Where is this town? I could make a killing opening a pharmacy there.

Or an Internet cafe.

Or a taxi service.

Or a pay phone.

And if this poor town with one now-pregnant woman and one mean rapist is so important, why hasn't Planned Parenthood or other health-care provider opened a store-front there?

It is within the state's power to require a pharmacy to fill prescriptions. The question isn't can the state do this. The question is should the state do this.

Posted by six shooter | December 10, 2007 7:53 PM

@25 - I invite you to drive through the town of Republic in Ferry County. Or Malott or Molson or Loomis in Okanogan County.

Washington State is full of tiny town with limited access and large per capita populations of women living right around the poverty line.

They are living in and around these small communities and do not have ready access to reliable medical or pharmaceutical care, and yes, if the one drugstore in Okanogan or the WalMart in Omak refuses to stock a medication they are totally SOL.

Posted by Soupytwist | December 10, 2007 8:06 PM


Do you have any idea how much money it takes to open and run a Planned Parenthood? Thanks to the crazy fundies, a lot, because PP has to invest an assload of money into security. They usually have to build their own facilities from scratch into ensuring security. I'm sure if PP could put a clinic in every small town in America, they would, but they can't.

If you're that enamored with the "free market" system, that's your problem. The rest of us will live in reality land, if you don't mind.

Oh, and by the way, very nice compassion for rape victims and women in general.

Posted by keshmeshi | December 10, 2007 8:14 PM

@25 -- There is a clear benefit (however small or large) from forcing pharmacies to stock all the meds we think are reasonable to prescribe. What is the cost?

One cost is that certain pharmacists will have to sell a product they consider odious or change professions.

A second (related) cost is that certain pharmacy-owners will be forced to stock and sell a product they consider odious or give up their license to sell drugs.

A third (related) cost is the potential decrease in the availability of pharmacies from the closing of the conscientious objectors.

A fourth cost is the implementation cost of the bureaucracy monitoring all the fundie pharmacists who happen to "run out" of Plan B when a damsel in distress enters the room.

The benefit is more standardized, more readily available medical care for women who need emergency contraception (and perhaps other drugs that this or that pharmacist might not want to sell), and the related decreases in unwanted pregnancies, abortions, unwanted children, etc.

The question of whether it's good policy comes down to our estimation (or, better, to the researched estimation of policy wonks) of these effects. You don't buy that the benefit is high. I don't buy that the cost is high, primarily because I don't have any sympathy for the moralists.

We can't estimate these effects too well at home, but consider an analogy to discriminatory practices in restaurants. Some owners and some waiters (as in the Jim Crow South) really didn't like serving black folk. They *really* didn't like it, and some would have rather closed or changed professions than to do so. All the costs seem analogous--businesses closing, people having to do things they consider odious, bureaucratic implementation mechanisms, etc. Do you think the benefit of desegregating restaurants was much higher than the benefit of more available medical care, or do you think we shouldn't have regulated the restaurants?

Posted by A. | December 10, 2007 8:21 PM

Two pennies:

1) Pharmacists need to make their willingness (or lack thereof) to dispense certain medications known in advance. Pharmacies should, at their discretion, be allowed to fire any pharmacist who refuses to do his or her job.

2) Pharmacies that do employ conscientious objectors should provide adequate signage stating that this pharmacy may, at its discretion, refuse to provide the following services or medications: etc., etc.

With these two provisions, companies are able to guarantee a certain quality of service to their customers, and customers have enough information (and in a timely fashion) to make the choices that suit them.

Wouldn't this compromise make everyone happy?

Posted by Big Adventure Steve | December 10, 2007 8:30 PM

I would prefer if it was mandatory to fill the prescription, but if not, yes, there should be big huge signs announcing that it won't be available there, so a woman doesn't have to hand over her prescription and get judged by some smarmy asshole. Then the rest of us could avoid patronizing them, like we do with the thriftway in Olympia.

Posted by jkjk | December 10, 2007 8:43 PM

Big Adventure Steve @29.


Your suggestion might work in Seattle, where there is a Bartells, Rite Aid, or Walgreens on practically every street corner. Pharmacies are almost as easy to find here as Starbucks. If someone refused to fill your prescription, you could easily walk a couple blocks and find another pharmacy that will.

But your compromise is dependant on customers having plenty of choices. There are lots of small towns around the state that don't have dozens of choices available. And not everybody has access to a car to drive all over the county trying to find another pharmacy that will give you the drugs your doctor prescribed.

As long as the state requires citizens to get their prescription drugs at pharmacies, and as long as there are small towns that only have one or two pharmacies available, then your compromise will not work. They must be required to carry and sell any drugs that any doctor in their area might reasonably prescribe.

Posted by SDA in SEA | December 10, 2007 8:53 PM

@1 - one problem with that argument here is that Plan B is not a prescription drug in this state, at least not for adults. Therefore, can it really be said that pharmacies have a government-enforced oligopoly on their distribution? (Or do they?)

Posted by tsm | December 10, 2007 8:57 PM

It's worth mentioning that anybody stupid enough to believe that Plan B has anything to do with abortion is probably not qualified to be pharmacist. I don't care if their hayseed pastor is too dumb to know, but pharmacists are supposed to be educated and have some fundamental knowledge of how the human body works.

Given a choice between reality and some bullshit superstition, they should choose reality.

You know, a civil engineer who told you the Alaska Way viaduct isn't going to fall because the Flying Spaghetti Monster said so in a dream would have his license yanked.

Posted by elenchos | December 10, 2007 9:00 PM


I'm very skeptical about the number of pharmacies that would close down due to this regulation. These pharmacy owners and pharmacists want to have their cake and eat it too. If the government refuses to let them deny necessary medications, the profit motive will make them comply. Or the pharmacy owners will just sell out to Bartell's or Rite Aid -- a small blow to small business, but a victory for reproductive rights.

Posted by keshmeshi | December 10, 2007 9:04 PM

I'm not sure what you've been smoking Josh. Of course the state can require a private business to stock certain products.

This is the second time this year where you've come out with a statement that basically affirms that the free market is the best tool to solve everything, and it's not. The free market really only serves the best interests of 'the public' when it operates in an environment with some heavy rules set by the government to define the playing field.

Following the logic of your position, its okay if AIDS drugs aren't available in Africa because private businesses can't make enough money to make it worthwhile to supply AIDS drugs there . . . which is in fact what AIDS drug companies did until several goverment ganged up on them and said you will offer the drugs at price we can afford - whether or not you make any profit - because to not do so is immoral and repugnant.

It's like your position is "watch out, don't get in the way of forcing private companies to do stuff they can't make a profit at because that would be . . . just wwrong!"

The premise of this isssue is that if you allow all pharmacies to pick and choose what drugs they will or will not stock, then you could have the situation where a particular drug is not stocked at ANY pharmacy in the state . . . or within driving distance.

This is not unlike the principle that governs anti-discrimination laws in public accomodations and jobs, etc. Pick race or pick sexual orientation or whatever you like. If you say it's okay for any individual business to decide to not sell their product or service to some people because they don't like them or they believe those people are immoral or against their religion or whatever, then you have to say it's okay for those people to never have access to whatever the product or service is, since conceivably EVERY business could refuse to offer that product or service to that particular set of people. Hence, 'homosexuals' can't find a place to rent because no one will rent their apartments to them, or black people can't buy products in stores that are 'white only,' etc.

(geeez this seems like such a basic tenent of the American Way that I'm surprised you have to have someone walk through this.)

It is outrageous that anyone is even toying with the idea that it would be okay for pharmacists to refuse to fill certain prescriptions BASED ON religious beliefs. Yes, pharmacists have some discretion to countermand a doctor's order (via refusing a prescription) based on MEDICAL FACTS about the prescription in question. But it is truly bizarre that this discretion is being applied to religious beliefs and that it's getting any traction in a court of law.

The outcome of this path is that any worker in any profession could refuse to serve any particular person or group of people based on what they claim is their religious beliefs. Think about that for a minute. The US government has a fairly wide tolerance when comes to saying what can and cannot be considered a religion.

So say a bartender had a religious belief that serving alchohol to people who write at shit local weekly rags is wrong because they believe doing so would undermine the moral wellbeing of the local community, then you wouldn't be able to get a drink in that bar when that bartender was on duty. Say it's a small bar with only one bartender on duty when you and your friend go in for a drink. You'd be SOL. But what if several bartenders at several of local bars had the same religious conviction? What if all bartenders had the same conviciton? Where does it end?

What happens when police or firefighters or 911 operators could decide who they didn't want to serve based on their religious beliefs?

So you see, first, that applying this pharmacist discretion principle to all jobs would be a pretty crazy, scary thing, and second, that access to medicines, especially ones that a doctor prescribes, can have life altering and life threatening consequences - and that should not be subject to one worker's personal religious beliefs.

Posted by I am your mother | December 10, 2007 9:04 PM

Dear writer that I once thought was smart:

"Should the state be able to tell a private business that it must sell a certain item."

This is the 'argument' that newcomers first think of when they are learning about this issue. Congratulations.

Thanks for those mad critical thinking skills, now you are officially eligible for sixth grade debate club.

And use a ? if it's a ?

Posted by ashfdal;s | December 10, 2007 9:09 PM

Everything SDA in SEA wrote.

Josh, you stuck your foot in it...again!

Posted by Tlazolteotl | December 10, 2007 9:31 PM

Does it matter that the pharmacists' grounds for objecting are religious?

Suppose a pharmacist wants to sell only those drugs that are made without testing on animals? Or those that are made by drug companies whose ethical practices are superior? Or suppose the pharmacy wants more rigorous approval procedures than those used by the FDA, and chooses not sell certain drugs it finds hastily approved by the FDA under political pressure from drug companies?

If we require pharmacists to sell every drug approved by the FDA, we make them slaves to the pharmaceutical-political complex.

Posted by Brendan | December 10, 2007 9:37 PM

"Suppose a pharmacist wants to sell only those drugs that are made without testing on animals?"

They could mail a check to PETA and do their job.

And so on.

Posted by elenchos | December 10, 2007 10:12 PM

This post is inane beyond my ability to exaggerate.

Pharmacies are not 7-11s or or Safeways. If pharmacists don't have to stock certain state-mandated items, then doctors don't have to see low-income patients, science teachers don't have to know or teach evolution, and waiters don't have to wait on Table 3. I mean, gawd, how completely, ridiculously, unfathomably naive and silly.

Posted by Slogur | December 10, 2007 10:14 PM

For the record, Josh, it's hardly a new precedent to dictate that pharmacies should be required to stock certain drugs. It's been on the books here for years.

Posted by tsm | December 10, 2007 10:24 PM

What ridiculous libertarian bullshit, Josh.

Posted by Kiru Banzai | December 10, 2007 10:39 PM

This is a silly argument. Either pharmacists are responsible to exercise their own judgement on what is or is not an appropriate medicine to dispense, or they should be replaced by McDonalds employees. (or a vending machine.)

If you went to see a doctor and didn't agree with their philosophical or medical tenets (or the color of their socks), you'd go see a different doctor. Why should the pharmacist be a slave to your predilections?

Posted by moofie | December 10, 2007 10:41 PM

What the fuck are you talking about? Of course pharmacies should be required to stock certain drugs.

Of course there are many cases in which forcing a "private business" to carry a certain item would be wrong, but we're not talking about telling a Christian bookstore to stock copies of the Koran or requiring a vegetarian restaurant to serve meat dishes. We're talking about medications. In the case of plan B, medications that have to be dispensed within a certain amount of time. BIG fucking difference.

I've never lived in a town where there's only one pharmacy within a day's drive, but there are a few near my hometown where you'd have to drive for an hour to get to the nearest pharmacy. There are towns where there is no reliable public transportation and maybe you can only get to the one place within walking distance. Not everyone can afford cabs.
Even in my hometown, a lot of the pharmacies are closed on Sundays. It's a small, conservative town (where this is likely to happen) and there's no Planned Parenthood. Public Health isn't open on weekends. What are you supposed to do if you have sex on Saturday night and the condom breaks? What happens if you're raped on Saturday night? Oops. Sure, you have 72 hours to get plan B, but you really want to take care of it asap.

It may sound alarmist to use the rape victim hypothetical (and I'm guessing it's men who suggest that), but that's really where the worry is. I know if I were ever raped, God forbid, the last thing on earth I'd want to do is drive to every pharmacy in town before I found a pharmacist who didn't think that what I do with my sexual organs was any of his/her business. The last thing in the world I would need is to be made to feel guilty or immoral.

It may also sound alarmist to ask what would happen if a scientoligist refused to dispense Prozac or if a member of religion X refused to dispense drug X that he is opposed to. But it's a valid point. The only reason we're having this argument is because the drug in question has to do with reproduction and is "controversial." If you work in a pharmacy that carries the drug I need, and I have the money to pay for it and a valid prescription, you have no right whatsoever to refuse it to me. You have no more right to force your religious beliefs on me by refusing to give me the pills than I have to refuse you service at my business because I don't like your religion.

If pharmacists were really concerned with the morality of medications, they wouldn't be in the business in the first place because the pharmaceutical companies are some of the worst businesses out there.

Pharmacists don't get to "exercise their own judgement about what is or is not an appropriate medicine." That's what a doctor is for. Clearly, if a doctor has prescribed a medication to me, he or she has determined that I need it. That's all you, as the pharmacist, need to know. As long as I'm not coming in with some huge number of requests for narcotics or something otherwise suspicious, it's none of your fucking business. Give me my pills, take the money.

Posted by Jo | December 10, 2007 11:40 PM

It's certainly a dangerous way for things to go. If the Pharmacist can decide not to sell Plan B because of their whacko "moral" objections, what's to stop them from not selling the HIV meds that so many need for the same reason?

Look, there are many things about my job that make me think twice about it - thankfully, while they are there, they are mostly forgettable. These pharmafreaks need to get off their high horses and get back to work.

Posted by Kevin Hamm | December 11, 2007 2:58 AM

I'm basically a Libertarian, and am sympathetic to the idea that private businesses shouldn't be regulated by the government.

Here's the catch: it's tough to live in a half-Libertarian world.

I don't think that medication sales should be restricted at all. Meaning, I don't think the government should be telling us that we need to go to a doctor before we can buy a product. If people want to self-diagnose and treat, fine by me. I think it's very unwise, and I will continue to see a doctor for my healthcare, even when I am one (I'm pre-med). But if other people think they are sufficiently educated to make those decisions, or just don't care. . . fine. :)

But as long as my chemical utopia doesn't exist, pharmacies/pharmacists are providing a unique service, meeting a basic need, and they shouldn't be permitted to pick and choose. Don't like it? Do something else with your life.

Posted by violet_dagrinder | December 11, 2007 6:25 AM

Re: "Pharmacists don't get to "exercise their own judgement about what is or is not an appropriate medicine." That's what a doctor is for. Clearly, if a doctor has prescribed a medication to me, he or she has determined that I need it. That's all you, as the pharmacist, need to know."

You may be right that pharmacists shouldn't be judging the morality of your medicine, but they absolutely have the right and responsibility to judge the appropriateness of your medicine. Nurses, too. Doctors make mistakes - decimals get put in wrong places, orders get written in wrong charts, drug names get substituted for other drug names.

The last health care professional to handle a drug before the patient gets it is the last line of defense against drug errors. In the community, that's probably a pharmacist, and in the hospital, that's probably a nurse. So it's very important to patient safety that pharmacists and nurses are able to second guess rather than blindly follow doctors' orders. If a drug or its dosage doesn't make sense to me, it's my job to withhold it. Same for pharmacists.

Posted by Rhymeswithlibrarian, RN | December 11, 2007 6:26 AM

@15: I work in a hospital, and I can assure you that no doctor in my hospital or any other I've worked at gives a patient any drug without involving a pharmacist. Who do you think mixes up the unusual or short-lived preparations and dispenses the right drugs to the right patients and keeps track of the controlled substances and double-checks drug interactions and allergy information? Just because you the patient don't see the pharmacist in question doesn't mean there isn't one involved in your care.

Posted by bolo | December 11, 2007 6:54 AM

I'm all for freedom and not having big brother crawling up your sphincter and all of that. But there's some things you just don't allow private citizens and businesses to mess with.

You don't allow firemen to choose which fire they'll put out.

You don't allow cops to decide whose emergency calls to ignore.

In that same vein, you don't allow a pharmacy to decide they're only going to treat a specific kind of patient (i.e. refusing to dispense or stock certain kinds of drugs). If you allow that, then you make it that much harder for patients to get a hold of the drugs they need.

My suggestion to all pharmacists who feel so personally assaulted at having to stock and provide all medications: find a new job, or resign yourself to the fact that not everyone shares your religious beliefs, and be a damn *professional*. Do your job.

Posted by Toby | December 11, 2007 7:07 AM

We hire professionals to do these jobs (fireman, police officer, pharmacist, nurse, school teacher, etc... etc... etc...). We require them to make judgements each and every day on how they do their jobs.

Yes, good firemen will refuse to aggressively attack fires in dangerous buildings. They most certainly choose which fires they'll put out.

Yes, good cops will refuse to respond to emergency calls if they aren't trained or have enough back-up. They most certainly choose which calls they'll respond to.

Yes, good teachers decide what they'll teach.

This is not a "free-market" argument. This is a freedom argument. It is the same freedom argument a teacher makes when the teacher decides he shouldn't be required to teach intelligent design. It's the same argument a cop makes when he decides he won't bust a guy for carrying "crack dust" because he knows the sentencing guildlines are too extremely stacked against crack cocaine.

You don't agree with the nut-job pharmacist. Great. Neither do I.

Posted by six shooter | December 11, 2007 7:51 AM

@26 -- There are two pharmacies in Ferry County. The hospital can and does despense medicine.

There are many pharmacies in Okanogan County.

Interesting to note, however; there are no mental health care providers left in Republic. Should the state require one to move there to provide counciling for your imaginary on-the-poverty-line rape victim?

(BTW, you and I both know there is also a Planned Parenthood in Republic.)

Heck, if we're going to abandon our freedoms for their convenience, maybe we should require all licensed professionals to work for free in at least one isolated area in the state.

Posted by six shooter | December 11, 2007 7:59 AM

@27 -- Nice compassion for religious people and freedom in general. I hope the State never forces you to do choose between your job, house, family, life and your beliefs.

Posted by six shooter | December 11, 2007 8:02 AM


Washington State shouldn't be in the business of legislating morality.

That is the MOST FATUOUS THING anyone's written in this thread. You think the state shouldn't forbid theft, rape, vandalism, assault, etc.? Whether or not those things are considered wrong, after all, depends on morals.

Posted by Greg | December 11, 2007 8:29 AM


Washington State shouldn't be in the business of legislating morality.

That is the MOST FATUOUS THING anyone's written in this thread. You think the state shouldn't forbid theft, rape, vandalism, assault, etc.? Whether or not those things are considered wrong, after all, depends on morals.

Posted by Greg | December 11, 2007 8:29 AM

@53 / 54:


Posted by six shooter | December 11, 2007 9:09 AM

@53 / 54:


Posted by six shooter | December 11, 2007 9:09 AM

Um, I think I'm missing the difference -- particularly when a small town's drugstore is, say, owned by the local pharmacist.

Being allowed to not stock Plan B is an end-run around any requirement to dispense it.

Could you imagine a pharmacist not stocking penicillin because s/he's anti-mold?

Posted by K | December 11, 2007 9:23 AM

Yes they chose to respond based on whether they can do the job. The first fire fighter that chooses not to respond to a fire at planned parenthood because they provide abortions and he is a Christian is fired. And you know what in some cases the state does have the right to make you choose between your livelihood and your religious beliefs if those beliefs interfere with your ability to do your job.

@32- Plan B is not prescription but it is over the counter meaning that you need a pharmacist to sell it to you. Much like certain types of cold medicine.

Posted by Rachel | December 11, 2007 9:34 AM

@12 - I grew up in such a town. Not everywhere in WA is like Seattle.

Posted by Will in Seattle | December 11, 2007 9:56 AM

@58 - Absolutely. A police officer who fails to enforce a law he disagrees with should also be punished.

However, the question isn't can the state force pharmacists to dispense Plan B. The question is should the state force pharmacists to dispense Plan B.

Without a compelling benefit (for example, a real, unmitigable hardship placed on a community), I see no reason for the state to revoke a right (for example, the right to make professional decisions on how to do one's job).

Posted by six shooter | December 11, 2007 10:01 AM

@50 -- That's a silly conflation of two issues and you know it. No one is saying pharmacists should have no discretion, just like no one is saying firemen should have no discretion. Everyone is saying that the discretion has to be exercised in good faith based on the rules of the job.

A fireman has to be willing to put out fires in the ghetto, but doesn't have to charge into a collapsing building. A pharmacist has to be willing to dispense all legal medicines, but doesn't have to dispense those prescriptions that have typos.

This isn't really complicated.

Posted by A. | December 11, 2007 10:03 AM

@59 - Where? Find me that town in today's age.

Let's pretend that town still exists, AND has no roads or internet, AND no doctors willing to tell their patients how to take more than one birth control pill at a time, AND no doctors willing to hand out samples of plan B.

Why don't we make a law requiring THE SINGLE pharmacy in this mythical town (presumably accessed only by jungle trail) to provide a constant supply of Plan B.

Heck, we could even solve this problem by declaring an Underserved Jungle Outpost Pharmacy Act.

Whereas imaginary rape victims with neither friends, cars, telephones nor internets continue to live in Washington State,

Whereas pharmacists servicing these imaginary rape victims refuse to act as drug vending machines,

The State of Washington will provide means for neighboring outpost pharmacies to transport medications as requested.

Posted by six shooter | December 11, 2007 10:15 AM
I don't think that medication sales should be restricted at all.

So you don't have a problem with superbugs being created by people taking antibiotics when they don't need them or failing to take antibiotics for the necessary amount of time? There are already worries about this sort of thing due to antibiotics being sold on the black market. Many/most people are morons. I'd rather not put everyone's health on the line so some dimwit can take an antibiotic as a "cleansing" after her period.

Posted by keshmeshi | December 11, 2007 11:35 AM
It is the same freedom argument a teacher makes when the teacher decides he shouldn't be required to teach intelligent design.

Does a religious teacher have the right to have a few minutes of prayer in his classroom? No. Does a religious teacher have the right to teach intelligent design even as the school district demands that he teach evolution? No.

There are two pharmacies in Ferry County. The hospital can and does despense medicine.

And what happens if both those pharmacies refuse to dispense EC? What happens if the pharmacist at the hospital refuses to dispense it? Do you have any idea how many nutjobs are clustered in rural areas?

Nice compassion for religious people and freedom in general. I hope the State never forces you to do choose between your job, house, family, life and your beliefs.

Oh, fuck off. I was unemployed for a damn long time during the last recession. I had the option of working in jobs that I find unethical. I chose not to take those jobs, because I'm an ethical person who also happens not to be an idiot. If a religious person can't deal with a certain requirement of a job, then he or she should find another line of work. Period.

Without a compelling benefit (for example, a real, unmitigable hardship placed on a community), I see no reason for the state to revoke a right (for example, the right to make professional decisions on how to do one's job).

There is no such right, for anyone. But I take it from this that, if we can prove that this does impose a real hardship, you'll shut the fuck up.

Here's one: emergency contraception must be administered within 72 hours of sex/rape. It's most effective within the first 24 hours. There have been documented cases of women stuck in rural fundie land who weren't able to get their prescriptions filled within that window. Is that good enough for you?

The State of Washington will provide means for neighboring outpost pharmacies to transport medications as requested.

And you really expect that the government is efficient/capable enough to do this within 24 hours?

All this work and money should go into protecting the nonexistent rights of people to take jobs that they ultimately refuse to perform. Right.

So what's your take on Quakers joining the military for the scholarships and then refusing to fight?

Posted by keshmeshi | December 11, 2007 11:47 AM

Six Shooter-- You keep mentioning that someone can take more than one birth control pill at a time to get the same effect. Has it occurred to you that a woman looking for plan B does not already have birth control pills? And if she doesn't have them, she can't get them. The pill DOES require a prescription, unlike Plan B. And if a pharmacist is allowed to refuse to give out Plan B, they can also refuse to give out the birth control pill.

If we find links to the many articles about actual women who have actually been unable to get their plan B in time due to crazy pharmacists, will you shut up?

(Not to mention those pharmacists who actually refused to hand the piece of paper with the prescription on it back to the woman, thus keeping her from getting it filled anywhere. Going back to the doctor takes a lot of time, and plan B needs to be taken asap. )

Posted by Hmm | December 11, 2007 12:34 PM

"The pill DOES require a prescription, unlike Plan B. And if a pharmacist is allowed to refuse to give out Plan B, they can also refuse to give out the birth control pill."

You're right. In fact, there have also been cases of pharmacists refusing to give out regular birth control pills because of their religious beliefs. Here's an old link that I posted in my own blog about two years ago. click here .

Of course, not getting refills of regular pills isn't as much of an emergency as the plan B thing, but the point that my sex life is none of your fucking business and you do not have the right to refuse to fill my prescription based solely on your own religious beliefs still stands.

Posted by Jo | December 11, 2007 1:23 PM


Especially if you have to drive out of your way everytime you need a new pack.

There's also really no excuse for that. The pill has been around for decades. At least EC is new and fundamentalist pharmacists apparently don't realize that it's not an abortifacient.

Posted by keshmeshi | December 11, 2007 2:22 PM

The state can and does tell pharmacies what to do all the time. Drugs and health care are two of the most highly regulated aspects of our society. This is to ensure public safety. Pharmacies have a near monopoly on selling drugs. Patients have no other way to access the drugs they need, whether they are prescription or behind-the-counter, like PlanB. These rules adopt that commonsense understanding.

The state already decided many years ago that Ipecac -- an emetic typically used when children eat stuff they shouldn't -- must be stocked in every pharmacy. State regulators determined that child safety was a social good of overwhelming importance, and issued this mandate accordingly. Maybe the state needs to adopt this approach with other urgent need time-sensitive drugs like emergency contraception, insulin or others.

Grocery stores are free to stock or not stock goods according to their customers’ preferences or even the owner's whim. Pharmacies are a different kind of commerce. Pharmacies are regulated because they provide highly regulated substances essential to human health, not general consumer goods.

Posted by Susan | December 11, 2007 3:50 PM

"Especially if you have to drive out of your way everytime you need a new pack."

No kidding.

God bless Planned Parenthood. They give me a year's supply at once (maybe that's just here in Oregon where we have a service called FPEP that provides free contraceptives), along with several packs of Plan B.

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