Conscience Situation OK - For Now

Oregon's assisted-suicide law allows all practitioners to opt out for moral reasons, whether they are doctors, nurses or pharmacists. But while doctors can refuse to do abortions or prescribe birth control, there is no law protecting a pharmacist who won't fill certain orders. And so far, neither is there a law compelling the pharmacist to fill any prescription.

"In other states, there are efforts afoot to prohibit pharmacists from exercising rights of conscience. We may be better off just not doing anything," says Rick Sahali, regional director of pharmacy services for Providence Health Services.

In 1997, when the assisted-suicide law was about to go into effect, Sahali spoke out strongly for pharmacists' rights, saying they should be notified if a prescription is intended to kill a patient.

In November 1998, the Oregon Board of Pharmacy ruled that doctors must specify which prescriptions are intended for use in suicides. The rule was meant to allow pharmacists to opt out of participating.

Physicians objected, saying such listing would violate patient-doctor confidentiality.

But in the years since, now that more than 200 Oregonians have used the assisted-suicide law to die, doctors and pharmacists have worked out a system on their own. Physicians writing lethal prescriptions call ahead to pharmacies to make sure the pharmacist is willing to comply.

Doctors now know in general who will cooperate and who will refuse out of conscience.

Providence pharmacies do not dispense drugs for assisted suicide.

The American Society of Health System Pharmacists has issued statements arguing that pharmacists should have rights to refuse to fill prescriptions.

Sahali agrees. To do anything less would be "reducing the pharmacist to something less than a professional, nothing more than middle-men in the chain of events," he says.

But Sahali adds that patients' rights should be recognized. Usually, that means making provisions for the troublesome prescription to be filled elsewhere, not too far away.

"One thing you don't want to do is abandon the patient," he says.

In the case of assisted suicide and birth control, time is usually not of the essence, Sahali says. So sending customers across town - or in rural areas maybe to the next town - is not an undue burden on the patient.

Oregon has never had a conscience clause for pharmacists. The issue did not come up until the assisted-suicide law was passed and then enacted. But with new kinds of therapies and drugs always around the corner, the issues for pro-life pharmacists are far from over.

Gary Schnabel, a pharmacist and executive director of the Oregon Board of Pharmacy, says there are no easy answers.

"It's tough to say a pharmacist doesn't have a right," Schnabel says. "On the other hand, you can't interfere with a patient's right."

In a nutshell, that has been the tenor of the Oregon Board of Pharmacy's discussions of conscience matters over the past eight years.

"Pharmacists cannot be a barrier to a people getting their prescriptions," Schnabel says. "They need to make an arrangement fast and not far away."

There is potential for problem in rural areas, where the next pharmacist may be some distance.

But in the past five years, only two complaints in that vein have reached the board.

Schnabel says that the practice set up for assisted suicide, in which doctors call ahead, may be the right thing to do for other prescriptions that could trouble conscience.

That is the position taken by the American Pharmacists Association.

"The Association supports the pharmacists' ability to choose not to fill a prescription based on moral or ethical values," says a June statement to the press from association executive vice president John Gans.

"But recognizing the pharmacist's important role in the health care system, APhA supports the establishment of systems to ensure that the patient's health care needs are served.

Essential to APhA's policy is establishing systems to assure patient access before the prescription ever reaches the pharmacist."

Arkansas, Georgia, Mississippi and South Dakota have enacted conscience clauses protecting pharmacists' acts of conscience.

Similar legislation is pending in 13 other states. In four states, including California, legislation has been introduced to compel pharmacists to fill prescriptions.

In April 2005, Senator Frank Lautenberg, D-N.J., and Rep. Carolyn Maloney, D-N.Y., introduced federal legislation, called the Access to Legal Pharmaceuticals Act, that would require pharmacies to fill all valid prescriptions in a timely manner.

This summer, the American Medical Association delegates adopted a resolution saying that responsibility to the patient is "paramount" and seeking authority to dispense drugs to their own patients if an agreeable pharmacist cannot be found within a 30-mile radius.