Pharmacists have professional obligation to serve public
HUGH SPITZER
Last spring, after a long public process, the Washington State Board of Pharmacy adopted rules requiring all pharmacies to fill valid prescriptions for legal medications. These rules are an appropriate exercise of the state’s job to protect public health and welfare. They simply require each pharmacy to do what it is licensed to do: fill prescriptions for patients.
Some individual pharmacists don’t want to fulfill their professional duties for reasons unrelated to patient care. They want to insert their personal beliefs and opinions into the pharmacist-patient relationship and obstruct access rather than facilitating patient needs. The Board of Pharmacy’s concern about this led to the rules.
Under these regulations, if an individual pharmacist objects to dispensing a particular medication for personal, moral, or religious reasons, it is up to the pharmacy to determine how to meet the patient’s needs. A pharmacy can accommodate the objecting pharmacist by having another available qualified staff person handle the prescription. But the pharmacy itself must fill the prescription in a timely manner.
This is a fair and balanced approach. But two pharmacists and a pharmacy owner filed a lawsuit challenging the rules’ constitutionality in federal court. The plaintiffs asserted the rules violate their constitutionally protected freedom of religion. In November, a judge granted a temporary injunction to prevent the rules from taking effect. On Feb. 15, he reaffirmed that decision. For the time being, Washingtonians could be denied their valid prescriptions when they walk into their local pharmacy.
Let’s get back to basics. The First Amendment protects an individual’s right to practice religion. But the U.S. Supreme Court has ruled that governments may protect public health and safety even if it affects religious worship – such as shutting down a church that is a fire trap. Governments can’t target religious beliefs, and governments often accommodate religious practices when practicable.
In this case, the Pharmacy Board has adopted neutral rules for public health reasons. The rules don’t target any religion or religious practices. But each pharmacy must fill valid prescriptions, and a pharmacist may not discriminate against or pressure a patient because of a patient-doctor medication choice.
The Pharmacy Board rules target a harmful refusal to fill a prescription, whether it is religiously motivated or not. Importantly, individual pharmacists still can avoid filling prescriptions for religious reasons if others at the pharmacy are available to take care of a patient’s needs.
Pharmacists might have to provide access to drugs they might not prescribe if they were physicians, or drugs they personally don’t like such as certain painkillers and antidepressants, or HIV anti-retroviral drugs, or prescriptions that prevent unplanned pregnancies. Some of these drugs, like emergency contraception, become less effective with each passing hour. But pharmacies exist to provide prescribed and behind-the-counter medications to patients. The state Pharmacy Board rules simply affirm that public health responsibility.
As a lawyer, I understand what it’s like to serve clients whose goals I don’t like or whose views I disagree with. But all professionals have an ethical obligation to serve, and when we choose to serve others we must let them make the choices, regardless of our personal opinions.
As a News Tribune editorial stated on Nov. 10, 2007: “Ensuring that patients, especially those in rural areas, don’t have to traipse from pharmacy to pharmacy trying to find the drugs they need remains a good public policy.”
Not only is that principle good public policy, but it is also a responsibility that the Pharmacy Board takes seriously. Pharmacies have a near monopoly on dispensing drugs. Along with that privilege comes the responsibility to do just that– dispense lawful drugs to patients who need them. The Board of Pharmacy rules do not violate plaintiffs’ religious freedom by requiring them to do what they have an exclusive license and professional responsibility to do.
Hugh Spitzer is an affiliate professor of law at the University of Washington.
