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Plan B Is Sometimes A Pretty Good Plan |
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| A Woman’s Right to Plan B by Helen Lipson Should health care professionals ever be forced to choose between keeping their jobs and betraying their religious beliefs? Or to put it another way: To what degree should they be expected to leave their private beliefs outside the workplace, in exchange for the power and privileges bestowed on them by the government? This is hardly an academic question, given the ongoing disputes over access to the emergency contraceptive Plan B, aka “the morning after pill.” (Actually consisting of two different pills, one taken 12 hours after the other, Plan B may be effective up to five days after sexual intercourse—the length of time it may take for a woman to become pregnant—but sooner is definitely better.) Available in Europe since the 1980s, it was not until 1999 that emergency contraceptive pills were approved as prescription drugs in the US. Since 2006, the drug has been legally available without a prescription to any woman 18 or older; and just last month, a US district court extended that option to 17-year-olds. But retail sales are still restricted to pharmacies, where Plan B must be dispensed from behind the pharmacists’ counter. And just as an electric car cannot help you fight global warming if there aren’t enough places to recharge your engine, emergency contraception can’t help an a rape victim at an ER where the pills are not offered, or a customer at a drugstore that won’t sell it to her. Along with a substantial percentage of the American populace, many health care professionals oppose Plan B, either because they think that its availability promotes promiscuity, or—a more compelling argument, in terms of our Constitution—because they see it as an abortion drug. Plan B has no effect on an embryo that’s already attached itself to the lining of the uterus; but it can prevent that attachment from taking place, even when egg and sperm have already joined. So if your religious tradition tells you there’s a new human life worth fostering from the moment of conception, then Plan B may be hard to swallow. Attempting to balance women’s rights against the “free exercise” clause of the First Amendment (and against state laws in a similar vein), just 18 of the 50 states have taken steps to ensure rape victims access to Plan B, health care providers’ personal objections not withstanding. Every emergency room in Oregon, Washington, California, Massachusetts, Minnesota, New Jersey, New Mexico, New York, Ohio, Pennsylvania, and Wisconsin is required both to inform these patients about the drug and to make it available to those who want it. According to the Guttmacher Institute, however, emergency rooms in South Carolina need only make it available to those who ask for it. And in Arkansas, Colorado, Illinois, Pennsylvania, and Texas, ERs are required to inform rape victims about their options, but need not dispense Plan B themselves. Drug store customers enjoy less protection. At the present time, New Jersey and California are the only states in which pharmacies are required to fill all valid prescriptions, while Illinois is the only state that actually requires pharmacies that sell other contraceptives to stock Plan B as well. Here in Oregon, the State Pharmacy Association is working with NARAL Pro-choice Oregon to help ensure that when a pharmacy does not stock Plan B—or when the pharmacist on duty won’t dispense it—customers are referred to another pharmacy not too far away where they can buy it. In Washington, the State Board of Pharmacy issued two rules in 2007 that would have required every pharmacy to fill all valid prescriptions, and to sell Plan B without a prescription to any woman of legal age. Pharmacists’ objections on moral or religious grounds would not have excused them from that obligation, unless a second pharmacist on the same shift was willing to process the customer’s request. Almost two years later, however, those rules remain unenforced, pending judicial decisions on Stormans v. Selecky, which pits the State Board against a Tacoma pharmacy and two pharmacists. Of the 1,014 Washington State pharmacies that participated in a recent NARAL survey (out of a total of 1,190 in the state), 7.4% percent do not stock Plan B, and another 3% who stock the drug also employ one or more pharmacists who will not dispense it. Under the new rules, such pharmacies would be forced either to spend money they can’t afford on additional pharmacists, or to fire any pharmacist who refused fall in line with the state’s mandate. So for anyone who supports the First Amendment, it is difficult not to feel some sympathy for those whose jobs these rules would put at risk. We need to keep in mind, however, that pharmacists and those who employ them are not simply private-sector professionals and businesses: They are among that small percentage of American workers and organizations designated by the government as gatekeepers to health-care products and services not legally obtainable from any other sources. In that sense, they are agents of the state. And from that perspective, a pharmacist who refuses to dispense a legal drug makes about as much sense as a police officer who, for “reasons of conscience,” refuses to ever fire on a suspect, a public school biology teacher who refuses to cover evolution, or a President who takes his orders from the Pope. We also need to remember that many neighborhoods and small towns simply cannot support more than one pharmacy, and that for many young girls without their own automobiles, getting to the next closest pharmacy is no small task. The First Amendment, moreover, can go both ways: If state laws and regulations concerning licensure have the practical effect of designating just one business and its employees as a small-town’s or neighborhood’s gatekeeper to critical products or services, then we ought to make sure that the religious beliefs of that gatekeeper’s owners or employees do not dictate which of those products or services consumers can purchase close to home. The bottom line, then? I’m rooting for the Washington State Board of Pharmacy, and any other government agency willing to take the same stand. However precious our religious freedom, it should not be allowed to narrow the range of reproductive choices that are every woman’s right.
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