Ales Rarus

There has recently been a great push in the world of women's health to consider prescription birth control (oral contraceptives, IUD, DepoProvera, etc.) not only a "right" but indeed a necessity - the "standard of care," if you will. The fact that ever-growing numbers of registered pharmacists are refusing to fill legal prescriptions for such birth control has caught the attention of quite a few powerful pro-choice and "feminist" groups, who have made it their goal to force such professionals by law to fill all such prescriptions with no questions asked. As a practicing pharmacist, I would like to try to address this issue.

First of all, I am one such pharmacist - I choose not to participate in any type of abortion, be it a physical or a chemical abortion. Let me start, then, by stating reasons why many consider birth control to be an abortifacient. The basic mechanism of most chemical birth control is three-fold: 1) to prevent ovulation 2) to thin the cervical fluid 3) to harden the uterine wall. Obviously, if a woman does not ovulate she cannot get pregnant, and since this is the primary mechanism of action, many would argue that abortion does not occur. However, no person or drug is perfect. Therefore, if and when ovulation does occur (a patient may forget to take it one or more days in the cycle, the dose may be too low for her body type, other medications/herbals may interfere, etc.) the other two mechanisms become important. The thinned cervical fluid makes it difficult for the sperm to reach the egg so that fertilization is unlikely. But should fertilization occur, the womb is now a hostile environment in which the fertilized egg is not likely to be able to implant. Now, this may be an area of dispute, but to me, life begins at fertilization (new DNA = new person), so when the fertilized egg is flushed out with the next period, an abortion occurs.

In my opinion, the two greatest pieces of evidence to prove that this is not so rare an occurence as we would like to believe are the number of pregnancies that occur while women are on birth control (we all know someone who got pregnant on the pill, and how many embryos were lost before that hearty one beat the odds?) and the fact that the so-called "morning after" pill is just a higher dose of the same hormone combination, given with specific intention of removing any fertilized eggs. It is impossible to know how compliant anyone is with her medications and therefore how likely she is to have one (or many) of these "silent abortions." I will not risk being a part of any of them - it is still killing and blood would be on my hands.

The groups that are pushing for pharmacists like me to "shut up and fill the prescription" argue that no matter what I believe about birth control, the decision occurs between a woman and her physician and I should not push my "morality" into the situation. I should not councel any patient about how this drug works (by the way, when was the last time your doctor told you how any drug works?) so that she can reconsider her decision, I should not warn her that birth control has been linked to an increased risk of breast cancer or can cause life-threatening thromboembolic events (blood clots) including stroke, I should not tell her about other side effects such as peripheral edema (swelling mainly of the ankles), severe nausea, decreased glucose tolerance (which can lead to diabetes), depression, anxiety, etc., and I most certainly should NOT be able to refuse to fill it. To me this is the same as forcing an OB/GYN to perform an abortion.

Why, then, does my profession exist? Why did I spend six years earning a doctorate in order to be told I play no part in the decision of what is appropriate drug therapy? Let me turn the situation around. Let's say a young woman is trying to get pregnant and succeeds but is not yet aware of the pregnancy. Unfortunately, she comes down with pneumonia. When she goes to the doctor, she tells him/her that she is allergic to penicillins. Said doctor prescribes doxycycline, but in haste forgets to ask if she may be pregnant and/or give the simple urine test to confirm such diagnosis. She brings me a prescription which is the right dose, duration and frequency, is perfectly legal, and seems to make sense for her infection. According to the above mentality, I should be required to fill it with no questions asked, since this treatment decision was already finalized between her and her physician. Indeed, I should not even bother mentioning whether the prescription was appropriate or not since it was legal - after all, that's all that counts, right? However, doxycycline is listed as pregnancy category D, meaning that it is known to be harmful to developing fetuses, and her baby is born with severe birth defects, or worse yet, does not survive. When her lawyer is making the list of health professionals to sue for malpractice, my name will be on it and I will have my license suspended if not revoked.

It is a horrible double standard to expect pharmacists to be on guard for honest mistakes in prescriptions, allergies and sensitivities, drug-drug and drug-food interactions, side effects, and other drug therapy problems that can cause illness or death, and yet to turn a blind eye to what they feel is murder. It is insulting that I am expected to only use my training and conscience to their full extent when it serves the whim of the masses and expected to act like a candy dispenser when the same training and conscience interfere with someone's comfort or lifestyle. It is discouraging that "freedom of choice" does not include the freedom of a licensed professional to practice the way that she chooses.

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