1. The Morning After Pill? Carly Sharp Janine Vance Ashley Walker Kalee Ankrum Wendy Cumberbatch

2. What is the Ethical Question? Should pharmacists have the right to refuse to dispense the morning after pill?

3. What are the Facts?  The morning after pill is a pill taken by a woman to avoid fertilization of an egg after having unprotected sex.  The first prescription-only combined estrogen-progestin dedicated product, Schering PC4 (ethinylestradiol and norgestrel), was approved in the UK in January 1984 and first marketed in October 1984.  It wasn ’ t until July 28, 1999, that the FDA approved the prescription progestin-only Plan B (two 750 µg levonorgestrel pills) emergency contraceptive in the U.S.A.

4. What are the Facts? (cont ’ d)  Pharmacists do have a moral right to refuse to dispense the morning after pill.  Although this moral right is given, they must still adhere to what is written in their job descriptions.

5. Perspective of Stakeholders  Patient Increased inconvenience Potential for embarrassment and humiliation Right of access to care Question of abortion Impact on future  During and after pregnancy  Life changes, job, finances  Their partner Impact on future  Marriage?, child support  Both families

6. Stakeholders (cont’d)  Pharmacists Dispensing violates personal code of ethics Can refuse and refer to another pharmacist Reputation  Pharmacies Reputation, customer satisfaction  General public Welfare, adoption agencies, increased cost to society

7. What Options do Pharmacists Have?  Direct customers to another pharmacy.  Step away and allow another pharmacist to dispense meds to patient; therefore, maintaining the woman ’ s rights.  Refuse to dispense based on personal beliefs.

8. Pharmacists’ Options (cont ’ d)  Direct customers to another pharmacy Acting against beliefs, yet still protecting a woman ’ s rights. Board of Pharmacy allows refusals but obligates pharmacists to direct customer where to get prescription filled.  Step away and allow another pharmacist to dispense meds to patient; Not getting involved, yet still allowing the dispense to occur.

9. Refusal to Dispense  Can be based on: Morales Ethics Religion  Pharmacist are protected by Refusal Laws and conscience clauses endorsed by the APA.  Georgia, Arkansas, Mississippi, S. Dakota are the only states that allow refusal.

10. What Should I Do? BEST COURSE OF ACTION:  Pharmacists should not be able to refuse to dispense the morning after pill based on personal, moral, or religious judgments. Refusal to dispense should be based on professional or medical concerns: potentially harmful contraindications, interactions with other drugs, improper dosage, or suspected drug abuse.

11. What Should I Do? (cont’d)  The pharmacist ultimately has the responsibility to ensure timely patient access to legally prescribed medications. Either by filling the prescription or transferring prescription to another pharmacist.  Pharmacists knowingly enter a profession where they serve the public, subject to regulation.  The objection to contraception is rooted in personal religious belief, not professional training, science, medicine, or the law.

12. What Should I Do? (cont’d)  Women rely on prescription contraceptives for a range of medical purposes in addition to birth control, such as regulation of cycles and endometriosis.  Refusals to dispense contraceptives or transfer prescription to another pharmacist can have devastating consequences for a woman’s health

13. Justifying Our Choice  Two theories that help justify this decision: 1) Utilitarian  Actions are right to the extent that they tend to promote happiness and wrong to the extent that they tend to promote the reverse of happiness. Refusing to dispense emergency contraceptives does not promote happiness. According to this theory, it is wrong to refuse access to EC’s because happiness is the most important thing, and that is not being considered.

14. Justifications (cont’d) 2) Deontological Considers whether it is one’s duty to perform or not perform an action.  It is the pharmacist’s duty to ensure timely patient access to legally prescribed medications.  “Can I, as a rational person, consistently will that everyone in a similar situation should act in the same way?” –Immanuel Kant  The proposed action is morally acceptable because all pharmacists should act in the same professional way, which is to fill medical prescriptions, regardless of personal belief.

15. Justifications (cont’d)  Ethical Approach that applies to this situation:  Analysis of Rights Based on the consideration of whether an action affirms or violates human rights  A right is an especially powerful moral claim that others are obligated to respect.  Pharmacists have both rights and responsibilities.  Is their right to refuse disbursement of the morning after pill ethical?

16. How Could this Ethical Problem have Been Prevented?  More specific laws pertaining to the dispense of the product be established before the arrival of the product.  The pharmacist should respect the patients request to purchase the “ morning after pill ”.  Early strict expectations of pharmacists in their job descriptions.

17. NAPRA Statement  National Association of Pharmacy Regulatory Authorities (NAPRA) places the onus on the pharmacist who declines to provide emergency contraceptives to prearrange access to an alternate source, either another pharmacist or a physician who has a supply of the drug.  NAPRA states that pharmacists “ shall hold the health and safety of the public to be their first consideration. ”