A Pharmacist Refuses to Fill a Prescription for Birth Control: An Ethics Case Study

On July 6, 2002, a University of Wisconsin-Stout student, went to the K-Mart in Menomonie, Wisconsin, to fill her prescription for oral contraceptives, birth control pills. The only pharmacist on duty, Neil Noesen, asked if she intended to use the prescription for contraception. When she replied in the affirmative, Noesen, a Roman Catholic, refused to fill the prescription, explaining that to do so would be against his religious beliefs. She thought that he was kidding.

But Noesen was very serious. As a devout Catholic, he had concluded that he could not dispense contraceptives. He also refused to transfer the prescription or tell her how or where she could get the prescription filled, all of which, he explained later, would, in his view, constitute participating in wrongful behavior. Significantly, prior to employment at K-Mart, Noesen had informed the district manager that he would not dispense contraceptives; however, he did not mention that he would refuse to refer or to transfer prescriptions.

The woman filed a complaint with the Wisconsin Department of Regulation and Licensing's Pharmacy Examining Board. The administrative law judge who heard the complaint found that the ordinary standard of care "requires that a pharmacist who exercises a conscientious objection to dispensing of a prescription must ensure that there is an alternative mechanism for the patient to receive his or her medication, including informing the patient of their options to obtain their prescription." Further, he found that Noesen's conduct constituted "a danger to the health, welfare, or safety of a patient and was practiced in a manner which substantially departs from the standard of care ordinarily exercised by a pharmacist and which harmed or could have harmed a patient."

His ruling also limited Noesen's license, requiring him to notify any pharmacy where he worked of any practices he would refuse to perform and how he would ensure patient access to prescriptions that he declined to fill.

Identify all of the affected Stakeholders and their values: Who are the individuals or programs affected by the ethical question?