In the mind of pharmacist Jim Ramseth, there is a moral hierarchy when it comes to preventing pregnancy: Selling condoms and birth control pills is OK. But emergency contraception known as Plan B is not, and Ramseth rejects to provide it. In recent months, the friendly 65-year-old owner of two local drug stores has fought hard for the right to make professional choices guided by such personal views. And during his stand on the morning-after pill may be a minority opinion in Washington -- where more than 2,000 women get Plan B directly from their pharmacists each month -- many of Ramseth's colleagues agree that they should not be forced to provide medication with which they have moral or ethical objections.
"Everybody draws their own lines," Ramseth said. "And if a customer’s point is to kill a fertilized egg, then I oppose with that. In spite of where the pharmacist draws that line, they must have the right."
Plan B, basically a high dose of the similar ingredient found in regular birth control pills, works by preventing ovulation and might stop fertilization, or prevent implantation of a fertilized egg. If a woman is already pregnant, the drug has no effect. But to Ramseth it still comes too close to abortion.
present state law says only that "pharmacies should maintain at all times a representative assortment of drugs in order to meet the pharmaceutical requirements of its patients," wording that proponents on all sides find frustratingly vague - particularly in light of a move by the Food and Drug Administration to loosen restrictions on Plan B. Now that it would be available without a prescription, should each pharmacist stock it?
Ramseth refuses. In addition to his moral objections, he said there was no customer demand. If there were, he will hand over a sheet listing 11 nearby pharmacies that might or might not carry emergency contraception and propose that his customer look around.
"I don't know exactly who's carrying it because I'm not going to call and find out," he said. "I believe people should be responsible for themselves. They can make a phone call." Many would disagree, among them Julie Alessio, who spent a recent afternoon trudging from store to store in Olympia, searching for emergency birth control.
Alessio, who is married and the mother of a 1-year-old girl, has had an abortion and does not wish to endure another. All she wanted was a supply of Plan B to keep on hand in case her regular birth control failed.
"It was like 'You're a bad person, why do you want this kind of thing?" she said. "They really seemed put off. I was pretty frustrated."
In other states, such as Illinois and Massachusetts, pharmacists have been required to stock the medication.
The difficulty comes in a murky area where personal views may overlap medical judgment. "It's a hugely different thing when you're refusing someone because you think there's a problem that's going to hurt the patient from a medical point of view versus a moral point of view," said Stewart Jay, a lawyer and primary drafter of the 1991 state Reproductive Privacy Act.
Present law makes no exception for matters of conscience, Jay said, so a pharmacist who disapproves of stimulants or tranquilizers should dispense them anyway. Broadly worded clauses allowing conscience to carry the day can well create more problems, he added. "You enter into a slippery slope where pharmacists can object to any number of things.”
Don Downing, a professor at the University of Washington who has been speaking in support of Plan B, believes such problems would never disappear completely. Pharmacists, he said, have always had an inalienable right to conscience. “However, a professional can't just deny care to somebody. There are a lot of duties that go with saying no."
1) Do owners/managers of public services which are privately delivered like pharmacies and medical offices have the right to reject to do something on the basis of their moral convictions?
2) This case is an ex of the moral dilemma. The right of an individual to medical treatment is in conflict with moral and religious beliefs of the treatment provider. In a multicultural society this type of conflict has the potential to occur frequently. What must be the role of the state in this case?