Another look at Plan B

In the January blog for Drug Topics, four soon-to-be pharmacists conclude that pharmacists should “NOT refuse to dispense Plan B.” I commend them for tackling a tough issue, but I disagree with their premises and thus their conclusion.

It appears that their primary argument is based on what they perceive to be the reason for some pharmacists’ objections: their moral belief that preventing a sperm and egg from meeting is prohibited. If this were the case, the objection would extend not just to Plan B but to any form of contraception. This premise goes far beyond the evidence.

The true basis of the objection, including my own, has to do with the known ability of Plan B to alter the chemical and physical properties of the endometrium and consequently prevent the implantation of a days-old human embryo.

I anticipate that some will say that pregnancy is defined as beginning at implantation, so Plan B “will not affect an existing pregnancy or harm a developing fetus.” This definition of pregnancy was put forth in 1972 in Obstetric–Gynecological Terminology published by American College of Obstetricians and Gynecologists. This radically departs from the usual definition of pregnancy and relies on the location of the embryo versus the presence of the embryo; in my view a scientific and logical absurdity. This alternate definition is far from universally accepted by the healthcare community or the general public.

The authors state “according to the beliefs of certain religions, life begins at the meeting of sperm and egg . . .” This is not a religious belief but a scientific fact. My view that Plan B is sometimes “abortive in nature” is based on scientific evidence that dispensing Plan B may well result in the unnatural death of a living human being. How else could this be described other than early abortion?

I’m concerned that the authors may have, perhaps even unknowingly, bought into moral relativism - the idea that there are no objective moral principles, only “personal beliefs.” I wonder if they would still hold this view if I stole their new I-Pod out of their locker because it served my “best interest”? If objective moral principles do not exist, then any statements about what pharmacists “should” or “should not” do are meaningless.

I appreciate the authors’ reference to the Oath of a Pharmacist. The first principle states, “I will consider the welfare of humanity and relief of suffering my primary concerns.” The welfare of a new human life is not served when it is abruptly terminated, and the general purpose of Plan B is not “the relief of suffering.”

In addition, the oath states, “I will hold myself and my colleagues to the highest principles of our profession’s moral, ethical, and legal conduct.” Pharmacists who decline to dispense Plan B are acting consistently with this principle by not compromising their deeply held moral and ethical convictions where human life is concerned.

In conclusion, the First Amendment to the Constitution reveals the highest priority of American citizens at that time - the protection of conscience. The right of conscience long held by all healthcare professionals is currently being eroded and threatened. Many healthcare professionals besides pharmacists have reported being forced or coerced into participating in abortions (see Freedom2Care.org).

The Obama administration is currently planning to remove the federal regulation protecting conscience rights in healthcare. If this comes to pass, those who have no current moral or ethical concerns in their profession have no guarantee that in the future they will be able to exercise their conscience regarding any “safe and legal” procedure.

I hope this response will stimulate the authors to some deeper thinking on this issue, and I wish them all success in their well-chosen careers.

Melissa Stahlecker, PharmD, is an Acute Care Pharmacist in Rapid City, S.D.