Plan B: The debate continues

January 4, 2011

Should pharmacists have the right to refuse to dispense Plan B? The issue has been hotly debated in pharmacies throughout the country. Four eager student pharmacists weigh in.

As four eager student pharmacists preparing to embark on a journey into future pharmaceutical practice, we have become aware of a number of moral and ethical dilemmas that we will face in coming years.

The general public currently views the profession of pharmacy as among the most dignified and trusted of all professions. We hope to maintain that patient-pharmacist trust and plan to do so by making educated decisions on a number of difficult ethical questions. One such issue prominent in today’s pharmaceutical practice is the dispensing of Plan B, the over-the-counter emergency contraceptive.

In recent years, many pharmacists have refused to dispense Plan B. As a result, there has been considerable debate throughout the country over whether pharmacists should have the right to refuse to dispense the medication. After much thought and consideration, we have come to the conclusion that pharmacists should NOT refuse to dispense Plan B. In the following paragraphs, we have outlined our reasoning and how we came to adopt this ethical stance.

Plan B prevents unplanned pregnancy resulting from unprotected intercourse or contraceptive failure through various mechanisms: prevention of ovulation, possible prevention of fertilization through alteration of tubal transport of sperm and/or egg, and alteration of the endometrium, which may inhibit implantation.1 Depending upon personal religious and moral views, many pharmacists may see this as “abortive” in nature.

Plan B, however, is not RU-486 (the abortion pill) and will not affect an existing pregnancy or harm a developing fetus.

1

In fact, Plan B works in a fashion similar to that of regular birth control pills; it simply contains a larger dose of the hormone levonorgestrel (the active ingredient in Yaz, Yasmin, and Seasonique).

According to the beliefs of certain religions, life begins at the meeting of sperm and egg, and interference with this process is prohibited. However, prohibiting women from receiving this medication interferes with our duty to serve the healthcare needs of the public. It is the professional responsibility of pharmacists to do what is in the best interests of our patients and provide counseling when we deem it appropriate. Pharmacists take an oath, and by that oath we promise to devote ourselves to a lifetime of service to others and to practice our profession according to moral, ethical, and legal guidelines.2

When looking through the eyes of the opposing side, we perceive its primary argument to be that pharmacists should be able to exercise personal beliefs in the same manner that lawyers pick and choose their clients and doctors decide whether or not to perform abortions. Although it is an extremely valid point, we believe that as pharmacists, we have a duty to provide medication services to our patients without bias or personal beliefs hindering this action.

For instance, when Plan B is denied to a 19-year-old college student who had a “mishap” the previous night and is seeking this medication, what is the duty of the pharmacist? Do we have the right to deny our services to this young woman, or are we obligated to serve her and provide her the information she needs to use this medication safely and effectively? We believe absolutely that it is our responsibility to use such a situation to counsel our patients on the use of Plan B and ways to avoid the same predicament in the future.

The term “emergency contraception” in and of itself touches off a debate within each of us. These words hold specific meaning for each individual, a meaning connected with personal beliefs. The issue of emergency contraception has rocked the ethical and moral codes of most pharmacy practitioners and raised questions about how they feel about dispensing this product. This issue is not one to be decided overnight. The debate may never be resolved. It may continue through the years, testing our personal beliefs and religious boundaries over the course of our careers as practicing pharmacists.

Kristin Thienemann, Brittany Ward, Kathleen Welch, and Kenneth Willinger III are PharmD Candidates, Class of 2011, at Sullivan University College of Pharmacy, Louisville, Ky.

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