Under current Maryland law, pharmacists are required to fill all lawful prescriptions unless they choose not to based on “professional judgment, experience, knowledge, or available reference materials.” Typically, this would allow a pharmacist to refuse to fill a prescription that might, in combination with other medication, put the patient at risk of an adverse reaction, or that might cause an allergic reaction or where the pharmacist was aware of drug abuse or misuse, etc. Virginia law currently allows a pharmacist to deny filling a prescription without clear limits on the grounds the pharmacist may invoke to do so. Although the original intent of the Virginia statute may have been to allow pharmacists to avoid filling fraudulent prescriptions, there is concern that pharmacists may claim the statute permits them to refuse to fill a prescription on the basis of their religious or other personal beliefs.
Over the last several years there have been reports across the nation of incidents where pharmacists have refused on moral or religious grounds to fill lawful prescriptions, often for contraceptives. There have been still other cases in which employees of a pharmacy have refused to fill a lawful prescription on moral or religious grounds and have then refused to transfer that lawful prescription to another pharmacist or to another pharmacy, thus preventing pharmacy customers from obtaining medications prescribed by their physicians. This has prompted the introduction of bills in the Maryland legislature that would subject pharmacists to disciplinary action – including suspension or revocation of a pharmacy’s license -– for refusal to fill lawful prescriptions (except as currently permitted) and has also raised calls to consider “conscience clause” legislation that would allow a pharmacist or pharmacy to refuse to fill a prescription on moral or religious grounds under certain circumstances.
Federal and state legislatures have considered legislation that would govern whether, and if so, under what circumstances, a pharmacy or pharmacist may, for moral or religious reasons, refuse to fill a lawful prescription (laws of this type have been termed pharmacist conscience clauses). Supporters of such laws maintain that, like physicians covered by similar legislation, pharmacists should not be forced to engage in activity that violates their personal beliefs. Opponents, on the other hand, maintain that pharmacy customers have a right to receive medication prescribed by their physicians and that pharmacists have a duty to serve the public and cannot interject their personal beliefs to override the medical judgments and lawful prescriptions of physicians.
Proposals for a conscience clause for pharmacists potentially impact three distinct constituencies: pharmacists, pharmacies and pharmacy customers. Like other aspects of the health delivery system, pharmacies and pharmacists – like public utilities – are regulated and licensed entities that do not operate in a fully free market.
Consumers need to have the unqualified ability to purchase lawfully prescribed medications from pharmacies without interference premised on a pharmacist’s personal beliefs. The availability of lawfully prescribed medications is a matter of public concern; and there should be no doubt about the rights of the public to have access to lawfully prescribed medications.
Any accommodation designed to permit pharmacies to act on the basis of their religious or moral beliefs must be subordinated to the right of the public to have prescriptions filled. In theory, it might be possible to fashion rules under which a pharmacy could, as a matter of conscience, decline to fill lawful prescriptions without burdening customers. But there is no practical way to fashion such rules without risking the rights of pharmacy customers to unobstructed access to all lawfully prescribed medications. Pharmacies may make accommodations for the religious beliefs of pharmacists they employ, but only where such accommodations do not interfere with the customers’ unqualified right to have their prescriptions filled without delay or potential embarrassment.
For these reasons, the JCRC resolves as follows:
Pharmacies have responsibilities akin to public utilities and the JCRC therefore (1) opposes legislation that would allow a pharmacy to obstruct the decision of a physician to prescribe any lawful medication for a patient by refusing to fill the prescription on moral or religious grounds and (2) supports legislation that would require every pharmacy to fill all lawful prescriptions. JCRC’s support for legislation requiring pharmacies to fill all lawful prescriptions is not intended to preclude a pharmacy from adopting a policy to accommodate the religious objections of individual employees to dispensing particular pharmaceutical products so long as all lawful prescriptions are promptly and conveniently filled with no inconvenience to the pharmacy customer – for example where pharmacy policy forbids employees unwilling to fill lawful prescriptions on religious grounds from having direct contact with patients or physicians and their staff.
Adopted January 11, 2007