I understand that we wouldn't want to make Plan B seem like a condom alternative, but there is a documented problem with doctors and pharmacists refusing to write/fill these prescriptions. I would be interested in proposals that would eliminate this barrier.
Here are some relevant studies:
Acad Emerg Med. 2005 Oct;12(10):987-93.
Availability of emergency contraception in Massachusetts emergency departments.
Temin E, Coles T, Feldman JA, Mehta SD.
Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA 02118, USA.
OBJECTIVES: To determine the availability of emergency contraception (EC) in Massachusetts emergency departments (EDs) and to identify patient, hospital, and system factors that could affect access to EC. METHODS: This was a prospective, cross-sectional study of all Massachusetts EDs using two structured scenarios: one, a patient asking for EC for condom failure (patient scenario); and the other, a social worker asking about EC for a client who was sexually assaulted the night before (social worker scenario). Calls were made during day and night shifts requesting information from a nurse or doctor. The data collected included EC availability, whether pills or prescription would be given, cost, services available to rape victims, and other institutions where EC could be obtained. Descriptive statistics and chi-square were used for comparisons. RESULTS: Responses were made by 248 of 288 nurses, ten of 288 physicians, and 30 of 288 clerks. Overall, EC was reported to be available in 80% of calls, not available in 15%, and up to the physician in 5%. In the patient scenario day shift, 53 of 72 (73%) responded that EC was available, 15 of 72 (20%) stated it was not available, and four of 72 (5%) said it was up to prescribing physician. In the social worker scenario day shift, 62 of 72 (86%) reported that EC was available, six of 72 (8%) reported it was not available, and four of 72 (5%) stated it was up to the prescribing physician. Availability did not vary comparing day vs. night shift for either scenario. Of the nine Catholic hospitals, for the patient scenario, one of nine (11%) reported that EC was available, seven of nine (78%) reported that EC was not available, and in one of nine (11%), it was up to the physician. In the social worker scenario, five of nine (56%) reported EC was available, three of nine (33%) reported it was not available, and in one of nine (11%), it was up to the physician. CONCLUSIONS: There was significant variability in access to EC in Massachusetts EDs and in services for sexual assault survivors. Hospital type and provider preference affected availability. This study suggests that access to EC is limited, and that there are not consistent services for women seeking EC, including for victims of sexual assault.
Contraception. 2003 Oct;68(4):261-7.
Pharmacists' knowledge and the difficulty of obtaining emergency contraception.
Bennett W, Petraitis C, D'Anella A,Marcella S.
University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, 675 Hoes Lane, Piscataway, NJ 08854, USA.
[email protected]
This cross-sectional study was performed to examine knowledge and attitudes among pharmacists about emergency contraception (EC) and determine the factors associated with their provision of EC. A random systematic sampling method was used to obtain a sample (N = 320) of pharmacies in Pennsylvania. A "mystery shopper" telephone survey method was utilized. Only 35% of pharmacists stated that they would be able to fill a prescription for EC that day. Also, many community pharmacists do not have sufficient or accurate information about EC. In a logistic regression model, pharmacists' lack of information relates to the low proportion of pharmacists able to dispense it. In conclusion, access to EC from community pharmacists in Pennsylvania is severely limited. Interventions to improve timely access to EC involve increased education for pharmacists, as well as increased community request for these products as an incentive for pharmacists to stock them.
Obstet Gynecol. 2006 May;107(5):1148-51.
Refusals by pharmacists to dispense emergency contraception: a critique. Wall LL, Brown D.
Department of Obstetrics-Gynecology, Washington University, St. Louis, Missouri 63110, USA.
[email protected]
Over the past several months, numerous instances have been reported in the United States media of pharmacists refusing to fill prescriptions written for emergency postcoital contraceptives. These pharmacists have asserted a "professional right of conscience" not to participate in what they interpret as an immoral act. In this commentary, we examine this assertion and conclude that it is not justifiable, for the following reasons: 1) postcoital contraception does not interfere with an implanted pregnancy and, therefore, does not cause an abortion; 2) because pharmacists do not control the therapeutic decision to prescribe medication but only exercise supervisory control over its dispensation, they do not possess the "professional right" to refuse to fill a legitimate prescription; 3) even if one were to grant pharmacists the "professional right" not to dispense prescriptions based on their own personal values and opinions, pharmacists "at the counter" lack the fundamental prerequisites necessary for making clinically sound ethical decisions, that is, they do not have access to the patient's complete medical background or the patient's own ethical preferences, have not discussed relevant quality-of-life issues with the patient, and do not understand the context in which the patient's clinical problem is occurring. We conclude that a policy that allows pharmacists to dispense or not dispense medications to patients on the basis of their personal values and opinions is inimical to the public welfare and should not be permitted.
J Med Philos. 2005 Dec;30(6):579-92.
Dispensing with liberty: conscientious refusal and the "morning-after pill".
* Fenton E, Lomasky L.
Department of Philosophy, University of Virginia, Charlottesville, Virginia 22904, USA.
[email protected]
Citing grounds of conscience, pharmacists are increasingly refusing to fill prescriptions for emergency contraception, or the "morning-after pill." Whether correctly or not, these pharmacists believe that emergency contraception either constitutes the destruction of post-conception human life, or poses a significant risk of such destruction. We argue that the liberty of conscientious refusal grounds a strong moral claim, one that cannot be defeated solely by consideration of the interests of those seeking medication. We examine, and find lacking, five arguments for requiring pharmacists to fill prescriptions. However, we argue that in their professional context, pharmacists benefit from liberty restrictions on those seeking medication. What would otherwise amount to very strong claims can be defeated if they rest on some prior restriction of the liberty of others. We conclude that the issue of what policy should require pharmacists to do must be settled by way of a theory of second best. Asking "What is second best?" rather than "What is best?" offers a way to navigate the liberty restrictions that may be fixed obstacles to optimality.
Even in cases of assault there is some reluctance to prescribe Plan B. As an OTC this barrier will be eliminated, but what good is it, if even a woman who is raped is denied the pill by her pharmacist?
There have been several mainstream and local press articles about this as well, in such magazine/papers as USA Today, Science and the Washington Post. These instances of refusal to dispense are not only occuring in some backwater locations, this is happening in big cities. Consider
this article written by a woman in Cleveland, Ohio who had to parade from hospital to hospital and then from pharmacy to pharmacy in an attempt to get Plan B.
Would making this OTC prevent pharmacies from stocking the drug? If stores are stocking it, will pharmacists no longer refuse to give it out?
Perhaps this should be stocked with behind the cashier's counter with the cigarettes? Of course, how do we know the cashier won't refuse to give it out, too?
This is not directed at all of you who are not preventing this drug from being obtained. I realize that not all doctors refuse to write the prescription. I realize that not all drug stores refuse to stock it. I realize that not all pharmacists refuse to dispense/fill it.
