A trial currently taking place in Tacoma Federal Court has some significant implications for the conscience rights of individuals, not only in the state of Washington, but across the country. The issue at hand is whether a pharmacist can be compelled to stock and sell a medication whose mode of action contradicts his/her personal moral standards. The drug under discussion is known as Plan B (technically known as levonorgestrel). This medication is to be taken within 72 hours after sexual intercourse in order to prevent pregnancy (1).

What is Plan B? According to the company web site, ”Plan B One-Step® is a backup plan that helps prevent pregnancy after birth control failure.” The site goes on to state ”Plan B One-Step® is not the abortion pill and it isn’t a substitute for routine birth control.” This statement attempts to differentiate Plan B from the known abortion-producing RU-486 (mifeprisone) which has become widely used for inducing abortions in the very early stages of pregnancy (2).

The plaintiffs in the present case are Ralph’s Thriftway pharmacy in Olympia and two licensed Washington pharmacists – Margo Thelen and Rhonda Mesler (3). These individuals believe it is a violation of their religious conscience to be required to stock and dispense drugs that can produce an abortion. The owner of the pharmacy stated that ”All our family wants is the chance to keep doing what Ralph’s Thriftway has aimed to do for four generations: to serve our customers in keeping with our deepest values.” The trial is currently underway and expects to close by December 21

The technical heart of the issue is whether Plan B causes abortions. The company web site denies the claim. But there is evidence to suggest that one of the mechanisms of action for this drug is to prevent implantation of a fertilized egg (4). To many individuals, once the egg is fertilized, any attempts to interfere with the normal development of pregnancy from that point on are considered an abortion.

The ”conscience clause” in Washington state law has been controversial for years. State law (5) has allowed individuals and organizations to opt out of providing services ”if they object to so doing for reason of conscience or religion”. However, in more recent years, there have been attempts made to remove this freedom and force the provision of goods and services in spite of personal moral objections. The Washington State Board of Pharmacy ruled in 2007 that all pharmacies stock and supply all medications a customer may request, including controversial drugs such as plan B. Subsequent debate led to a state Pharmacy Board meeting in November of 2010 upheld the 2007 regulation, effectively eliminating any option of a conscience clause (6).

On the federal level, there is pressure to make Plan B available to anyone of any age without a prescription. On December 7, 2011, Health and Human Services Secretary Kathleen Sebelius overruled an earlier FDA recommendation to make the drug available without prescription to females of all ages (7). Immediately, fourteen senators (thirteen Democrats and one independent) sent her a letter protesting this decision (8). The group was led by Patty Murray (D-Washington). Senator Maria Cantwell of Washington was a cosigner of the letter.

What does all this mean for the ordinary citizen? In summary, we are seeing growing encroachment of the religious and ethical freedoms we have had for decades. As medical science progresses, there are more ethical dilemmas that require individual evaluation and decision. More and more, we are seeing these decisions being taken out of our hands and decided by groups that do not share our basic values. My next column will pursue this issue further by taking a look at recent executive decisions to force organizations to provide insurance and services that cover abortion as well as the ”morning after” pill.

Plan B One-Step: http://planbonestep.com/index2.aspx
RU-486 Facts: http://www.ru486facts.org/
”Trial over Plan B prescriptions begins Monday”, Seattle Times, November 27, 2011

http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/021998lbl.pdf

RCW 48.43.065 http://apps.leg.wa.gov/rcw/default.aspx?cite=48.43.065
”Conscience Rights at Stake”, Washington State Catholic Conference, December 2, 2011

http://www.thewscc.org/index.php?option=com_content&view=article&id=67&Itemid=38

http://www.hhs.gov/news/press/2011pres/12/20111207a.pdf

http://murray.senate.gov/public/index.cfm/newsreleases?ContentRecord_id=77e3d54b-bb6b-4c7c -9f05-bfe8c8d3b304