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Morality of a ‘morning-after pill’

FDA decision to make Plan B available over the counter
raises moral questions for some pharmacists
Sunday, October 15, 2006 | 12:00 a.m. CDT; updated 11:42 p.m. CDT, Monday, July 21, 2008

Darran Alberty has no objections to selling Plan B emergency contraceptives at his pharmacy.

Why? He says it’s simple. Plan B is a medicine. He’s a pharmacist. He said his job at D & H Prescription Drug Store on Paris Road is to sell medicine to customers who want it.

[photo]

Plan B, an emergency contraceptive that can prevent pregnancy up to 72 hours after unprotected sex, retails for $25 or more. The FDA recently approved the drug for over-the-counter sales which are expected to begin by the end of the year.

(STEVE BARTEL/Missourian)

Plan B doesn’t sell very often anyway, he said.

But the contraceptive that Alberty and many other pharmacists sell without question has launched a battle of rhetoric across the country. Opponents of the drug say it’s irresponsible and it stops a life. Supporters say it can protect a woman’s sexual health and serve as a safeguard for rape victims.

Either way, the FDA says Plan B, commonly called the “morning-after pill,” will be sold over-the-counter to women age 18 and older at U.S. pharmacies by year’s end. The medicine was formerly sold by prescription only, and the FDA has maintained the prescription rule for customers age 17 and younger.

Plan B is marketed by Duramed Pharmaceuticals Inc., a subsidiary of Barr Pharmaceuticals Inc. The drug works by preventing ovulation, interfering with fertilization or possibly inhibiting an egg from implanting itself into the endometrium if it has already been fertilized, Barr spokeswoman Carol Cox said. Plan B is not the same as RU-486, also known as the “abortion pill,” which is FDA-approved for non-surgical, first trimester abortions.

Plan B contains high levels of the same hormone used in other birth control medicines, and if taken within 72 hours of having unprotected sex, the drug is 89 percent effective in preventing pregnancy. Plan B will be useless if a woman is already pregnant and an egg has already attached to the uterus, Cox said.

Despite the differences between Plan B and more intense pharmaceuticals such as the “abortion pill,” some health care providers and politicians say the medicine crosses moral and religious lines.

The long-standing question is this: Do pharmacists have a duty to provide consumers with products that may conflict with their personal beliefs?

Lori Bowland, a pharmacist at Saults Drug Store in Fulton, says the answer is yes. Bowland is a Catholic who is morally opposed to a drug she said she would never personally use. Still, she said she has sold Plan B since it was introduced and approved by the FDA in 1999 without passing judgment on consumers who request it.

“I’m a health care provider, and I just think it’s my job to provide medicine to people,” said Bowland, who lives in Columbia. “I don’t think my opinions come into that.”

Bill Bondeson, a philosophy professor at MU who has taught medical ethics courses, said a pharmacist should provide customers with any medication he or she wants or needs, within the realm of the law.

Bondeson said health care workers are entitled to their beliefs, but he said they should not have the power to withhold medication from individuals if doctors have decided they need it. If pharmacists feel uncomfortable with selling Plan B, he said, they should send consumers elsewhere.

“The pharmacist is obviously going to be concerned about how the medicine is going to be used and whether or not it’s going to be used as a contraceptive or used for (what they view as) some form of abortion,” Bondeson said. “They might think they’re enabling people to do things they believe are morally wrong.

“I’m sympathetic to the pharmacists, and if a pharmacist has objections to providing that type of medication and wants to find someone else to provide it, that’s certainly a reasonable way around that problem,” Bondeson said.

A number of pharmacies in Columbia sell Plan B, including Walgreens. For pharmacists who believe selling the medicine compromises their beliefs, Walgreens implements a policy it calls a “conscience clause.”

Where state law allows, Walgreens’ conscience clause provides that pharmacists who do not wish to fill Plan B prescriptions may refer customers to another pharmacist on duty. The company’s pharmacists also may arrange for prescriptions to be filled at a nearby pharmacy while customers wait, if no other pharmacists are available.

Walgreens corporate spokeswoman Carol Hively said few of the company’s pharmacists have expressed objections to filling Plan B prescriptions, and she said the company offers training to help prepare workers for potential ethical dilemmas.

Committees in the Missouri General Assembly considered several bills last session that would have affected Plan B sales in the state’s pharmacies. One bill, for example, would have required pharmacists to dispense prescriptions without delay and without judgment, or refer customers elsewhere.

Another proposed bill, however, would have exempted pharmacists from any such requirements and would have protected them from civil or criminal liability for not dispensing valid prescriptions. Even a pharmacist who refused to fill a prescription or refer a consumer would not have his or her license revoked.

Gov. Matt Blunt has pushed for legislation of the second type, freeing pharmacists from penalties for not dispensing drugs they find morally objectionable.

Several of the pharmacies in Columbia that do not stock Plan B, including The Medicine Shoppe on Broadway, choose not to sell it for business reasons. Pharmacist Mary Walden said the store serves primarily older customers, so if The Medicine Shoppe stocked contraceptives such as Plan B, they would likely sit on the shelves until they expire.

Despite concerns from lawmakers and the public, Missouri Pharmacy Association CEO Ron Fitzwater said choosing to sell Plan B is rarely an ethical decision. His organization has not polled its approximately 1,200 members, but Fitzwater said many members with whom he spoke said the FDA’s decision to allow over-the-counter Plan B sales will change little.

“I know there’s a push to make this a moral issue,” said Fitzwater, “but from most pharmacists’ perspectives, it’s just a business change.”

Plan B will be sold over-the-counter by the end of 2006, Cox said. The company is preparing packaging, determining how the medicine will be distributed to stores and organizing an education program for Plan B.

Until then, women will need a prescription to use the drug. Bondeson said prescriptions should be filled, in one way or another, without question.

“I think health providers, in general, are there to help people carry out their own best interests,” he said. “When push comes to shove, medicine exists to help people better their lives.”

Plan B

What It Is

An emergency contraceptive that may help prevent a woman from becoming pregnant after she has unprotected sex. The drug is often used when condoms break or when a woman is raped.

Who Can Get It

Currently, women who have a valid prescription. Soon, women 18 and over will be able to get it over-the-counter as a result of approval from the FDA in August.

What It Costs

About $25, according to a representative from the company that sells Plan B. Some pharmacies charge more, however, after adding their own fees.

Why It Matters

The access of Plan B over-the-counter prompts the ethical debate of pregnancy prevention methods. Lawmakers have spent hours debating whether Plan B prescriptions have to be filled, but pharmacists must also confront the ethics involved with selling the drug.


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