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Updated November 2007

Health provider “refusal clauses” (also known as "conscience clauses") were first enacted in response to the United States Supreme Court's decision in the Roe v. Wade case, 410 U.S. 113 (1973).  Roe v. Wade was the landmark decision establishing that most laws against abortion violate a constitutional righy to privacy, overturning all state laws outlawing or restricting abortion.  Some states have subsequently proposed legislation and passed laws designed to allow doctors and other direct providers of health care to refuse to perform or assist in an abortion, and hospitals to refuse to allow abortion on their premises.  Now, the issue is expanding as pharmacists are refusing to fill emergency contraception and contraception prescriptions. This movement resulted in the term “conscience clause," which gives pharmacists the right to refuse to perform certain services based on a violation of personal beliefs or values. Most of the debate revolves around a pharmacist dispensing emergency contraception. Emergency contraception is used to prevent a pregnancy, not terminate a pregnancy, and is a general term used to describe several different types of birth control pills that are used in increased doses within 72 hours of unprotected intercourse.  Emergency contraception is not the same thing as Mifeprex, which is the brand name of mifepristone in the United States and is sometimes referred to as non-surgical abortion, medical abortion, or RU-486.  Pharmacists do not play a role in administering these medications.  

In some states, legislators are introducing bills that would explicitly grant pharmacists the right to refuse to dispense drugs related to contraception on moral grounds. Other state legislators are introducing legislation that would require pharmacies to fill any legal prescription for birth control, much like Governor Blagojevich's emergency rule in Illinois, which requires pharmacies to provide the morning after pill.

California pharmacists have a duty to dispense prescriptions and can only refuse to dispense a prescription, including contraceptives, when their employer approves the refusal and the woman can still access her prescription in a timely manner.

New Jersey's new law (effective November 2007), prohibits pharmacists for refusing to fill prescriptions solely on moral, religious or ethical grounds. (see 2007 legislative chart).

Conscience Clause Laws (allowing the refusal to fill)

Arkansas § 20-9-1001 allows certain individuals or entities to refuse to perform abortion services and provide or dispense contraceptives in all or most circumstances.

California SB 644 Chapter No. 417 prohibits a health care licentiate from obstructing a patient in obtaining a prescription drug or device and would require the licentiate to dispense drugs and devices pursuant to a lawful prescription or order except in specified circumstances, including on ethical, moral, or religious grounds asserted by the licentiate.

Colorado Rev. Stat. 25-6-102 states that no private institution, it employees, or physicians may be held liable for refusing to dispense contraceptive supplies, procedures or information if their refusal is based on a moral or religious objection to such activities.

Florida 2003 Stat. XXIX 381.0051 states that physicians or other people may not be held liable for refusing to dispense contraceptive or family planning devices, services or information.

Georgia Admin. Code § 480-5-.03 provides that a pharmacist shall not be required to fill a prescription for an emergency contraceptive drug; provides that such refusal shall not be the basis for any claim for damages; provides for the duration of the effectiveness of the written objection; provides for related matters; repeals conflicting laws.

Illinois requires pharmacies to dispense contraception. Gov. Rod Blagojevich (D) issued emergency rules that require pharmacies in the state to dispense FDA-approved contraceptives. If the pharmacy does not have the drug or a suitable substitute in stock, then the pharmacy must order the medication through standard procedures, transfer the prescription to another local pharmacy or return the prescription to the patient. The emergency rules will be in effect only for 150 days, after which the state is expected to begin the normal rulemaking process in order to make the requirement rule permanent.

Maine Rev. Stat. tit. 22, 1903 (1973) gives physicians and agents of medical and related facilities the right to refuse to provide family planning services when such actions would interfere with moral or religious beliefs. 

Mississippi Code Ann. § 41-41-215 permits health care providers, including pharmacists or other pharmacy employees, counselors, social workers, health insures and health care facilities to refuse to provide [any] medical services, including counseling and referral, on religious or ethical grounds (SB 2619).

South Dakota Codified Laws § 36-11-70  allows pharmacists the right to refuse to provide services.

Tennessee Code Ann. 68-34-104 allows physicians or any agent of such an entity to refuse to offer contraceptive services, supplies, or information if it interferes with a moral or religious belief.  States that physicians or other agents may not be held liable for this refusal.

On June 1, 2006 the Washington Board of Pharmacy approved proposed rule language regarding a pharmacist’s responsibilities in dispensing a lawful prescription.  This language would amend Washington Admin. Code 246-863-095 to prohibit a pharmacist from delegating the decision not to dispense prescriptions for any reason.

2007 Legislation (as of March 6, 2007)

PHARMACIST REFUSAL CLAUSES and REQUIRE TO FILL
AZ SB 1470 Sen. Aboud	Would allow a pharmacist to refuse to dispense a prescription for a contraceptive if the pharmacist has previously notified the pharmacy in writing of the drug or class of drugs to which the pharmacist objects and another pharmacist in the same pharmacy dispenses the prescription without delay. (Filed and referred to committee 1/29/07)
MO HB 434 Rep. Stevenson	Would establish the Health Care Rights of Conscience Act to protect the religious, moral, or ethical principles held by a health care provider, health care institution, or health care payer.  Under this bill, the definition of "health care provider" includes pharmacists. (Filed and referred to committee 1/17/07)
MO SB 285 Sen. Crowell	Would protect the conscience rights of pharmaceutical professionals, where they would not be required to perform, assist, recommend, refer for, or participate in any service involving a particular drug or device that they have a good faith belief is used for abortions. (Filed and referred to committee 1/16/07)
NC HB 155 Rep. Hilton	Would allow a pharmacist to refuse to prescribe or dispense drugs or devices, based on a moral, ethical or religious objection, that would result in an abortion. (Filed and referred to committee 2/12/07)
NJ A 2016 Rep. Kean	Would permit health care professionals to refuse to perform or assist in health care services that violate their religious, moral, or ethical convictions. (Filed and referred to committee 1/10/06; carried over to 2007 session)
NJ AB 992 Rep. Stender S 1195 Sen. Madden	Would prohibit pharmacists from refusing to dispense medication solely for philosophical, moral or religious reasons. (AB 992 filed and referred to committee 1/10/06; added as a substitute to S 1195 10/19/06) (S 1195 filed and referred to committee 1/30/06; passed Senate 31y-6n, 6/26/06; to Assembly 2nd reading 10/19/06) (S 1195 passed Assembly 6/11/07; Approved P.L.2007, c.199 11/2/07)
NY S 2317 Sen. Duane	Would establish duties for pharmacies when pharmacists employed by such pharmacy refuse to fill prescriptions on the basis of personal beliefs. (Filed and referred to committee 2/2/07)
NY S 2344 Sen. Schneiderman	Would prohibit pharmacists from refusing to dispense medication solely for philosophical, moral, or religious reasons. (Filed and referred to committee 2/2/07)
RI HB 5274 Rep. Brien SB 452 Sen. Goodwin	Would provide protection from discrimination to all health care providers who chose not to participate in a health care service that violates the conscience of the health care provider.  Under this bill, the definition of "health care provider" includes pharmacists. (H 5274 filed and referred to committee 2/1/07: S 452 filed and referred to committee 2/13/07)
SC HB 3283 Rep. Davenport	Would enact the Health Care Freedom of Conscience Act, which would prohibit all forms of discrimination, disqualification, coercion, disability, or liability upon such health care providers, institutions, and payers that decline to perform any health care service that violates their conscience.  Under this bill, the definition of "health care provider" includes pharmacists. (Filed and referred to committee 1/17/07)
SC SB 126 Sen. Bryant	Would allow a pharmacist to refuse to fill prescriptions for a drug, class of drugs, or device on ethical, moral, or religious grounds if the pharmacist has previously notified his employer, in writing, of the drug, class of drugs, or device to which he objects. (Filed and referred to committee 1/9/07)
TX HB 1996 Rep. Gonzalez Toureilles	Would allow a pharmacist to refuse, for moral or ethical reasons, to dispense a prescription drug if the pharmacist follows the policies and procedures established by the pharmacy in which the pharmacist practices to ensure a patient has reasonable access to a valid prescription at that pharmacy or another pharmacy. (Filed and referred to committee 2/26/07)
VT HB 315 Rep. Donahue	Would seek to respect and protect the fundamental rights of conscience of all individuals who provide health care services by allowing a health care provider (includes pharmacists) to not participate in a health care service that violates his or her conscience. (Filed and referred to committee 2/15/07)
WV HB 2092 Rep. Schoen	Would allow pharmacists and other individuals involved in dispensing medicines to refuse to fill prescriptions or dispense any substance that can be used as part of an abortion-related procedure. (Filed and referred to committee 1/12/07)
WV HB 2416 Rep. Hatfield	Would prohibit pharmacists and other persons involved in dispensing medicines from refusing to fill prescriptions. Filed and referred to committee 1/23/07)
WV SB 743 Sen. Sypolt	Would allow pharmacists to refuse to fill prescriptions used as abortion-related procedure. (Filed and referred to committee 2/19/07)

2006 Legislation

PHARMACIST REFUSAL CLAUSES
AL HB 609 Rep. McClurkin	Would give health care providers, health care institutions, and health care payers the authority to refuse to perform or to participate in health care services that violate their conscience and would provide immunity from discrimination based on and liability for such refusal.  Although a general refusal clause, the bill defines "health care provider" to include pharmacists. (Filed and referred to committee 2/9/06; did not pass by end of 2006 regular session)
CA AB 2583 Rep. Nation	Would require the State Board of Pharmacy to create and provide a sign informing a patient of his or her right to timely access to a prescribed drug or device that a licensed pharmacist has refused to dispense based on ethical, moral, or religious grounds.  The bill would require pharmacists authorized to make such a refusal, or their employers, to visibly place the sign at or near the entrance of the business. (Filed and referred to committee 2/24/06; passed House 47y-31n, 5/25/06; passed Senate 24y-15n, 8/17/06; signed into law by governor as Ch. 487, 9/26/06)
GA HB 566 Rep. Loudermilk	Would allow any employee of the agencies engaged in the administration of this chapter to refuse to accept the duty of offering family-planning services to the extent that such duty is contrary to such employee´s personal religious beliefs; would provide that such refusal not be grounds for any disciplinary action, for dismissal, for any interdepartmental transfer, for any other discrimination in employment, for suspension from employment, or for any loss in pay or other benefits.  Would authorize the directors or supervisors of such agencies to reassign the duties of any such employees in order to carry out this chapter effectively.  Would only apply to state employees. (Filed and referred to committee 2/18/05; carried over from 2005 regular session; did not pass by end of 2006 regular session)
GA SB 123 Sen. Whitehead	Would allow a pharmacist who states in writing an objection to any abortion to be exempt from filling a prescription for a drug if the pharmacist believes the drug would have the effect or possible effect of terminating a pregnancy. (Filed and referred to committee 2/7/05; passed Senate 3/2/06; did not pass House by end of 2006 regular session)
IL HB 4230 Rep. Granberg	Would amend the Pharmacy Practice Act of 1987.  Would provide that a pharmacist licensed under the Act may, based on his or her personal religious beliefs, refuse to fill a prescription for and to dispense emergency contraception. (Filed and referred to committee 12/5/05; re-referred to committee 1/4/06)
IL HB 4246 Rep. Stephens	Would amend the Pharmacy Practice Act of 1987.  Would provide that a pharmacist licensed under the Act may, based on his or her personal religious beliefs, refuse to fill a prescription for and to dispense emergency contraception. (Filed and referred to committee 12/12/05; re-referred to committee 1/4/06)
IL HB 4346 Rep. Granberg	Would amend the Pharmacy Practice Act of 1987.  Would provide that a pharmacist licensed under the Act may, based on his or her personal religious beliefes, refuse to fill a prescription for and to dispense emergency contraception. (Filed and referred to committee 1/3/06; first reading and referred to committee 1/4/06; reassigned to committee 3/3/06)
IL HB 4786 Rep. Stephens	Would amend the Pharmacy Practice Act of 1987 to provide that a pharmacist licensed under the Act may, based on his or her personal religious beliefs, refuse to fill a prescription for and to dispense emergency contraception.  Amends the Health Care Right of Conscience Act to add the dispensation of prescribed medication to the list of activities included in the definition of "health care", adds pharmacist to the list of occupations included in the definition of "health care personnel", and adds pharmacy to the list of facilities included in the definition of "health care facility". (Filed and referred to committee 1/18/06)
IL SB 2343 Sen. Brady	Would amend the Pharmacy Practice Act of 1987 to provide that a pharmacist licensed under the Act may, based on his or her personal religious beliefs, refuse to fill a prescription for and to dispense emergency contraception.  Amends the Health Care Right of Conscience Act to add the dispensation of prescribed medication to the list of activities included in the definition of "health care", adds pharmacist to the list of occupations included in the definition of "health care personnel", and adds pharmacy to the list of facilities included in the definition of "health care facility". (Filed and referred to committee 1/12/06)
IN SB 4 Sen. Drozda	Would provide that a person may not be required, as a condition of training, employment, pay, promotion, or privileges, to dispense a medical device or drug that may result in an abortion or a birth control device or medication. (Filed and referred to committee 1/9/06; did not pass by end of 2006 regular session)
MI HB 4741 Rep. Palmer SB 938 Sen. George	Would provide standards for personnel policies to protect and accommodate the right of conscience of health care providers who conscientiously object to providing or participating in certain health care services under certain circumstances; would provide for protection from certain liability; would provide for penalties and remedies. (HB 4741 filed and referred to committee 5/5/05; SB 938 filed and referred to committee 12/13/05; carried over from 2005 regular session)
MI HB 5978 Rep. Gonzales	Would prohibit a pharmacist from refusing to dispense or transfer a prescription based solely on his or her ethical, moral, or religious beliefs. (Filed and referred to committee 4/25/06)
MN HF 2597 Rep. Emmer SF 2430 Sen. Wergin	Would authorize pharmacists to refuse to dispense medication that they find morally objectionable. (Filed and referred to committee 3/1/06; did not pass by end of 2006 regular session)
MN HF 3032 Rep. Emmer SF 2647 Sen. Kiscaden	Would prohibit pharmacists from refusing to dispense a prescription drug or device except under certain circumstances. (Filed and referred to committee 3/1/06; did not pass by end of 2006 regular session)
MN HF 3104 Rep. Goodwin SF 3277 Sen. Lourey	Would require the Board of Pharmacy to investigate and take appropriate discipline against a registered pharmacy if pharmacy employees fail to compound or dispense a drug that is medically appropriate for the patient for which it was prescribed, and the patient is denied a drug that may reasonably be expected to be compounded or dispensed in pharmacies by pharmacists. (Filed and referred to committee 3/2/06; did not pass by end of 2006 regular session)
MN HF 3560 Rep. Goodwin SF 3242 Sen. Lourey	Would prohibit pharmacists from refusing to dispense a prescription drug or device except under certain circumstances. (Filed and referred to committee 3/15/06; did not pass by end of 2006 regular session)
MO HB 1539 Rep. Stevenson	Would establish the Health Care Rights of Conscience Act to protect the religious, moral, or ethical principles held by a health care provider, health care institution, or health care payer.  Specifies that a health care provider is not required to participate in a health care service that violates his or her conscience and will not be held liable for or descriminated against for refusing to provide a health care service.  Although a general refusal clause, the bill defines "health care provider" to include pharmacists. (Filed and referred to committee 2/2/06; favorable committee report 3/8/06; did not pass by end of 2006 regular session)
MO SB 609 Sen. Crowell	Would protect the conscience rights of pharmaceutical professionals, who shall not be required to perform, assist, recommend, refer for, or participate in any service involving a particular drug or device that they have a good faith belief is used for abortions.  In these instances, the pharmaceutical professional shall be immune from civil or criminal liability and will not have their license suspended or revoked.  Would provide that employers cannot refuse to hire, discriminate against, segregate, or terminate a pharmaceutical professional because of their opposition to any service involving a particular drug or device that they have a good faith belief is used for abortions. (Filed and referred to committee 1/4/06; committee hearing conducted 2/13/06; did not pass by end of 2006 regular session)
NH HB 1492 Rep. Hunter	Would grant immunity from liability to pharmacists who refuse to dispense an emergency contraceptive pill. (Filed and referred to committee 1/4/06; public hearing set for 2/14/06; did not pass by end of 2006 regular session)
NH SB 343 Sen. Letourneau	Would establish a pharmacist conscience clause which shields pharmacists refusing to fill emergency contraceptive prescriptions from civil liability and disciplinary action by the pharmacy board. (Filed and referred to committee 1/4/06; did not pass by end of 2006 regular session)
NJ AB 992 Rep. Stender S 1195 Sen. Madden	Would prohibit pharmacists from refusing to dispense medication solely for philosophical, moral or religious reasons. (AB 992 filed and referred to committee 1/10/06; added as a substitute to S 1195 10/19/06) (S 1195 filed and referred to committee 1/30/06; passed Senate 31y-6n, 6/26/06; to Assembly 2nd reading 10/19/06) (S 1195 passed Assembly 6/11/07; Approved P.L.2007, c.199 11/2/07)
NY A 9536 Rep. Seminario	Would give complete and effective civil rights protection to health and human services workers who have conscientious objections to morally offensive medical procedures and policies, including pharmacists who provide contraception. (Filed and referred to committee 1/17/06)
NY S 1873 Sen. Maltese	Would allow any individual to refuse to provide assistance or information, or refuse to refer a person for such assistance or information, when providing a person with any form of assistance of information about contraception or contraceptive devices would be contrary to the conscience or religious beliefs of that individual; would prohibit discrimination by any public or private human services or health care agency, hospital, person, firm, corporation or association against the person so refusing to act. (Filed and referred to committee 2/4/05; carried over from 2005 regular session; refiled and referred to committee 1/4/06)
NY S 5994 Sen. Schneiderman	Would prohibit pharmacists from refusing to dispense medication solely for philosophical, moral, or religious reasons. (Filed and referred to committee 10/12/05; carried over from 2005 regular session; reassigned to committee 1/4/06)
NY S 7361 Sen. Duane	Would establish duties for pharmacies when pharmacists employed by such pharmacyrefuse to fill prescriptions on the basis of personal beliefs and would require a pharmacy to ensure the prescription is filled by another pharmacist. (Filed and referred to committee 4/19/06)
NC HB 1407 Rep. Barnhart	Would allow a pharmacist who states an objection to abortion on moral, ethical, or religious grounds, to refuse to prescribe or dispense drugs or devices that result in an abortion; such refusal would not be a basis for damages or for any disciplinary or any other recriminatory action against the pharmacist. (Filed and referred to committee 4/20/05; carried over from 2005 regular session; did not pass by end of 2006 regular session)
OK HB 2884 Rep. Steele	Would authorize a pharmacist's refusal to dispense medication. (Filed and referred to committee 2/6/06; passed House 64y-34n, 3/14/06; did not pass Senate by end of 2006 regular session)
PA HB 2311 Rep. Kirkland	Would make it illegal for any pharmacist to refuse to dispense or refill a prescription solely on the grounds that dispensing or refilling the prescription would contravene the pharmacist's philosophical, moral or religious beliefs. (Filed and referred to committee 12/7/05; carried over from 2005 regular session)
PA HB 2217 Rep. Frankel	Would establish certain duties for pharmacies when pharmacists employed by the pharmacies refuse to fill valid prescriptions for drugs or devices on the basis of personal beliefs. (Filed and referred to committee 11/14/05; carried over from 2005 regular session)
PA SB 1089 Sen. Williams	Would establish certain duties for pharmacies when pharmacists employed by the pharmacies refuse to fill valid prescriptions for drugs or devices on the basis of personal beliefs. (Filed and referred to committee 3/16/06)
RI HB 5085 Rep. Corvese	Would provide protection from discrimination to all health care providers who chose not to participate in a health care service that violates the conscience of the health care provider. The act would also provide a civil cause of action for damages in instances of violations of this act. (Filed and referred to committee 1/13/05; carried over from 2005 regular session; did not pass by end of 2006 regular session)
RI HB 6793 Rep. Corvese SB 2804 Sen. Alves	Would provide protection from discrimination to all health care providers, including pharmacists, who choose not to participate in a health care service that violates the conscience of the health care provider. (HB 6793 filed and referred to committee 1/17/06; SB 2804 filed and referred to committee 2/14/06; did not pass by end of 2006 regular session)
SD HB 1184 Rep. Van Etten	Would allow health care providers, including pharmacists, and institutions to refuse to participate in certain health care services if those services violate the conscience of the health care provider; would provide protection from discrimination and administrative and civil liability. (Filed and referred to committee 1/23/06; did not pass House 2/6/06; reconsideration failed 2/7/06)
TN HB 1383 Rep. Casada	Concerns pharmacy and pharmacists; enacts the "Pharmacist's Freedom of Conscience Act." (Filed and referred to committee 2/9/05; carried over from 2005 regular session; did not pass by end of 2006 regular session)
TN SB 76 Sen. Finney	Concerns pharmacy and pharmacists; enacts the "Pharmacist's Freedom of Conscience Act." (Filed and referred to committee 1/13/05; carried over from 2005 regular session; did not pass by end of 2006 regular session)
VT HB 183 Rep. Donahue	Would respect and protect the fundamental rights of conscience of all individuals who provide health care services. (Filed and referred to committee 2/8/05; carried over from 2005 regular session; did not pass by end of 2006 regular session)
WA HB 1654 Rep. Ahern	Would ensure health care provider and insurer right of conscience. (Filed and referred to committee 2/1/05; carried over from 2005 regular session and reintroduced 1/9/06; did not pass by end of 2006 regular session)
WA SB 5851 Sen. Mulliken	Would ensure health care provider and insurer right of conscience. (Filed and referred to committee 2/10/05; carried over from 2005 regular session and reintroduced 1/9/06; did not pass by end of 2006 regular session)
WV HB 2042 Rep. Schoen	Would allow pharmacists and other individuals involved in dispensing medicines to refuse to fill prescriptions or dispense any substance that can be used as part of an abortion-related procedure. (Filed and referred to committee 1/11/06; did not pass by end of 2006 regular session)
WV HB 2807 Rep. Hatfield	Would prohibit pharmacists and other persons involved in dispensing medicines from refusing to fill prescriptions. (Filed and referred to committee 1/11/06; did not pass by end of 2006 regular session)
WV HB 3030 Rep. Houston	Would provide that health care providers (including pharmacists), health care institutions, or health care payers are not required to participate in abortion procedures that violate their respective consciences. (Filed and referred to committee 1/11/06; did not pass by end of 2006 regular session)
WV  HB 4449 Rep. Houston SB 447 Sen. Sprouse	Would provide that health care providers (including pharmacists), health care institutions, or health care payers are not required to participate in abortion procedures that violate their respective consciences. (Filed and referred to committee 2/7/06; did not pass by end of 2006 regular session)
WV  HB 4644 Rep. Kiss	Would provide that pharmacists may exercise moral discretion without legal consequence to refuse to fill a prescription for "the morning after pill." (Filed and referred to committee 2/20/06; did not pass by end of 2006 regular session)
WV SB 29 Sen. Weeks	Would allow pharmacists and others to refuse to dispense abortion-related prescriptions. (Filed and referred to committee 1/11/06; did not pass by end of 2006 regular session)
WV SB 673 Sen. Barnes	Would give pharmacists the right to refuse to provide services. (Filed and referred to committee 3/21/05; carried over from 2005 regular session; did not pass by end of 2006 regular session)
WI AB 285 Rep. Owens	Would provide that a pharmacist's refusal to dispense a prescribed drug or device because he or she believes that the drug or device would be used for a purpose described above may not be the basis for a claim for damages against the pharmacist or the pharmacist's pharmacy.  Also, such a refusal may not be the basis for disciplinary action. (Filed and referred to committee 4/4/05; carried over from 2005 regular session; did not pass by end of 2006 regular session)
WI SB 155 Sen. Reynolds	Would relate to employment discrimination based on creed and exemption from liability and discipline for pharmacists who refuse to dispense for abortions, assisted suicides, and euthanasia; would provide that a pharmacist's refusal to dispense a prescribed drug or device because he or she believes that the drug or device would be used for a purpose described above may not be the basis for a claim for damages against the pharmacist or the pharmacist's pharmacy. (Filed and referred to committee 4/1/05; carried over from 2005 regular session; did not pass by end of 2006 regular session)

2005 Legislation

PHARMACIST REFUSAL CLAUSES

REQUIRES A PHARMACIST TO FILL PRESCRIPTIONS

GENERAL CONSCIENCE CLAUSES

Sources: National Conference of State Legislatures; Denver, Colorado.

Compiled by NCSL Health Program, Denver.

Note: List may not be comprehensive, but is representative of state laws that exist. NCSL appreciates additions and corrections.