Pharmacist Conscience Clauses: Laws and Information
Updated September 2018
Health providers can generally refusal services based on personal beliefs. Also known as "conscience clauses", these protections 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 right to privacy, overturning 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.
The issue now includes pharmacists who refusing to fill emergency contraception and contraception prescriptions. Conscience clauses give pharmacists the right to refuse to perform certain services if it violates their religious or personal beliefs or values. Most conscience-related policies focus on the pharmacist dispensing emergency contraception. Emergency contraception is used to disrupt fertilization or ovulation, 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 does not cause an abortion, unlike mifepristone which is sometimes referred to as non-surgical abortion, medical abortion, or RU-486. Pharmacists do not play a role in administering mifepristone. They can, however, provide misoprostol which is often dispenses in conjunction with mifepristone.
Some states explicitly grant pharmacists the right to refuse to dispense drugs related to contraception on moral grounds. Other states require pharmacies to fill any legal prescription for birth control or any other medication.
Below are three categories of laws being enacted on this topic. The first is pharmacists’ right to refuse with patient protections, such as referrals to other providers or other protections that ensure patient access (6 states). The second type of laws are pharmacists’ right to refuse laws that do not include patient protections (7 states). The third category is laws that apply to health care providers generally but may or may not apply to pharmacists (7 states).
Right to Refuse with Patient Protections
Cal. Bus. & Prof. Code § 733 (2009)- A licentiate shall not obstruct a patient in obtaining a prescription drug or device that has been legally prescribed or ordered for that patient.
Delaware Code Regs. 24 2500 §188.8.131.52 (Regulations 2009)- Allows the refusal to dispense pharmaceuticals based on the religious, moral, or ethical beliefs of the dispensing pharmacist, however these procedures shall include proper supervision of supportive personnel and delegation of authority to another pharmacist when not on duty.
New York Policy Guideline Concerning Matters of Conscience (Regulation 2009) – In the case of a pharmacist who realizes they have a moral objection to providing a certain medication, the pharmacist has a professional obligation to take appropriate steps to avoid the possibility of abandoning or neglecting a patient. When a pharmacist begins practice in a professional setting, they should take steps that may include notification to the owner and supervising pharmacist if their beliefs will limit the drug products they will dispense.
North Carolina Board of Pharmacy (Regulation 2005)- A pharmacist has the right to avoid being complicit in behavior that is inconsistent with his or her morals or ethics, however it is unacceptable for pharmacists to impose their moral or ethical beliefs on the patients they serve. Pharmacists cannot obstruct a patient’s right to obtain such medication.
The Oregon Board of Pharmacy (Regulation 2005) – Requires the Pharmacist-in-Charge (PIC) to adopt written policies and procedures that address the issues of pharmacists' moral, ethical and professional responsibilities. Pharmacy policies and procedures could allow a pharmacist to exercise his or her choice to not participate, and at the same time not interfere with the patient's right to receive appropriate and lawfully prescribed drug therapy or drugs.
Pennsylvania Cons. §27.103 (2009) – Pharmacists may decline to fill or refill a prescription if, in the pharmacist’s professional judgment exercised in the interest of the safety of the patient, the pharmacist believes the prescription should not be filled or refilled. When a pharmacist recognizes that religious, moral or ethical beliefs will result in the refusal to fill a prescription that is otherwise available in a pharmacy, the pharmacist has a professional obligation to take steps to avoid the possibility of abandoning or neglecting a patient.
Right to Refuse without Patient Protections
Georgia Admin. Code § 480-5-.03 (2001) – 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.
Arizona Rev Stat § 36-2154 (2009) – Allows a pharmacist to refuse to participate in abortion, abortion medication or emergency contraception.
Arkansas § 20-16-304(1973) – Physicians, pharmacists and private institutions cannot be required to fill a prescription if their refusal is based on religious or conscientious objection.
Idaho Code § 18-611 (2010) – Provides that no health care professional shall be required to provide any health care service that violates his or her conscience.
South Dakota Codified Laws § 36-11-70 (1998) – Allows pharmacists the right to refuse to provide services.
Missouri RS 191.724 (2012) – No employer, health plan provider, health plan sponsor, health care provider, or any other person or entity shall be compelled to provide coverage for, or be discriminated against or penalized for declining or refusing coverage for, abortion, contraception, or sterilization in a health plan if such items or procedures are contrary to the religious beliefs or moral convictions of such employer, health plan provider, health plan sponsor, health care provider, person, or entity.
Texas Insurance Code § 1271.007 (2003) – Allows a health maintenance organization, physician, or provider to refuse to recommend, offer advice concerning, pay for, provide, assist in, perform, arrange, or participate in providing or performing any health care service that violates the religious convictions of the health maintenance organization, physician, or provider.
Right to Refuse Laws for Providers (Includes laws with and without patient protections)
Alabama Act 2017-189 (2017) – A health care provider has the right not to participate in services that violate their conscience as long as the provider has objected in writing prior to being asked to provide such services and a plan in place to make sure patient access is not interrupted.
745 Ill. Comp. Stat. Ann. 70/4 (1998) – No physician or health care personnel shall be civilly or criminally liable to any person, estate, public or private entity or public official by reason of his or her refusal to perform, assist, counsel, suggest, recommend, refer or participate in any way in any particular form of health care service which is contrary to the conscience of such physician or health care personnel.
Maine Rev. Stat. tit. 22, 1903 (1973) – Physicians and agents of medical and related facilities have the right to refuse to provide family planning services when such actions would interfere with moral or religious beliefs.
Nev. Admin. Code § 639.753 (2008) – A pharmacist may only decline to fill a prescription if the pharmacist reasonably believes, in his or her professional judgment, that the filling of the prescription would be unlawful, the filling of the prescription would be imminently harmful to the medical health of the patient, the prescription is fraudulent or the prescription is not for a legitimate medical purpose.
NJ Rev Stat §45:14-67.1 (2013) – A pharmacy practice site has a duty to properly fill lawful prescriptions for prescription drugs or devices that it carries for customers, without undue delay, despite any conflicts of employees to filling a prescription and dispensing a particular prescription drug or device due to sincerely held moral, philosophical or religious beliefs.
Wash. Admin. Code §246-869-010 (2007) – Pharmacies have a duty to deliver lawfully prescribed drugs or devices to patients and to distribute drugs and devices approved by the U.S. Food and Drug Administration for restricted distribution by pharmacies, or provide a therapeutically equivalent drug or device in a timely manner consistent with reasonable expectations for filling the prescription. FOR CONTRACEPTION SPECIFICALLY
Wis. Stat. Ann. § 450.095 (2009) – Requires that a pharmacy dispense lawfully prescribed contraceptive drugs and devices and shall deliver contraceptive drugs and devices restricted to distribution by a pharmacy to a patient without delay.
Note: List may not be comprehensive, but is representative of state laws that exist. NCSL appreciates additions and corrections.