The pharmacy sign riddle

At my local pharmacy, there’s a big sign on the wall near the pick-up counter. A variation of it hangs at any accredited pharmacy in the United States, as part of their legal liability. I’d like to talk about this sign. There is a certain dishonesty to it that does not sit well with me. At all.

In essence, it states three important things. Two of them are indicated by bullet points, in large font at the top. The third is further town and in smaller italics. However, they are all the same- reasons that you can show up with a legal prescription and not leave with what was prescribed.

The first two are pretty obvious and non-controversial. The first is that if a pharmacy doesn’t have the relevant drug in stock, they can’t give it to you. The second is that if the pharmacist thinks in their professional opinion that what you are seeking will have a serious negative effect on their health, they can deny it to you. The first is math, the second is the reason pharmacists are not low-level retail clerks.

Thirdly, almost (but not actually) as an afterthought, it the moral out clause. If the pharmacist has some kind of religious or personal objection, they can refuse you service. They are (theoretically) supposed to find a nearby pharmacy that will fill that prescription, but there are several problems with that. Plenty of Americans live in rural and semi-rural places where pharmacies are far apart, often with restrictive hours. If you don’t have a car and your local pharmacy wants nothing to do with you, you’re boned. And of course, if all the nearby pharmacists also have religious or personal objections, it becomes a farce.

This mostly applies to birth control. Now there is a substantial argument that birth control shouldn’t need a prescription at all; ACOG, the dominant group of ob-gyn doctors in the United States, says overly restrictive access is more dangerous than potential complications from the medicine. But as it stands, birth control is a huge chunk of prescriptions for women. And the refusals are across many states and crop up year after year. As the National Women’s Law Center explains:

Reports of pharmacist refusals to fill prescriptions for birth control—or provide EC [ed: emergency contraception like Plan B] to individuals who do not require a prescription—have surfaced in at least twenty-four states across the nation…

These refusals to dispense prescription contraceptives or provide EC are based on personal beliefs, not on legitimate medical or professional concerns.  The same pharmacists who refuse to dispense contraceptives because of their personal beliefs often refuse to transfer a woman’s prescription to another pharmacist or to refer her to another pharmacy.  These refusals can have devastating consequences for women’s health.

Now as someone who believes in civil liberties to a degree that most people wouldn’t venture, I understand that freedom to act the way you wish is important. At the same time, I find trained individuals refusing to fulfill their obligations troubling, and a creeping of conservative religious beliefs into realms that create a great amount of conflict.

A pharmacy is not a restaurant. It is an essential building where the ideology of its employees can have a serious impact. If the waiters at the local BBQ joint are a bit too conservative for you, it’s not a terrible burden for you to seek somewhere more hospitable to eat. If you’re looking for drugs that may shape you short and long-term, things are more constrained.

I’ll go further and say that this third statement is in tension with the second. Denying based on a moral belief can create a serious impact on someone’s health- for instance, a woman unable to get emergency contraception could have problems beyond possible pregnancy- it could have dangerous mental and emotional effects. The second statement says that the reason to withhold drugs is a belief that giving them will cause damage. The third is silent on the fact that withholding drugs can also create damage.

The next time you visit your pharmacy, looks for this sign. Read through it, see what it says openly and what the fine print states as well. Then see if you, like me, feel it doesn’t quite add up.

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