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The Moral Dilemma for Pharmacists

Posted on: Wednesday, 26 October 2005, 21:00 CDT

By Gala M. Pierce Daily Herald Staff Writer

Pharmacists Glenn Kosirog and Luke Vander Bleek have no qualms about dispensing regular birth control.

But they see emergency contraception in quite a different light.

While the former works solely as a preventive measure, Plan B emergency contraception might abort a human embryo by preventing the fertilized egg from implanting in a woman's womb, they say.

Gov. Rod Blagojevich recently mandated that if pharmacies stock any contraceptives, they need to dispense federally approved emergency contraception "without delay."

And it has caused a moral dilemma for some pharmacists such as Vander Bleek and Kosirog, who also own drugstores.

"I can't think of another occupation in the United States that would require you to do something against your conscience," said Kosirog, a Wheaton resident who runs a pharmacy in Chicago with his wife.

The pair could decide to not stock contraceptives at all but instead are taking the governor to court.

"I'm not comfortable being out of compliance, but I'm less comfortable being in a moral dilemma," said Vander Bleek, who owns or is partner to four pharmacies, including in his hometown of Morrison.

Also named on the lawsuit is the Illinois Division of Professional Regulation, which regulates and licenses industries and professions while protecting residents in the process.

Originally, Vander Bleek filed a lawsuit in June against the emergency rule Blagojevich enacted, which became permanent in August. Kosirog joined Vander Bleek in filing another lawsuit in September.

On Sept. 26, a Sangamon County judge denied an "emergency" request for a temporary restraining order that would have blocked the enforcement of that rule.

St. Louis attorney Ed Martin, who is representing the two pharmacists, plans to file a preliminary junction Oct. 28. It also would block enforcement until the judge rules on the case.

"We're not very optimistic, but we're going to file it anyway," Martin said.

Moral dilemma

The U.S. Federal and Drug Administration says emergency contraception is a method of preventing pregnancy used after a contraceptive fails or following unprotected sex.

The government approved two emergency contraceptives available by prescription only: Preven and Plan B, approved in 1998 and 1999, respectively.

Plan B has sparked concern among opponents of abortion because of how it can potentially destroy a fertilized egg.

The FDA's Center for Drug Evaluation and Research asserts that if a fertilized egg is implanted in the womb before Plan B is taken, the contraceptives simply will not work.

Most often, the pills stop the release of an egg from the ovary or the process of ovulation, according to the FDA. The hormones also may prevent the union of sperm and egg.

However according to the organization's 2004 data, if fertilization does occur, Plan B may prevent a fertilized egg from attaching to the womb.

This is what concerns the pharmacists the most.

"What we're saying is that a fertilized egg is a human baby," Kosirog said.

"If there was some way to know with certainty if the woman has ovulated, then it would be very, very different situation," Vander Bleek said. "But we can't so we don't know if human life is hanging in the balance."

Planned Parenthood Federation of America, which is a major advocate for a woman's right to choose, cites a 2003 study on its literature that suggests morning-after pills only prevent ovulation or fertilization and have no effect on implantation. The organization also says that Plan B cannot induce abortions and actually helps prevent the need for abortions.

Vander Bleek said the scientific community has not come to a consensus on whether the pills can cause a fertilized egg to abort and the manufacturer of Plan B has not provided any scientific evidence that puts him at ease.

"I need to err on the side of caution and I don't want to be involved in products that may cause an abortion," Vander Bleek said.

Since the FDA sees Plan B as a method to prevent pregnancy and not terminate one, Blagojevich spokeswoman Abby Ottenhoff said it's not up to pharmacists to decide whether a woman should have access to emergency contraceptive if her doctor prescribes it.

She added that pharmacy license holders don't have to sell emergency contraception at all.

"If a pharmacy owner has objections they can choose not to sell birth control at all - that is their right," she said.

Rule now a law

Last spring, at least two pharmacists in the Peoria and Chicago areas refused to dispense Plan B and regular birth control.

Complaints from women who were turned away at the pharmacy counter prompted Blagojevich to institute an emergency rule in April to ensure they receive their prescribed contraceptives.

"It was clear that women were being denied access to the medicines their doctor said they needed," Ottenhoff said. "He felt strongly that it required quick action."

Representatives from Planned Parenthood and the National Women's Law Center - a Washington, D.C.-based group that has a mission of protecting and advancing the progress of women and girls - supported the governor's measure.

Other states are considering, or have, similar provisions.

For example, North Carolina and Massachusetts have rules similar to Illinois'.

In California, pharmacists can refuse to dispense contraceptives only with their employers' approval if the woman can still access her prescription in a timely manner.

On the other hand, Arkansas, Georgia, Mississippi and South Dakota have laws that allow pharmacists to refuse to dispense contraceptives.

Vander Bleek first took action by filing a lawsuit in June to prevent the rule from becoming law.

He felt that the Illinois Health Care Right of Conscience Act, among other laws, shielded him. The act specifies that those involved in the delivery, arrangement or payment of health care services should not be forced to perform duties against their conscience.

Vander Bleek partnered with Americans United for Life for legal representation. Incorporated in 1971, the nonprofit organization based in Chicago offers free legal services to protect the rights of conscience of all health care professionals, among other initiatives.

To counter the governor's main concern of access, neither Vander Bleek nor Kosirog believes that it would be a problem without the law.

While Kosirog's drug store is three blocks away from another pharmacy, Vander Bleek said his store in Morrison is about 11 miles away from another one.

"It (emergency contraception) is not any more difficult to access than a pair of shoes," Vander Bleek said.

Instead of increasing women's access, the pharmacists believe the law will only diminish the number of pharmacists and pharmacies in Illinois.

In August, the Illinois Joint Committee on Administrative Rules made the "emergency" rule permanent.

"It hasn't even been debated," Kosirog said.

Martin believes the governor essentially overstepped his authority.

"He bypassed legislation - he made a power grab and bypassed all the democratic procedures that were supposed to take place," Martin said.

Ottenhoff retorted that Blagojevich went through all the proper administrative procedures to institute the law.

The lawsuit claims that, according to the Illinois Pharmacy Practice Act of 1987, the governor should have gotten more feedback from the state board of pharmacy, which is under the umbrella of the Division of Professional Regulation.

No pharmacy organizations have fought the new law including the Illinois Pharmacists Association, to which Vander Bleek belongs. The state group and the American Pharmaceutical Association believe in protecting a pharmacist's right to conscience but also advocate that a pharmacist refer the patient elsewhere.

Vander Bleek said it isn't right that the rule makes no differentiation between regular birth control and emergency contraceptives either.

But the governor disagrees.

"They (emergency contraceptives) are, essentially, a higher dose of monthly oral contraceptives," Ottenhoff said. "Just like oral contraceptives, they are intended to prevent pregnancy - they do not terminate pregnancy."

On Sept. 15, The Illinois Department of Professional Regulation charged three pharmacies with failing to comply with the law. Cited were two Walgreens locations - one each in the Chicago and Peoria areas - and an Osco pharmacy in St. Charles.

Both Vander Bleek and Kosirog have spent most of their lives in the pharmacy profession and want to continue conducting business in the same way.

Vander Bleek owns and runs Fitzgerald Pharmacy in Morrison and Prophetstown and is partner to two more pharmacies in Genoa and Sycamore.

Kosirog has groomed himself for the pharmacy field since age 6 when he helped at the register for his dad's Wicker Park pharmacy, which he now owns and runs.

Vander Bleek said he often refuses to fill a prescription if a dosage seems too high or if a medicine is incompatible with other prescriptions for that patient.

"People will say we're just dispensers, but we're still human beings," Kosirog said. "The governor should not be legislating morality."

GRAPHIC: Plan B

What is it? Emergency contraception.

When is it used? Within 72 hours after unprotected sex or as a backup to regular birth control.

What does it look like? It comes in the form of two pills, each containing .75 mg of levonorgestrel, a synthetic hormone used in birth control pills for more 35 years.

How does it work? It works like other birth control pills to prevent pregnancy. Primarily, it stops the release of an egg from the ovary. It also may prevent the union of a sperm and egg. If fertilization does occur, it may prevent a fertilized egg from attaching to the womb. If a fertilized egg is implanted prior to taking Plan B, Plan B will not work.

Source: The U.S. Federal and Drug Administration's Center for Drug Evaluation and Research

Source: Daily Herald; Arlington Heights, Ill.

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