Karen Brauer lost her job at a K-Mart pharmacy in Ohio because she would not fill a prescription for a birth control pill called Micronor.
"It's particularly inefficient in stopping ovulation," she said. "So a good portion of its efficacy is attributable to mechanisms that happen after fertilization…that is, it can stop human life after it has started."
As president of a group called Pharmacists for Life International, Ms. Brauer works to protect what she calls "the human right of medical professionals to exclude themselves from participating in a procedure that can stop human life."
A number of pharmacists across America have refused on moral ground to fill prescriptions for emergency contraception, or what is often called the "morning-after pill." Some of them also won't dispense other contraceptives if there is even a remote chance that the medications could act to kill a fertilized egg.
Although, in Ms. Brauer’s case, she referred the prescription to another pharmacy, she defends pharmacists who won't direct customers to someone else.
"The suggestion that a pharmacist who refuses to dispense a drug which can kill a human should refer the patient to another person who will dispense a drug which can kill a human is ridiculous," she said. "There should not be an expectation to refer. It's another expectation to participate."
But Susanne Martinez of the Planned Parenthood Federation of America says pharmacists should not be allowed to "impose their moral beliefs" on a woman and her doctor. "That's outrageous that someone can deny someone access to the health care services that their physician has prescribed for them," she said. "One of the most tragic stories that we've heard about is a survivor of a sexual assault who's been to the emergency room, been given the prescription, goes and tries to get it filled, and is obviously in an emotionally distressed situation already…and then denied access to the medication that can prevent an unintended pregnancy."
With 50,000 members, the American Pharmacists Association is the industry's largest professional group. Vice President Susan Winckler says the organization’s ethics policy requires pharmacists who refuse to fill certain prescriptions on moral grounds to make arrangements to ensure that patients get their medications.
"There may be situations where there is something that a pharmacist does not want to participate in," said Ms. Winckler. "Our policy supports that pharmacist stepping away. But, to do that, they need to have proactively identified what the alternative way is for the patient to access that therapy."
Ms. Winckler says few pharmacists across America are acting contrary to those guidelines. "There are about 8.8 million prescriptions dispensed every day," she said. "We're aware of fewer than ten incidents where a pharmacist has stepped away from providing this medication and then obstructed or hindered the patient from getting the medication somewhere else."
Ms. Winckler says the small number of confrontations across the country provide a wake-up call for the nation's drug stores and pharmacists to develop alternative systems for dispensing sometimes controversial medications.
That approach was largely endorsed this month in an article in the New England Journal of Medicine. Co-author Julie Cantor weighed the rights and responsibilities of pharmacists. "Saying that pharmacists have absolutely no right to object forces pharmacists - unlike other professionals, especially in health care - to completely abandon their morals," she said. "That imposes too heavy a toll."
On the other hand, Ms. Cantor also does not support an absolute ban on pharmacists refusing to fill contraception prescriptions. "This is not a life-or-death situation," she said. "People do have options. And, in America, conscience matters. If it was possible to respect both the patient and the provider, we wanted to do that."
Karen Brauer of Pharmacists for Life International says a middle ground is unnecessary because patients can always call ahead to their pharmacies or order medicines over the Internet. Planned Parenthood Vice President Susanne Martinez says customers who go to a pharmacy ought to be able to get their medicines without any delay or interference.
Medical ethicist Julie Cantor says, at some point, protecting the rights of both patients and pharmacists may be irreconcilable. In those cases - for example, in a rural community served by a single pharmacist - she comes down on the side of providing patient care. "We really can't abandon our patients," she said. "If you choose to go into a health care profession and you choose to work in a setting that is secular - where you have patients of all stripes coming for care - we really need to attend to that obligation to our patients."
It is up to each of the 50 states to decide where to draw the line. In July, Mississippi joined South Dakota and Arkansas in putting a law into effect guaranteeing a pharmacist's right to refuse to dispense medicines on moral grounds. This year 10 other states considered such legislation.