Access Denied- The Pill = Abortion

[Chewbacca]

This is a long article, so long I only posted the first half here.

Refusing to prescribe or dispense medicine based on unproven speculation and the doctor's or pharmacist's personal beleifs just reeks of quackery to me. At best these service providers should be required to make full disclosure of their beleifs and the proven impact on health, to any client who walks unsuspectedly into their office or pharmacy. At worst perhaps they shouldn't be practicing in medicine at all if their own personal beleifs may interfere with the health and/or well-being of their clients.

What do you think?
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Source- Prevention.com

Access Denied

Find out why growing numbers of doctors and pharmacists across the US are refusing to prescribe or dispense birth control pills


In April, Julee Lacey, 33, a Fort Worth, TX, mother of two, went to her local CVS drugstore for a last-minute Pill refill. She had been getting her prescription filled there for a year, so she was astonished when the pharmacist told her, "I personally don't believe in birth control and therefore I'm not going to fill your prescription." Lacey, an elementary school teacher, was shocked. "The pharmacist had no idea why I was even taking the Pill. I might have needed it for a medical condition."

Melissa Kelley, 35, was just as stunned when her gynecologist told her she would not renew her prescription for birth control pills last fall.

"She told me she couldn't in good faith prescribe the Pill anymore," says Kelley, who lives with her husband and son in Allentown, PA. Then the gynecologist told Kelley she wouldn't be able to get a new prescription from her family doctor, either. "She said my primary care physician was the one who helped her make the decision."

Lacey's pharmacist and Kelley's doctors are among hundreds, perhaps thousands, of physicians and pharmacists who now adhere to a controversial belief that birth control pills and other forms of hormonal contraception--including the skin patch, the vaginal ring, and progesterone injections--cause tens of thousands of "silent" abortions every year. Consequently, they are refusing to prescribe or dispense them.

Scenarios like these--virtually unheard of 10 years ago--are happening with increasing frequency. However, until this spring, the issue received little attention outside the antiabortion community. It wasn't high on the agendas of reproductive rights advocates, who have been preoccupied with defending abortion rights and emergency contraception. But when Lacey's story was picked up by a Texas TV station and later made the national news, Planned Parenthood Federation of America and others took notice.

Limiting access to the Pill, these groups now say, threatens a basic aspect of women's health care. An estimated 12 million American women use hormonal contraceptives, the most popular form of birth control in the United States after sterilization. The Pill is also widely prescribed by gynecologists and family doctors for other uses, such as clearing up acne, shrinking fibroids, reducing ovarian cancer risk, and controlling endometriosis.

"Where will this all stop?" asks Lacey. "And what if these pharmacists decide they suddenly don't believe in a new lifesaving medicine? I don't think pharmacists should be in a position to decide these things."

A Matter of Belief

The members of the antiabortion group Pharmacists for Life International say they have every right to make that kind of decision. "Our job is to enhance life," explains the organization's president, pharmacist Karen Brauer, RPh, who first refused to fill prescriptions for some types of birth control pills in 1989. "We shouldn't have to dispense a medication that we think takes lives."

Anti-Pill doctors and pharmacists base their stand on the fact that the Pill isn't perfect: Although it is designed to suppress ovulation and prevent fertilization, both can--and do--occur in rare cases. About 1 woman in every 1,000 who takes the Pill exactly as directed becomes pregnant in a given year. But while mainstream experts say ovulation happens only 2 to 3 percent of the time and fertilization is rare, anti-Pill groups claim both happen frequently. They say most of these fertilized eggs--in their view, nascent human lives--are unable to attach to the hormonally altered uterine lining. Instead of implanting and growing, they slough off. This theoretical action, which scientists can't confirm, is called the post-fertilization effect.

At the heart of the debate between anti-Pill forces and mainstream medicine lies a profound difference of opinion about when pregnancy and life begin. The long-standing medical definition of pregnancy, held by the American College of Obstetricians and Gynecologists, is that it starts not when an egg is fertilized, but when the fertilized egg implants in the uterine lining.

This distinction is practical: A pregnancy test won't show a positive result before implantation. "It can't be an abortion before there is a pregnancy," points out David Grimes, MD, a clinical professor in obstetrics and gynecology at the University of North Carolina School of Medicine and one of the leading contraception experts in the US.

But anti-Pill doctors and pharmacists say life begins sooner, at fertilization. Sloughing off a fertilized egg, in their view, is a "chemical abortion."

"How many women know that if they become pregnant after breakthrough ovulation, these 'contraceptives' will almost always kill any son or daughter they've conceived?" asks the anti-Pill organization Pro-Life America on the group's Web site, ProLife.com.

Surprisingly, there's no science to back the theory that birth control pills really do discourage implantation. This claim, made by contraceptive manufacturers for decades, has never been proven, Grimes says. Even the American Association of Pro-Life Obstetricians and Gynecologists agrees that it's just speculation.

Under the Radar

In the past decade or so, the "hormonal birth control equals abortion" view has quietly grown roots in the antiabortion underground. It's spread from doctor to doctor, through local newsletters, in books with titles such as Does the Birth Control Pill Cause Abortions? (written by Randy Alcorn, an Oregon-based antiabortion pastor and author), and through lobbying groups that have encouraged lawmakers in Arkansas, South Dakota, and most recently Mississippi to enact "conscience clauses." These legislative provisions protect health care professionals--in this case, pharmacists--who refuse to provide services they oppose on moral, ethical, or legal grounds. At press time, similar legislation had been introduced in 11 more states.

An Internet search turns up thousands of Web sites containing articles with titles such as "The Pill Kills Babies," "Are Contraception and Abortion Siamese Twins?" and "The Dirty Little Secrets about the Birth Control Pill." Hundreds of physicians and pharmacists have pledged not to provide hormonal birth control. Among them: 450 doctors affiliated with the Dayton, OH-based natural family planning group One More Soul; some members of the 2,500 doctors in the Holland, MI-based American Association of Pro-Life Obstetricians and Gynecologists; and a growing number of the 1,500-member Web-based Pharmacists for Life International, says Brauer.

Not even anti-Pill groups know how many doctors and druggists are involved. And while the total is still a small percentage of the 117,500 family physicians and OB/GYNs and 173,000 pharmacists in the US, they are making their presence felt in women's lives and among law and policy makers on both the state and national levels. Their influence is far-reaching and disproportionate to their size--a quiet version of the public shock waves produced by the nation's relatively small number of antiabortion activists.

"Refusing women access to the Pill is a very disturbing trend," says Gloria Feldt, president of Planned Parenthood Federation of America. "The war on choice is not just about abortion anymore. It's about our right to birth control."

Morality Versus Public Health

Anti-Pill doctors and pharmacists say the issue isn't about a woman's right to hormonal contraceptives, but about the right to act according to their beliefs. "I feel chemical contraceptives have the potential to harm an embryo," says Mary Martin, MD, an OB/GYN in private practice in Midwest City, OK. "And I decided, based on moral and ethical grounds, that I simply could no longer prescribe them." She stopped writing prescriptions for hormonal birth control in 1999. OB/GYN Arthur Stehly, of Escondido, CA, who hasn't prescribed contraceptives since 1989, says he feels the same way: "I function better and I sleep better at night knowing I'm not giving the Pill."

But at what point does personal belief undermine public health? If more women lose access to hormonal contraceptives, rates of unintended pregnancy and abortions will rise in the US, predicts Beth Jordan, MD, medical director of the Washington, DC-based Feminist Majority Foundation, an advocacy and research group.

What's more, oral contraceptives aren't only used to prevent pregnancy. The Pill may cut the risk of ovarian cancer by up to 80% and is used by women at high genetic risk for this hard-to-detect and usually fatal cancer. "There are easily more than 20 noncontraceptive uses for the Pill in common practice," says Giovannina Anthony, MD, an attending physician of obstetrics and gynecology at Beth Israel Medical Center in New York City. "This drug saves women from surgery for gynecological conditions like endometriosis, fibroids, and severe bleeding and pain."

Most women's doctors agree that contraceptives are an important tool of good medical care. "I have a hard time with people who market themselves as women's health care physicians but who won't prescribe such a basic part of women's health care," says Anne Drapkin Lyerly, MD, a reproductive rights ethicist and an assistant professor of obstetrics and gynecology at Duke University Medical Center. "We're seeing a growing trend among pharmacists and medical practitioners who consider it acceptable to impose their morality on women's bodies. I don't think moral aspects should be a concern. Imagine a pharmacist asking a customer whether his Viagra prescription is to enhance sexual performance in his marriage or in an extramarital affair. Never!"
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Follow the link for 3 more pages....

[Thoran]

I don't believe it's quackery, but I do believe such doctors should provide information to their patients regarding other doctors who don't share their beliefs and will provide them with the pill.

I see these people as "consciencous objectors" and frankly I think the article is unabashed advocacy (at least the above portion is)... and as such is only of value in that it provides the Pro-Abortion/Birth Control half the picture, but it's useless unless the reader spends the time to dig up the other half.

Furthermore... I see tactics at work in the article that make me cringe. Attempting to frame the decision of the care-giver as "imposing thier beliefs" on a person is pathetic. They're no more "imposing" their beliefs than McDonalds does when it won't sell you a Whopper. Want a Whopper? You're FREE to go to Buger King and pick one up. Want the Pill? You're FREE to go to a practitioner that will provide one. There is no imposition but by suggesting one they attempt to whip up artifical outrage. Frankly I'm amused that they would assume we're stupid enough to fall for such infantile tactics.

If you don't accept the moral stance of your doctor or phamacist, vote with your feet!

[Aerich]

I don't like the denial of access (limited denial though it may be) to birth control pills. To me, it smacks of letting religious beliefs infringe on other concerns. I would prefer conception not to occur, if a woman does not want a child. The Pill is a better alternative to adoption or abortion.

Now before I get jumped on for not respecting the rights of doctors and pharmacists to choose...

I would be prepared to allow a certain percentage of medical practitioners to be "conscientious objectors." There must be adequate "competition" that will supply the Pill. Also, if a medical practitioner refuses to provide the Pill, they MUST provide a list of other doctors who will provide the Pill AND a different opinion (I agree with Thoran on this point).

I see two major worries here:

1) This issue is an extension of the debate over a woman's right to control her own body.

2) The potential for abuse of the doctor-patient relationship rises if the doctor is allowed to let personal (not medical) opinions affect the way they practice. It's possible for a trusted doctor to exert a large measure of influence over patients, especially if they are not well-informed.

What if you sustained a life-altering injury that could be repaired with surgery and your doctor refused to refer you because he/she didn't believe in invasive medical procedures?

[Chewbacca]

Thoran,

What more (medicinally) is there to tell from the "no-pill" side of the debate that isn't in the article? The entire second page of the article is dedicated to that veiwpoint and a websource for further information is provided. If you have some more relevant medicinal info on the topic from that side of the argument please feel free to share.

Of course the forum's moratorium on religous topics makes discussion (either pro or con) from that angle one to step lightly with.

I do agree wholeheartily with sentiment that anti-pill health providers should make referals to colleauges who don't limit patient's options. This would be part of the full disclosure mentioned in my best case scenario.

Regards,

edit- ah I reread you post and see I mistook your issue with article. It wasn't the amount or quality of the information contained but how some of wording was framed.

This is why we have a quote function- it helps insure replys are to the point! *drinks desperately needed coffee* [img]smile.gif[/img]

[ 07-07-2004, 01:21 PM: Message edited by: Chewbacca ]

[Cloudbringer]

Actually Aerich, if the doctor/pharmacist in question BELIEVES that it is taking a life, the he/she is following their OATH not to do harm, but to save lives.

I don't know about Canadian medical personnel, but I thought the US doctors subscribed to the Hippocratic oath, most versions of which make some disclaimer about not taking life or causing harm, I think.

So I think for those who are objecting now, it's a matter of life/death and not just 'invasive procedures'.

Still, I agree that those who do decide that they can't in good faith supply or prescribe the pill, should refer their patients who need/want the medication to other physicians who don't have that belief/dilemma.


edit: It will be interesting to see how the research pans out on this one, since it seems that the medical community is not sure what happens or if it happens very often.

[ 07-07-2004, 01:21 PM: Message edited by: Cloudbringer ]

[Thoran]

Originally posted by Chewbacca: Thoran, What more (medicinally) is there to tell from the "no-pill" side of the debate that isn't in the article? The entire second page of the article is dedicated to that veiwpoint and a websource for further information is provided. If you have some more relevant medicinal info on the topic from that side of the argument please feel free to share. Of course the forum's moratorium on religous topics makes discussion (either pro or con) from that angle one to step lightly with. I do agree wholeheartily with sentiment that anti-pill health providers should make referals to colleauges who don't limit patient's options. This would be part of the full disclosure mentioned in my best case scenario. Regards, edit- ah I reread you post and see I mistook your issue with article. It wasn't the amount or quality of the information contained but how some of wording was framed. This is why we have a quote function- it helps insure replys are to the point! *drinks desperately needed coffee* [img]smile.gif[/img]

No problem, I also stated that I'd only read the included portion of the story (gotta get SOME work done during the day), so admittedly the perception is based on the initial portion of the article. Framing is very important and tells you a lot about the intent of the writer, I typically find that framing is key to comprehension. I'll grind through the whole article tonight, I would be interested to see a writer who starts an article with such a bias finish up with a balanced result.

[Aerich]

Ours do take the Hippocratic oath as well, Cloudy. I think all Western-trained doctors are supposed to.

The invasive procedures snippet was an analogous (not identical) example of a doctor's beliefs possibly getting in the way of the patient's best interests.

While I can see that the Oath could be used as justification for objection, I think it's a bit far-fetched. A fetus does not exist before conception, and will not necessarily result even if contraception is not used. Therefore, it is not harming a life, but removing the possibility that life would occur BEFORE the circumstances are right for it. The Oath argument is much stronger if used in the context of the abortion debate.

The major worry here is about medical professionals who allow their personal religious beliefs to alter their practices. I think those who object to the Pill purely on medical/Hippocratic grounds are in the distinct minority.

[ 07-07-2004, 02:31 PM: Message edited by: Aerich ]

[Cerek the Barbaric]

Interesting article and some good responses so far. My thoughts on several of the issues mentioned so far are....

1) I do not agree that doctors have an obligation to refer patients to another doctor that will prescribe the Pill. I have a chronic illness that can be potentially life-threatening if not treated properly. I didn't feel my former physician was treating it properly, so I looked up another physician on my own. And my disagreement with my former physician centered specifically around his refusal to change my medication or offer an alternative. But despite my disagreement with him, I didn't say "I don't agree with the meds you're prescribing, so you have to give me a list of other gastroenterologists that will prescribe the medicine I want." I agree that it would be nice for the physician to do that, but I don't feel they have an obligation to do it.

2) I agree with Thoran that individual doctors have every right to refuse to prescribe the Pill if they don't feel comfortable doing that. As far as this being equivalent to the doctor "imposing his/her beliefs" on the patient, the same can be said of any medicine a doctor does or does not prescribe. My wife works in an office with 3 pediatricians. All 3 have different approaches to treating the same illnesses and conditions. One doctor is especially reluctant to prescribe any antibiotics, due to the number of resistant viruses that are evolving. He also feels the body should be given a chance to heal itself first and that antibiotics should be used ONLY in severe cases - or as a last resort. So he - in effect - is "imposing his beliefs" on my children when he doesn't prescribe them antibiotics. And if I don't like him not prescribing the meds I want for my kids, I can always go to another doctor. (and just to beat the dead horse one more time, I don't feel that the pediatrician should provide me with a list of other doctors that will prescribe antibiotics more freely).

3) I will agree that the pharmacist does not have as much freedom to refuse a prescription as the doctor does. Even if the pharmicist disagrees with the pill for personal reasons, that doesn't give them the right to refuse a doctor's order to give the pill to their patient. Still, if the pharmacist feels that strongly, they should discuss it with their superiors and simply post a sign stating that "This Pharmacy will not fill prescriptions for birth control pills" - or words to that effect.

4)I do NOT agree that the pharmacists or doctors either one should be required to give a "full disclosure" of their personal beliefs. If they believe the Pill is harmful or is equivalent to abortion, they have a right to not prescribe it or dispense it because of those concerns. The personal beliefs of the individual are a private matter and there is no reason to make them public. Would the pharmacist or doctor be required to disclose their religious beliefs if they were other than Christianity? Would a Wiccan, pagan, or witch be required to fully disclose their beliefs also if they happened to disagree with prescribing or dispensing the pill? Would they be required to disclose they were an atheist if they agreed with prescribing or dispensing the pill? The fact that they have medical and personal concerns is sufficient reason without having to fully disclose what their personal beliefs are.

5) I don't like the argument that goes "What if they decide not to give life-saving drugs or perform life-saving procedures next?" That is nothing but a scare-tactic designed to create false hysteria. Doctor's perform procedures that go against their personal beliefs everyday. There are some patients that refuse to have life-saving procedures performed on loved ones - and a doctor HAS to respect those wishes despite his/her desire to save the patient. The same is true for patients who refuse to have blood transfusion for personal or religious reasons. Even though it might well save the patients life, they CANNOT perform the procedure and must simply do everything else they can that the family will allow. No doctor is going to refuse to give life-saving meds or perform a life-saving procedure due to their personal beliefs. While the Pill does have other medical uses (most notably to help regulate a woman's menstrual period), it is not considered a "life saving" medication. And even though a minority of doctors and pharmacists may refuse to provide the Pill to patients that have a medical need for it, that does NOT mean that the doctor is not providing OTHER medications for to treat that medical condition.

That is another fact that is not mentioned in the excerpt or the article provided. It mentions a number of times that the Pill has many other uses other than birth control, but fails to mention that each of those 20 or so medical conditions can also be treated with medications other than the Pill.

On a personal note, I do think it is a BIG stretch to equate the Pill with abortion. I agree with the definition of "life" given in the excerpt of the article - that it begins when the fertilized egg bonds with uterine wall.

[Ronn_Bman]

The pharmacist has no right to refuse, as far as I'm concerned, because s/he has no way of knowing why the pill is being prescribed. Sure the obvious reason is birth control, but my wife has been on the pill for the past 5 years in an effort to regulate her system due to female problems.

A doctor should certainly make it clear that they are unwilling to prescribe BC before they accept payment for a visit. Taking payment from a person who wants BC for birth control reasons while knowing you won't prescribe it is nothing more than stealing.

Originally posted by Cerek the Barbaric: On a personal note, I do think it is a BIG stretch to equate the Pill with abortion.

The argument goes all the way back to Natural Law. While contraception is certainly not murder -- though the argument that abortion *is* can be equally well refuted -- it goes directly contrary to what has always been the classic accepted function of sex: to produce children.

Some groups, notably the Catholic Church (I know, moratorium...), are big believers in Natural Law -- the Apostle Paul and St. Augustine were some of the first writers on the subject.

In short, only the ignorant are "equating" contraception and abortion in any real sense. The argument is that both go contrary to the function of sex, i.e. they both prevent the birth of a child. Were one to take the argument to its logical conclusion -- and some have -- it could be argued that the function of mothers is to produce *healthy* children, and as such drinking/smoking/&c. during pregnancy could be equally immoral.

Of course, all this assumes that one agrees on the function of sex. Were sex, for example, primarily for enjoyment, or to increase the bond of intimacy between two people, the entire argument would be worthless...