No reproductive health for you!

The Washington Post writes about the new hotness in the dominionist "parallel economy"--and right off the bat, reveals to us just how extensive the problem of "moral refusal" has become:

When DMC Pharmacy opens this summer on Route 50 in Chantilly, the shelves will be stocked with allergy remedies, pain relievers, antiseptic ointments and almost everything else sold in any drugstore. But anyone who wants condoms, birth control pills or the Plan B emergency contraceptive will be turned away.

That's because the drugstore, located in a typical shopping plaza featuring a Ruby Tuesday, a Papa John's and a Kmart, will be a "pro-life pharmacy" -- meaning, among other things, that it will eschew all contraceptives.

The pharmacy is one of a small but growing number of drugstores around the country that have become the latest front in a conflict pitting patients' rights against those of health-care workers who assert a "right of conscience" to refuse to provide care or products that they find objectionable.

"The United States was founded on the idea that people act on their conscience -- that they have a sense of right and wrong and do what they think is right and moral," said Tom Brejcha, president and chief counsel at the Thomas More Society, a Chicago public-interest law firm that is defending a pharmacist who was fined and reprimanded for refusing to fill prescriptions for birth control pills. "Every pharmacist has the right to do the same thing," Brejcha said.

Of course, there's a more ulterior reason why the trend is going towards setting up completely dominionist-run pharmacies (in a remarkably similar way to how attempts to promote young-earth creationism have morphed over the years as the courts shoot them down).

A number of states--California, New Jersey, Illinois and Washington State among them--have laws on the books requiring "must dispense or refer"--that is, if someone does have a "moral objection" to dispensing a drug, they either must dispense it, refer the prescription to another pharmacist on staff, or refer to the nearest drugstore that carries it--and if there are no other options, they must dispense.  At least ten other states--thanks to the increasing awareness of the real healthcare costs of "moral refusal"--have bills in their state General Assemblies that would also mandate "must dispense or refer".

Unfortunately, many if not most of these laws and bills have a rather considerable loophole, as documented in the article:

California, New Jersey, Illinois and Washington state recently began requiring pharmacies to fill all prescriptions or help women fill them elsewhere, and at least another 10 states are considering such requirements. But some states exempt pharmacies that do not generally stock contraceptives, and it is unclear how other existing rules and laws and those being considered would apply to those pharmacies.

(Never let it be said that dominionist groups do not have a talent in finding the one loophole and managing to stick the camel's nose under the tent with it.)

In addition, many of these new dominionist "parallel economy" pharmacies--largely linked with a group called Pharmacists for Life International, which organises "moral refusal" campaigns and is seeking to get broad "moral refusal" clauses nationwide--will have de facto religious tests to work there (which in and of itself could be a violation of employment laws--unless they're run as divisions of churches).  Often, these tend to be linked to an increasing number of "parallel economy" OB/GYN services:

The DMC Pharmacy opening in August marks an expansion by Divine Mercy Care in Fairfax, a nonprofit health-care organization that adheres to the teachings of the Catholic Church. The group runs the Tepeyac Family Center, an obstetrics-gynecology practice in Fairfax that offers "natural family planning" instead of contraceptives, sterilization or abortion.

"We're trying not to leave our faith at the door," said John Bruchalski, who chairs the group's board of directors, noting that one of the organization's major goals is helping needy, uninsured patients obtain health care. "We're trying to create an environment where belief and professionalism come together."

Like the doctors, nurses and other staff members at Tepeyac, Robert Semler, the pharmacist who will run DMC Pharmacy, plans to start each workday with a prayer with his staff, which at first will just be his wife, Pam, a nurse.

"Being a faith-based workplace, it's a logical thing to do," Semler said.

Real life consequences for women

The sad thing is, these sorts of "moral refusal" clauses--and the existence of loopholes that allow dominionist pharmacies to completely skirt around "must carry or refer"--do have very real consequences for women.

For starters, "the pill" is not just used for birth control.  It turns out that "the pill" is used for many conditions where hormonal regulation is a must--PCOS (in which "the pill", longterm, can be both lifesaving and fertility-saving; the only treatment for PCOS other than "The Pill" or Depo-Provera is surgical removal of the ovaries, and untreated PCOS can lead to morbid obesity, type II diabetes, and certain forms of cancer), as well as other problems of hormonal regulation, are commonly treated with "The pill".  Newer versions of "The Pill" such as Seasonale (that only have a "period cycle" once every three months) are also becoming frequently used for treatment of endometriosis.

Secondly, there are conditions where it would be very harmful--to the mother, to the fetus, or both--for her to become pregnant, and not having effective hormonal therapy could well deprive women of healthcare options unrelated to pregnancy.  Among other things, prescriptions for a number of drugs including Thalomid (thalidomide, now used both in leprosy treatment and in clinical trials for various cancers) and Accutane and other retinoids (used in treatment of severe, disabling acne and certain types of psoriasis as well as basal cell carcinoma chemo) require you to be on at least two separate forms of birth control (one hormonal, one a barrier method) unless you have had a hysterectomy--and yes, documentation is required of this.

Thirdly--and this has been less publicised--"moral refusal" goes far beyond just refusing to fill "the Pill" and Plan B.   As I've written before, "moral refusal" of any prescription from women's clinics has been documented--even those prescriptions that are explicitly for support of a pregnancy to term such as pregnancy-related vitamins.  In addition, refusal of antibiotics prescribed by women's clinics have been documented, as have refusals of medication that can be used for treatment of genital herpes (and also has applications of treatment of stuff NOT for genital herpes--like, oh, chickenpox in adults or immunosuppressed kids, or people exposed to simian herpes B virus--both of which can kill, and kill in particularly grotesque manner).

And it gets worse from here.

Dominionist "moral refusals" that can kill women

I've already noted in past in a series on the dominionist "parallel economy" in medicine--which includes a section on dominionist OB/GYN services--how Mississippi in fact has such a broad "moral refusal" law that even EMTs and ambulance drivers can claim "moral refusal" in regards to rendering emergency treatment and transport to hospital.  I predicted, two years ago, that this would end up with people being refused to be taken for needed lifesaving healthcare as a result.

Unfortunately--and in a sad confirmation--the Washington Post article has noted that there are now cases of women being refused transport for medically necessary abortions:

The pharmacies are emerging at a time when a variety of health-care workers are refusing to perform medical procedures they find objectionable. Fertility doctors have refused to inseminate gay women. Ambulance drivers have refused to transport patients for abortions. Anesthesiologists have refused to assist in sterilizations.

(Emphasis mine.)

This is bad.  Really, really Bad.

Generally, a woman won't be taking an ambulance to have an abortion unless there is a bona fide medical reason she may need one--and there are a plethora of reasons why a woman, even one normally "pro-life", would be required to make the choice to terminate her pregnancy.

Ectopic pregnancy is when a pregnancy develops in the fallopian tubes--if an emergency surgical abortion is not performed, the fallopian tubes usually burst (which is a lifethreatening emergency).  There is quite literally no way for a tubal pregnancy to make it to term, or often even to viability.

One wonders if the "every zygote is sacred" crowd would be happy to let women die in attempts to carry tubal pregnancies--or rather, one would wonder if they would, if one wasn't aware that this is in fact the case in El Salvador, which not only has banned abortion (even in medically necessary cases) but considers it a felony--and has several women die a year of ruptured tubal pregnancies.

For that matter, what about hyatidiform moles, or what is normally referred to as "molar pregnancy"?

Molar pregnancy is a way in which pregnancy can go horribly, horribly wrong--it is, quite literally, a type of cancer that originates in either placental tissue or in embryos with certain severe chromosomal defects.  In other words--unlike practically all other cancers--it is a type of cancer that develops from a fertilised zygote whose development goes tragically wrong, and partial moles in particular can literally be described as embryo-based cancers.

Molar pregnancy not only can kill (from being a pregnancy related cancer) but in fact the massive hormonal disruptions (completely aside from the "if untreated it will invade your uterus, your other tissues, and kill you" aspect) can themselves be life-threatening.

The cure is a common abortion technique--a D&C--followed up with a course or two of chemo.  In the rare cases where there have been "twinned" pregnancies where one embryo develops normally and the other becomes a molar pregnancy, these have a much higher risk of metastasis and a bad outcome; in fact, the risk of death from cancer is so high that in these cases abortion (of both the healthy embryo and the molar pregnancy) is recommended as a lifesaving measure for the mother because there is just too much risk in trying to carry the healthy embryo to term (in fact, molar pregnancies can metastasize to their "twin", too).

Again, just like ectopic pregnancies, there is no way a molar pregnancy--even though it developed from a fertilised egg--will ever develop normally, and if one attempted to "carry it to term" it'd likely kill the mother in the process.

And there are still other reasons why an abortion may be medically necessary to save the mother's life.  One common reason is a fetus dying in utero and becoming septic; another reason is a hormone-sensitive cancer that develops in pregnancy (especially in the uterus, ovaries or breasts); other reasons still are preeclampsia and HELLP Syndrome--both of which can only be cured by delivery or abortion, and both of which kill (and preeclampsia has historically been one of the biggest killers of pregnant women).  Another reason still is a fetus that will never survive outside the womb (including those with major organs missing--anencephalic fetuses, fetuses that developed without hearts or kidneys, and so on).  Another reason is maternal renal failure.  Another reason is the discovery of a catastrophic chromosomal disorder.  Sometimes the mother's water breaks or she has a partial miscarriage.  There are many reasons, almost all of them in the  "heartwrenching" category, that a woman may have to terminate a pregnancy that she was very much hoping would result in a healthy son or daughter being brought into the world.

In fact, there is an entire website entitled "A Heartbreaking Choice" for people who had to end up terminating pregnancies--very much wanted pregnancies--for medical reasons.  It's a horrible thing to go through--but it happens.

And extending "moral refusal" to refusing to take an ill woman to the women's clinic or one of the few hospitals allowed to perform an abortion can end up in losing both the fetus and the mother. :(

Still too much room for "refusal"--and a potential way of narrowing the loopholes

And there's another aspect that has been little mentioned, but has been touched upon in the Washington Post article--even in states that have "must dispense or refer" laws, the laws become rather useless if most of the pharmacies refuse to carry or have pharmacists that "refuse"--or if the person lives in an area that has only one or two pharmacies, with one of those being Wal-Mart (which has had a history of refusing to carry birth control and Plan B).

Especially if the only non-Wal-Mart pharmacy in town is one of those innocent-sounding "independent pharmacies" that just happens to be a big player in the dominionist "parallel economy"--women, even with a "must dispense or refer" law in their home state, can be left with no options.  This is far from an idle concern:

But others worry about what will happen if such pharmacies proliferate, especially in rural areas.

"We may find ourselves with whole regions of the country where virtually every pharmacy follows these limiting, discriminatory policies and women are unable to access legal, physician-prescribed medications," said R. Alta Charo, a University of Wisconsin lawyer and bioethicist. "We're talking about creating a separate universe of pharmacies that puts women at a disadvantage."

A much better solution, IMHO, is multi-fold:

a) Require licensed pharmacists to dispense all medication if there are less than two licensed pharmacists on staff.  If there are two or more licensed pharmacists on staff, one must be willing to dispense medication in the event of one giving moral objections.  (Yes, make this part of the formal licensing, too, and start yanking accreditation and licenses of pharmacists who try to make "moral refusal" cases.)

b) Formulate a state list of essential medications and require at least one pharmacy per incorporated town (or better yet, one pharmacy per "x amount of people in an area" to cover major metro areas) to be a "state formulary pharmacy".  State formulary pharmacies would be required to carry all medications on the formulary (birth control pills and Plan B, and other reproductive health medications, will be included).  Revoke licenses of pharmacies who are listed as "primary formulary providers" in their area.

c) (This could potentially be used in lieu of b) above) Require all pharmacies carrying pregnancy category D or pregnancy category X drugs to also carry all contraceptives, including "the pill", Plan B, condoms, etc.  This would be especially effective--and would drive the point home.  (The one bad thing is that it does have a loophole--namely, drugstores could opt out of carrying category D or X drugs--but combined with a "formulary pharmacy" law, that could eliminate the issue.)

(Note that I do not mention misoprostol, aka "RU-486".  Due to federal regulations, this can only be given in a doctor's office.)

d) Require formal accreditation at a legitimate, mainstream pharmacists' association as a condition of hire (such as APhA) and do not let dominionist "parallel economy" groups in as alternate accreditation bodies.   One possible way of doing this is requiring continuing medical education (CME) as a condition of pharmacist licensure and only accepting CME credit from legit groups like APhA.