Health care providers have an obligation to act in the best interest of their patients, even when doing so requires acting against their personal beliefs, according to "Rights vs. Responsibilities: Professional Standards and Provider Refusals," by Adam Sonfield, which appears in the August 2005 issue of The Guttmacher Report on Public Policy (TGR). The author reached this conclusion after studying providers’ professional codes of ethics, which define providers' rights and responsibilities and specify what is and is not appropriate when caring for patients.

Health care associations generally uphold a provider's right to decline to provide a service that violates his or her moral or religious beliefs. However, they also accept that there must be limits to this right, in order to ensure that patients receive the information, services and respect to which they are entitled. The health care community has come out loud and clear on this issue, despite the ongoing political and public controversy around providers’ right to refuse: A provider does not have the right to obstruct access, impose his or her own beliefs on a patient or attempt to use personal beliefs to block or deny a patient's right to care.

Nearly eight in 10 Americans believe that a pharmacist should be required to fill prescriptions for birth control, even when he or she has a religious objection. Yet, in addition to refusing to fill prescriptions, pharmacists have refused to transfer prescriptions or provide referrals, or have made overtly hostile attempts to dissuade women from using regular birth control or emergency contraceptive pills—all actions that are in direct conflict with the ethical guidelines governing health care professionals.

A less publicized but potentially more problematic issue is pharmacy policies that prohibit the sale of emergency contraception, even in pharmacies where ordinary birth control pills are sold, according to "Beyond the Issue of Pharmacist Refusals: Pharmacies That Won’t Sell Emergency Contraception," by Cynthia Dailard, also in the August issue of TGR. This can be especially problematic for rural women, whose access to this time-sensitive drug may be impeded if no other pharmacies exist nearby.

According to Dailard, there is no rational reason to single out emergency contraception for less favorable treatment than other birth control pills, given that both types of pills work to prevent ovulation, fertilization or implantation; how the method works depends more on when in the menstrual cycle the pills are taken than on when the woman last had sexual intercourse. Yet those who oppose the use of emergency contraception typically try to distinguish it from other birth control pills because it is taken after, rather than before, intercourse.

Extreme behaviors by pharmacists, pharmacies and other health care providers are beginning to fuel a backlash. This year, both Illinois and Nevada have adopted polices to ensure that patients have access to legally prescribed medications, often by requiring referrals to another pharmacy or by requiring a pharmacy to meet this need even if an individual pharmacist refuses. Five other states and Congress have introduced similar bills. Fewer attempts have been made to address pharmacies’ policies independent of the actions of their employees.

"Professional standards exist for a reason," says Sonfield, public policy associate with the Guttmacher Institute. "They remind health care providers that responsibility to the patient must always come first, and the right to refuse to provide certain services should never be mistaken for the right to obstruct access."

Also in this issue:

"Politicizing Statutory Rape Reporting Requirements: A Mounting Campaign?" by Chinue Turner Richardson and Cynthia Dailard;

"U.S. Global AIDS Policy and Sexually Active Youth: A High-Risk Strategy," by Susan A. Cohen; and

"Legislatures in Three States Seek to Expand Medicaid Family Planning Services Eligibility," by Rachel Benson Gold.