On the March 29 edition of CNN's American Morning, anchor Carol Costello interviewed a "pharmacist fired for refusing to fill a prescription for birth control pills." But while Costello's co-anchor, Bill Hemmer, teased the segment as a report on the tension between "pharmacist beliefs" and "women's rights," Pharmacists for Life president Karen Brauer appeared by herself to discuss the topic, with no one presenting an opposing view. Further, Costello failed to point out the serious questions about Pharmacists for Life's credibility, ask Brauer about her own credibility problems, or ask Brauer obvious questions about the appropriateness of pharmacists refusing to fill prescriptions. CNN's treatment of Brauer, though, is consistent with several other news reports that have mentioned her or her organization without explaining their background or giving readers and viewers a full picture of them.
Brauer and Pharmacists for Life are at the forefront of a growing movement aimed at giving pharmacists the right to refuse to fill prescriptions if filling them would be inconsistent with their moral or ethical beliefs. Thus far, the fight has primarily revolved around birth control prescriptions.
On February 10, the Associated Press reported:
Last year, Mississippi lawmakers passed a bill that allows all types of health care workers and facilities to refuse performing virtually any service they object to on moral or religious grounds. Anti-abortion organizations and a group called Pharmacists for Life are urging pharmacists to refuse to distribute emergency contraceptives.
Examples of pharmacists doing exactly that abound; USA Today highlighted two in a November 9, 2004, article:
In Madison, Wis., a pharmacist faces possible disciplinary action by the state pharmacy board for refusing to transfer a woman's prescription for birth-control pills to another druggist or to give the slip back to her. He would not refill it because of his religious views.
In February, another Texas pharmacist at an Eckerd drug store in Denton wouldn't give contraceptives to a woman who was said to be a rape victim. In the Madison case, pharmacist Neil Noesen, 30, after refusing to refill a birth-control prescription, did not transfer it to another pharmacist or return it to the woman. She was able to get her prescription refilled two days later at the same pharmacy, but she missed a pill because of the delay.
A February 7, 2005, National Law Journal article illustrates that while the bulk of attention has been given to pharmacists who refuse to fill prescriptions for birth control pills, the potential exists for pharmacists to refuse to dispense a wide range of essential, prescribed medicine if advocates of the so-called "conscience clause" for pharmacists are successful; the article noted that in 2004, "a Dallas pharmacist refused to fill a mother's prescription for her son's Ritalin."
Though "conscience clause" advocates prefer to focus on birth control pills -- and the media reports that cover the controversy do likewise -- their position that pharmacists need not fill prescriptions they disagree with has far-reaching implications. By the same rationale, a pharmacist who believes, as the Rev. Jerry Falwell once claimed, that AIDS is "God's punishment for homosexuals" could refuse to fill a prescription for an AIDS patient. Pharmacists could refuse to fill prescriptions for heart medicine for the elderly, antidepressants for a suicidal patient -- anything.
According to The Washington Post, "The American Pharmacists Association [APA] recently reaffirmed its policy that pharmacists can refuse to fill prescriptions as long as they make sure customers can get their medications some other way." APA vice president for policy and communications Susan Winckler explained:
What we suggest is that they identify those situations ahead of time and have an alternative system set up so the patient has access to their therapy. ... The key is that it should be seamless and avoids a conflict between the pharmacist's right to step away and the patient's right to obtain their medication.
But Lauryn Shipp, president of Voices for Planned Parenthood at Ohio State University, noted the consequences for women of allowing pharmacists to refuse to fill certain prescriptions, as the Ohio State Lantern reported on February 8:
Lauryn Shipp, president of Voices for Planned Parenthood at Ohio State, said Ohio's bill has the potential to affect every woman in Ohio, however the poor, the young and women in rural areas are likely to feel the greatest impact.
"Imagine you're a teenager who has been a victim of sexual assault. You have no car. You have a little over 72 hours to fill a prescription for emergency contraception -- what if the only pharmacist around refuses to give it to you?," Shipp said.
In a November 17, 2004, Voice of America News report, medical ethicist Julie Cantor explained further:
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."
Karen Brauer & Pharmacists for Life:
Though CNN apparently considered Pharmacists for Life a significant enough organization to invite its president to appear on American Morning unopposed, the organization is rather obscure. Pharmacists for Life's most recent IRS filings indicate that the organization has no paid employees and raised and spent less than $30,000 in 2003 (the most recent year for which figures are available), with more than half going for "VIT, GLOVES, SUPPLIES."
Pharmacists for Life president Karen Brauer was fired by a Kmart pharmacy in Ohio for refusing to fill birth control prescriptions. As Brauer acknowledged during an April 16, 2001, appearance on Fox News' The O'Reilly Factor, Brauer didn't merely refuse to fill a patient's prescription, she lied to the patient, as well:
O'REILLY: I got you. Now, when the customer complained, what happened there? Did you refer that customer to somewhere else?
BRAUER: I asked -- I -- she did not complain to me. OK? What happened is, she came in for a refill. I informed her that we did not carry the drug at the time. And I offered to call a copy of her prescription to the pharmacy of her choice.
O'REILLY: And then she complained. But did you -- how -- why would she complain about that, if you didn't have the drug on hand?
BRAUER: Somehow she found out that this pharmacy actually did have the drug at the time.
O'REILLY: So you lied to her.
BRAUER: Yes, I did.
O'REILLY: Ohh. Well, that wasn't good.
BRAUER: The situation concerning her privacy and concerning the people present did not really -- it was not really amenable to giving her information about her drug.
Presumably, the mere act of lying to a patient would have been reason enough for Brauer to be fired; at the least, it seems to be a direct violation of the American Pharmacists Association's "Principles of Practice for Pharmaceutical Care," which state: "Interaction between the pharmacist and the patient must occur to assure that a relationship based upon caring, trust, open communication, cooperation, and mutual decision making is established and maintained."
Brauer's decision not to give her patient "information about her drug" would also seem to be contrary to the APA's guidelines, which repeatedly emphasize that "The pharmacist holds the patient's welfare paramount" and declares that "The pharmacist must also assure that the patient has a thorough understanding of the disease and the therapy/medications prescribed in the plan."
But CNN's Costello didn't ask Brauer about her lies to her patient, or her decision not to give her patient information about the drug. Nor did The Washington Post or any other recent news reports that have mentioned Brauer and her organization.
Nor did CNN note an apparent contradiction between Brauer's own actions and public statements she and her organization have made. On CNN, Brauer said that, though she refused to fill a prescription for birth control pills, she "offered to transfer her prescription to the pharmacy of her choice, because the prescription is her property in the state of Ohio."
But Brauer and Pharmacists for Life have both publicly denounced such transfers. The Washington Post reported on March 27:
Brauer, of Pharmacists for Life, defends the right of pharmacists not only to decline to fill prescriptions themselves but also to refuse to refer customers elsewhere or transfer prescriptions.
"That's like saying, 'I don't kill people myself but let me tell you about the guy down the street who does.' What's that saying? 'I will not off your husband, but I know a buddy who will?' It's the same thing," said Brauer, who now works at a hospital pharmacy.
Likewise, the Associated Press reported on September 16, 2004, that Brauer "does not believe there should be any obligation to refer rebuffed customers to another pharmacist who would fill their prescription. 'Forced referral is stupid,' she said. 'If we're not going to kill a human being, we're not going to help the customer go do it somewhere else.' "
Brauer further explained her opposition to referrals in Drug Topics:
"There is no moral or ethical obligation to tell a person where to get a drug that is detrimental," Brauer said. "Any patients who can transport themselves to a pharmacy can obtain the product they desire without need of a direct referral. Patients have proven themselves to be quite resourceful in obtaining pharmaceuticals. The referral rhetoric has been a tool to obtain involvement by the unwilling in dispensing drugs that stop human life or are detrimental. Obtaining the involvement of the unwilling has been used as a tool to legitimize the procedures and drugs that are in controversy."
Brauer's organization, Pharmacists for Life, goes even further, explicitly denouncing pharmacists who -- as Brauer claims to have done -- refer patients to other pharmacists who will fill the prescription:
A pharmacist by virtue of properly understood conscience cannot be licitly compelled to cooperate in such a fashion with what he knows will result in a chemical abortion and, hence, a dead baby. Such activity is called material cooperation. Further, it is not an inconvenience to refuse to refer such a client since the pharmacist is doing the woman and her preborn child a favor in terms of physical and spiritual health.
Material cooperation with such an evil can never be licit even if it may be lawful, as it is in today's society. In fact, pharmacists aware of the evil nature of such a scenario would have a duty as a pharmacist and a person not to cooperate in such an evil even under pain of serious adverse ramifications. Some authors, hiding their publicly stated support for any and all baby killing, have erroneously stated shameful opinions which equivocate on the rights of conscience and thus claim a pharmacist may have a right of conscience, but if all else fails, he must cooperate with the evil in our example. Such thinking shows the irrational absurdity and confusion in the minds of those who adhere to such ideas.
But CNN's Costello didn't ask Brauer to reconcile her actions with statements she and her organization have made. Nor did she ask Brauer about her history of controversial statements; for example, the December 31, 2004, edition of The Daily News of Los Angeles quotes Brauer saying, "Birth control serves to make women sexually available to men at the convenience of men and not at the most convenient time necessarily for women. It's really to place women at the service of men."
Neither CNN's Costello nor other journalists who have covered Brauer and Pharmacists for Life recently have asked Brauer about her organization's funding, or that of Brauer's lawsuit against Kmart, which was filed by the American Center for Law and Justice (ACLJ). The ACLJ was founded by Pat Robertson, who serves as president of ACLJ's board of directors. ACLJ's executive director/chief counsel, Jay Sekulow, is a graduate of Robertson's Regent University. Sekulow and ACLJ board member Thomas P. Monaghan represented Randall Terry in his 1993 appeal of a criminal contempt judgment.
Pharmacists for Life's web page contains numerous controversial statements that have thus far escaped the notice of the media outlets that have given the group attention. PFL's "Frequently asked questions" section states "Pharmacists are under no obligation, even if written in the positive law, to violate the Divine Law." This suggestion that pharmacists are not bound by the laws of the United States so long as they think God disagrees with those laws is but the tip of the iceberg. Other examples, taken from the group's recent comments on the Terri Schiavo case:
"The ultimate test is, will Gov. Bush, or anyone, step up and be a real man before an innocent [Terri Schiavo] loses her life."
"The modern day 'Sanhedrin' in charge of the political/justice machine has shown its face and wishes her dead as the original one did the same to Jesus Christ 2000 years ago."
"Judge Greer officially opened the Pinellas County division of Auschwitz by ordering that Terri's feeding tube be removed yet again."
"Will Terri undergo the same fate as these gypsy innocents at Auschwitz?" [accompanied by photos of Auschwitz]
"This [Terri Schiavo being called to testify before Congress] may be the miracle Terri needs. At least it temporarily stops the murderous intentions of Michael Schiavo, his concubine and less than ethical lawyers, the ACLU and all anti-lifers ..."
On Michael Schiavo's attorney: "It's not easy being a weasel!"
"Michael Schaivo [sic], victim extraordinaire in the Scott Peterson lineage, working hard to make sure Terri dies and that any evidence is quickly destroyed via cremation."
That last quote appears as a caption under a photo of Schiavo; the placement of the photo and caption suggest that they are the work of The New York Times -- the photo and caption appear beneath a Times headline and byline, but above the first paragraph of the article excerpted.
While most of Pharmacists for Life and Brauer's public comments relate to pharmacists refusing to dispense birth control medication, their efforts -- and their effects -- are not limited to issues of reproductive rights; Brauer said during her O'Reilly Factor appearance that she refused to fill prescriptions for diet pills "due to the abuse potential in the area in which I was working."
And a caption on a photo accompanying a February 2 Santa Fe New Mexican article suggests that Pharmacists for Life's agenda may go well beyond pharmacies. The caption reads:
GRAPHIC: 1. Sen. Bill Sharer, left, R-Farmington, meets Tuesday with supporters of his bill defining marriage in New Mexico as only between a man and a woman. Meeting with Sharer are representatives of the Pharmacists for Life and Life League of New Mexico, Abran Gabaldon, former Sen. Tom Benavides of Albuquerque and Manuel Rodriguez.