Responding to complaints about a Chicago pharmacist who refused to dispense birth control pills, Illinois Gov. Rod Blagojevich on Friday issued an executive order requiring drugstores to fill prescriptions for contraceptives.
The policy, the first of its kind in the U.S., requires pharmacies that carry contraceptives to fill prescriptions without delay.
"No hassles, no lecture, just fill the prescription," Blagojevich said.
If an individual pharmacist will not provide birth control pills because of moral or religious beliefs, the drugstore must have a plan to ensure that the patient receives the pills promptly.
In most cases, that means having another pharmacist on hand to dispense the drug.
The policy does not require that all drugstores carry contraceptives; many don't, especially in Catholic hospitals.
But if the pharmacy has them, it must dispense them to anyone with a valid prescription -- or risk suspension of its license, said Susan Hofer of the Illinois Department of Financial and Professional Regulation, which oversees pharmacies.
Because Blagojevich issued the policy as an emergency rule, it would remain in place for 150 days. During that time, Hofer said, the state will hold public hearings on a proposal to make the policy permanent.
"When you or I walk into a pharmacy with a prescription," she said, "we have to have a strong level of confidence that we're going to walk out carrying the drugs we need. If the drug is in stock, it must be dispensed. End of discussion."
But that's not the end of the discussion for a growing number of pharmacists who consider it immoral to dispense birth control pills and morning-after emergency contraceptives.
Some consider the morning-after pill a form of abortion because the hormones can block a fertilized egg from implanting in the uterus. Because they view that as tantamount to murder, they may not only refuse to provide the hormones, but also to transfer the prescription to another pharmacist.
"To transfer the prescription would make me part of a bucket brigade ... a party to selling something that demeans or endangers life," pharmacist Neil Noesen told the National Catholic Register this year.
Noesen was recently reprimanded by an administrative law judge in Wisconsin for refusing to fill a college student's birth control prescription in 2002. That state's Pharmacy Examining Board will meet this month to decide whether his license should be restricted.
Similar cases have cropped up in Georgia, New York, Ohio, Texas, Missouri and other states in recent years.
"We're hearing about it happening more and more frequently," said Karen Pearl, interim president of the Planned Parenthood Federation of America.
In response, abortion rights groups are promoting legislation that would require pharmacists to fill prescriptions or promptly transfer them to someone who will. A California Assembly committee is scheduled to consider such a bill next week.
On the other side of the debate, abortion opponents have proposed bills to protect pharmacists from lawsuits and disciplinary action if they refuse to provide contraceptives.
In the mid-1970s, after abortion was legalized, most states passed laws that let doctors and nurses refuse to participate in procedures that violated their religious beliefs. But only Arkansas, Florida, Mississippi and South Dakota explicitly extend that right to pharmacists.
Legislation to give pharmacists the right to act based on their beliefs is pending in several states, including Wisconsin.
"People should not feel excluded from entering the pharmacy field because they hold a certain view on when life begins," said Francis Manion, a lawyer with the American Center for Law and Justice, a group that presses religious rights cases.
Manion acknowledged that letting pharmacists turn away prescriptions could be "horribly inconvenient" for some patients, especially those in rural areas who might not have ready access to another drugstore.
"I know if I went into a drugstore and was told the pharmacist wouldn't give me my medicine, I'd be really mad," Manion said.
"But that's the price we pay for being a society that values religious freedom."