Oklahoma health care workers are divided along familiar lines with respect to a new federal rule. The "right of conscience" rule, signed by President George W. Bush on Dec. 18, extends federal protection to health care workers who have a "reasonable" connection to the delivery of health care services, including pharmacists, nurses and, conceivably, custodians, from providing services they feel violate their beliefs.
The rule is scheduled to go into effect on Jan. 18, 2009, two days before President-elect Barack Obama takes office.
Federal law already protects medical doctors who refuse to provide abortions, but those protections did not extend to pharmacists who did not want to provide emergency contraception or to nurse practitioners who refused to write prescriptions for emergency contraception. Under the new rule, health care organizations will have to provide written documentation of their compliance with the rule by Oct. 1, 2009, or possibly lose federal funding.
Bryan Potter, executive director of the Oklahoma State Board of Pharmacy, said pharmacists in Oklahoma have had no legal right to refuse to fill or dispense medication for moral or religious reasons.
"The right to refuse with regard to pharmacists is related to what is unsafe or detrimental to the patient," Potter said. "If they suspect a patient is an addict, they can refuse to fill a prescription, but current law in Oklahoma does not provide for refusing based on conscience."
Jennifer Buckingham is a retail pharmacist in Oklahoma City. She recently moved from a "closed-door" facility where she filled prescriptions for nursing home patients. That job provided no opportunity to meet with or counsel patients. The new position calls for face-to-face interaction with patients on a daily basis.
Buckingham said she wasn't aware that pharmacists did not have the right to refuse service in Oklahoma.
"I always thought we had the right, and the company I work for doesn't provide Plan B or the morning-after pill so the issue has never come up," she said.
Buckingham, a mother of two with another on the way, is a regular churchgoer. She said her religious beliefs and convictions shape how she views the subject. Still, she said she is deeply conflicted about emergency contraception.
"I don't think I could dispense it," Buckingham said. "I would refer them to another pharmacist. Although, if I was the 14-year-old girl who was raped and living in a small town, I would probably want the pill, and I would hope the pharmacist would give it to me."
This is the kind of scenario that is often used to frame the debate between pro-life and pro-choice voices. Pro-life advocates cheered the new rule as long overdue protection, especially for people of certain faiths. But pro-choice advocates, like Jon O'Brien, president of Catholics for Choice, called the new rule "draconian" and said the poor and powerless will be adversely affected.
Michelle Cuevas and Myrth Mehl are nurses in Oklahoma City and classmates in a nurse practitioner program at Midwestern State University in Wichita Falls, Texas. A nurse practitioner is a registered nurse with additional nursing education " in the case of Cuevas and Mehl, a master's degree. Nurse practitioners are able to diagnose and treat patients, write prescriptions and counsel patients in family planning or other medical issues.
Cuevas and Mehl are also friends, and they disagree vehemently about the new rule. Cuevas said her personal convictions about family planning methods should not factor into patient care.
"If a patient wanted emergency contraception and I felt it was appropriate and necessary for them, I would provide it," Cuevas said. "I don't think that what an individual believes ought to be imposed on someone else. To do what is best for the patient sometimes requires setting aside your personal beliefs."
Mehl believes that a good health care provider must follow her conscience. "If you go against your conscience, you can't be a good health care provider," she said. "I've always practiced this way. Why would anyone go to a health care provider who goes against their own principles? The thing to remember is that people will still get care. They are free to go someplace else to get what they want."
It is unclear at this point what the fate of the rule will be. Sen. Hillary Rodham Clinton, D-N.Y., and Sen. Patty Murray, D-Wash., have already introduced a bill to repeal the rule. Another possibility, according to the Chicago Tribune, is that President Obama could exercise lax enforcement until the rule is overturned. "Greg Horton