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On July 6, 2002, Neil Noesen found himself on the front line of the culture wars. Less than three days after taking a job as a pharmacist at a Kmart in Menomonie, Wisconsin, he received a refill request from University of Wisconsin-Stout student Amanda Renz for the contraceptive Loestrin.

Noesen, a devout Catholic, had always refused to dispense birth control. For six years previous, he had been willing to refer patients seeking contraception to another pharmacist, but a recent trip to Calcutta—where he realized anew that health care is about helping the suffering—had convicted him that this was wrong. "Finally, my conscience caught up to me," Noesen told CT. "I couldn't do it anymore. I felt like I was being used by the system, that I was becoming part of the problem rather than part of the solution."

Now back home in Wisconsin, he faced the first real test of his new policy. He told Renz he could not provide Loestrin.

The store's head pharmacist, who knew Noesen's concerns, had agreed to personally fill such prescriptions, but he was out of town for the weekend. Renz asked where else she could get the prescription filled. Noesen declined to tell her. Renz went to the local Wal-Mart, but when the pharmacist there attempted to transfer her prescription over the phone, Noesen refused.

The resulting deadlock put Noesen's name in newspapers around the country and brought the case to the attention of the Wisconsin Department of Regulation and Licensing (DRL). Though Noesen had violated no state law or administrative code, DRL's Pharmacy Examining Board looked into the matter. They found that Noesen was within his rights when he refused to fill the prescription, but that he had not served the public in a "minimally competent manner," because no procedure was in place to ensure that patients could fill prescriptions to which he objected.

On April 13, 2004, an administrative law judge agreed. She ruled that Noesen must take six credit hours of ethics courses and pay the full costs of the proceedings against him—around $20,000. Noesen's principled stand cost him dearly.

Noesen's case is not an isolated incident. Since 2004, pharmacist refusals have made headlines across the country—and have often spurred local governments into action. In Denton, Texas, three pharmacists were fired from Eckerd after refusing to fill an emergency contraception prescription for a rape victim. Gene Herr told the Associated Press that he "went in the back room and briefly prayed about it" and decided that he could not in good conscience provide the pills, which he believes can cause an abortion. Similar refusals have been reported in Georgia, Alabama, New Hampshire, Missouri, Illinois, and Wisconsin.

Some states have already acted to limit such refusals. In response to reports that some Chicago pharmacists were refusing to fill certain prescriptions, Illinois Gov. Rod Blagojevich signed an emergency rule in early 2005 that ordered pharmacies to dispense drugs in a timely manner—no transfers or referrals allowed. Blagojevich argued that the state's Health Care Right of Conscience Act does not cover pharmacists. He later moved to make the rule permanent, saying there should be "No delays. No hassles. No lectures" (CT, June 2005, p. 29).

In 2005 alone, state legislatures considered more than 20 bills aimed at sorting out the situation. Some would force pharmacists to dispense all legal prescriptions, while others would allow pharmacists to refuse for any reason of conscience and prevent employers from taking action against them. Arkansas, South Dakota, Mississippi, and Georgia already have laws that give pharmacists the right to refuse, and many other states will decide one way or another in the next year.

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August 2006, Vol. 50, No. 8