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The issue has exploded during the last five years, in part because of the recent availability of emergency contraception (EC). Both Preven (approved in 1998) and Plan B (1999) can be taken within 72 hours of unprotected sex. If properly used, they are more than 70 percent effective at preventing pregnancy. Though all forms of contraception raise ethical issues for Catholic pharmacists, EC raises the ante for Protestant pro-lifers as well, because some claim that the drug is an abortifacient.

"For pro-life pharmacists, this is a real bright line in the sand," David Stevens, executive director of the Christian Medical and Dental Associations, told CT. "There's a difference between dispensing EC and a birth-control pill."

The Religious Coalition for Reproductive Choice—a group that represents Episcopalians, Presbyterians (PCUSA), Conservative and Reform Judaism, United Methodists, and Unitarians, among others—argues that EC is little more than a potent birth-control pill of the kind that Christian women take routinely. It works the same way and contains the same ingredients as birth control (unlike the abortion pill, RU-486, which is not available in pharmacies), so it should pose no moral problems for pharmacists. The Rev. Carlton W. Veazey, the group's president, told CT, "People need to understand: The medical fact is that neither birth-control pills nor emergency contraception—a concentrated dose of these same birth-control pills—cause an abortion."

So is this simply a case of some pro-life Christians refusing to look at the science? Not quite. As with many aspects of the abortion debate, defining terms is critical.

The American College of Obstetricians and Gynecologists (ACOG) defines conception (and therefore pregnancy) as beginning at the moment of implantation. "Conception is implantation," says ACOG, and therefore EC cannot, by definition, cause an abortion—even if it affects a fertilized egg. But, as Karen Brauer of Pharmacists for Life International told CT, "Our issue has to do with human life, not their definition of pregnancy." In her view, human life begins the moment that an egg is fertilized.

This difference in emphasis is crucial. According to its maker, Plan B "prevents pregnancy mainly by stopping the release of an egg from the ovary and may also prevent the fertilization of an egg. Plan B may also work by preventing it from attaching to the uterus." Though EC will do nothing to stop the growth of a developing fetus, it has the potential to prevent a fertilized egg from implanting in the uterine wall. To many pro-life pharmacists, this makes it an abortion-inducing drug, and its presence in the neighborhood pharmacy has caused them to fight for their right not to dispense it.

Their refusal got the attention of NARAL Pro-Choice America, which launched a campaign in March 2005 to pressure pharmacies and legislators. NARAL president Nancy Keenan said, "In 2005, it is appalling that women do not know whether their prescriptions will be filled. Pharmacies have no right to override a decision made by a woman and her doctor."

This move brought publicity to the debate about whether pharmacists should have the right to refuse any drug to any patient at any time. Most states passed "conscience clauses" years ago, but these were generally targeted at individual physicians, approved in the years following Roe v. Wade to allow doctors to opt out of performing abortions. The position of pharmacists has been more ambiguous. Few states have laws explicitly granting them the same conscience protection that doctors have.

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August 2006, Vol. 50, No. 8