More thoughts on being denied the morning-after pill by a pharmacist

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      First, I want to thank London Drugs for their quick and professional response to the original article, and for the emphasis placed on educating their customers as to their practices and procedures. A lot of people have called for a boycott of London Drugs or requested that I “name” the pharmacist in question. I do not believe that a boycotting of this location—or any London Drugs—is necessary or appropriate. This was a single pharmacist acting on her own. Naming her (if I could remember her name) wouldn’t do much good. This woman losing her job is going to have much less of an effect than if companies like London Drugs and individual consumers take a clear stand on unprofessional behaviour on the part of pharmacists. But for those still interested in the woman’s identity, a member of the pharmacy staff for Georgia and Granville contacted me via email to say that none of the four pharmacists at this location would have denied emergency contraception to a customer. He believes that this woman was a relief pharmacist who was on hand during the holidays and is no longer employed at their location.

      While I stand by everything I said in my original article, I want to address a number of misconceptions or lingering questions caused both by my situation and the drug itself.

      First is the question of whether I am right to call this woman anti-choice. Can I absolutely—beyond a shadow of a doubt—state that this particular pharmacist chose to deny me access to Plan B because of her moral values? No, because she did not offer a single reason for her rejection, other than that I had not had the pill before. What causes me to suspect that this was moral-based, rather than experience-based, is that she did not then follow the procedure required of her. She did not warn me that this was a potent drug that would have serious side effects—even though I already knew that, having done quite a bit of research ahead of time. She did not say that I could speak to one of her colleagues or that another store might be willing to dispense this to me. She told me unequivocally that a first-time user needed a prescription. So yes, this was a lie and, yes, it was unprofessional.

      I do not believe that pharmacists are “slaves” or “robots” that should just hand me my drugs and not raise any objections. An objection would have been welcome or understood. But an objection and a rejection are two different things. She had every right to tell me that her religion or her experience made her wary of dispensation, but she did not have the right to intentionally mislead me about the requirements surrounding a legal, over-the-counter, prescription-free drug.

      And while it’s a far less easily measured or determined fact, the truth is that she also made me feel both shamed and judged. We did not have this conversation in a separate consultation room, which should be available at such a large location. We did not have the conversation quietly or even in another part of the store. She had me sit down at the pharmacy desk and asked all of her questions in a regular speaking voice. She was smug and officious throughout, and her denial was given with a condescending smile. In short, she did not act like a professional either in her manner or in the information she provided. So I will not treat her as one.

      The feeling of shame associated with this request is hard to convey in writing—especially to someone who has never been in a similar situation. My partner jokingly related that he’s been able to buy condoms in anything from a gas station to a school bathroom to a 7-11 and the reactions at the till range anywhere from amusement to camaraderie to mild disinterest—not to mention the number of times he’s been able to get them for free at public events or clinics. As condoms are currently the only form of contraception that men are expected to take or to use, the average heterosexual man has not had to feel a similar sense of judgment associated with the purchase of female contraceptive products.

      A number of people have suggested that I should have known my rights or demanded at the time that she release the drug to me. Why shouldn’t I have had every reason to assume that this woman was performing her job in a legal and responsible manner? What this situation, and the countless number of situations like it, has proven is that information and education are sorely lacking on this issue—on both sides of the cash register. In the United States, Plan B can be purchased over the counter from age 17 onwards (there is no current age limit for Canada), but a recent study has shown that one in five 17-year-olds are denied on the basis that they are “too young” or that they need a parent’s permission. Are that many pharmacists really this undereducated about their own profession? Unlikely. So if they have a legitimate issue to raise regarding the side-effects or the health ramifications of this product, why not say so? My assumption is that the misinformation is intentional, and its reasons are moral—not scientific—in nature.

      “Gentleman Jack”, one of the most fervent naysayers in the comment section for the original article, believes that a pharmacist has every right to deny a woman access to a drug that would enable her to end a life. But Plan B is not an abortion pill. It is termed emergency contraception for a reason—it does not and will not work to remove a fertilized, implanted ova. Rather, it works as a very potent form of the pill to prevent fertilization by stopping the release of the egg from your ovary. There is no evidence to suggest that it will have any effect on a fertilized egg or fetus whatsoever.

      Gentleman Jack suggests that Plan B, which he likens to Zyklon-B, is “chemical warfare against the unborn”, and states that it is a miscarriage “in the sense that proper carriage of the semen/egg is to term, if nature will allow it” defining miscarriage as “any other carriage, whether induced by nature or artifice”. By this poorly worded and ignorant definition, Jack believes that every time a woman menstruates, she is destroying a life.

      The actual definition of a miscarriage is the spontaneous loss of a fetus before the 20th week of pregnancy, while an abortion is the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability. An unfertilized egg, by its very definition, cannot be an embryo.

      While Gentleman Jack is an extreme example, would the average person who more casually raises objections about Plan B also oppose the birth control pill, condoms, diaphragms, the rhythm method, female condoms, spermicidal foam/gel, and masturbation with the same fervour? Probably not—because most people have either been misinformed or are willfully ignorant as to the actual use and effect of this product.

      In the end, no matter what the reason, this was a case of someone not performing her job correctly and not providing accurate information. It’s very easy to say that young women should stand up for themselves and not allow pharmacists like this woman to push them around or deny them access to these drugs, but such a suggestion implies that every woman who goes to buy Plan B does so to prove a point or to further the cause of feminism. I would wager that most of us just want the legal, over-the-counter emergency contraception that we have every right to. It is tantamount to victim-blaming to suggest that the onus rests with us. Rather, the responsibility lies with the health professional, who is expected to act professionally.

      Sarah Arboleda is a recent graduate of Simon Fraser University with a BA Honours in English. She has written for a number of online and print publications, including the Peak at SFU, Sad Mag, Zelda Lily, and her own blog, Tea Leaves and Dog Ears.

      Comments

      21 Comments

      John Picur

      Apr 23, 2012 at 3:03pm

      I appreciate your informative article on the Plan-B pill. I would suggest to you, however, that you do NOT know how men feel when they are buying condoms and are obviously being judged by the vendor -- whether by smirk or other reaction.

      @John Picur

      Apr 23, 2012 at 3:07pm

      The point is: how many times have you been denied and outright shamed for it? When was the last time a pharmacist sat you down and explained that you couldn't/shouldn't have condoms? A smile is one thing -- someone not *allowing* you to buy a necessary and legal contraceptive is quite another.

      bc

      Apr 23, 2012 at 3:19pm

      I am a pharmacy student and I am sorry that this happened to you. This is not how we are taught in school.

      @bc

      Apr 23, 2012 at 3:42pm

      Quick before it's not too late - change your major and avoid a career from hell. You may think being a pharmacist is a fascinating and noble profession but you will find the reality is far from that. You will deal with sick, drug-addicted, ill-educated morons and self-righteosu soccer moms who blame you for every regulation and law you try to uphold day after day. You will have junkies verbally abuse you, elderly patients threaten you all the while exposing you to every disease known to science. Run away, run away.

      Martin Dunphy

      Apr 23, 2012 at 3:52pm

      @bc:

      In other words, your day is the same as that of a BC Transit bus driver.

      Cristina Alarcon

      Apr 23, 2012 at 8:42pm

      re: Being denied the morning after pill by a pharmacist

      Yes, pharmacists should always speak the truth….Yet very few acknowledge the abortifacient potential of morning-after pills, potent hormones that interfere with the complex implantation process of the human embryo…
      While a lying pharmacist is highly reprehensible, no less so is a highly misinformed English Major.
      Cristina Alarcon, Vancouver pharmacist

      Skulander

      Apr 23, 2012 at 10:16pm

      I feel sorry that Cristina Alarcon is so misinformed about Plan B, considering she is a pharmacist (???). Sarah really has done a thorough research and honestly, she is right. Plan B will not work if the fertilized egg has already implanted in the uterus and therefore, Plan B is NOT an abortifacient drug. That some pharmacists can still be so ignorant about an essential product for women in need of emergency contraception is simply astounding.

      In any case, Health Canada has deemed the product safe, and while the pharmacist certainly can provide further explanations and ask the woman questions to make sure the use of the product is safe, he/she simply hasn't got the right to deny someone Plan B just because it conflicts with their values. It is quite surreal that this nonsense happens in Canada, in 2012.

      R u kiddingme

      Apr 23, 2012 at 10:27pm

      @christine

      Let's say that's true. So what?

      John Wilks, Consultant Pharmacist

      Apr 24, 2012 at 3:26am

      A few facts of embryological life:
      1. The human (sperm DNA unified to oocyte DNA ) - does not implant for 5-6 after fertilization. A new, DNA unique human entity now exists. Implantation is a process of life-sustanance only.
      2. The process of implantation is an extraordinary process involving cascading immunosuppresant factors designed to make the precise point of nidation immune-unresponsive because the embryo is allograft.
      3. Of the dozens of implantation factors involved (IL, MMP, heptoglobin, M-CSF, LIF etc), many are controlled directly or otherwise by progesterone.
      4. The expected pregnancy rate when the MAP is used is less than that seen in the general population of non-users of the MAP.
      5. What has happened? Interference by supra-physiological dose of hormone in the MAP interfere with the maternal-embryo "cell-talk" that is vital to implantation Piccinni has summarised the complexities of the pre-implantation process as requiring “exquisite dialogue” between the human embryo (at the blastocyst stage), and the maternal endometrium.(see Piccinni et al. Role of hormone-controlled T-cell cytokines in the maintenance of pregnancy. Biochemical Society Transactions. 2000; 28:212-215)
      6. Because implantation is impaired, an abortion has occured. (See: Moore KL, Persaud TVN. The Developing Human: Clinically Orientated Embryology.6th edition. Philadelphia: W.B. Saunders Company 1998)
      7. The popularly accepted definition of an abortion is an artifical construct of the American College of Obstetricians and Gyanecologists, made for political reasons in 1972. This definition stated that conception occured at implantation, rather than the proper definition as set out by the peak embryology body – the International Nomina Embryologica Committee (INEC) - who do not hold to the definitions advanced by the ACOG.
      8. Finally, as Horne has noted (The endometrium and embryo implantation. BMJ 2000). “The embryo is not passive but is an active orchestrator of its attachment and fate.”

      Riddle Me This

      Apr 24, 2012 at 8:16am

      So then, by these definitions John Wilks "Consultant Pharmacist" (btw -- what are you, the Sherlock Holmes of pharmacists?), what *isn't* abortion?

      Do you, then, believe that menstruation is tantamount to abortion? Every time a woman mentruates, it means yet another ova has failed to become fertilized and implanted.

      Or, wait -- what about condoms? They prevent fertilization. Masturbation?

      But right, I forgot -- only women should be shamed and punished for their sexuality, especially since they're the ones who absolutely have to face the consequences of childbirth.