Public Hearing on Proposed Amendment to Illinois Pharmacy Practice Act

June 2, 2005 Thank you for the opportunity to speak today. My name is Peggy Pace and I am a licensed pharmacist in Illinois. I’m sharing testimony with you to explain why I believe the governor’s emergency rule is bad for the people of Illinois, and bad for the pharmacy professionals in this state. I work for a large chain at a southern Illinois location. Prior to working at my current location, I worked for the same chain at a Missouri location, where the pharmacy manager decided not to stock the morning after pill. His decision not to stock it had nothing to do with me, and I was notified of his decision after the fact. After I reciprocated my license to Illinois, I transferred to an Illinois location of the same chain that did stock the morning after pill. I was also aware of the Illinois Health Care Right of Conscience Act of 1997, and the protection it guarantees to health care personnel like me. The governor’s rule is in direct violation of that Act. I cannot in good conscience dispense a drug that is designed to destroy human life. This drug’s action cannot be accounted for in its effect on mucous, since it is taken post-coitally, and fertility specialists tell us that the sperm are already at the distal end of the fallopian tube, where fertilization takes place, within 20 to 30 minutes. Daily progestin administration only inhibits ovulation in about half of the women who use it, so the ability of this drug to inhibit ovulation, after only being taken twice during a woman’s cycle (12 hours apart) is questionable. The mechanism of action which inhibits implantation of an embryo, living and human, is in large part responsible for its effect. I understand that the morning after pill is classed as a contraceptive. I also understand that the reason it is called a contraceptive, and not an abortifacient, is because the American College of Obstetricians and Gynecologists, in 1965, redefined the terms “pregnancy” and “conception” to now only mean after implantation of an embryo has occurred. However, embryologists world-wide agree unanimously that time zero for human life is fertilization, not implantation, which doesn’t begin until the embryo is about 7 days old. This drug would therefore be more properly termed a “contraimplantive”, rather than a contraceptive. Further, to describe this drug as ending the life of a “fertilized egg” is scientifically incorrect, since a fertilized egg is properly called an embryo. But the issue before us is not some arcane redefining of medical terms, but the real human right not to participate in purposefully killing another human being in early development. Since the passage of this rule on April 1, I have not gotten a clear answer from my employer on where I stand and what will be the consequences of my not filling one of these prescriptions. Since I always work alone, the patient would be required to drive about 11 miles to get it filled after hours, and less than that during the hours of 8am to 10pm. In spoken communication with my supervisor, she assures me that I can invoke the Health Care Right of Conscience Act, but she will not put this in writing. All written communication from my employer tells me to fill, or face discipline. So it appears my employer is confused about who this rule applies to, and how to apply it. The attorney general’s office has said that the rule applies to pharmacies, not pharmacists, but this government’s own publication, the Flinn Report, states that those affected by this rule includes pharmacists. To further confuse matters, Sheila Nix, the governor’s Senior Policy Advisor, said in a televised news report that this rule really only applies to chains. So each time I go to work, I am under the “sword of Damocles,” and can only wonder what will happen to me the next time I am presented a prescription for the morning after pill. I have a gnawing ache in the pit of my stomach, and nausea nearly all the time that I’m there. This added stress is not good for me or the people that I serve. In order to comply with this rule, I have to pretend that what I believe is false. My Christian faith, which informs my morals, is not a whim or a personal feeling that I can set aside when I go to work each day. Therefore, I cannot and will not participate in the ending of a human life. Does the governor think that by making a rule a public law, he has settled this moral issue? Does he also intend that in order to practice pharmacy in this state I must adopt his world-view, which includes abortion on demand, as my own? Since we cannot agree on an objective moral truth, why must I accept his demand to participate in killing as the moral absolute? Everything I do as a pharmacist is an act of moral conscience. For example, many times I have had to advise a physician of a dosage error for a patient. Other times I’ve had to contact the prescriber because of a drug interaction, or a disease state contraindication, and I do not dispense the drug until such time as I can discuss with him or her how to proceed. Still other times I refuse to fill a habit-forming drug when it is clear that the patient is overusing it, and may, in fact, be forming an unhealthy habit that the prescribing physician never intended. In each of these situations, if I were to act otherwise it would be immoral, because it is immoral to harm a patient. These types of decisions are required by this licensing body, as an exercise of professional conscience, which is actually an outworking of moral conscience, that is, it is wrong to do harm based on professional training and experience. But this same moral conscience is what this rule is asking me to abandon. The law protecting conscientious objectors is not designed to block access to so-called legal therapies. It is about giving healthcare workers the freedom to follow their conscience and protecting us from forced participation in something to which we are morally, ethically, and/or religiously opposed. When our employers demand that we do something that we believe is wrong, we need to be able to follow our conscience without fear of demotion, termination, discipline or fines. By taking the stand that I have, I have already garnered disapproval from my employer. I have already put my professional reputation on the line. I have read scathing editorials in local newspapers and heard derogatory opinions of me and other pharmacists of conscience expressed on various news outlets. I have even read an article that insinuated that I have actually threatened to keep a customer’s prescription, and only returned it to her when she threatened to call the police. The story’s details got embellished somewhat, when, in a rally in Springfield, it was touted that the police were actually called. This is utterly ridiculous. Neither I, nor any of my colleagues with whom I have discussed the matter, have ever kept a customer’s prescription for the morning after pill. Neither do we “preach”, unless you consider answering a customer-initiated question about how this drug works as “preaching”. I call it counseling, and I have a professional mandate to do so. The people propagating these stories are doing it for one reason: to try to get public support for their cause. But who are these lying, judging, preaching pharmacists who are ripping up or otherwise keeping prescriptions? There’s no actual evidence of this happening, mainly because it isn’t happening. The mere accusation of these acts produces the results they want. In all of the years that I studied pharmacy, “a patient’s expectations” was never taught as a standard by which we must operate. There were many standards taught us which are to govern the way we practice, but a patient’s individual expectations, because they can be incorrect or unrealistic, was never held out as the model by which we practice. Now, however, it seems that this has become a new standard, and must include that we do whatever the patient wants, even if it harms him or her; after all, the argument goes, the patient is entitled to live in a risky way. Is this really the change that this board wants to usher into our profession? Americans just celebrated Memorial Day. Part of its observation is the honoring of our servicemen and women, past and present. My father was one of these noble folks, serving in the Marine Corps during World War II. While I’ve heard public citizens and public officials alike over the past 2 months express their disbelief that we are even having this conversation, Dad would have understood it. You see, he taught me that American freedoms are unique, and come with a hefty price-tag. To protect them, sometimes the shedding of American blood in foreign lands is required. But far more often, what is required is ordinary citizens keeping a vigilant watch over these freedoms, and standing up when they see them being eroded. In honor of all who ever wore the uniform, it is our duty here to have this conversation. We are grappling with the idea that no one should be forced by his government to do something that he finds morally repugnant, and whether individual convenience trumps religious freedom. We are also deciding whether we have a government of laws, or of men. I am obliged to use every platform open to me to engage in this conversation. In closing, I know that convictions cost. I know that taking a stand against the governor could potentially cost me my license and my income. Has this board considered the cost of running pharmacists of conscience out of Illinois? With pharmacists at an all-time shortage, does this one-size-fits-all moral code really serve the people of this state, in light of the fact that it will force the part time closing of some pharmacies? This would deny access to a far greater number of people to their life-saving medications. And all for one drug, marketed by one company, for one non-emergency, non-life-threatening indication. Thank you for your time.