Tuesday, August 11, 2015
The National Women's Law Center explains the existing law of pharmacists' "right" to refuse to dispense contraception. Pharmacy Refusals 101
Refusal to Dispense Contraception are Increasing
- Reports of pharmacies refusing to fill prescriptions for birth control—or provide EC—have surfaced in at least twenty-five states across the nation, including: AZ, CA, DC, GA, IL, LA, MA, MI, MN, MO, MT, NH, NJ, NY, NC, OH, OK, OR, RI, TN, TX, VA, WA, WV, WI.
- These refusals to dispense prescription contraceptives or provide EC are based on personal beliefs, not on legitimate medical or professional concerns. The same pharmacies that refuse to dispense contraceptives because of personal beliefs often refuse to transfer a woman’s prescription or refer her to another pharmacy. These refusals can have devastating consequences for women’s health.
- Despite the fact one type of EC is available without a prescription, refusals based on personal beliefs are still a problem. Some stores prefer to keep non-prescription EC behind the counter or in locked cases, so individuals seeking it must interact with pharmacists or other pharmacy staff who may have personal beliefs against providing the drug.
The Legal Landscape: What Governs the Practice of Pharmacy?
- The laws governing pharmacies vary from state to state. Pharmacies must abide by state laws and regulations, which are written by the state legislature and the state Pharmacy Board.
- The laws and regulations in most states do not specifically speak to the issue of pharmacy refusals based on personal beliefs. States that provide general guidance about when pharmacies or pharmacists may refuse to dispense tend to limit the reasons for such a refusal to professional or medical considerations—such as potentially harmful contraindication, interactions with other drugs, improper dosage, and suspected drug abuse or misuse—as opposed to personal judgments.
- Many pharmacist associations that have considered this issue, including the American Pharmacists Association, have issued policies requiring that patient access to legally prescribed medications is not compromised—for example by either filling valid prescriptions or transferring them to another pharmacist who can. Although such policies are not legally binding, they encourage pharmacies to meet consumers’ needs.
Thursday, July 23, 2015
Linda Greenhouse (NYT/Yale) and Reva Siegel (Yale), Casey and the Clinic Closings: When "Protecting Health" is an Undue Burden, Yale L. J (forthcoming).
Abstract:We seek in this article to understand how the Supreme Court's abortion jurisprudence addresses laws that invoke, not potential life, but women's health as a reason to single out abortion for burdensome regulation that closes clinics. We approach this project with a sense of urgency. The current wave of health-justified restrictions — prominently including laws that require abortion providers to secure admitting privileges at nearby hospitals or to become the functional equivalents of hospitals themselves — is destroying the clinic infrastructure on which women depend in order to exercise their constitutional right to terminate a pregnancy.
There is now a sharp circuit conflict over how judges are to evaluate the states' claims that admitting privilege laws protect women's health. Some circuits read Planned Parenthood of Southeastern Pennsylvania v. Casey and the Court’s subsequent decision in Gonzales v. Carhart to require courts to examine whether health-justified regulations actually and effectively serve health-related ends. Others construe the cases to require judicial deference to the states' claims. We argue that Casey/Carhart require judicial scrutiny of health-justified regulations to ensure these regulations do not obstruct abortion by unconstitutional means.
The analysis of health-justified restrictions we offer rests on an understanding of Casey's undue burden standard — reaffirmed in Carhart — as the product of a compromise over Roe v. Wade. While prohibiting states from banning abortion before fetal viability, Casey allowed government to express a preference for childbirth throughout a woman's pregnancy by trying to persuade her, through a 24-hour waiting period and the provision of information, to forego abortion. Persuasion is the heart of the Casey compromise: government may protect potential life, but not in ways that obstruct women from acting on their constitutionally protected choice.
Regulations that close clinics in the name of women's health, but without health-related justification, do not persuade; they prevent. In so doing, they violate the constitutional principle at the core of the Casey compromise: that government express respect for the dignity of human life by means that respect the dignity of women.
Thursday, July 16, 2015
Women in Oregon will soon be able to receive birth control prescriptions from pharmacists, thanks to a new law signed by Gov. Kate Brown this week. Under the new rule, birth control can be obtained without the added burden of scheduling a doctor’s visit. The bill passed the state’s house in a 50-10 bipartisan vote.
To get birth control from a pharmacist, women over 18 will have to fill out a simple health questionnaire so that pharmacists can recommend the best contraceptive method for them. Those under 18 will need proof of a previous birth control prescription, but aren’t required to get a new one. The contraception will still be covered by the patient’s insurance.
State Rep. Knute Buehler (R) celebrated the bill in a press release, saying that his background as a medical professional informed his beliefs on access to contraception.
Tuesday, June 30, 2015
A federal district court today dismissed a lawsuit filed by the American Civil Liberties Union and the ACLU of Michigan on behalf of a pregnant woman who was denied appropriate medical treatment because of the hospital’s religious directives.
In terminating the lawsuit brought by Muskegon resident Tamesha Means against the U.S. Conference of Catholic Bishops, the U.S. District Court for the Western District of Michigan said it was doing so, in part, because resolution of the case would involve reviewing religious doctrine. ***
In 2010, Ms. Means rushed to Mercy Health Partners when her water broke after only 18 weeks of pregnancy. The hospital, which was the only one in Muskegon County, sent her home twice even though she was in excruciating pain. Because of its Catholic affiliation and binding directives, the hospital told Ms. Means that there was nothing it could do, and it did not tell Ms. Means that terminating her pregnancy was an option and the safest course for her condition.
When Ms. Means returned to the hospital in extreme distress and with an infection, the hospital prepared to send her home for a third time. While staff prepared her discharge paperwork, she began to deliver. Only then did the hospital begin tending to Ms. Means’ miscarriage.
Tuesday, June 23, 2015
On Monday, the Fifth Circuit—one of the most conservative appeals courts in the country—rejected a challenge to the Affordable Care Act's contraceptive mandate in an opinion written by Judge Jerry E. Smith—one of the most conservative federal judges on the bench. The challenge, brought by nonprofit religious groups, claimed that the mandate violated the Religious Freedom Restoration Act (RFRA) by forcing these groups to sign a form that would eventually allow their employees to access contraception. In a concise, emphatic opinion, the court ruled that the mandate complies with RFRA. ***
The religious groups currently suing the government claim that the act of submitting this form constitutes a substantial burden on their religious exericse, in violation of RFRA. Signing the form, they argue, will set into motion a chain of events that ultimately allows their employees to gain access to contraception. The Third, Sixth, Seventh, and D.C. Circuits have already rejected this argument; the Fifth Circuit now joins their ranks. At the heart of the court's opinion is this remarkable passage:
Although the plaintiffs have identified several acts that offend their religious beliefs, the acts they are required to perform do not include providing or facilitating access to contraceptives. Instead, the acts that violate their faith are those of third parties. Because RFRA confers no right to challenge the independent conduct of third parties, we join our sister circuits in concluding that the plaintiffs have not shown a substantial burden on their religious exercise.
Thursday, April 23, 2015
Before the passage of the Affordable Care Act (ACA), Geneva College, which is associated with the Reformed Presbyterian Church of North America, regularly notified its insurance carrier that it would not provide coverage for four contraceptives that it deemed to be abortifacients, namely, emergency contraceptives Plan B and ella and two intrauterine devices. Similarly, the Roman Catholic Bishops and Dioceses of Pittsburgh and Erie, Pennsylvania, along with their affiliated nonprofit organizations Catholic Charities, Prince of Peace Center, St. Martin Center, and Erie Catholic Cathedral Preparatory School, regularly notified their insurance carriers that they would not provide any contraceptive insurance. Geneva College administrators believe some contraceptives cause abortion and abortion is immoral; Catholic officials believe all contraception is immoral.
After the passage of the ACA, Geneva College is required to tell either its insurance company or the Department of Health and Human Services (HHS) that it will not provide coverage for four contraceptives that it deems to be abortifacients, namely, emergency contraceptives Plan B and ella and two intrauterine devices. Similarly, the Roman Catholic organizations are required to tell either their insurance companies or HHS that they will not provide contraceptive coverage to their employees.
Post-ACA, however, the religious organizations argue that filling out a simple notification form, just as they did in the past, substantially burdens their religion in violation of the Religious Freedom Restoration Act (RFRA). They argue that filling out a form makes them “complicit” in the sins of abortion and contraception because their signatures immorally “trigger” abortion and contraception.
Four courts of appeals—the Sixth, Seventh, D.C., and, most recently, the Third Circuits, in Geneva College v. Burwell— rejected that argument. The “trigger” to insurance coverage, those courts concluded, is the ACA itself, which legally requires contraceptive access for employees. Thus there is no “causal link” or trigger between the notification forms and contraception. Without a trigger, there is no substantial burden on religion, because women’s independent access to contraception is not a substantial burden on the religious organizations’ religious exercise. As the Third Circuit shrewdly observed:
The appellees’ real objection is to what happens after the form is provided—that is, to the actions of the insurance issuers and the third-party administrators, required by law, once the appellees give notice of their objection.
The court then refused to give the religious organizations a veto over women’s rights on such non-substantial ground.
There things stood until Justice Samuel Alito shot down women’s rights last week by staying the Third Circuit’s opinion for the Catholic plaintiffs. Geneva College has asked the Court for a similar stay.
Wednesday, November 19, 2014
Medicine has not traditionally been very kind to lesbian, gay, bisexual, and transgender people. While homosexuality was removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1973, and was no longer considered a disorder, attempts by doctors to “treat” it persist even today. Though research and understanding of LGBT healthcare has improved in recent years, the social stigma and discrimination faced by LGBT people leads to health disparities that put them at higher risk for certain conditions. This is also the case with those who are gender non-conforming, or who are born with atypical sex anatomy (sometimes called “intersex,” though the medical term for the condition is “disorders of sex development,” or DSD).
With all that in mind, the American Association of Medical Colleges released new guidelines earlier this week on how to improve med school curricula to better prepare young doctors to treat their LGBT, gender non-conforming, and DSD patients. Authors of the publication spanned all aspects of the medical profession, from psychiatry to genetics to clinical practice. I spoke with Kristen Eckstrand, a fourth-year medical student at Vanderbilt University, chair of the AAMC Advisory Committee on Sexual Orientation, Gender Identity, and Sex Development, and editor of the guidelines about what doctors need to know to treat their patients effectively and respectfully.
Thursday, October 23, 2014
So suggests the Korea Herald. The fertility rate (or lack thereof) among South Koreans is owing in part to the class inequality in the country and the demands of an industrial nation-state.
South Korea’s low birthrate is generating deep concern among policymakers.
The government is scrambling to shore up the falling birthrate, a threat that could jeopardize Asia’s fourth-largest economy, which is saddled with a rapidly aging population.
What many policymakers have failed to tackle is the underlying problem that forces Koreans to delay or forgo having children.
Just ask Kim Jin-ah, a 28-year-old Seoulite who still hasn’t been “properly” employed, despite her two university degrees.
“I don’t think marriage is an option for me right now,” said Kim, who currently works as a part-time tutor. “Having kids is just not even thinkable. I can’t even take care of myself right now. I am not sure if I deserve to be happy at this moment.”
After finishing her master’s degree in biology, Kim, at age 26, realized she didn’t want to be a scientist. She started looking for jobs ― a full-time position that would pay her enough to move out of her parents’ house and start a family of her own ― but never found one.
During one job interview, for a marketing position at a big firm, Kim was told that she was “too old” for the company’s entry-level positions.
Kim, who lives with her parents, is considering going back to school, or even overseas for job opportunities. She is putting off marriage until she gets a full time job.
“If you are not working full time and want to be married, you have to have wealthy parents,” she said. “That’s just not the case for me.”
Monday, September 29, 2014
Corey Ciocchetti, Denver (Business School), has uploaded to SSRN "Religious Freedom and Closely Held Corporations: The Hobby Lobby Case and Its Ethical Implications." The abstract reads:
Hobby Lobby and its quest for religious freedom captured the attention of a nation for a few moments in late June 2014. The country homed in on the Supreme Court as the justices weighed the rights of an incorporated, profit-making entity run by devout individuals that objected to particular entitlements granted to women under the Affordable Care Act. The case raised important legal issues such as whether the law allows for-profit corporations to exercise religion (yes!) and whether protection for religious freedom trumps the rights of third parties to cost free preventive care (sort of!). The Supreme Court’s decision also brought to light some major ethical dilemmas such as: (1) whether the government has the right to second-guess a person’s religious beliefs, (2) when do religious beliefs become too attenuated from the actions they oppose to truly pose a burden on religion and (3) whether religion can only be experienced by human beings. Though the lawyers will move on to the next legal challenge, Americans in general must continue to grapple with these ethical dilemmas as citizens of a society needing to find the appropriate balance between religious freedom and improving public heath.
This article attempts to answer some of these questions by evaluating the Hobby Lobby case from many different angles. Part II recounts the stories underlying the legal challenge. These stories, often-neglected in law review articles and judicial opinions, when told in depth add context and nuance to the case and help bring to life topics that seem boring if analyzed purely in legalese. For example, the Greens tell a story of a family who consider their work at Hobby Lobby to fulfill their calling from God. They sincerely believe they are expected to practice their religion at work even if it costs the corporation, and themselves personally, a great deal of money. The federal government tells the story of a nation in desperate need of better and less expensive health care options -- particularly for women. The government claims that women need cost-free preventive care (and particularly cost-free contraceptives) in order to improve their health and reduce unwanted pregnancies. Better access to contraceptives will also give women more power to control their reproductive lives and compete more effectively in the workplace. Part II brings these litigants to life and sets the stage for a discussion of the law in Part III and the application of the law to these parties in Part IV.
More specifically, Part III synthesizes the state of the law surrounding religious freedom and preventive health care at the time the Hobby Lobby case hit the Supreme Court. The article recounts the history of religious freedom in America and how this concept worked its way into the first words of the First Amendment and eventually into the very broadly protective Religious Freedom Restoration Act. This part ends with an evaluation of the ACA’s contraceptive mandate and its requirements regarding access to cost free preventive care for women.
Part IV evaluates the court decisions in the Hobby Lobby case. The discussion begins with the District Court’s denial of Hobby Lobby’s request that mandate be stayed and ends with the Supreme Court’s decision issued on the last day of its October 2013 term. All in all, the discussion moves with the case from a federal district court (where Hobby Lobby asked for a preliminary injunction) to the Tenth Circuit Court of appeals (where that decision was affirmed) to the United States Supreme Court (where Hobby Lobby’s appeal was summarily denied) back to the Circuit Court sitting en banc (where the district court was urged to issue the preliminary injunction) back to the district court (where the judge reversed himself and issued the injunction) and finally to the Supreme Court (where Hobby Lobby emerged victorious). This part summarizes the lower court decisions and evaluates the Supreme Court decision in detail, section by section.
Part V, the final substantive part of the article, begins with the statement that the Court reached the correct legal decision in the case considering: (1) the important place religious exercise holds in the fabric of America, today and historically, (2) the broad brush with which Congress painted RFRA and (3) the fact that Hobby Lobby’s employees will still receive all twenty FDA-approved contraceptives at no cost. The discussion then moves to the ethical issues spun off by the Supreme Court decision. The three ethical dilemmas chosen for analysis revolve around the questions of whether corporations can exercise religion, whether it is ethical for religion to trump third party rights and whether governments have any business analyzing the beliefs of a religious adherent in order to better craft public policy.
The article concludes with a call for further research into potential answers to these and other ethical dilemmas keeping in mind that Hobby Lobby is just the first shoe to drop in the fight between religious freedom and parts of the Affordable Care Act.
Saturday, July 12, 2014
[T]he US supreme court's Hobby Lobby decision left most women's groups livid. Terry O'Neill, president of the National Organization for Women, called it "a shocking disregard for women's health and lives." The co-president of the National Women's Law Center, Marcia Greenberger, said the ruling gave companies "a license to harm their female employees in the name of religion."
But the Independent Women's Forum (IWF) - a conservative women's group with at least a quarter-million dollars in financial ties to Rush Limbaugh - called the decision "undoubtedly good news". The group's director of cultural programs, Charlotte Hays, told a crowd outside the court, "This is a great day," and called the ruling a victory "for anyone who believes in freedom of conscience." This from the same woman who has written that women shouldn't be astronauts and that rape culture on college campuses is all "inflated numbers" and "hysteria".
This latest crop of female anti-feminists - powerful, Washington-based organizations like IWF and Concerned Women for America - want to repeal the Violence Against Women Act and argue that pay inequity doesn't exist. These organizations, along with a handful of popularwriters and authors, want to convince women that it's men who are the underserved sex. They want to convince you that inequality is just a trade-off.
Thursday, July 10, 2014
Yes, still more on Hobby Lobby. For women, this is a game-changing decision with both significant legal and practical consequences. It's not going to go away quietly.
Congress takes action. NYT, Democrats Push Bill to Reverse Supreme Court Ruling on Contraceptives
Saturday, July 5, 2014
Of interesting note in these and other articles on Justice Sotomayor's dissent is the journalistic choice of words used to describe the decision: searing, fierce, outraged, scold, women get together
The White House released a new report from the Council of Economic Advisors on Wednesday, detailing the healthcare and economic impact of refusing to accept Medicaid expansion, as 24 states have. Bottom line, it's 5.7 million people who would qualify for Medicaid, but be uninsured by 2016, "and these states will forgo billions in federal dollars that could boost their economies."....
But there's another part of the story that Think Progress picks up: the refusal to expand Medicaid has a hugely disproportionate effect on women.
Tuesday, June 3, 2014
Sarudzayi Matambanadzo (Tulane), has posted The Fourth Trimester, U. Mich. J. Law Reform (2014). From the abstract:
This article introduces a new conceptual framework to the legal literature on pregnancy and pregnancy discrimination: the fourth trimester. The concept of a fourth trimester, drawn from maternal nursing and midwifery, refers to the crucial period of three to six months after birth when many of the physical, psychological, emotional, and social effects of pregnancy continue. Giving this concept legal relevance extends the scope of pregnancy beyond the narrow period defined by conception, gestation, and birth, and acknowledges that pregnancy is a relational process, not an individual event. In the United States, however, anti-discrimination law has failed to acknowledge the demands of the fourth trimester; it operates from the presumption that pregnancy begins at conception and ends with the birth of the infant. Without employing a fourth trimester framework, the current federal anti-discrimination regime will continue to permit discrimination against women in relation to pregnancy because employers can discriminate on the basis of activities which typify the fourth trimester of the pregnancy. It is time for judges, administrative actors, movement lawyers, and other policy makers to recognize that discrimination on the basis of fourth trimester activities like breastfeeding, caring for newborn infants, or recovery constitute pregnancy discrimination that should be prohibited by law.
Tuesday, May 20, 2014
From NY Times, Labs are Told to Start Including a Neglected Variable
From Slate, Why Are All the Lab Rats Boys?
And why we need feminist science.
You can think of feminist biology as having two components. First, it identifies gender bias in traditional biology and alerting students and scientists to possible gender bias. Scientists want, in general, to be not biased, so in a way this is just improving biology, right? Another part is constructing new theories and new research that does away with these biases and leads to a more balanced biology that takes women into account.
Thursday, May 15, 2014
Nancy Ehrenreich has uploaded an article, "Breastfeeding on a Nickel and a Dime: Why the Affordable Care Act Won't Help LowWage Mothers." It's forthcoming from the Michigan J. of Race and Law and its abstract reads:
As part of the Patient Protection and Affordable Care Act of 2010 (also known as “Obamacare”), Congress passed a new law requiring employers to provide accommodation to working mothers who want to express breast milk while at work. This accommodation requirement is a step forward from the preceding legal regime, under which federal courts consistently found that “lactation discrimination” did not constitute sex discrimination. But this article predicts that the new law will nevertheless fall short of guaranteeing all women the ability to work while breast feeding. The generality of the act’s brief provisions, along with the broad discretion it assigns to employers to determine the details of the accommodation to be provided, make it likely that class- and race-inflected attitudes towards both breast feeding and women’s roles will influence employer (and possibly judicial) decisions in this area. Examining psychological studies of popular attitudes towards breast feeding, as well as the history of women’s relationship to work, the author concludes that the influence of cultural attitudes on interpretations of the Act is likely to have a disparately negative impact on low-income women, perhaps especially those who are African-American. In short, the new law is likely to help produce a two-tiered system of breast feeding access, encouraging employers to grant generous accommodations to economically privileged women, while increasing the social pressure on low-income women to breast feed, without meaningfully improving their ability to do so.
More from this month's guest blogger, Professor Jamie Abrams from the University of Louisville School of Law. Her scholarly interests include integrating masculinities theory in feminist law reforms such as military integration and domestic violence; examining the tort complexities governing standards of care in childbirth; gendered conceptualizations of citizenship; and legal education pedagogy.
This Huffington Post piece by Chelsea Carmona, Criminalizing Good Maternal Health Care in Tennessee, highlights the troublesome gendered dimensions of Tennessee’s new law criminalizing drug use during pregnancy. Tennessee’s bill takes effect on July 1st and is the first law of its kind in the United States. The Huffington Post piece notes gendered differences in women’s patterns of drug addiction, describes critical gaps in care for pregnant women in substance abuse programs, and summarizes concerns anticipating the disproportionate prosecution of pregnant women of color, particularly rural women.
What is perhaps most striking about Tennessee’s law is its enactment against such an overwhelming volume of dissent from diverse stakeholders in law, medicine, and social services. Implementation of the bill is especially complex when considered in the context of tort law. As noted, it remains uncertain how a doctor could navigate the duty of care owed to the pregnant woman undergoing methadone maintenance without risking her possible incarceration. Yet to forego the “gold standard” for treating opioid addiction seems to breach a medical standard of care as well. As the law’s effective date looms, the question becomes how opponents of this bill can capture the law’s inevitably troubling impact when the gender, class, and race dimensions are so systematic and pervasive.
Friday, April 25, 2014
The Boston City Council passed the following law on April 16:
The City of Boston, to the extent permissible by federal and state law after this ordinance is in
force, shall not contract with any health insurance company that refuses to insure any person or that discriminates in the amount of premium, policy fees, or rates charged for any policy or contract of insurance, or in the benefits payable thereunder, or in any of the terms or conditions of such contract, because of gender identity or expression.
And here was a preface to the law:
Many transgender people have been diagnosed with a medical condition known as
Gender Dysphoria (GD), a well-recognized medical condition. In 2008, the
American Medical Association (AMA) adopted a resolution that recognizes
Gender Dysphoria as a “serious medical condition” which can result in severe
psychological impacts if untreated – including increased risk of suicide and death....
Thursday, March 27, 2014
From Jeffrey Toobin, Women Justices Rock the Hobby Lobby Argument
There were two lessons from Tuesday’s argument in the Hobby Lobby case in the Supreme Court. First, it’s very important that there are now three women Justices. Second, it’s even more important that it takes five votes to win.
The issue in the case is straightforward. The Affordable Care Act requires employers who provide health insurance to their employees to include coverage for contraception. The owners of Hobby Lobby, a large (thirteen-thousand-employee), privately held chain of stores, regard certain kinds of birth control (like the I.U.D. and morning-after pills) as forms of abortion, which is against their religious principles. Does the employees’ right to choose and obtain birth control trump the employer’s right to religious freedom?
There was little doubt where the Court’s three female Justices stood. After Paul Clement, the lawyer for Hobby Lobby, began his argument, twenty-eight of the first thirty-two questions to him came from Ruth Bader Ginsburg (four questions), Sonia Sotomayor (eleven), and Elena Kagan (thirteen). The queries varied, of course, but they were all variations on a theme. The trio saw the case from the perspective of the women employees. They regarded the employer as the party in the case with the money and the power.
Tuesday, March 25, 2014
The U.S. Supreme Court hears argument in the contraceptive mandate cases today. Lots of good reading on the case and its far-reaching implications.
Lots of good questions being asked out there. Why is religion always in opposition to women's rights? Why does gender discrimination seem more palatable than race -- What if employers refused health insurance coverage for black employees? And how did we get to this place of inserting our employers into our private health decisions?