Some ideas seem so dumb they make my ears just about burst into flames when I first hear them. Then I remember there are smart people who support the idea and I am forced to reconsider. So I reconsidered, really, but the idea that a pharmacist should be able to refuse to fill a prescription for the so-called “morning after pill” because he or she thinks it might cause an abortion is still a dumb idea.

Despite that the idea is gaining momentum around the country, and some pharmacists now routinely refuse to fill morning after pill (emergency contraception) prescriptions. (One of the several ways emergency contraception works may be prevention of implantation of a fertilized egg in the womb, which they believe is abortion.) Some states are considering so-called “pharmacist shield” laws to prevent pharmacists from being fired for refusing to fill these prescriptions. The U.S. Congress, a body long known for its willingness to turn dumb ideas into law, is now conducting hearings about the issue, and a federal bill is sure to follow. Illinois, on the other hand, just passed a law barring pharmacists from refusing.

The reluctance of a pharmacist morally opposed to abortion to do anything that might result in an abortion is certainly understandable. However, a pharmacist pursing his or her moral and political agendas in the pharmacy makes a bull running amok in the china shop looks like a neurosurgeon operating in the brain by comparison. The idea is not just a slippery slope; it’s a greased chute to pharmacy chaos for three key reasons.

First, once we establish the precedent that a pharmacist can refuse to fill a legal, properly prescribed medication for personal reasons there is no place to set a limit on the practice; a pharmacist could conceivably refuse any prescription based on some ethical objection.

With such a precedent, a pharmacist could refuse prescriptions for narcotics because he or she thinks patients who use them long term are junkies, or prescriptions for medications derived from stem cell research because the research cells came from human fetuses. One might object to the dispensing of pork insulin because it was derived from animals, or in the past to growth hormone because it once was derived from human cadavers. Misoprostol is an ulcer medication which can be used to cause abortion; could a pharmacist refuse to dispense that? One pharmacist might refuse any prescription for emergency contraception, while another might agree to dispense it for prevention pregnancy after rape.

Once this line is crossed, there is no other place to draw a new line, and any of us might be the next target of the pharmacist putting his personal agenda between us and our medications.

Second, allowing pharmacists to refuse legitimate prescriptions on ethical grounds means there is no protection for the patient from a pharmacist pursuing any ethical agenda at the public setting of the prescription counter. That is among the last places in the world one ought to be able to pursue such an agenda. Why would this privacy-loving society allow a pharmacist to force a woman standing at that counter in front of other customers to be subject to a moral debate about her need for emergency contraception, especially in a country in which one half of all women will experience an unplanned pregnancy?

Is the pharmacy counter where the pharmacist conducts the interview about whether the sexual encounter that produced the need for emergency contraception was a rape? Or does the pharmacist just refuse all morning after prescriptions, even those for rape, thereby victimizing the raped woman again? Perhaps the next patient would then be interviewed in front of other customers about whether he is addicted to his Vicodin, and the next subjected to a lecture about losing weight instead of spending Medicare tax dollars on prescription medications to control blood pressure and diabetes?

Some would argue that physicians have the right to refuse to do abortions, so pharmacists should have the right to refuse to dispense the morning after pill. That argument does not hold up, for several reasons. No physician can do every procedure anyway, while pharmacists are in the business of filling all legitimate prescriptions. To do an abortion a physician must actually do the procedure; there is nothing indirect about the physician’s role. Pharmacists, by comparison, do not administer emergency contraception to the patient; they are only intermediaries in the pregnancy prevention. Unlike the pharmacy, the sensitive discussions and care provided to patients by physicians happen behind closed doors.

If some pharmacists want out of the emergency contraception role completely they can convince the Food and Drug Administration to allow over the counter (OTC) status of the morning after pill. The patient needing emergency contraception is only forced to deal with a pharmacist because this country has refused to allow it to be sold without a prescription. OTC status has been recommended by an expert panel of the FDA, but the FDA has refused to proceed largely because of opposition from abortion foes. These are some of the same foes who support laws allowing pharmacists protection for refusing emergency contraception prescriptions, suggesting pharmacist shield laws are more about preventing all access to emergency contraception than protecting pharmacists’ ethics.

Finally, most pharmacists cannot refuse emergency contraception on moral grounds without having to confront the hypocrisy of working in a retail setting that sells lots of things that harm and kill. The typical retail pharmacy sits in a store that sells cigarettes, liquor, alcohol, acetaminophen and the decongestant pseudoephedrine, just to name a few products which can kill people.

Cigarettes cause more than 400,000 premature deaths a year in this country, and pregnancy complications including low birth weight and premature labor. They also cause Sudden Infant Death syndrome. A pharmacist cannot refuse emergency contraception prescriptions in a store that also sells cigarettes without overdosing on his own hypocrisy.

Pseudoephedrine can be cooked up into methamphetamine, aka speed, a ruinous drug that is taking the country by storm. Acetominophen is commonly used by depressed patients to commit suicide. Alcohol is social mayhem and death in liquid form, causing an estimated 100,000 deaths in this country each year, and untold human misery. It is also our most common preventable cause of mental retardation, because it causes fetal alcohol syndrome. One has to wonder at a shield law for pharmacists that would allow them to refuse to dispense a product that might cause fetal abortion and still work in a store that sells a product that causes fetal brain damage.

At the pharmacy counter that all sounds like this: “OK, that’s $4.25 for your death-dealing and pregnancy-harming cigarettes, $7.95 for your fetal brain-damaging beer, $2.29 for your potential suicide agent acetominophen, and $1.95 for your methamphetamine-precursor decongestant. Anything else? Oh, you want emergency contraception? No, sorry, you can’t get that from me because I think it might harm a human life.”

As I said, it is a dumb idea. The pharmacy is a health care setting, not a public forum. Let pharmacists who object to emergency contraception find a better medicine for their problem than refusal to fill legitimate prescriptions for patients.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region.