US asks pharmacists not to withhold drugs that can cause abortion

WASHINGTON – The Biden administration warned the nation’s 60,000 retail pharmacies on Wednesday that they risk violating federal civil rights law if they refuse to prescribe drugs that can cause abortions – for the second time this week. they used their executive power to set up shops with states where abortion is now illegal.

In four pages of guidelines, the federal Department of Health and Human Services has highlighted a wide range of conditions — including miscarriage, stomach ulcers, and ectopic pregnancy — that are commonly treated with drugs that can cause serious health problems. abortion. It warned that failure to distribute such pills “could be discriminatory” on the basis of gender or disability.

The guidance comes two days after Xavier Becerra, President Biden’s health secretary, instructed hospitals that even in states where abortion is now illegal, Federal law requires doctors to have an abortion for pregnant women to go to the emergency department if they believe it is “stabilizing treatment necessary” to address the medical emergency.

The backlash makes clear that while Mr Biden’s powers to protect access to abortion were limited after the Supreme Court removed his constitutional due process rights last month, he will push for those limits where possible. Legal experts on both sides of the issue agreed in interviews that the administration is trying to assert that federal law takes precedence over state laws banning abortions, a move almost certainly will be challenged in court.

“They are trying to define federal statutes in some way that will replace abortion restrictions and bans,” said Lawrence O. Gostin, an expert in public health law at Georgetown University. of the state. In the guide to pharmacists, he says, “The clear goal is to have abortion pills available to treat a wide range of medical conditions and be available for abortion.”

However, the new guidance is carefully written and avoids telling pharmacies that they must supply the drug for the purpose of a medical abortion, which is prohibited or restricted in some states. The guidance also does not mention how a provision in federal law known as the Church Amendment would be applied. That measure allows health care providers, including pharmacists, not to perform or support abortions if they have religious or ethical objections.

The problem is that three drugs – mifepristone, misoprostol and methotrexate – are commonly prescribed for other conditions but can also cause abortions. Experts said the administration was responding to reports that women of childbearing age were being denied the drug following the ruling.

Mifepristone is used to manage certain patients with a hormonal disorder called Cushing’s syndrome, and misoprostol is prescribed for ulcers. But they are also allowed by the Food and Drug Administration combination of two drugs Can be used to terminate pregnancy during the first 10 weeks and can also be used in combination after miscarriages. Methotrexate is used to treat autoimmune disorders, such as rheumatoid arthritis, as well as cancer.

“These are very legitimate issues when people are concerned about access to the basic drugs they have been receiving for years, just because of the problems,” said Alina Salganicoff, director of women’s health policy. the drug has the potential to terminate a pregnancy. in Kaiser Family Foundation. “Looks like they don’t block this for men.”

The administration’s moves will almost certainly be challenged in court, and abortion rights advocates admit it could be a losing battle. If legal challenges come before the Supreme Court, the administration will have to bring its case before the same large conservative division that voted to oust Roe v. Wade, the landmark legal case established abortion rights in 1973.

“They’re trying to mandate the stockpiling of the abortion pill and perform abortions across the country with tools that don’t grant the federal government that right,” said Roger Severino, who runs the Office for Civil Rights in the department. on Health and Human Services when Donald J. Trump was president. “They’re trying to make abortion a law that’s clearly not designed to tackle abortion.”

Wednesday’s action could put pharmacists in a difficult position. The National Association of Community Pharmacists, which represents 19,400 independent pharmacies nationwide, said pharmacists “acting in good faith under their state’s law” lack “a clear roadmap” and need more guidance from the states.

B. Douglas Hoey, executive director of the organization, said in a statement: “States have provided little clarity on how pharmacists should proceed in light of state laws and regulations. State and federal are at odds,” B. Douglas Hoey, the organization’s executive director, said in a statement. “It is unfair to state and federal governments to threaten active action against pharmacists who are merely trying to serve their patients within new regulatory boundaries that are still forming.”

A spokesman for Walgreens, one of the nation’s largest pharmacy chains, said the company would review the guidelines; he has no further comment.

In an interview with reporters, an official with the Department of Health and Human Services said that when federal and state laws conflict, federal law applies.

Mr. Biden has come under intense pressure from Democrats and reproductive rights advocates to take bold steps to protect abortion rights following the court ruling in the Dobbs Women’s Health Foundation. sue Jackson. Among other things, they pushed him to declare a public health emergency – something his administration seems reluctant to do.

Wednesday’s guidance was issued by the health department’s Office for Civil Rights. Monday guide for hospital is accompanied by a letter to health care providerstheir responsibilities under the Emergency Medical Treatment and Active Labor Act, known as EMTALA, a 1986 law that requires anyone who goes to the emergency room to be stabilized and treated regardless of their condition. insurance status or ability to pay.

Mr Severino argued that the guidance for hospitals “changes EMTALA over the head”, because the law defines an emergency as a condition where immediate medical care is not available “that can be reasonably expected”. reason to affect the patient’s health, or (in the case of pregnancy, the unborn child) is in grave danger.” But Mr. Gostin took to the administration’s position, saying that in the case of a woman pregnant woman in distress, the law allows abortion “if it is necessary to save her life and there is no other way to stabilize her.”

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