Should health care providers be required to dispense emergency contraception? (Pro & Con).

YES

There was a recent court case in California Y E S involving a public health nurse who was fired for refusing to dispense emergency contraception. The jury decided in her favor, and she was awarded $47,000 in back pay and damages.

The point is that if she were the only person in that clinic who was available to dispense that medication, then she'd be obliged to do it. And if there were others who covered for her, she should have said, "I can't do this, but so-and-so can do it."

When I was in my residency some 30-odd years ago, abortions had just been made legal. There were plenty of residents who didn't want to do them, and that was fine because others were willing to do these procedures. But if the mission of the service they were working for was to offer abortions, then someone had to do them.

It's the same thing in this case. If you hire someone, and they know that dispensing emergency contraception is part of the mission of that practice, they should do it or leave the practice. If I were hiring a nurse to work in a clinic, I would tell her what services the clinic offers and make sure she doesn't have any problems with them.

The reason some people object to dispensing these pills is that they consider them abortifacients. What the pills do, however, is prevent implantation of the fetus; they do not cause abortions because they prevent a pregnancy from being established in the first place. Suppose a woman decides to try in vitro fertilization. The doctor gets an egg from her and a sperm from her husband and puts it into a dish and it fertilizes, growing from two to four to eight cells. Is she pregnant? No, because the embryo has not been implanted into the uterus. Similarly emergency contraceptives do not cause abortion, because they work by preventing implantation.

Dr. Richard Falk is clinical professor of ob.gyn. at George Washington University, Washington.