Who should decide what religious doctrines you obey? You or your pharmacist. In a move that troubles many civil liberties advocates, some pharmacists across the nation are refusing to fill certain prescriptions, claiming a First Amendment right to the free exercise of religion.

Media reports, including a recent article from The Washington Post, note an increasing number of pharmacists who refuse to fill birth control prescriptions citing religious qualms for doing so. It is a troubling trend. And one that is being fueled by fundamentalists who believe their free exercise of religion is absolute even if it affects other people who don't share their views.

The Christian Legal Society (CLS), a Religious Right outfit, told the Post that, "More and more pharmacists are becoming aware of their right to conscientiously refuse to pass objectionable medications across the counter. We are on the very front edge of a wave that's going to break not too far down the line."

An Ohio-based group, dubbed Pharmacists for Life International (PFLI), also advocates the use of the First Amendment by pharmacists to refuse to fill prescriptions for people whose lifestyles offend fundamentalist religious proclivities.According to the group's web site, www.pfli.org, it "is the only pharmacy association which is exclusively pro-life, something no other pharmacy organization can say (or would have the courage to say!).' Karen L. Brauer, the group's president, was fired from a pharmacy job in Ohio after refusing to fill birth control prescriptions.

Other Religious Right lobbying groups, such as TV preacher Pat Robertson's American Center for Law and Justice (ACLJ), have filed lawsuits on behalf of pharmacists who, citing their personal religious beliefs, refuse to fill certain types of prescriptions.Francis Manion, an ACLJ attorney, told The National Law Journal earlier this year that pharmacists' free exercise of religion must trump patients' needs.

"The Constitution says government shall not interfere with the freedom of religion," Manion said. "That right to freedom, even though the result may be inconvenient, overrides the mere convenience of somebody else who's looking for a certain medical procedure."

Manion's group is representing in federal court an Illinois emergency medical technician who was fired for refusing to drive a woman to an abortion clinic

The Religious Right's First Amendment claims have produced a raft of state bills, some of which have been enacted. Illinois, for example, has a law that allows health care professionals to refuse any medical procedure they find morally repugnant. Some observers say the statute would allow a fundamentalist nurse who believes AIDS is God's punishment for gays to refuse treatment for AIDS patients. At least nine other states are contemplating laws similar to the one in Illinois.

According to a study by the American Bar Association, exemption laws for pharmacists and other medical professionals have resulted in several troubling incidents. Cancer patients, pregnant patients, patients near death and rape victims have all been harmed by such practices.

Religious Right lobbyists have been overreaching for many years now. And they are emboldened by the 2004 elections and the media-hyped conventional wisdom that evangelicals played a major role in the election of social conservatives. But like the whole of the Bill of Rights, the free exercise clause of the First Amendment is not absolute. The First Amendment strongly protects religious beliefs. But federal courts have ruled on a number of occasions that religious expression that can cause physical harm to others must be restricted.

The laws and policies advocated by groups such as Pharmacists for Life raise troubling questions. The health of millions of Americans are at stake.