By declining to hear the case on Monday, the U.S. Supreme Court allowed a lower court ruling to stand which will allow Washington to be the only state in the U.S. that denies Christian pharmacists the right to make conscience-based referrals.

According to Alliance Defending Freedom, a non-profit legal organization that defends religious freedom, the U.S. Supreme Court has refused to hear a case involving Ralph’s Thriftway, a small grocery store and pharmacy located in Olympia, Washington. Owned by the Storman family for four generations, this Christian family has refused to dispense Plan B or ella, two drugs which FDA guidelines confirm can destroy a human embryo, because of their religious beliefs. When their pharmacists receive requests for these drugs, they refer them to nearby pharmacies that sell the drugs.

In 2005, Planned Parenthood and Washington Governor Christine Gregoire began pressuring the Washington Pharmacy Commission to prohibit conscience-based referrals for Plan B. The commission resisted and unanimously agreed to continue supporting conscience-based referrals. Planned Parenthood and the governor continued to pressure the commission, threatening the members with personal liability under anti-discrimination laws if they voted in favor of such referrals. This culminated in the governor refusing to re-appoint the commission chairperson and, instead, appointing two new members that Planned Parenthood recommended. In 2007, the commission enacted the governor’s rule requiring pharmacies to dispense Plan B and ella and making conscience-based referrals illegal; however, pharmacies were permitted to continue daily referrals for all kinds of other reasons.

After years of litigation, a federal trial began in 2012 that resulted in the issuing of extensive factual findings, concluding that the anti-conscience regulations violated the First Amendment’s Free Exercise Clause and finding that the regulations were “riddled with exemptions for secular conduct, but contain no such exemptions for identical religiously-motivated conduct.”

The court also concluded that the regulations “were not the product of a neutral, bureaucratic process based solely on pharmaceutical expertise,” but rather, “a highly political affair, driven largely by the Governor and Planned Parenthood – both outspoken opponents of conscientious objections to Plan B.”

The court entered a permanent injunction in favor of the Stormans and two other pharmacists who joined the case that stopped the state’s regulations from being applied to them.

The state appealed to the U.S. Court of Appeals for the 9th Circuit. In 2015, the 9th Circuit ruled against the Stormans and the two pharmacists, upholding the regulations that force pharmacists to dispense drugs contrary to their conscience, resulting in Washington being the only state in the country to make conscience referrals illegal.

The Stormans then appealed to the U.S. Supreme Court which chose not to hear the case, which leaves the 9th Circuit Court’s ruling in place. As a result, pharmacy owners and pharmacists in the state of Washington who do not wish to sell Plan B and similar drugs because of their religious beliefs will no longer be permitted to refer customers to nearby pharmacies.

“All Americans should be free to peacefully live and work consistent with their faith without fear of unjust punishment, and no one should be forced to participate in the taking of human life,” said Alliance Defending Freedom Senior Counsel Kristen Waggoner.

“We had hoped that the U.S. Supreme Court would take this opportunity to reaffirm these long-held principles. The state of Washington allows pharmacists to refer customers for just about any reason—except reasons of conscience. Singling out people of faith and denying them the same freedom to refer is a violation of federal law. All 49 other states allow conscience-based referrals, which are fully supported by the American Pharmacists Association, the Washington Pharmacy Association, and 36 other pharmacy associations. Not one customer in Washington has been denied timely access to any drug due to a religious objection. As the trial court found, the government designed its law for the ‘primary—if not sole—purpose’ of targeting religious health care providers. We are disappointed that the high court didn’t take this case and uphold the trial court’s finding.”

Justice Samuel Alito, joined by Chief Justice John Roberts and Justice Clarence Thomas, dissented from the denial and would have agreed to hear the case.

“This case is an ominous sign,” they wrote in their dissent.

“At issue are Washington State regulations that are likely to make a pharmacist unemployable if he or she objects on religious grounds to dispensing certain prescription medications. There are strong reasons to doubt whether the regulations were adopted for—or that they actually serve—any legitimate purpose. And there is much evidence that the impetus for the adoption of the regulations was hostility to pharmacists whose religious beliefs regarding abortion and contraception are out of step with prevailing opinion in the State. Yet the Ninth Circuit held that the regulations do not violate the First Amendment, and this Court does not deem the case worthy of our time.”

They added: “If this is a sign of how religious liberty claims will be treated in the years ahead, those who value religious freedom have cause for great concern.”