Citing grounds of conscience, pharmacists are increasingly refusing to fill prescriptions for emergency contraception, or the “morning-after pill.” Whether correctly or not, these pharmacists believe that emergency contraception either constitutes the destruction of post-conception human life, or poses a significant risk of such destruction. We argue that the liberty of conscientious refusal grounds a strong moral claim, one that cannot be defeated solely by consideration of the interests of those seeking medication. We examine, and find lacking, five arguments for requiring pharmacists to fill prescriptions. However, we argue that in their professional context, pharmacists benefit from liberty restrictions on those seeking medication. What would otherwise amount to very strong claims can be defeated if they rest on some prior restriction of the liberty of others. We conclude that the issue of what policy should require pharmacists to do must be settled by way of a theory of second best. Asking “What is second best?” rather than “What is best?” offers a way to navigate the liberty restrictions that may be fixed obstacles to optimality.