A Pharmacist’s Conscience
Syndicated columnist Bonnie Erbe has an opinion column this week addressing what she labels a “growing movement among pharmacists”–refusing to fill prescriptions for birth control drugs on moral grounds. Erbe seems to be referring to Protection of Conscience Laws, which seek to protect the right of individuals to refuse to participate in activities that violate their moral beliefs.
Erbe claims this is an example of the “extreme right wing” forcing their beliefs on others. But shouldn’t a private business owner have the right to decide which legal products he/she will or will not sell? And what real effect is there if a pharmacist declines to fill a birth control prescription? It is safe to say that the vast majority of Americans live in close proximity to multiple pharmacies; if one will not fill the prescription, another likely will. Failing that, there are many mail-order pharmacies accessible by telephone or Internet.
The only apparent situation where a pharmacist’s refusal to fill a prescription could effectively block access to medical treatment would be in the case of emergency contraception, which must be taken within a short window of time to be effective. But all currently-available drugs in this class function at least part of the time as abortifacients, i.e., rather than preventing conception they prevent the fertilized egg from implanting in the uterus. To many pharmacists, providing such a drug would be equivalent to performing an abortion.
Indeed, it would seem that it is Erbe who would force her beliefs on other people. She makes the suggestion, dripping with sarcasm, that pharmacists opposed to birth control or abortifacients “drop out of the profession entirely and become missionaries.” Would she say the same thing about a prison employee who did not wish to be involved in any way with capital punishment? Should the sole doctor in a small town be forced to either perform abortions or leave the profession?
Surely even the most limited definition of tolerance must allow people the freedom not to violate their own conscience.
Update: Expertise commented on Sunday about a case in Illinois which is a good example of where I think a pharmacist’s conscience should be respected. Chain pharmacy Osco supported their pharmacist’s decision to decline to fill a “morning after” prescription and ask that the customer come back when another pharmacist was on duty. Yet Illinois Governor Rod Blagojevich has signed an executive order to force pharmacists to participate in what they believe is murder.
I have posted a response here.
There was an Op-ed piece on this topic in the LAT this morning. I think this statement, by Mr. Drum, in response, sums up a point well.
“lots of jobs — librarian, teacher, public defender, telephone operator — legitimately require you to provide neutral services to the public even if your own opinions aren’t neutral. If you really can’t stand it, don’t take the job. But if you do take a job that requires you to serve the public as an honest broker, don’t pretend that your political views allow you to second guess medical decisions that should be the sole provenance of doctors and patients. If certain types of medicine are that repellent to you, the right way to demonstrate your moral conscience is simple: find another career.”
I disagree. Why should a person who is otherwise a wonderful doctor, nurse, or pharmacist be compelled to find another career simply because they refuse to perform abortions or prescribe the ‘morning after’ pill? They should not.
Those actions are but a tiny fraction of the hundreds of services that any given health care professional performs for his or her patients. To say they should find another career based solely on such a moral decision is ridiculous.
Balta, the examples you list are clearly examples of public service jobs. But a privately-owned pharmacy is clearly a private enterprise. As I said in response to Nick’s post, I think it’s fine if CVS requires its pharmacists to dispense whatever legal drugs it wants to sell. But I find it chilling to suggest that the government should be able to require a privately-owned store to sell things it does not wish to sell.
BTW, judging by your (Drum’s) argument, I presume that you would have no problem in forcing a prison employee to be involved with an execution–that his only recourse would be to quit his job?
In addition to cases of individual conscience, corporate entities are also being moved upon by the government to act contrary to their moral beliefs. Governor Bill Owens of Colorado vetoed a state bill yesterday that would require all hospitals in the state, including Catholic hospitals, to inform rape victims about emergency-contraception pills. See the Denver Post today.
I understand, and am open to correction, that the emergency contraception pill is a misnomer. That the pill in fact prevents the continuation of a pregnancy, i.e. fertilized eggs do not implant in the uterus. [I read the article you linked on the FDA and morning after pill, that was helpful] Is it fair to say that the drug is only doing its job when it prevents a fertilized egg from implanting? Does it really do any ‘contra-concepting’? Again, I am open to more information on the topic. Even if it prevents conception some of the time and prevents implantation of a fertilized egg the rest of the time, it is abortifacient. The trickier question would be if the drug were truly and only contraceptive, since the Catholic church opposes contraception, as well.
Without claiming to be an expert, Catholic moral tradition would, I believe, call a Catholic hospital’s capitulation and acceptance of the law in question “implicit formal cooperation in an intrinsically evil act”, which is never licit:
Implicit formal cooperation occurs when, even though the cooperator denies intending the object of the principal agent, the cooperating person or organization participates in the action directly and in such a way that the it could not be done without this participation. Formal cooperation in intrinsically evil actions, either explicitly or implicitly, is morally illicit.
Apparently, Jim Spence, writing in the Denver Post today, is unimpressed:
[Owens] veto statement could have been written by the Catholic archbishop of Denver. In fact, most of Owens’ points parroted Charles Chaput’s criticisms that some emergency contraception is really a form of abortion because it could keep a fertilized egg from attaching to the uterine wall.
Besides being suspect science, this concern for rapists’ sacred sperm rings hollow for Owens, a man who prides himself on being tough on crime.
Owens, who is Catholic, also repeated Chaput’s spiel that the mere mention of the existence of emergency contraception posed a “grave moral problem” for Catholics and Catholic hospitals that unconstitutionally infringed on their religious freedom.
This gives new meaning to the Hippocratic Oath.
Sure, that sounds ugly and insensitive, but it’s not nearly as ugly or insensitive as forcing a rape victim to give birth to a rapist’s baby or to get a real abortion because her doctors withheld vital medical information on purpose.
As Stone pointed out, Owens’ “priority is the church’s definition of when life begins, not the medical community’s.”
Two points: one, for Jim Spence it’s not a real abortion since it takes place so soon after conception, and two, we don’t really know when life begins, anyway. The church has its view, the medical community has its own. Well, in fact it’s not a matter of opinion, it’s a fact that, medically speaking, life begins at conception. The question in dispute is the value of that life. I can imagine Spence arguing something like, “Well, a third of all those new lives are going to be spontaneously aborted anyway …” That is a different question. A sloppy and poorly argued article, dripping with disdain.
Sorry if I went on for too long …
The abortion argument is a wee bit pointless; if you don’t want to have to perform abortions, then my advice is to move into a different field of medicine, such as one where you don’t perform abortions. If you’re working at an abortion clinic and you refuse to perform abortions…well…
Secondly, yes a privately owned pharmacy is a privately owned company, but it is also given a license to operate by the government. It is given a license to distribute items that are regulated by the government. The government grants those licenses to distribute regulated substances because it is for the good of the people. If a pharmacist wishes to choose which drugs it wishes to distribute, and willfully deny patients drugs that they have legal permission to receive, then I see no reason why that pharmacy should maintain its license to distribute those items.
Thirdly…yes, if a prison guard were assigned by his superiors to be involved in an execution and he refused based on opposition to the death penalty, he should request to be reassigned, and if he is not, he should either quit his job or tolerate it. I see no problem with that; the government is mandating that the convicted criminal die, and if you don’t want to be a part of it, then no one is forcing you to be employed there.
I disagree. Why should a person who is otherwise a wonderful doctor, nurse, or pharmacist be compelled to find another career simply because they refuse to perform abortions or prescribe the ‘morning after’ pill? They should not.
I disagree. Why should a person who is otherwise wonderful be compelled to find another doctor, nurse, or pharmacist simply because they refuse to perfom abortions or prescribe the ‘morning after’ pill? They should not.
Really, regardless of which side one falls on, there must be better arguments than the above. Freedom of choice will be impugned by a government ruling on either side. Allowing pharmacists to not dispense some drugs nullifies the freedom of choice of the prescribee, and compelling pharmacists to dispense them nullifies their own freedom of choice - with the notable caveat that no one forces someone to be a pharmacist/doctor/nurse.
Strangely, I tend to agree with Balta on this one. The government is already deeply mired in health care, and only the strictest libertarians think that the govrnment should pull out rather than get even more involved. Health care professionals are - rather they should be or not - effectively public servants.
Side note: Imagine a woman on Medicare who is prescribed birth control in order to regulate an irregular menstrual cycle. Would a “conscientious” pharmacist give her the scrip because it is not for birth control purposes? Should it matter that the woman is on Medicare, making the state even more involved?
The abortion argument is a wee bit pointless; if you don’t want to have to perform abortions, then my advice is to move into a different field of medicine
Actually, I recall a concern being raised a few years ago about abortion’s place in general medical education. I can’t recall whether it was about forcing religious med schools to teach it or forcing objecting med students to learn it. But it was clear that “pro-choice” activists were questioning someone’s right to opt out.
a privately owned pharmacy is a privately owned company, but it is also given a license to operate by the government.
Yes, and the purpose of that license is to make sure that the pharmacy and its employees are properly qualified to dispense safe medications in a legal way. I.e., so that we don’t have snake oil salesmen traveling from town to town anymore.
I don’t see why the license should allow the government to dictate what products the pharmacy must sell anymore than a license for a tattoo parlor should allow the gov’t to dictate what designs can be etched into someone’s skin.
Allowing pharmacists to not dispense some drugs nullifies the freedom of choice of the prescribee
That is definitely not true. The only case I can think of in which a mail-order pharmacy cannot adequately provide for the prescribee’s choice is the case of abortifacient drugs. In that case, someone living in a rural area might theoretically have to drive some distance to obtain the drug. But when you consider that the alternative is asking pharmacists to be complicit in what many of them consider to be murder, I think it’s not too much to ask.
To me, the bigger issue is that a pharmacist, who does not know the medical conditions of the patient, is interfering with the doctor’s treatment which could have health consequences. Birth control pills are used for other purposes than just contraception; I know it can be used to treat acne, and maybe other hormonal imbalances but I’m guessing on that. If you let the pharmacist pick and choose what to fill, regardless of their ‘moral/religious reasons’ (which are so varied that they could ‘justify’ not filling almost any prescription) it seems possible that the pharmacist could cause some further harm or discomfort for the patient. Should we also allow pharmacists to not prescribe drugs that used animal testing in their studies? And I would argue that a patient’s right to privacy, especially concerning their health, would override any pharmacist’s right to question exactly for what condition the patient is being treated.
As far as comparing it to forcing a doctor to perform abortions or choose another profession, the analogy doesn’t hold as medical fields are already specialized (brain surgeons don’t do cardiac surgeries), but as far as I know there is no such specialization in pharmacists. The comparison to a prison guard and executions is interesting though.
Eric,
You’re giving a false argument. In fact the current court case involving this issue has nothing to do with some small pharmacy owner refusing to dispense a morning after pill. It is an employee of a large pharmacy chain suing his former employer because he was fired for refusing to dispense the medicine. Are you going to stop with morning after pills? Are you also going to defend their rights to not dispense any birth control at all? You also don’t address the situation that can easily arise when the available sources for health care anywhere near someone is only a Catholic hospital given how ubiquitous they are. Of course I doubt that would really bother you. You find what the government might do chilling. I find people who want to protect a fertilized but not implanted egg at all costs because they have no doubt about the validity of their religious beliefs more chilling, especially when they are equally willing to have it enforced by government fiat.
Illinois Governor forces pharmacies to provide bir
On April Fools Day (how ironic) Illinois Governor Rod Blagojevich signed an “emergency rule” (aka royal decree) ordering pharmacies to provide contraceptives for women:
In fact the current court case involving this issue has nothing to do with some small pharmacy owner refusing to dispense a morning after pill.
Jim, I was addressing Erbe’s column, which makes no mention of that court case. As I’ve clearly stated, I support the right of a pharmacy chain to decide what legal drugs they are going to sell, and not to have an employee overriding corporate policy. OTOH, if a reasonable accomodation of the objecting pharmacist could be made (e.g. if there is more than one pharmacist on duty at a time, have the non-objecting pharmacist fill the prescription) then I think they should make the accomodation–not unlike how employers are required to make reasonable accomodations for disabled employees.
And I would argue that a patient’s right to privacy, especially concerning their health, would override any pharmacist’s right to question
Dave, no one is saying a pharmacist should have the right to question a customer. Only that a pharmacist can decline to provide a particular product completely, regardless of who the customer is or the exact reason they’ll be using it.
no one is saying a pharmacist should have the right to question a customer. Only that a pharmacist can decline to provide a particular product completely, regardless of who the customer is or the exact reason they’ll be using it.
What if the pharmacist believes that certain diseases, say cancer or AIDS, are curses from god or something, and that they feel morally unable to interfere in that process by dispensing the doctor ordered medication? Would you consider this an acceptable practice?
What if they also then refuse to give the prescription back to the customer or refer them to a different pharmacy, as has happened to women who have presented prescriptions for birth control pills or morning after pills.
This is okay as well, for a private pharmacy? If not, where is the line drawn?