Conscience Objectors

There was a solid discussion over at MetaFilter the other day, around this article about several "conscience clause" bills making their way through US legislatures. The article includes a tale from earlier this year, about a pharamacist who refused to prescribe emergency contraception to a rape victim. The MeFites responded by breaking down some arguments, extrapolating others, and everything in between.

I find this debate interesting for a couple of reasons: first, because the chaos that would befall my hospital if the staff chose which patients to treat is a morbid fascination (and, fortunately, something likely to remain in the realm of imagination).

Second, because the debate over pharmacists' rights, with respect to emergency contraceptions, forces some logical contortions: Suddenly, pro-life groups are asking to keep the law out of a private matter of conscience. Of course, these same people would jump at the chance to make abortion illegal, regardless of one's private feelings. Neat, huh? But everyone's got an agenda:

Lourdes Rivera, who assists low-income patients as director of the Los Angeles-based National Health Law Program, worries that anti-abortion health providers are gaining too much leeway.

"Yes, we need to respect individual freedom of religion. But at what point does it cross the line of not providing essential medical care? At what point is it malpractice?" she asked. "If someone's beliefs interfere with practicing their profession, perhaps they should do something else."

This can be interpreted as inconsistent with pro-choice doctrine -- a woman has domain over her body, but pharmacists must do the bidding of the state. Yet Rivera's advice strikes me as exactly right, and exactly why these conflicts of service don't grind society to a halt: People tend to choose jobs that don't compromise their beliefs.

But I think any job can ultimately put someone in such a position (the MeFites propose: Jewish sympathizers in the Nazi ranks, vegetarian waiters, and many more). ROU_Xenophobe writes:

If you refuse to kill people, stop being a hit man. If you're no longer willing to employ the various shady tactics, stop selling used cars, or accept that you'll be fired when your sales drop.

If you can negotiate a contract with your employer so that you're allowed to refuse to fill prescriptions, yay for you. So far, the pharmacies haven't been willing to do so, which seems reasonable to me given the possibility of lawsuits when they refuse to fill (or refer) prescriptions and people suffer as a result. I don't see any valid reason why the state should require them to accept pharmacists who refuse to fill valid prescriptions if they don't wish to.

If the fired pharmacists want to band together to form Holiness Tabernacle Pharmacy or First Baptist Pharmacy, well, I wouldn't stop them, but I'd hope the market would.

I'd like to think the market can show some people the folly of their ways, be it segregation or opposition to gay marriage (now raising state revenue in Massachusetts). But as Bashos_frog writes (and I'm not even trying to understand those screen names):

...I realize I am glad there were severe consequences for people like Rosa Parks, because it woke up more of society. What do you think would have happened if that one bus company had just changed its policy when Parks refused to move? Probably there would not have been much news, the company would have attracted more black business and less white business and a year later, instead of the laws changing, the buses would be segregated by company, insead of front/back.

I guess it's possible things could've unfolded that way. And it suggests what might happen with pharmacies. Already, primary care docs know which drugstores around town don't carry oxycontin (for fear in burglaries) -- and they pass this information along to patients when precribing pain meds. Will the docs have to learn which pharmacists won't fill prescriptions for emergency contraception? For birth control? STD's? Addictions?

Maybe. Of course, it'll be easy to remember to avoid the Christian Science Pharmacy (it's the one with all the empty shelves). But either we force druggists to honor prescriptions for all that's legal, or we memorize their morals, quirks, and biases.

One can only hope patients don't get sicker as they race around town, trying to find someone who believes in treating them.