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Conscientious Objectors in White Coats
The fight about pharmacists, conscience, and Plan B, the morning-after pill, is heating up. It looks as if it is going to be a state-by-state fight, with different states coming to different conclusions.
An interesting piece in the Washington Post this morning noted a variety of ways in which state legislatures seek to have the pill dispensed:
"Many of the state bills intended to expand access give specially trained pharmacists in states including Maryland, New York, Kentucky and Illinois the right to dispense emergency contraception without a prescription. Other bills require pharmacies to stock and distribute the drug, and to ensure that the pill is made available to women who come into emergency rooms after a sexual assault.
"But some bills would make it more difficult for many women to get emergency contraception, which is effective for only 72 hours after a woman experiences a contraceptive failure or unprotected sex. Legislation in New Hampshire, for instance, would require parental notification before the drug is dispensed, and more than 20 other states will consider bills that give pharmacies the right not to stock the drug and pharmacists the right not to dispense it, even to women with valid prescriptions.
"'Basically, every state now has an effort going to either make Plan B more easily available or to slow it down or make sure that pharmacists don't have to dispense if they oppose it,' said Edward R. Martin, a lawyer and lobbyist with Americans United for Life, who has helped put together some of the proposed 'conscience' clauses."
Most of us would say that we are a society that does not force you to act against your own conscience. The idea that someone might have moral qualms about dispensing this pill and insist upon acting on their consciences, however, is another matter, especially to the "enlightened" among us, people who would ordinarily hail those (conscientious objectors, for example) who act upon their consciences. But the morning-after pill brings out the illogical in its staunch supporters.
Nowhere was this more obvious in Slate writer Dahlia Lithwick's piece yesterday in the Washington Post. She started this way:
"No one disputes that there are circumstances in which people have a fundamental right to assert a moral or religious objection to performing duties -- such as military service -- and thus cannot be pressed by law into performing them. The problem lies in sorting out who can opt out and when.
"Consider, through that lens, the parallels between California physicians who refused last week to participate in the execution of a convicted killer and the growing numbers of pharmacists around the country who refuse to dispense morning-after pills."
You read this and think: How is she going to uphold the right of the California physicians and still deny the right to the pharmacists? You know it will take some fancy footwork, and fancy footwork is what you get. (By the way, Loose Canon, a supporter of capital punishment, not only believes the California doctors had the right to refuse--she believes they did the correct thing: the court has decreed a death, but using doctors to carry out the sentence blurs the distinction between medicine and execution. )
But back to Ms. Lithwick's dance of illogic. She is certainly to be commended for arriving at the "right" position:
"Physicians and pharmacists who refuse to participate in what they deem to be killing have more in common than many of us might like to admit. But the most important distinction between them has to do with their differing relationship with patients. The law recognizes that doctors' special relationship with their patients warrants a legal privilege: Their discussions are kept secret. You may like and trust your pharmacist. You may even trust him with intimate details about your yeast infection. But your pharmacist has neither the tools nor the right to probe details about rape and abuse, incest and health risks. Which is why pharmacists who interpose between decisions made by a doctor and her patient are overstepping not just moral but legal boundaries--and undermining another professional relationship that is fundamentally different from their own."
And this gem:
"The right of conscience is a subjective one. And no one disputes that a pharmacist's moral objection to dispensing certain drugs is as heartfelt or urgent as a physician's refusal to inject lethal doses of sodium thiopental. But as a legal or legislative matter, the inquiry should begin, not end, with that moral objection. Legal regimes that balance an individual's right to opt out against safeguards for patients (like making it the pharmacy's responsibility to provide timely alternatives) are good compromises. Similarly, if physicians cannot supervise executions consonant with their professional obligations, we may need to devise some new form of capital punishment that does not require a doctor's intervention to ensure against violent, painful death.
"There should and will always be space in this country for conscientious objectors. But it cannot and should not follow that murder is murder is murder."
I have no idea what the last sentence means. But I love, "the right of conscience is a subjective one." Such an overtly Orwellian sentence is rare. In this piece, the pharmacist has no right to exercise her conscience because the doctor and patient have exercised theirs. By that reasoning, the California physicians should just be told that the courts have decided: they have no right to exercise their own consciences. In Ms. Lithwick's word, there is "space" for conscientious objectors in matters of war but not for pharmacists who may in some states soon be required to do things they regard as morally repugnant.
I want to thank those who responded to my two quotes about Western civ in Friday's post. Thanks to the marvels of modern air travel, I arrived home this morning instead of last night (don't ask!) from a trip. I plan to read the comments in the morning after I have rested from my night of the living dead in a motel I'd better not name for fear of slandering it.
An interesting piece in the Washington Post this morning noted a variety of ways in which state legislatures seek to have the pill dispensed:
"Many of the state bills intended to expand access give specially trained pharmacists in states including Maryland, New York, Kentucky and Illinois the right to dispense emergency contraception without a prescription. Other bills require pharmacies to stock and distribute the drug, and to ensure that the pill is made available to women who come into emergency rooms after a sexual assault.
"But some bills would make it more difficult for many women to get emergency contraception, which is effective for only 72 hours after a woman experiences a contraceptive failure or unprotected sex. Legislation in New Hampshire, for instance, would require parental notification before the drug is dispensed, and more than 20 other states will consider bills that give pharmacies the right not to stock the drug and pharmacists the right not to dispense it, even to women with valid prescriptions.
"'Basically, every state now has an effort going to either make Plan B more easily available or to slow it down or make sure that pharmacists don't have to dispense if they oppose it,' said Edward R. Martin, a lawyer and lobbyist with Americans United for Life, who has helped put together some of the proposed 'conscience' clauses."
Most of us would say that we are a society that does not force you to act against your own conscience. The idea that someone might have moral qualms about dispensing this pill and insist upon acting on their consciences, however, is another matter, especially to the "enlightened" among us, people who would ordinarily hail those (conscientious objectors, for example) who act upon their consciences. But the morning-after pill brings out the illogical in its staunch supporters.
Nowhere was this more obvious in Slate writer Dahlia Lithwick's piece yesterday in the Washington Post. She started this way:
"No one disputes that there are circumstances in which people have a fundamental right to assert a moral or religious objection to performing duties -- such as military service -- and thus cannot be pressed by law into performing them. The problem lies in sorting out who can opt out and when.
"Consider, through that lens, the parallels between California physicians who refused last week to participate in the execution of a convicted killer and the growing numbers of pharmacists around the country who refuse to dispense morning-after pills."
You read this and think: How is she going to uphold the right of the California physicians and still deny the right to the pharmacists? You know it will take some fancy footwork, and fancy footwork is what you get. (By the way, Loose Canon, a supporter of capital punishment, not only believes the California doctors had the right to refuse--she believes they did the correct thing: the court has decreed a death, but using doctors to carry out the sentence blurs the distinction between medicine and execution. )
But back to Ms. Lithwick's dance of illogic. She is certainly to be commended for arriving at the "right" position:
"Physicians and pharmacists who refuse to participate in what they deem to be killing have more in common than many of us might like to admit. But the most important distinction between them has to do with their differing relationship with patients. The law recognizes that doctors' special relationship with their patients warrants a legal privilege: Their discussions are kept secret. You may like and trust your pharmacist. You may even trust him with intimate details about your yeast infection. But your pharmacist has neither the tools nor the right to probe details about rape and abuse, incest and health risks. Which is why pharmacists who interpose between decisions made by a doctor and her patient are overstepping not just moral but legal boundaries--and undermining another professional relationship that is fundamentally different from their own."
And this gem:
"The right of conscience is a subjective one. And no one disputes that a pharmacist's moral objection to dispensing certain drugs is as heartfelt or urgent as a physician's refusal to inject lethal doses of sodium thiopental. But as a legal or legislative matter, the inquiry should begin, not end, with that moral objection. Legal regimes that balance an individual's right to opt out against safeguards for patients (like making it the pharmacy's responsibility to provide timely alternatives) are good compromises. Similarly, if physicians cannot supervise executions consonant with their professional obligations, we may need to devise some new form of capital punishment that does not require a doctor's intervention to ensure against violent, painful death.
"There should and will always be space in this country for conscientious objectors. But it cannot and should not follow that murder is murder is murder."
I have no idea what the last sentence means. But I love, "the right of conscience is a subjective one." Such an overtly Orwellian sentence is rare. In this piece, the pharmacist has no right to exercise her conscience because the doctor and patient have exercised theirs. By that reasoning, the California physicians should just be told that the courts have decided: they have no right to exercise their own consciences. In Ms. Lithwick's word, there is "space" for conscientious objectors in matters of war but not for pharmacists who may in some states soon be required to do things they regard as morally repugnant.
I want to thank those who responded to my two quotes about Western civ in Friday's post. Thanks to the marvels of modern air travel, I arrived home this morning instead of last night (don't ask!) from a trip. I plan to read the comments in the morning after I have rested from my night of the living dead in a motel I'd better not name for fear of slandering it.
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