Sunday, April 03, 2005

A pharmacist and his conscience 

Newshounds know that Illinois' governor has ordered the pharmacies in that state to fill prescriptions for birth control pills, including the morning after pill, whether they want to or not. There apparently have been instances of pharmacists who refuse to fill such prescriptions on moral grounds, or who lecture women who seek to have prescriptions filled.

TigerHawk belongs to the "more the merrier" school of birth control, so I do not subscribe to the thinking of these moralist pharmacists. However, some of them believe that certain types of birth control, including particularly pills in a "morning after" dose, act to abort a conceived egg, and that by selling these pills they are participating in an abortion. Or maybe they just oppose contraception. In either case, I think their position is asinine.

The difference between me and The New York Times, however, is that I believe that these pharmacists should be free to have a conscience, and act in accordance with it. The Times argues that pharmacists should be required to fill prescriptions with which they disagree as a moral matter.
Scattered reports suggest that a growing number of pharmacists around the country are refusing to fill prescriptions for contraceptives or morning-after birth control pills because of moral or religious objections.... This is an intolerable abuse of power by pharmacists who have no business forcing their own moral or ethical views onto customers who may not share them. Any pharmacist who cannot dispense medicines lawfully prescribed by a doctor should find another line of work.

The New York Times usually finds itself lecturing health care professionals and businessmen to think and act morally, in addition to lawfully. In this case, though, the Times is saying that licensed medical professionals who refuse to act against their own conscience are guilty of "an intolerable abuse of power" and are "forcing their own moral or ethical view onto customers." We have yet to see the Times argue that lawyers may not refuse to defend child molesters, or that doctors may not refuse to perform abortions. Apparently there is one profession that should never take its ethics into account, and that's pharmacy.

It seems to me that if a pharmacy wants to put its business at risk by refusing to cater to women who use birth control -- rest assured that those women will take the rest of their family's business elsewhere as well -- that pharmacy should be free to do so. Indeed, under any other circumstance the Times would applaud and probably want to subsidize a business that was in danger of going under because it would not compromise its principles. I'm sure that a careful examination of its editorials on labor and environmental practices would reveal precisely such sentiments.

The Times is not receptive to the argument that these women can go elsewhere. The Times argues that in small towns there may not be alternatives, so one pharmacist's refusal has the effect of denying women access to birth control (never mind that the Illinois case was triggered by the stand taken by a pharmacist in Chicago). When the The New York Times twists its hanky over the poor people in small towns, watch out.

First, if you don't like the many limitations of rinky-dink small towns, move out. That's what built America -- when the small town gets too small and gossipy, we leave. Bright lights, big city, and all that.

Second, every employer I know desperately wishes that their patients would use mail order pharmacies because they are cheaper. Mail order pharmacies aren't really in a position to give you a sanctimonious lecture, and they will definitely take your money.

Third, so what if a woman can't buy a morning after pill in a particular town? There's lots of other medical care that she can't get either. She can't get an abortion in most of the small towns in the country, for example, or decent care in case of traumatic head injury. Small towns generally suck when it comes to medical care.

The good news, though, is that small-town women have it within their own power to solve this problem: Keep a big old stock of birth control pills handy. If you don't have 'em, have friends who have 'em. If you accidently have unprotected sex, take several the next morning and several more before you go to bed the next night. Read this, and read the label on the pill so you can calculate the dose. And since I don't give medical advice, which is smart because I'm a lawyer, consult your doctor.

The Times missed a great opportunity to protect the right of a pharmacist to his conscience and flank the activists who are trying to drive birth control out of the economy. Had I been writing this morning's editorial I would have argued that the morning after pill -- "Plan B" -- be sold over the counter. If it were sold in every 7-Eleven as it should be, we would not have to write rules ordering pharmacists to choose between their God and their livelihood.


By Blogger Gordon Smith, at Sun Apr 03, 12:23:00 PM:

I hear you, Tigerhawk. You seem to be using the same argument that purveyors of controversial television use when confronted by moralists, "If you don't like, don't watch it!" If you don't like small-town morals...move!

I wonder though if it would be ok for me not to give someone their prescription for Viagra if I thought that was immoral. What about their pseudo-ephedrine laden allergy meds?

Where's the line is what I'm asking?  

By Anonymous Anonymous, at Sun Apr 03, 04:08:00 PM:

pharmacists waive their right to moralism on the job when they apply for state granted licenses to dispense drugs.  

By Blogger TigerHawk, at Sun Apr 03, 05:22:00 PM:

Point is, Screwy, there are lots of remedies to the problem, and the problem in any case pales in comparison to other shortcomings of medical care in small towns. And yes, I would say that if a pharmacist had a moral objection to dispensing Viagra I see no reason to compel that pharmacist to do so.

Anonymous dude: I am unaware of any law or rule of ethics that provides that a license to do something results in a requirement that it be done notwithstanding bona fide objections. Doctors are not compelled to perform abortions. Lawyers aren't required to bring cases they do not like or defend criminals to whom they object. Barbers are free to turn away customers. Why the exception for pharmacists? There is no principled case that I can detect.  

By Blogger Patton, at Sun Apr 03, 05:24:00 PM:

If a pharmacist has moral issues with dispensing valid prescriptions, that's a matter between the pharmacist and whomever owns the pharmacy. It's a business, after all, nothing more.

I have no problem with pharmacists having moral stances, just as I have no problem with pharmacy owners firing insubordinate employees. And if the pharmacist happens to own the pharmacy, he or she is free simply not to stock the "troubling" medications.

But aside from approving medications as safe for sale, the state should stay the hell out of it.

That, I respectfully submit, is where the line is drawn.  

By Anonymous Anonymous, at Mon Apr 04, 12:54:00 PM:

i can't see any reason why a state couldn't compel any of the professionals you list to do the acts you describe or risk losing their privilege to ply their trade. Additionally, public accomodation laws already take care of many of the barbershops (or restaurant, bar,etc..) issues. Since presumably the governor of Illinois is the proper state official to regulate pharmacists within the state (at least you don't base your objection on overreaching authority), I can't see why he shouldn't be able to make the determination that Illinois would rather inconvenience pharmacists by making them move or pursue another means of making a living, rather than inconveniencing (or worse) fertile women. Presumably the voters of Illinois are competent to decide at the polls whether they agree. "Morality" and "prejudice" are sometimes blurry to people (segregation practices pop to mind) when they are happening and are exactly the sort of issues that should be allowed to be resolved via the democratic process.  

By Anonymous Anonymous, at Tue Apr 05, 01:00:00 PM:

What I find amazing about this whole discussion is, like, the New York Times really gives a @#*&$# about small town America?  

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