Thursday, March 31, 2005

Medicine: The Separation of Church and Pharmacy

By way of MediaMatters, The American Center for Law & Justice has a good piece on the rise of so called "conscience clauses" being passed in several states. These laws permit doctors, pharmacists, or other health care workers to not provide access or information on anything they find morally offensive. Such laws have already been used to refuse prescriptions for Ritalin, emergency contraception for a rape victim, and birth control refills. One pharmacist not only refused to give out the birth control, but even refused to return the prescription slip.

MediaMatters points out:

Though "conscience clause" advocates prefer to focus on birth control pills -- and the media reports that cover the controversy do likewise -- their position that pharmacists need not fill prescriptions they disagree with has far-reaching implications. By the same rationale, a pharmacist who believes, as the Rev. Jerry Falwell once claimed, that AIDS is "God's punishment for homosexuals" could refuse to fill a prescription for an AIDS patient. Pharmacists could refuse to fill prescriptions for heart medicine for the elderly, antidepressants for a suicidal patient -- anything.
Luckily the Michigan government defeated a bill to introduce these clauses, but there's no telling what might happen in the future.

At what point do people simply realize that when their career choices might conflict with their moral views, maybe they should find a different profession?


Steve said...

I do see the slippery slope danger of these conscience clauses, but I do think that these laws are valid. I do not believe that a person should avoid becoming a pharmacist or doctor because there are a few procedures or drugs to which they are moraley oppossed. The question is where do we draw the line with these clauses. Erin Boyd sent out an interesting (and sad) article that stated that the LGBT community could get denied treatment in Michigan if a conscience clause was passed - i.e. if a doctor did not want to treat a gay or lesbian patient in a non-emergent situation, he/she would not have to provide treatment. I am uncomfortable with this - denying all care for a patient based on sexuality.

I guess I am very conflicted by this issue. As a Catholic, I can see how I as, a future doctor, do not want to perform abortions or learn how to do abortions. I'm not sure how I feel about the whole birth control issue personally, but I respect the Church's position on birth control and can understand why people would not want to prescribe EC or the pill. I think that as a Catholic doctor I will still be doing worlds of good for my patients, and I should not steer away from my career choice because I cannot provide every medical procedure. I do see how these conscience clauses could be a BIG problem in rural areas, or in heavily conservative areas, where it may be VERY difficult to find a provider to perform an abortion, birth control, or in the worst case scenario, even see you as a patient if they do not agree with your lifestyle. The thing that we really need is a national dialouge on this issue, just like we've needed one on end-of-life issues.

I just had an interesting thought too - if I wanted to be a judge, but am against the death penalty, could I conscientiously object to sentencing somebody to death?

Since I am stream-of-consciousness right now, I have one more beef with the career-choice-conflicts-with- morals-so-choose-another-career-theory: I believe this type of argument was used against conscientious objectors at times of war during the draft-era (i.e. if you do not want to be a part of this country and do your duty by protecting it, then get out of the country for good). Okay I'm not sure that this comparison added anything to my point, but thanks Pepper for a thought provoking post :)

Garrett said...

I believe the operative point in this debate isn't so much that pharmacists or doctors should be forced to deliver services that they are morally opposed to; they shouldn't. But that pharmacist or doctor, by virtue of being licensed, should be required to make sure that a service deemed standard of care by the medical community can be obtained from somewhere else.

If you're in a small town with one pharmacy, and you deny a 15 year old who can't drive to get to the next pharmacy emergency contraception, that's criminal. However, if you're a pharmacist in Ann Arbor, and there's another pharmacy across the street, it seems perfectly valid to say, "Hey, I can't fill this, but let me call it in across the street."

So should a strict pro-lifer not be able to be a pharmacist or a doctor? Of course not. But they better damn well practice in a context where their personal beliefs do not conflict with the ability of a patient to receive what is standard of care--and abortions and birth control and emergency contraception are in fact standard of care. If a person disputes standard of care, THEN they have no right being in the profession.

Disagreeing with standard of care is valid and even respectable. Obstructing it is sick and criminal.

So does that mean that I think the pharmacist in podunk should have to drive the fifteen year old across the river to Podunk Flats to the next pharmacy if he denied the girl emergency contraception? You betcha :)

michael said...

medicine needs more people who aren't into that whole "conscience" thing.

btw i was reading high yield behavioral science, and it mentions that giving morphine that will kill the patient is ethical and legal. well in that case, the doctrine of double effect should also allow that if someone cuts himself, and then uses cocaine to vasoconstrict and stop the bleeding, then the secondary effect of being a junkie should be ethical and legal.

the whole field of ethics is fertile ground for further such mockery. i say that anyone who spends his life as an "ethicist" on a think-tank group should be labeled as nothing more than an argumentative asshole who spent his childhood making up rules as he goes when playing with his peers.