Saturday, April 09, 2005

Rx Regnant Sed Non Gubernat

Ellen Goodman has an op-ed in today's Washington Post titled "Dispensing Morality," on the theme previously raised here (see "What Would Jesus Prescribe?") about pharmacists exercising conscience clauses and refusing to fill prescriptions for, among other things, contraceptives.

The pharmacist who refuses emergency contraception is not just following his moral code, he's trumping the moral beliefs of the doctor and the patient. "If you open the door to this, I don't see any place to draw a line," says Anita Allen, law professor at the University of Pennsylvania and author of "The New Ethics." If the pharmacist is officially sanctioned as the moral arbiter of the drugstore, does he then ask the customer whether the pills are for cramps or contraception? If he's parsing his conscience with each prescription, can he ask if the morning-after pill is for carelessness or rape? For that matter, can his conscience be the guide to second-guessing Ritalin as well as Viagra?
Today's New York Times published several letters on this subject.

As Goodman notes, while we need to respect the conscience of each individual we can ill afford to allow healthcare providers and others who have accepted responsibility for protecting our lives to become the self-appointed arbiters of our morality. In the case of pharmacists, their responsibility to ensure the validity and safety of physician instructions should not extend to subjective judgments on morality. We would scarely tolerate such moralizing by providers of non-essential services (e.g. a hotel refusing a room to a homosexual couple or a bookstore refusing the sale of books promoting secular Humanism), and must not tolerate it among physicians, pharmacists, soldiers and first-response emergency personnel. Accepting such jobs means that, to some degree, personal morality is suspended while on duty.

Overly-permissive "conscience clauses" merely transfer the right to exercise conscience from the end user to an intermediary. It is not inconceivable that the continued liberalization of such regulations will result in pronounced regional differences in access to certain forms of healthcare. To what degree can we permit the personal autonomy of the service provider to trump that of the client?


Sven said...

Those who would give authority over this type of moral decisions to pharmacist should consider what the same type of choice would entail in the case of an American soldier in Iraq who would suddenly experience a divine revelation that he should only listen to Allah.

After all, virtually all believers would agree that the pharmacist took orders from the very same God.

Mary Ellen Sikes said...

Bloggers may be interested in reading Dahlia Lithwick's commentary on Slate: Martyrs and Pestles. She argues that the 'least cost avoider' solution is, while imperfect, the best principle to apply in such cases. When a pharmacist's freedom of conscience conflicts with a customer's need for certain kinds of medication, for example, the least burden falls to the pharmacist. The customer should, therefore, be accommodated.