Bioethical Controversies Proof of Nearly Unbridgeable Cultural Chasm
To state the obvious, the USA is losing its common culture and moral values, creating an almost unbridgeable cultural chasm. This, in turn, is disintegrating our social cohesion and leading to the me-me/I-I consciousness of radical individualism.
But radical individualism is intended for only one side of the cultural divide until it becomes predominate and can gain control of society. When the other attempts to get in on the act--cohercion tends to rule. Case in point, the angry reaction against "pro life pharmacies" by some of the very people who yell the loudest about "pro choice" values, with some states outlawing the practice. From the story in the Washington Post:
Such stories call for quotes from bioethicists!When DMC Pharmacy opens this summer on Route 50 in Chantilly, the shelves will be stocked with allergy remedies, pain relievers, antiseptic ointments and almost everything else sold in any drugstore. But anyone who wants condoms, birth control pills or the Plan B emergency contraceptive will be turned away.
That's because the drugstore, located in a typical shopping plaza featuring a Ruby Tuesday, a Papa John's and a Kmart, will be a "pro-life pharmacy"--meaning, among other things, that it will eschew all contraceptives.The pharmacy is one of a small but growing number of drugstores around the country that have become the latest front in a conflict pitting patients' rights against those of health-care workers who assert a "right of conscience" to refuse to provide care or products that they find objectionable.
Bioethicists disagree about the pharmacies. Some [me: very few] argue that they are consistent with national values that accommodate a spectrum of beliefs. "In general, I think product differentiation expressive of differing values is a very good thing for a free, pluralistic society," said Loren E. Lomasky, a bioethicist at the University of Virginia in Charlottesville. "If we can have 20 different brands of toothpaste, why not a few different conceptions of how pharmacies ought to operate?"Yet, in a seeming paradox, many of the anti pro life pharmacy advocates support futile care theory allowing doctor/bioethics committee values to trump those of patients by refusing wanted life-sustaining treatment, while pro life pharmacy supporters generally oppose medical futility on the grounds that doctors have no right to impose their values on patients.
Others maintain that pharmacists, like other professionals, have a responsibility to put their patients' needs ahead of their personal beliefs...Critics also worry that women might unsuspectingly seek contraceptives at such a store and be humiliated, or that women needing the morning-after pill, which is most effective when used quickly, may waste precious time. "Rape victims could end up in a pharmacy not understanding this pharmacy will not meet their needs," Greenberger said. "We've seen an alarming development of pharmacists over the last several years refusing to fill prescriptions, and sometimes even taking the prescription from the woman and refusing to give it back to her so she can fill it in another pharmacy."
But these seeming contradictions are not really paradoxical. Rather, they are in keeping with both sides' overarching world views. Thus, pro life pharmacy proponents generally oppose futile care because their first principle is supporting the overarching Judeo/Christian philosophical belief in the sanctity of human life and a restrained approach to sexual morality.
Similarly, pro futile care advocates who oppose pro life pharmacies act consistent with their utilitarian (quality of life) beliefs and hedonistic devotion to utter nonjudgmentalism about personal behaviors between and among consenting adults.
But nature abhors a vacuum and the kind of cultural chaos all of this breeds cannot long be sustained. Eventually, as Lincoln put it about the great cultural divide of his time, we will either become all one side or the other. The cats will eventually be herded--both through laws passed by the states and decrees about these laws (or even in the absence of them) issued by judges. And we know which way, at least for now, the tide is running.
posted by Wesley J. Smith @ 8:02 AM
15 Comments
15 Comments:
Wesley, you note a pungent contradiction in the pro-choice movement.
To return to the issue of "pro-life" pharmacists, however, refusal to stock or issue contraceptives and birth control pills is against public policy on many levels. Pharmacies are supposed to be a line of defense in the public health system. Society has a vested interest in preventing both the spread of disease (i.e., through use of condoms) and unwanted pregnancy, preferably without recourse to abortion as a method of birth control. Family planning is always legitimate. In addition, "the pill" has other medical uses besides contraception, and the reason the patient needs this medication is really none of the pharmacist's business.
To go so far as to refuse to return a patient's prescription for birth control after declining to fill it is, I would suspect, actionable professionally and legally. It definitely imposes the pharmacist's beliefs on the unfortunate patient. Those beliefs include a toxic notion that pregnancy should be a "punishment" for having sex, and also the erroneous ideas that oral contraceptives and the morning-after pill are abortifacients and that people will be abstinent if contraceptives aren't available.
Had they been in practice 50 years ago, many of these same strictly pro-life pharmacists would have refused to fill any prescription for a black person, citing biblical "interpretations" that "black skin is the mark of Cain" and "blacks are supposed to be our slaves anyway, so who cares about their health needs?" That attitude is politically and morally unacceptable today, at least in the open, but similar attitudes toward legitimate health issues for women and couples hold sway among the same people today. There should be no excuse.
To use an extreme example, we would never put up with a Christian Science pharmacist refusing to fill prescriptions for anybody by telling them to go to a CS reading room instead to treat their illness. But you yourself have recently provided another extreme example of medical providers citing their "conscience" in refusing treatment, and that is the Golubchuk case in Canada. Refusing to care for him is as bad as the actions of the pharmacists mentioned here.
The analogy of African-Americans being refused service doesn't hold up, because these pharmacies are simply deciding not to stock a line of products, not agreeing to sell them to one group of people but not another.
I really don't understand the fuss. Perhaps I should sue the local bookstore because they don't carry a certain magazine, or picket the supermarket that won't carry strawberry syrup.
This whole nonsense about "refusing to return a prescription after refusing to fill it" is beyond me. I saw _nothing_ about that in the stories I've read about these pharmacies. The phrase makes it sound like the person at the pharmacy desk is physically taking the prescription, looking down at it, saying, "Oh, we don't sell that," and then (what?) going, "Nah-nah-nah-nah-nah, I'm not going to give it back!" (Laughs fiendishly and tears it up or flings it into the garbage can before the woman's eyes.)
Is there the remotest, slightest evidence that these pro-life pharmacists are confiscating prescription slips? Any at all?
I'll bet there isn't.
Or is this just some crazy Planned Parenthood urban legend that is their crazy interpretation of the statement taht the pharmacies won't "refer" women to other pharmacies? (As if adult people are so helpless that they can't check the Yellow Pages or walk across the street all on their own.)
Lydia, I'm an opponent, and so is our group Nevada LIFE, of violating pharmacists's rights of conscience in refusing to distribute abortifactient birth control pills and end of life pills that might be prescribed by an MD to help a client kill themselves. Both are violations of the conscience of pharmacists and force them to be involved in the life of a human being.
This is not a crazy Planned Parenthood legend, though there are aspects of it that are legend or rare enough to be irrelevant. There are indeed pharmacists who will not refer and feel that forcing them to do so violates their consciences by involving them in the possible ending of human life. Our group in NV supported this right to refuse to refer and give it back to the person requesting drugs to end their own lives or drugs that could end the life of an newly conceived human being.
And why not? Doctors are not required to perform abortions and most do not and many do not refer.
That was our argument to the Nevada State Board of Pharmacy in 2006 at http://www.nevadalife.org/news/pharmacycomments0406.htm.
"The Pharmacy Board’s counsel Louis Ling says, "nobody tells a physician he has to perform an abortion. No other health care professional is forced to do something over her beliefs." Doctors have the right of conscience to provide or refuse to provide abortions. Almost all of them do not perform abortions and many will not refer for abortions. Since pharmacists are full-fledged necessary health care providers, they should have the same freedom of conscience to keep from being forced into participating in morally objectionable medicine. Doctors have conscience rights. So do nurses. So should pharmacists."
I think the consensus is moving towards the right not to fill, but some requirement to refer.
If this happens, then what's teh argument to stop the AMA from forcing OB-GYNS from refering women to an abortionist or to someone who will counsel for abortion and etc, or move their practice close to someone who will. Life Ethics, a sometime Commentator at SHS has more info on this at http://www.lifeethics.org/www.lifeethics.org/2007/12/doctors-abortion-and-conscience.html.
I think if we force pharmacists to refer, then violation of conscience rights of MD's with abortion are not far behind.
They are attacking pharmacists because they are the easiest targets and it attempts to make us look like kooks, as if it can take the focus of partial birth abortion. But once these deeply trained people they demean by calling them order fillers are forced to check their consciences at the state line to work in Nevada, they will note what important, deeply trained medical professionals they are and then they will ask why doctors and nurses should not be forced to do the same. So we object to forcing them to refer.
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A sensible solution would be for "pro-life" pharmacies to prominently display some kind of symbol indicating that they are "pro-life" so that they attract the customers who share their world-view. I suggest the fish symbol that I sometimes see on cars.
Another approach is to simply make all of the birth control stuff "over the counter" so that pharmacists do not have to deal with this at all, whether they be "pro-life" or not.
I've never heard of having to go to a pharmacist to buy condoms. You can simply get these at any local grocery store.
I think a "pro-life" pharmacist has the right to refuse to sell birth control stuff if they like. However, if they refuse to return a customer's prescription, they are engaging in a criminal act. The prescription is the property of the customer, not the pharamcist. Any pharmacist who steals a customer's prescription should be prosecuted to the fullest extent of the law. At minimum, they should loose their pharmacy license. Perhaps they should be fined and/or imprisoned.
Again, if they adopted my sensible suggestion, this would never be a problem because they would be able to avoid having to deal with non "pro-life" customers in the first place.
"Our group in NV supported this right to refuse to refer and give it back to the person requesting..."
Somebody please explain to me why a refusal to refer, or a right to refuse to refer, is the same thing as or entails destroying the physical prescription or refusing to hand it back to the customer.
I don't understand that at all. I mean, you look at the thing, you go, "Oh, no, we don't sell that. Sorry." And you hand it back to the person. It's just a slip of paper. If they fill it and it's a wrong thing to get and use, that's on their conscience. You aren't referring them elsewhere simply in the act of handing them back their piece of paper. The only reason you took it was to see what it was and to fill it _if_ it's the kind of thing your pharmacy carries. Handing back the prescription isn't the same thing as a referral.
And I repeat: I see nothing in these stories about these pro-life pharmacies that indicates that they are taking the physical prescription from the customer as if they are going to fill them and then refusing to give them back when they see the nature of the prescription.
Lydia and Kurt, the sentence Lydia quotes from me shows that I could have been clearer and that what I wrote can be taken to mean something I did not intend and our group Nevada LIFE does not believe.
When I say "Our group in NV supported this right to refuse to refer and give it back to the person requesting..." I meant that we supported the right of the pharmacist to refuse to refer conscience violating prescriptions. The pharmacist would be able to give the prescription back to them without being required to fill it or being required to refer them to another pharmacist.
I did not mean that we also support the right of pharmacists to confiscate legal prescriptions he or she does not want to fill for reasons of conscience. Maybe someone somewhere meant that, but not me and I'm not aware of anyone in the pro-life movement advocating that. And maybe some pharmacist somewhere has done that, but I think these have an urban legend and are so few in number as to be irrelevant.
Thanks for bringing this to my attention so I could set our position straight.
Thanks for the clarification, Don. I'm glad we're on the same wavelength. I originally pushed the point because K-Man implied (beginning of his second paragraph) that this prescription-confiscation was being done or argued for. Who knows where these things start. (I've heard that one before, though, from the people who are pushing for the requirement to refer.) I'm sorry I misunderstood you. I think we're in complete agreement.
I wonder again - why the rush to push some humans off the edge to death?
Here - I refer to many of those who vigorously protest any attempts by persons to NOT accommodate human death wishes.
I heard (But have not yet verified this) that Planned Parenthood got $300 million in government aid & made $1 BILLION in profits. Also heard (in a catholic prolife letter someone sent me - something I can partly verify - Planned Parenthood wants to "cut into" a more upscale market. Thus, I've seen Planned Parenthood rent large billboards in the middle class Northwest Indiana area -
"We'll take care of you" they say to the young couple. (Sorta a Mafia edge to the phrase "take care of you..." here...)
About the pharmacists confiscating birth control prescriptions, I was quoting from the story excerpts as Wesley posted them:
"'Rape victims could end up in a pharmacy not understanding this pharmacy will not meet their needs,' Greenberger said. 'We've seen an alarming development of pharmacists over the last several years refusing to fill prescriptions, and [b]sometimes even taking the prescription from the woman and refusing to give it back to her so she can fill it in another pharmacy.'[/b]"
Lydia: There has been at least one case where a pharmacist both refused to fill a prescription and refused to forward or return it. Neil Noesen,a pharmacist in Wisconsin, did just that. The case went before an administrative law judge, and it was recommended that Noesen have his license limited for two years.
I think that it's a deserved sanction. Refusing to fill or even transfer a prescription is one thing. (And something I strongly disagree with.) Taking away the prescription and not returning it is something completely different. It's analogous to a physician not only refusing to provide or refer a woman for abortion, but also imprisoning her so that she can't use her own resources to find a willing provider.
k-man also raises an important point. Despite being colloquially known as the "birth control pill," oral contraceptives actually have other uses, too. They are the recommended treatment for polycystic ovary syndrome, which is linked to hirsutism, difficulty in conceiving, and insulin resistance. So denying someone an oral contraceptive is potentially allowing what is a prediabetic condition to go untreated. Since a pharmacist will not automatically know WHY a woman has the prescription, he or she should not be allowed to refuse to fill it or return it to her.
It's not as if BC is hard to get. Any 11 or 12 year old can get it from a Planned Parenthood or Title X clinic without their parents ever knowing.
I agree with dr_dredd on this one. I think a pharmacist, like any other businessman or service provider, has the right to choose what products and services to offer. As such, if a pharmacist does not want to sell BC products, I respect their right to not sell them. However, they have NO business taking a customer's prescription in order to prevent them from going to another pharmacists. This is like going to the tire shop when your car has a flat tire and they not only refusing to sell you new tires, but impounding your car so that you cannot go to another tire shop. This is just so illegal in so many ways I cannot imagine why anyone would think this is reasonable.
It is theft (of the prescription), restraint of trade (prevent one from going to competing pharmacy), and coercion of one's personal world-view on another person who might not have any connection or interest in that world-view at all.
I think the root of the problem here is the presumption on the part of many religious people that their religion has some kind of legal or moral "jurisdiction" over all other human beings, whether those other human beings have chosen to join that religion or not. It is precisely this characteristic of religious people that irritates me to no end. I also think that this is root cause of much of the perceived hostility that they feel that they receive from those of us who are not religious.
This is the one single characteristic about religious people that irritates me to no end.
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