Conscience Clause Court Victory in Illinois
A federal judge has issued a temporary restraining order against the Governor of Illinois, protecting two pharmacists from having to dispense "Plan B" contraceptive pills due to religious objections. From the story:
I hate it when the media report stories about these kinds of matters and state that so and so "believes" something. I don't know the answer to this question: But either Plan B works as an abortifacient or it doesn't. It isn't a matter of "belief."A central Illinois judge has ruled that the state can't force two pharmacists with religious objections to abortion to dispense emergency contraception. Sangamon County Circuit Judge John Belz issued a temporary restraining order Friday until he can hear arguments against the rule from druggists who object on religious grounds.
The pill reduces the chance of pregnancy if taken within 72 hours of sex. The pharmacists believe it's tantamount to abortion.
Belz is the same judge who sided with the state and dismissed the lawsuit filed in 2005 by Luke VanderBleek and Glenn Kosirog, who own five northern Illinois pharmacies between them...The Illinois Supreme Court ruled in December that the pharmacists' case must be heard. The court decided then-Gov. Rod Blagojevich, who issued a rule in 2005 ordering pharmacies to dispense the so-called "morning-after" pill, had made statements indicating there would be no exceptions. "You cannot enact a law that targets people because of their religious objection," Manion said Monday.
In any event, this doesn't mean that the pharmacists have won the case. It merely means the rule can't be enforced for now. However, it does mean that the judge believes that the pharmacists could win their case, which is a clear change since his original ruling.
The issue of conscience clauses is just getting warmed up. It will be a huge bioethical issue for years to come.
Labels: Conscience Clauses. Illinois. Luke VanderBleek and Glenn Kosirog. Plan B Contraceptive.
posted by Wesley J. Smith @ 11:48 AM
18 Comments
18 Comments:
The matter of whether or not Plan B causes an abortion depends on one's notions of whether life begins or has moral significance at conception or at implantation. Plan B does not cause an abortion after implantation, as opposed to abortifacients, which do cause abortions up to 40-78 days after implantation, depending on when those drugs are taken.
Plan B, on the other hand, can prevent implantation after conception by preventing the egg from attaching itself to the uterine lining, so that the fertilized egg leaves the body instead of attaching and developing further. That is why some pharmacists refuse to distribute the drug.
Personally, if I were running a pro life pharmacy, I would be willing to sell Plan B but not abortifacients. I think selling Plan B is better than the woman getting pregnant and possibly having an abortion later on. But, that's just my opinion.
P.S. Plan B also prevents conception if it hasn't already occurred.
Kind of off topic, but I love Sangamon County. They've been all over the news (us Chicagoans love hearing about those wild and crazy cowboys south of us!), first for refusing to enforce the smoking ban and now for all this.
SAFEpres, once the egg has been fertilized, isn't it alive? The fact that it hasn't implanted doesn't make it any less human.
Yes, it's alive, but I still think that until it implants, it is arguably a potential life, since it cannot survive unless it attaches and develops. I don't feel like this argument applies to an embryo that has attached itself to the uterus because it has started its development and an abortion cuts that development, and that life, short, thus, it takes a life. But, like I said, that's my opinion. I feel that pharmacies should distribute what they feel comfortable distributing.
I don't think a doctor should have to do things that violate his or her conscience -- unless his or her "conscience" thinks that someone should not live. That's the other side of this issue, remember -- there are doctors now who feel justified in deciding that someone should not live.
If there were no "bioethics," there wouldn't BE all these problems. When I read "in bioethics for years to come" I knew that things are going to stay messed up for years to come. Ethics are NOT debatable.
But when it comes to pharmacists, we're talking about people who sell things. It's legal to sell, they have to sell it. Like alcohol and guns, or candy or mashed potatoes to someone morbidly obese. Me, I don't like selling things. But if one is going to do it, one has no choice, conscience or no.
All doctors should strive to heal, not kill. A doctor who is racist should be required to heal any patient, despite race. A doctor who is racist should *not* be allowed to do something to kill a black woman because he happens to think the world would be a better place without that woman in it.
A person who is ageist should be required to continue serving elderly people, even if his personal opinion is that an elderly man is a waste of resources. A person who is ageist should *not* be allowed to kill an elderly man just because it's his opinion that elderly people are a burden.
A Jehova's Witness should be required to arrange a blood transfusion for a sick child, even though he thinks it's a sin. A Jehova's Witness should *not* be allowed to refuse the transfusion and let the child die just becuase it's his religious opinion that the transfusion is worse than dying.
A Catholic doctor should be required to treat an anti-Catholic skinhead, even if the skinhead has preached the death of Catholics. A Catholic doctor should *not* be allowed to refuse treating the skinhead based on his beliefs.
And an Evangelical pharamcist should be required to fill any perscriptions that will improve the life and health of his customers. He should *not* be required to fill a perscription he believes will do harm or kill a human person.
It's as simple as that.
I agree, TE
With regard to when a woman is actually pregnant: It is my understanding that upon completion of fertilization, there is an impact on the woman's body, in that hormones change and, I believe, a signal is sent to to the uterus not to sluff off the blood that lines the organ in case of impregnation.
If that is true, implantation is not the first guidepost.
If so, if the embryo is at that very early stage helping create an environment from which it can receive nurture--as happens along the way with implantation, which is a process, and then the development of the placenta, etc.--then it would seem to me the woman is pregant and Plan B causes an abortion (which is any delivery of the embryo/fetus before 20 weeks whether induced or natural) since but for the drug, implantation would probably have occurred.
On the other hand, having a living human organism within her even if there is no impact, it would seem to me that she is pregnant.
Any embryologists out there?
Wesley: I think that's angels dancing on the head of a pin. We're not supposed to see these things for a reason. It's like in vitro.
T.E. and SAFEpres: I have to disagree. Yes a doctor should heal not kill. In fact adherence to that doctrine obviates the need for the conscience clause. Except in the case of abortion... Damn abortion and all the controversy around it, it's a matter for a woman and her priest (in the religion I was born into) and ok let the doctor follow his individual conscience on that. But a pharmacist is a dispenser -- a dispensing machine in human form. The ethics of a doctor are to preserve life. I don't agree that it's life before it's viable outside the womb, other than technically potential life which takes us all the way to embryoes. The responsibility of the pharmacist is to dispense what is prescribed exactly as prescribed -- period. I have to agree with HistoryWriter on this one. Suppose the pharmacist believes, as some people do, that cancer should not be treated. Supppose the pharmacist believes, as some do, that Aids is a punishment from God (and therefore should not be treated). See what I mean? This conscience clause stuff re pharmacists is lunacy. In an orderly society, you have a prescription, you need it filled, you go to a pharmacy, just as you would go to a supermarket for food, and the prescription gets filled, period. Maybe a crisis of conscience for the pharmacist, sleepless nights, etc. but his or her job is MERELY to fill prescriptioons properly. Now, do I think the abortifacient and conception-preventing drugs should exist? Maybe not. But that's not the point. You can't have a person running to a pharmacy with a prescription and that prescription not being filled. You just can't. It's not the same thing as a doctor refusing to perform an abortion or prescribe an aborticificiant or conception-preventer or pull a plug. The pharmacist has an obligation to honor that little piece of paper. Period. Or would we like prescriptions to stop meaning anything too?
For what it's worth, I spoke with a few individuals who may be in the know and the general consensus seems to be that "pregnancy" occurs upon "implantation" and an "abortion" is termination of a "pregnancy". This seems to agree with a few medical texts I scanned. By THESE working definitions, Plan B does not cause an "abortion".
However, what I can say is that it basically appears Plan B will prevent ovulation, it MAY prevent fertilization, and it MAY prevent implantation of a fertilized egg/embryo/zygote. Presumably the mentioned health care professionals may be primarily concerned with the last possibility. For obvious reasons, the research on this mechanism is more limited than other meds. There is a little bit of a black box aspect; take pill - seems to prevent "pregnancy".
Sometimes it seems that human/legal definitions, such as what constitutes a 'pregnancy', can needlessly cloud moral/ethical arguments when a conceptual context may be better suited.
Anyways, I'm not an embryologist, but here's a reference to a paper I read, but no link:
http://www.ncbi.nlm.nih.gov/pubmed/17207342?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=3&log$=relatedreviews&logdbfrom=pubmed
ooopps, that should be "take pills..." Plan B is two pills.
T.E.: If the pharmacist should not be required to do it, s/he should not be permitted to do it, either. Same with doctors. Either it's right or it's wrong, and it has nothing to do with individual conscience. At least that's the logical way to look at it. Of course the other side of it is that if it's ok then doctors and pharmacists should have to do it. The issue isn't really individual conscience, it's whether it's right or wrong. The whole individual conscience thing is just a red herring. It can't be ok for some doctors and pharmacists but not for others; it may be ok for some patients but not for others. Or would it be?
If it prevents ovulation or fertilization, it is contraception. If it prevents implantation of a living organism that would otherwise have gone on developing, it seems to me it is an abortifacient.
I don't trust medical definitions these days on these matters, they have become so political.
That being said, I think conscience should apply as this is an elective procedure that results in the destruction of a living human organism.
Wesley is correct about the definition. The definition of pregnancy has been changed, not just to reflect new understandings in science, but to reflect an attitude toward the embryo.
It seems that it can work either way. It can prevent contraception and it can prevent implantation, it's just not possible to know which the drug prevented after the woman has taken it and pregnancy has not occurred.
Like I said, I generally support access to the morning after pill, but I remain uncomfortable with forcing anyone to dispense drugs that take human life in some shape or form. I feel a bit torn because frankly I would rather the egg not implant itself than the woman go and have an abortion after implantation and the egg has become a fetus, and it might prevent that from happening. And, when the egg hasn't implanted, is the woman truly responsible for whether or not it implants and develops? I'm not sure about that. Anyhow, I think that the most basic thing that should resolve consicence issues is the pharmacist making it clear that he or she does not carry Plan B, so that people do not waste their time going to a pharmacy that won't give it to them. That way people can make the decision to go someplace else.
excuse me, I guess I should say "embryo," not "egg" in terms of implantation.
But I'm glad that we know that plan B could terminate an embryo. It's something I didn't know before I really began looking into why some people objected to plan B, and I would want to know this in determining whether to use Plan B myself.
SAFEpress, I believe you're working with an incorrect definition of "abortifacient" in your first comment. Abortifacient includes anything that expels the embryo or fetus, causing an abortion, from conception onward.
It is true that Plan B does not cause an abortion after implantation has happened. The question is whether it prevents implantation if an egg is fertilized, which you mentioned.
Dr. J. Willke discusses abortifacients as well as the change in medical terminology to redefine "conception" for political expediency here: http://www.lifeissues.org/abortifacients/index.html
(Scientism, anyone?) This should answer Dana's comment about when "pregnancy" occurs.
I am not an embryologist, but here is an excerpt from an embryology text book:
"...Fertilization is a critical landmark because, under ordinary circumstances, a new, genetically distinct human organism is thereby formed.... The combination of 23 chromosomes present in each pronucleus results in 46 chromosomes in the zygote. Thus the diploid number is restored and the embryonic genome is formed. The embryo now exists as a genetic unity." [O'Rahilly, Ronan and Müller, Fabiola. Human Embryology & Teratology. 2nd edition. New York: Wiley-Liss, 1996, pp. 8, 29.]
To address Wesley's point: "I hate it when the media report stories about these kinds of matters and state that so and so 'believes' something. I don't know the answer to this question: But either Plan B works as an abortifacient or it doesn't. It isn't a matter of 'belief.'"
Here is the abstract from a peer-reviewed medical article about the possible postfertilization effect of Plan B:
OBJECTIVE:To assess the possibility of a postfertilization effect in regard to the most common types of hormonal emergency
contraception (EC) used in the US and to explore the ethical impact of this possibility.
DATASOURCESANDSTUDYSELECTION:A MEDLINE search (1966–November 2001) was done to identify all pertinent English-
language journal articles. A review of reference sections of the major review articles was performed to identify additional articles.
Search terms included emergency contraception, postcoital contraception, postfertilization effect, Yuzpe regimen, levonorgestrel,
mechanism of action, Plan B.
DATASYNTHESIS:The 2 most common types of hormonal EC used in the US are the Yuzpe regimen (high-dose ethinyl estradiol with
high-dose levonorgestrel) and Plan B (high-dose levonorgestrel alone). Although both methods sometimes stop ovulation, they
may also act by reducing the probability of implantation, due to their adverse effect on the endometrium (a postfertilization effect).
The available evidence for a postfertilization effect is moderately strong, whether hormonal EC is used in the preovulatory, ovulatory,
or postovulatory phase of the menstrual cycle.
CONCLUSIONS:Based on the present theoretical and empirical evidence, both the Yuzpe regimen and Plan B likely act at times by
causing a postfertilization effect, regardless of when in the menstrual cycle they are used. These findings have potential implications
in such areas as informed consent, emergency department protocols, and conscience clauses.
I have the whole PDF of the study if anyone wants it.
Wesley is right - pharmacists do not "believe" Plan B can cause an abortion. The postfertilization effect/abortifacient action is scientifically and pharmacologically one of Plan B's mechanisms of action.
-Becky Miller
Education Coordinator
Rhode Island Right to Life
Post a Comment
Subscribe to Post Comments [Atom]
<< Home