Should a doctor be able to refuse to help patients?

September 17, 2004 7:33 PM

Conscience Clauses and Health Care--"Yes, we need to respect individual freedom of religion. But at what point does it cross the line of not providing essential medical care? At what point is it malpractice?" she asked. "If someone's beliefs interfere with practicing their profession, perhaps they should do something else." The Protection of Conscience Project feels differently: Protection of Conscience Laws are needed because powerful interests are inclined to force health care workers and others to participate, directly or indirectly, in morally controversial procedures, while NARAL says: ... Many of these clauses go far beyond respecting individuals' beliefs to the point of harming women by not providing them with full information or access to medical treatment. Medicine, not ideology, should determine medical decisions.
posted by amberglow (69 comments total)

I think it's perfectly reasonable for any health care worker to be able to refuse to perform a procedure or service they find morally objectionable - as long as that is made clear upon their job interview.

I also think any hospital or pharmacy that, based on full knowledge of this, agrees to employ any such person in anything other than a redundant position, should not be allowed to call themselves a "hospital" or "pharmacy," but should instead have to use a modified term, e.g. "abortion-free hospital" or "uptight-asshole pharmacy," etc. Pretty simple. Everybody wins.
posted by soyjoy at 8:24 PM on September 17, 2004

I feel that if states are going to decide to let people opt out of providing birth control, abortions or emergency contraception to rape victims, then the public has a right to be notified about it. Pharmacists and doctors should be required to display a sticker or there should be a public database so that women can choose to patronize places that provide the healthcare that they need. In 2002 a pharmacist not only refused to fill a birth control prescription, but also refused to transfer the prescription to another pharmacy. It would be best to be armed with the information to prevent anyone from dealing with strangers who insist on making healthcare decisions for you.

Still, I feel ill about how women could be denied medical care in life-threatening cases. And I feel even worse about women (or anyone, really) who may live in remote areas where the care they need isn't available.
posted by Alison at 8:33 PM on September 17, 2004

Tangentially related question: have you ever experienced moral qualms about doing something that most other people would probably tell you there was nothing wrong with?

Though it is relevant to the issues at stake here, I'm really not trying to make a point here, I'm just curious.
posted by weston at 8:34 PM on September 17, 2004

I think it's perfectly reasonable for any health care worker to be able to refuse to perform a procedure or service they find morally objectionable - as long as that is made clear upon their job interview.

Unacceptable for health care. It is the unwavering duty of a medical professional to help those in need of treatment. Abortion, birth control, and contraception are all fucking legal. Do the job you swore you'd do.

The idea that people want to allow themselves the right to not help a rape victim infuriates me. The idea that it's not currently legal and people want to make it that way makes me want to start hitting people.

Out of curiosity, what's the bill's stance on refusing to help a rape victim when she comes in needing help with her internal bleeding after stabbing herself with a coat hanger when Ms. "I'm here to help" nametag decided to give her a lecture instead of some fucking help three months earlier?
posted by XQUZYPHYR at 8:55 PM on September 17, 2004

So doctors can refuse to help the guy the police just shot because he doesn't want to work on "criminals"?

Conscience Clauses are one of those things that sound good on first blush, but with even a moment of thought become ridiculous.

We don't allow other professions to refuse their duty based on beliefs. Could a cop refuse to arrest criminals because she has anarchist beliefs? Could a teacher refuse to teach black children because he believes they are inferior? Can a trash man refuse to pick up the garbage at a Catholic family's house because he thinks the Pope is an abomination?

In all those cases, we compel the worker to do their duty. Even military doctors are compelled to treat enemy soldiers they encounter.

A doctor's job is to competently treat those who need medical attention, for whatever ailment. That's the sole reason he is there. A pharmacist's job is to competently fill legally obtained prescriptions, regardless of the ailment. That's the sole reason she is there.

Conscience Clauses are based on the notion that medical care givers are somehow "superior" and are not bound by the usual rules and ethics everyone else is. That what they do is special, and they deserve a level of prejudice that others are not entitled to.

I disagree with this sentiment.

Disclaimer: I work in healthcare.
posted by Ynoxas at 9:10 PM on September 17, 2004

Half the country still thinks abortion is morally wrong. I think attempting to draw clear lines in the sand about what doctors have to and have not do is pretty silly given wide disagreement. You shouldn't be forced to do something you find morally reprehensible just because its legal .On top of that, its not a procedure necessary for life (in the majority of cases).

At the same time, if you aren't going to perform the service yourself, you should at least have the professional responsibility to tell your patient where she can go to have the procedure done. It is extremely reprehensible to provide misinformation or withhold information. Options should be discussed openly with the patient -- even nif you don't want to provide the service yourself.

I think pharmacists are stretching things a bit, I don't think they have are really as morally accountable for the providing the emergency contraception pills (at least no more accountable than bullet manufacturers). The doctor who doesn't want to prescribe birth control probably will not be in business for too long.

I'm also in healthcare.
posted by nads at 9:24 PM on September 17, 2004

Working in healthcare isn't even the main part of this concept. A portion of this country thinks killing animals is morally wrong. If you worked in Burger King, refusing to serve a customer anything but milkshakes because you were a vegan would get your ass kicked out the door. Show me the suggested law protecting them. Jesus, if your car breaks down in fucking Amish Country they'll tell you how to get to a phone to call a tow truck. Refusing to help someone in need is what's immoral.

To me, the only moral reprehension is with the pharmacist who thinks they're some kind of martyr for being negligent. Refusing to give a rape victim time-sensitve emergency contraception and then refusing to transfer the prescription is no less decent than refusing to treat a gunshot wound.
posted by XQUZYPHYR at 9:40 PM on September 17, 2004

You shouldn't be forced to do something you find morally reprehensible just because its legal

Nobody's being forced to do anything. Pharmacists who object to doling out birth-control pills or morning-after pills can switch to another line of work at any time.

If you find giving someone a legitimately prescribed drug with no obvious interactions or contraindications for a particular patient to be morally objectionable, that just means that you find pharmacy to be immoral and should quit.
posted by ROU_Xenophobe at 10:20 PM on September 17, 2004

It's the same with cops. If you don't want to beat the shit of prisoners and the like, you can just get another fucking job. No one forced you to be a cop. Just do your job already.

Less biased example: if you object to capital punishment and you're a prison worker (or prison doctor!), you have no business refusing to do your job just because you personally believe that aspect of it is immoral. It's part of the job and society says that it's moral and you're expected to do it.

Hmm. Well, as a former rape crisis center worker, a (lapsed) member of NARAL, yadda yadda yadda, I can say that I have many, many problems with the above attitude.

What gets me steamed up on this argument is not so much that I think these objectors should have a legal right to not perform what is thought by most to be part of their job. No, I'm extremely hesitant to talk about anything like "rights" to keep a job but not do a portion of it because such a a right creates more problems than it solves.

No, what gets me upset is the tone, the outrage of the critics who say that these people should just do their fucking jobs, dammit. Who the hell do they think they are? Etc.

The last time I checked, liberals especially advocated the idea of ethical self-determination, that people should act according to their conscience and refuse to be coerced by convention or peer pressure or whatever. The price we collectively pay by encouraging this is that sometimes, somewhere, some people are going to make ethics choices that we think are wrong. Deal with it.
posted by Ethereal Bligh at 11:37 PM on September 17, 2004

The last time I checked, liberals especially advocated the idea of ethical self-determination, that people should act according to their conscience and refuse to be coerced by convention or peer pressure or whatever. The price we collectively pay by encouraging this is that sometimes, somewhere, some people are going to make ethics choices that we think are wrong. Deal with it.

Except that you're placing the point at which ethical self-determination is relevant in the wrong place. There are jobs for pharmacists which do not involve the "risk" of their being asked to prescribe medications which they might find morally objectionable: they can work in a hospital where it's likely that there will be more than one pharmacist on duty at any given time, they can work in research. Doctors and nurses who do not wish to have any part in morally-sensitive procedures can ethically self-determine to work in areas which are unlikely to require them to do so. The time for them to think about what they are and are not prepared to do in the course of their job is before they're in a situation where a refusal to perform their job for their own reasons can cause serious harm to someone.

As a former nurse, I have no problem with saying that the responsibilities of medical professionals are not the same or even really comparable to many other jobs, and that, while I'm all for ethical self-determination, there is an appropriate place in your job search to think about this, and that place is not when you're in a position to force your personal morality on someone whose health and wellbeing and right to their own personal ethical self-determination are at your mercy.
posted by biscotti at 12:07 AM on September 18, 2004

XQ and the "force the doctor" crowd -- you are totally, totally whacked on this. You cannot possibly simultaneously believe:

(1) a woman has the right to choose what to do with her own body, even if it means ending an incipient human life within

(2) a doctor does not have the right to do with his own body/skills as he chooses

You are either pro-choice or you are not. None of this "pro-choice for actions I agree with, not for those I don't." This smacks of the worst kind of hypocrisy -- as bad as the worst foaming-fundy that you love to mock, because you're suggesting exactly the same thing that you fear from them: enforcing your morals on others who don't share them.
posted by namespan at 12:08 AM on September 18, 2004

XQUZYPHYR:Unacceptable for health care. It is the unwavering duty of a medical professional to help those in need of treatment. Abortion, birth control, and contraception are all fucking legal. Do the job you swore you'd do.

What a bullshit argument. If someone wants to practice medicine, we require that he take the Hippocratic Oath. Taking the oath is a condition of employment and thus it can be a product of coercion. When you require the oath, and mandate that the oath be interpreted in such a fashion, you are in effect telling (some) people that thay may not practice medicine in a manner consistent with their values. In other words-- if you want to be a doctor, you must perform your duties in the manner that XQUZYPHYR deems appropriate.

Oh, you're a Christian who believes that abortion is murder? Well, you'll need to look at careers outside of medicine, then-- we can't have anyone deviating from the party line, here. Our view of civil society is much more important than your freedom or your conscience.

Enjoy your little authoritarian paradise.
posted by Kwantsar at 12:09 AM on September 18, 2004

Beating up defendants is not an inherent part of police duty. Last I checked, it was legally forbidden in most jurisdictions though possibly not in Texas.

Executing prisoners is not an inherent part of being a prison guard or physician.

Dispensing medication, however, is an inherent part of the job of a pharmacist. Any moral decisions are made by patients in consultation with their physicians; the pharmacist is not a moral agent in the process any more than the architect of the hospital is.

The price we collectively pay by encouraging this is that sometimes, somewhere, some people are going to make ethics choices that we think are wrong. Deal with it.

It's the pharmacists' refusal to deal with it that's the problem.
posted by ROU_Xenophobe at 12:13 AM on September 18, 2004

And I don't buy this "it comes with the occupation" thing. If that's valid, then so is the argument that the consequence of pregnancy comes with being sexually active. How condescending does it seem to you to have someone tell you "the time for women to think about whether they are prepared to bear a child is before they're in a situation where a refusal to carry out a pregnancy means fetuscide"?
posted by namespan at 12:14 AM on September 18, 2004

That's pretty condescending, because in that case it's some poor schlub who's being placed under serious risk of injury and death, while a pharmacist who fills a prescription he or she morally objects to suffers no harm whatsoever.

Could the power company refuse to supply power to a hospital that performs abortions, or to a pharmacy that dispenses birth-control pills?

Could the phone company refuse to service pharmacies that dispense emergency contraception?

I can't think that you'd accept either of these firms refusing to be a part of the chain that allows a woman to take emergency contraception. Why should the last link in the chain, no more a moral agent than the power company, be allowed to thwart someone else's moral agency?
posted by ROU_Xenophobe at 12:38 AM on September 18, 2004

Still, I feel ill about how women could be denied medical care in life-threatening cases. And I feel even worse about women (or anyone, really) who may live in remote areas where the care they need isn't available.

I think you'd find that even a large portion of the pro-life crowd would consider a life-threatening case justification for performing any procedure, including one which meant the loss of the fetus. Similarly with rape.
posted by weston at 12:39 AM on September 18, 2004

Could the power company refuse to supply power to a hospital that performs abortions, or to a pharmacy that dispenses birth-control pills?

Irrelevant. There's such a thing a proximity to a moral decision. To say there isn't is to accuse aircraft mechanics of complicity in 9/11.
posted by namespan at 12:47 AM on September 18, 2004

Airline mechanics aren't culpable in 9/11 because they had no reasonable way of knowing that the aircraft that they were maintaining would be used as bombs. If a mechanic had worked on the planes in the sure and certain knowledge that they were going to be bombs, I'd certainly hold him or her complicitous.

On the other hand, it's entirely foreseeable that a pharmacy that dispenses emergency contraception will continue to do so, and the power and phone companies have the physical power to nearly prevent them from doing this. Do you support their right to prevent feticide by denying power and phone service?

Pharmacists aren't a moral factor in this decision any more than the power or phone companies are, or the agencies that build the roads, or anyone else in the economic web that leads to a woman taking emergency contraception. The only differences are that it's an individual pharmacist instead of a faceless telco company, and maybe that it's very easy physically for the pharmacist to physically deny the drugs on a whim.
posted by ROU_Xenophobe at 1:44 AM on September 18, 2004

Do you support their right to prevent feticide by denying power and phone service?

Yes.
posted by Ethereal Bligh at 3:17 AM on September 18, 2004

interesting how people's job descriptions become more important than their personal moral beliefs in this society, isn't it? ... and that has a lot more implications than what doctors and pharmacists do or don't do

but that's one service the corporate structure provides for us ... turning moral questions of individual responsibility into a diffused and nebulous sense of unease ... except, of course, in the cases we are currently discussing

interesting, isn't it?
posted by pyramid termite at 5:04 AM on September 18, 2004

XQ:

> It is the unwavering duty of a medical professional to help those in need
> of treatment. Abortion, birth control, and contraception are all fucking legal.

[Devil's advocate] Great first step. All that remains is for you to prove they're helpful. You presently don't have anything remotely like a world consensus that they are.
posted by jfuller at 5:56 AM on September 18, 2004

Oh, you're a Christian who believes that abortion is murder? Well, you'll need to look at careers outside of medicine, then

No, you'll need to look at careers outside of gynecology. Orthopedic surgeons are rarely asked to provide abortions.
posted by LittleMissCranky at 7:17 AM on September 18, 2004

I think the suggestion that health care workers should be allowed to withhold services is ridiculous. I am a librarian. If I believed (really, really believed) that the holocaust didn't happen, should I have the legal right to withhold sources that dispute that claim?

From the ALA: The development of library collections in support of an institution’s instruction and research programs should transcend the personal values of the selector. In the interests of research and learning, it is essential that collections contain materials representing a variety of perspectives on subjects that may be considered controversial.

As a librarian, I am expected to collect materials that reflect as many viewpoints as possible, not only my own. I am not required to collect books that are illegal; we don't keep child pornography in the library just because some people may want it. If something is illegal, we don't don't cater to it, that's the policy. If it's legal but distasteful, I have no right to withhold it. Why are healthcare workers any different? Why should anyone who works for the public follow personal regulations and ignore public regulations?

My job doesn't force me to accept that the holocaust didn't happen just because I have a duty to collect books that argue that point. I don't have to take all those books home and read them myself. I don't have to teach the children in my neighbourhood about them. I have the right to remain an ethical person. I don't have the right to force my ethical position on anyone else; that's part of living and working in a multicultural society.

If a pharmacist or doctor has an issue with a medical procedure or a medication, they should be fighting against the policy that inisists they provide it or the law that keeps it legal, not the patient requesting something they have every right to recieve. They is nothing stopping healthcare workers from pressing for social and legal change.
posted by Hildegarde at 7:47 AM on September 18, 2004

A trouble with "Medicine" making medical decisions is that "Medicine", per se, doesn't have or respect any ethical limitations. The Hippocratic oath is non-binding, and any Frankenstein who wishes to, can, within some limitations, go crazy.

Avoiding the abortion/stem cell debate clears the air a little bit. Look back to earlier issues. For example, "preserving life at all costs, even if the brain is dead and the heart can only beat with assistance." There is no *medical* ethos that rejects such a thing.

Even the revolting "Tuskegee Experiment" was acceptable. Just observing the course of a disease when its victims could have been helped. Like firemen who just watch a fire burn, for whatever reason.

Doctors are also allowed to experiment, in many, many ways. Even unscientifically, and often crossing the grounds into crackpottery. Being a "Medical Doctor" is a license to toy with the health and well-being of your fellow man, again, with some limitations. But enough?

Doctors are *not* pharmacists. Few are even able to keep up with the myriad changes taking place in pharmacology. If you have any questions about drugs, do NOT rely solely on what your doctor knows, ask your pharmacist. And yet, doctors can play with not just prescription and OTC medicines, but also with "alternative therapies", based solely on their "considered opinion."

Doctors gone wild is one of the reasons medical organizations like the AMA were founded, not just to keep out the unlicensed. And yet, this self regulation is pitifully caught in the paradox that experts are least likely to punish their peers for wrongdoing. And yet, what laymen can adequately state when doctors are crossing the line?

More and more, juries are limited in the penalties that can be levied in civil actions. Perhaps the alternative is criminal sanction.
posted by kablam at 7:51 AM on September 18, 2004

This is all very interesting as debate here at Mefi but we don't make the laws, at least I don't guess that many Mefites are working legislators. For me the larger moral problem is that these sorts of rulings or laws are being slipped in, buried in omnibus bills that few legislators have either the time or energy to think through in any depth. At the moment, too many of us are too distracted by the upcoming presidential elections which will and, possibly already have, provided cover for a lot of this kind of stuff regardless of who rules us for the next four years.
posted by donfactor at 8:12 AM on September 18, 2004

Hildegarde, there's two seperate issues here. One is whether there should be a legal right to fail to do X; and the other is whether someone is morally obligated to do X as a function of their job. That is to say, what I've been responding to here is what seems strongly to me to be a condemnation of a person acting in accordance with their conscience.

Because, frankly, that's what it is. Your hypothetical is revealing: that of a holocaust denier refusing to check out holocaust books. Could you have possibly picked anything more designed to favor your position? How about if you refused to check out a book arguing in favor of holocaust denial? If you believed that holocaust denial is a serious and dangerous example of activist antisemitism and bigotry and that faciliating access to it would be an immoral act on your part?

Or, what if child porn was legal? Does that mean you'd check it out to library patrons? Are you prepared to accept that the majority (or legal) view about what is acceptable to be published trumps your own views about what you will personally be involved with?

Now, maybe you might. Maybe you'd argue that the function a librarian serves is important enough that it needs to be institutionally protected from controversies such as this and that, on balance, it's best for the librarian, as a rule, to check out indiscriminately everything that is sanctioned for check-out, regarldess of the individual librarian's personal morality. Compare this to, say, the institutional role a criminal defense attorney plays. What he/he thinks of the client's guilt or innocence is, for them, essentially beside the point.

Let's transpose that argument to medicine. That would mean that if the majority and legal view allowed for involuntary medical testing on the mentally disabled, or involuntary sterilization, or involuntary euthenasia, then that majority view, the necessity of playing the institutional role should trump an individual practictioner's view of what's right and wrong.

Are you prepared to defend that position?

I don't see any way in which you or anyone else here can argue that the pharmacist is wrong to fail to supply those pills even though he believes doing so is immoral without also arguing that the pharmacist supplying a lethal OD for an involuntary euthenasia (or prison execution) is also required and "part of the job" and "wrong" of the pharmacist to refuse just so long as doing so is legal and part of what most people consider to be a normal and acceptable part of the job.

Bottom line is that you cannot expect of and cheer on the people that smuggled Jews out of Germany or whatever without also expecting and not cheering, but accepting anyway, that other people are going to act on their conscience in ways that are opposed to your morality. You can't have one without the other. Either you expect people to be ethically self-determined or you endorse, essentially, the moral tyranny of the majority.
posted by Ethereal Bligh at 8:33 AM on September 18, 2004

But pharmacists and doctors deal with people's lives--they're punished when they kill or maim or give the wrong drug, or take the wrong organ out, etc... I say these people should be fired and/or punished if they can't operate within the law and the rules of their professions.

Why are they allowed to withhold legal drugs or procedures (or information about those drugs or procedures), knowing the enormous impact of their actions--impacts that don't affect them at all, but the life of their patient? They don't have that right, and it's in direct contradiction to the law, and their job description. It makes them feel good, but that's not their job. A emt or fireman saves lives too, but doesn't do a conscience/morality check first. Why should pharmacists or doctors get to? Or are some of you arguing that everyone should get to?
posted by amberglow at 8:44 AM on September 18, 2004

Oh, you're a Christian who believes that abortion is murder? Well, you'll need to look at careers outside of medicine, then-- we can't have anyone deviating from the party line, here. Our view of civil society is much more important than your freedom or your conscience. Enjoy your little authoritarian paradise.

And enjoy your own bullshit argument there, Kwaanstar. If you refuse to dispense certain legal, physician authorized drugs because of a moral dispute? Yeah, you get fired. You don't get a law protecting yourself.

Do you think teachers who work in the public school system should suddenly be allowed to say history and biology textbooks are both completely wrong, because the earth is clearly only 10,000 years old and evolution is a fraud? Or, like namespan, would you like to accuse me of being a hypocrite who's insistence on telling our children the earth revolves around the sun is "forcing my views on others?"

"Authoritarian paradise?" Riiiight. I'm rolling my eyes on that one about as far back as I did when EB tried to cough up the idea that refusing to sell someone the morning-after pill is the same as saving Jews from the holocaust.

donfactor made an interesting point. Despite most of the country being pro-choice in at least some form, and for all thh talk about "moral self-determination," the GOP sure did slip this one in covertly and attached it to a bigger bill to force it into play, didn't they? It's almost as if a bill like this would fall flat on its face in a single vote if presented on its own... oh wait, that's right, it already did. Who's subverting democracy now?
posted by XQUZYPHYR at 9:05 AM on September 18, 2004

I read about this a couple of days ago and it disturbed me a great deal. Let us set aside abortion for a minute, shall we.

In Mississippi, a bill became law in July that admirers and critics consider the nation's most sweeping "conscience clause." It allows all types of health care workers and facilities to refuse performing virtually any service they object to on moral or religious grounds.

So if I interpret this right, all I have to say is "Sorry, I'm morally against 65 year olds having sex, therefore no Viagra for youi."

"Sorry, you ruined your liver with your alcoholism. Even though you have stopped drinking, other people are more deserving of that transplant."

"Sorry, you are an unwed mother. I can't help you with prenatal care."

"I believe that God has chosen to scourge the homosexuals with AIDs. I can't treat you."

"I am a pharmacist second, and a Christian Science follower first. Sorry, I can't give you any drugs, but I will pray for you."

The mind boggles at what could happen if we are allowed to inflict our moral beliefs on each other. Our society would come to a standstill.
posted by Secret Life of Gravy at 9:31 AM on September 18, 2004

If a doctor is opposed to perferming abortions, s/he should either not be a gynecologist or work at a Catholic hospital.

If a pharmacist is opposed to dispensing certain drugs, s/he should either work at a Catholic hospital or declare her stance and not be allowed to be the only one on duty.

This would seem to balance the provider's right to conscience with the customer's right to legal medicine in a timely manner. Also, I agree with Alison that a pharmacist or doctor who refuses to provide these services be required to put up a sticker so I can avoid giving them any of my money.
posted by dame at 9:37 AM on September 18, 2004

You are either pro-choice or you are not. None of this "pro-choice for actions I agree with, not for those I don't."
And it is interesting that namespan has brought this up, because I have been dying to ask this question of the pro-life people ever since I heard George Bush state he was against abortion except in case of rape or incest.

I understand that if you are pro-life, you believe that life begins at conception and abortion (or the day-after pill) is murder. I fully sympathize with anyone wanting to stop murder. What I don't understand is why is it then ok to murder a fetus if the child's father is a rapist?

You are either pro-life or you are not. None of this "pro-life for babies I like, not for those I don't."
posted by Secret Life of Gravy at 9:42 AM on September 18, 2004

jfuller says:
XQ:

> It is the unwavering duty of a medical professional to help those in need
> of treatment. Abortion, birth control, and contraception are all fucking legal.

[Devil's advocate] Great first step. All that remains is for you to prove they're helpful. You presently don't have anything remotely like a world consensus that they are.

I’ll bite. Abortion is helpful because it prevents children who are unwanted from being born into situations where caretakers are financially or emotionally incapable of caring for them. There are plenty of miserable people in the world and making more in bad situations is stupid, especially in the U.S., whose citizens use far and above their fair share of the earth’s resources. It has also been argued that abortion reduces crime by preventing said children.

Birth control/contraception have the same plusses along with the added benefit of preventing children in a way that does not involve invasive surgery.

Further, lower birth rates are better for women, as evidenced by the fact that status and birth rate are inextricably linked—the more power women have to control their lives, the fewer children they have. Since women make up half of society, women doing better means everyone does better.

How’s that?
posted by dame at 9:50 AM on September 18, 2004

I didn't argue that refusing to sell the morning after pill was morally the same as helping save a Jew from the Holocaust. The two acts are different and there are (arguably) two different moral principles motivating those acts. But in one specific sense those two situations are the same: aside from everything else, they are examples of someone acting in accordance with their morality when it contradicts convention or law or custom. And it is in this very specific sense that you and others are condemning the pharamacist's actions. You are saying that he/she is morally wrong to act in accordance with their morality when it contradicts convention or law or custom. You are making that argument independently of the question of the rightness or wrongness of the principle they are acting upon. Indeed, it's as if you consider their greatest offense to be this pride in acting on their wrong belief, with the wrong belief and the subsequent wrong action being the lesser offenses.

I see no inherent offense in someone taking what I consider a wrong action as the result of a wrong belief. I do take offense at the wrong action. (And I do even take a lesser offense at the wrong belief). But I take no offense that someone would be consistent between their beliefs and their actions, even in the case where I consider their beliefs are wrong.

Note that I grant the possibility of the validity of the argument that the institutional, functional utility of acting in accordance with an external (and possibly unshared) specific moral principle can be greater than acting in accordance with the relevant internal principle. But this will be the case only when another internally held principle is believed to be prior. For example, the idea of greater social justice achieved by the playing of the advocacy role of a defense attorney. Even then, however, there are limits beyond which most thoughtful people expect an attorney to discard the institutional imperative and act according to his/her personal conscience.

There is something far too convenient, far too easy about applauding the courage and intrinsic correctness of unconventional acts of conscience with which one agrees while decrying unconventional acts of conscience with which one does not. An act of conscience qua "act of conscience" is virtuous, even when the act and the conscience are not.
posted by Ethereal Bligh at 9:50 AM on September 18, 2004

Are the people who are opposed to a doctor's right to refuse to perform a procedure they feel is morally wrong also opposed to whistle blower legislation that allows an employee to come forward with information about something dangerous to the public good without fear of retribution?

Are the people who are in favor of a doctor's right to refuse to perform a procedure they feel is morally wrong also in favor of a doctor's right to mislead a patient. For instance, is it acceptable for a doctor to tell a patient considering abortion that they are not a good candidate for the procedure, that the procedure would likely injure or kill the patient when the truth is that is not true?
posted by willnot at 9:54 AM on September 18, 2004

I think that health care conscientious objector status should be rooted out at the level of licensure, or even school admission. People have the right not to perform jobs they disagree with ethically; the point of refusal should not be the point of care, but the point of entering the profession or accepting a job.

This reminds me, though: Do HMOs still set up contracts with physicians that forbid the physician to discuss treatments not covered under the HMO plan? (Such contracts also stipulated that if the physician recommended a procedure and the HMO refused to cover it, the physician would not be allowed to reveal that disagreement to the patient.) I know this was a point of debate a few years ago, and I knew physicians under such contracts. So, if you have no problem with health care professionals refusing care or information on a personal ethical basis, where do you stand on having such service withheld on the basis of such a business contract? If we have to respect doctors' personal ethics in allowing them to refuse to provide care or pertinent medical information, does this not include their business ethics?
posted by troybob at 10:15 AM on September 18, 2004

Good questions, willnot. I can answer your second one as it applies to me. My answer is a tenative "no". But a "no" requiring lots of qualifications. On the first level of analysis, I see what I think is a qualitative difference between refusing to be complicit in an act one considers immoral and actively intervening to prevent an act one considers immoral. However, I'm still willing to agree that the degree to which one might think the second act immoral is the degree to which one may reasonably justify an intervention. In this case, let's assume the moral seriousness implied in the belief is at the level of "murder". In that context, I'm willing to accept a commensurate justified intervention.

Even so, though, in this particular hypothetical I believe we're deep into ambiguities and complicating circumstances. There is the fact that a large portion of society finds the act to be radically unlike murder. Most of that same portion finds the intervention we're discussing to be a violation of human rights. Also, there is the value of the sanctity of honesty in the role that a doctor plays with regard to treating patients and being a doctor, and this intervention obviously does great violence to that. Finally, it's not clear at all that such an intervention would likely be successful. Taken together, to my mind even granting the seriousness of the moral issues at stake, an intervention of this nature would be difficult to fully justify.

Utilitarians and their opponents have spent a great deal of time trying to work out the distinction, if any, between the morality of an act or a refusal to act. It's a difficult topic.

On Preview: People have the right not to perform jobs they disagree with ethically; the point of refusal should not be the point of care, but the point of entering the profession or accepting a job. But I don't see why this same schema wouldn't necessarily apply as well to soldiers or police officers or similar. That is, your argument is that once one has agreed to be a soldier or a police officer, then one no longer can act according to one's conscience when it conflicts with orders, or convention, or whatever. It's hard to imagine any profession where it would never be the case that "accepted practices" could never be expected to conflict with one's own principles. Are you prepared to argue that entering into any profession means signing away one's right to an independent morality? I'm very much not prepared to go along with that point of view.

When I waited tables, at some restaurants in some circumstances it was "accepted practice" to rinse off a piece of food that was dropped to the floor in the kitchen and return it to the customer's plate. I refused to do this. Is it your argument that merely by virtue of accepting the position as waiter, or a position of waiter at a particular restaurant, that I've implicitly agreed to forgo my own conscience and follow the management's?

Now, I'm not saying that management doesn't have a "right" to fire me when I so refuse to follow accepted practice. All I'm saying is that you can't claim that I don't have a personal "right" to refuse to follow that practice just because I agreed to be a waiter and lots of other waiters and management think rinsing the food off and returning it to the plate is acceptable. Maybe I simply refuse to agree that that's what it means, intrinsically, to be a waiter...to be "a person who rinses off dropped food and returns it to plates".

The view that being a pharamacist is not inherently to be a person who dispenses morning-after pills is a perfectly reasonable, defensible view.
posted by Ethereal Bligh at 10:38 AM on September 18, 2004

they are examples of someone acting in accordance with their morality when it contradicts convention or law or custom

There is just the tiniest difference that hiding Jews from Nazis is a good thing, and denying people medicine a bad thing. There's also the weensiest difference that people hiding Jews from Nazis know full well the consequences of their actions, but these pharmacists are trying get rid of the consequences of their actions by crafting new law.

You are saying that he/she is morally wrong to act in accordance with their morality when it contradicts convention or law or custom

No, I at least am saying that (s)he should not expect to have her cake and eat it too. If you want to act in accordance with you own morality, knock yourself out, but holding your current job makes that impossible. If you're going to behave in ways that contravene your professional or employee obligations, you should expect to get sacked. If that's the price you pay for following your own moral beliefs, well, getting fired seems to me to be a pretty featherweight cross to bear compared to the real one.

But I don't see why this same schema wouldn't necessarily apply as well to soldiers or police officers or similar

It does, at least most of the time. You can quit the force anytime you like if you object to policing. If you "merely" object to police misconduct, you can report it, or join internal affairs or whatever. Soldiers seem a bit of a special case, but still I think it makes a lot more sense for a pacifist to not join, or not re-up, instead of continuing on for a couple of decades and then and only then refusing to do what you've been agreeing to do for decades.

It's hard to imagine any profession where it would never be the case that "accepted practices" could never be expected to conflict with one's own principles

And I can think of only one profession, military service, that you can't simply put your tools down and walk away from at almost any point.

Now, I'm not saying that management doesn't have a "right" to fire me when I so refuse to follow accepted practice.

But that's exactly what the pharmacists of doom are after -- they want to be able to refuse to do their job, but keep it.
posted by ROU_Xenophobe at 10:51 AM on September 18, 2004

Are you prepared to argue that entering into any profession means signing away one's right to an independent morality?

No. I'm prepared to argue that the time for deciding whether your independent morality conflicts with the service responsibilities of the profession you are entering is before you enter the profession and not when you meet the conflict face-to-face.
posted by troybob at 11:21 AM on September 18, 2004

How about this: if someone is truly, honestly a pacifist, is it justifiable for them to enter the armed forces, then refuse to provide cover for their fellow soldiers when they engage the enemy?

Once again: It's not an argument about whether people should have the right to make their own moral choices; it's about when these choices need to be made.
posted by LittleMissCranky at 12:58 PM on September 18, 2004

dame:

[well-known, oft-rehearsed reasons why contraception, birth control and abortion may be considered Good Things]

I don't disagree with a bit of this, but you can list the good aspects of pretty much anything. The real question is, does the good outweigh the bad, and it doesn't do to tilt the scales by listing only the good things. Many medical examples come to mind in which a treatment does very nasty, damaging things to you and you only accept it because not accepting it is worse. One thinks of chemotherapy and radiation therapy for cancer: you lose weight, you hurt, you shake, you vomit, your hair falls out. No one would ever have a thing to do with either, except that the alternative is dying of cancer. On beyond radiation and chemo, there are many examples of treatments that are not used because they are worse than the disease they treat--frontal lobotomies for schizophrenics, for instance. My response to XQ was a shorthand way of suggesting he not be so contemptuously self-righteous about, say, abortion, when millions support it and other millions worldwide believe it is a cure worse than the ill it cures. It doesn't help advance his position (or reflect any credit on him) to act as if the debate is already settled (or would be if it weren't for a handful of anthropoid retard Appalachian Baptists--it's fucking legal, do your job) when that isn't the case.

My own take on amber's topic is pretty much the standard small "l" libertarian one spelled out in Thoreau's Civil Disobedience, namely, stand up for your conscience certainly--and then be prepared to take the consequences, whatever they are. But we already have so many silly laws protecting people from gnat-bite trivialities that I really don't know how this issue is going to play out.
posted by jfuller at 1:29 PM on September 18, 2004

Your hypothetical is revealing: that of a holocaust denier refusing to check out holocaust books. Could you have possibly picked anything more designed to favor your position? How about if you refused to check out a book arguing in favor of holocaust denial? If you believed that holocaust denial is a serious and dangerous example of activist antisemitism and bigotry and that faciliating access to it would be an immoral act on your part?

In fact, that situation is the one we discuss first in library school. For libraries and librarians who accept the ALA's statement on intellectual freedom, it is unethical to prevent access to materials that argue in favour of holocaust denial. That's the basis for intellectual freedom, and as keepers of public information, librarians need to provide access to information they agree with and that which they don't. So you can shape that scenario in any way you like, my answer is the same.

Or, what if child porn was legal? Does that mean you'd check it out to library patrons?

Yes, I would.

Are you prepared to accept that the majority (or legal) view about what is acceptable to be published trumps your own views about what you will personally be involved with?

Yes, I do. My job is not to create a library of things I want to read, it's to provide a resource for the public.

Let's transpose that argument to medicine. That would mean that if the majority and legal view allowed for involuntary medical testing on the mentally disabled, or involuntary sterilization, or involuntary euthenasia, then that majority view, the necessity of playing the institutional role should trump an individual practictioner's view of what's right and wrong.

Are you prepared to defend that position?

Are you a fan of democracy, or would you prefer a dictatorship? Because at this point we need to have at least some faith that the laws we live by reflect something just and real, something we can stand behind and have faith in. If we're going to live and work in a democratic state, we have to have some respect for the laws of our society and agree to abide by them. The very bad things we legislate against; if something is deemed necessary and important to our society, we don't legislate against it. If we suddenly found ourselves living in a society with a government that is likely to make involuntary euthenasia mandatory, perhaps you'd have an argument. At that point I'd hope that people even outside the medical profession would fight to change that. So far we are talking about issues that are problematic for some people but important to others; you do not have the right to remove a woman's burka just because it offends you. You do not at present have the right (in North America, at least) to prevent a woman from taking birth control, or from having an abortion. You do not have the right to prevent anyone from reading about holocaust denial.

I agree with what others here have said; if you are in a profession with elements that you find distasteful, you can avoid participating in those elements, and if you are serious about them you should lobby for those laws to be amended. I believe that you can be a OBGYN without performing abortions, but outside of prompting for a change in legislation, you have no right bar a woman from seeking and obtaining one, and to do so is an extreme abuse of power.
posted by Hildegarde at 2:10 PM on September 18, 2004

Upon thinking of this further...

Does this clause open up the possibility that if/when the US recriminalizes abortion, practitioners who perform abortions might be legally protected because their consciences compelled them?
posted by Hildegarde at 2:35 PM on September 18, 2004

Hildegarde, you rock...but I bet they make it so that it's only about refusing to do something, and not about doing something (so that if it was recriminalized, performing abortions or dispensing birth control wouldn't be protected.)
posted by amberglow at 2:58 PM on September 18, 2004

You do not at present have the right (in North America, at least) to prevent a woman from taking birth control, or from having an abortion. You do not have the right to prevent anyone from reading about holocaust denial.

That is a huge distortion of my argument. Again, I am not talking about "rights", especially legal rights. Secondly, I am not talking about preventing a woman from taking birth control or preventing anyone from reading a book that is a denial of the holocaust. What I am talking about is the choice that one always has about one's own actions and their consequences and the personal (not legal) "right" to refuse to participate or be complicit in an activity one finds immoral or otherwise objectionable. You and others here seem to be making the argument that regardless of the morality of the activity in question, implicit in taking up the responsibility of working in a particular job is the reassignment of one's moral authority for one's own actions, where they are part of one's professional duties, to an external authority, that typically being convention.

My contention is that especially in a democracy it is antithetical to the idea of indviduals as moral agents responsible for their actions to externalize and institutionalize their moral capacity in this manner. Only where a very strong argument can be made for the greater utility of the externalization and institutionalization of such moral choice is this acceptable. Some contexts where such arguments are commonly and persuasively made are military (maintaince of discipline and the like, almost without fail, is a necessary requirement for even the possibiltiy of success), medical, legal, and others. Yet even in each of these examples we find widely recognized limits on just how much one is expected to place their conscience into authoritys' hands. Almost without exception, one is ultimately expected to be responsible for one's own actions. "I was following orders" is not a defense against every possible charge.

Similarly, regarldess of what is widely thought to be (or at least locally institutionally thought to be) acceptable lending material to children by a library, you, the librarian who lent that book to that child will be held responsible for the decision and will likely (or at least should) hold yourself responsible for that decision. And I assert that there are books that you know you would refuse to check-out to a child. ("How to Murder your Baby Brother in his Crib and Get Away With It", for example.) I can hear you and ROU_Xenophobe protesting that legal or institutional standards would never expect you to lend that book to a child. Well, that's a convenient assertion, isn't it? That your personal morality will always be in accordance with convention and the law? (Or, rather, it with yours.)

The pharmacist who refuses to dispense morning-after pills to the rape victim (or anyone) sincerely believes that contemporary morality on this issue has gone horribly, evily awry. To accomodate that conventional morality would be to participate in, be complicit, an act he/she finds abohorrent. Yes, such a person may also feel compelled to try to prevent the act completely...but not necessarily. And, regardless, that is a seperate (though related) issue to the fundamental issue of being morally responsible for one's own actions.

I spent some of the best and most intense years of my life in an academic environment where (in the classroom) one is always expected to address everyone else with the appropriate honorific. For young women, by convention the correct honorific is "Miss [X]". But I find "Miss" and "Mrs" offensive in a variety of ways and I refuse to participate in social convention that I believe has very real and wide-ranging consequences in how women are forced to live their lives in our society. I will not use either "Miss" or "Mrs". Yes, it is significant that some women prefer "Miss" or "Mrs", and their preference is important. And, yes, conforming to institutional and cultural norms is also important. And, yes, I agreed to be a member of that community and abide by its conventions. Nevertheless, I refused to be complicit in an act I believe to be wrong. I have a responsibility to my conscience. It is deeply dehumanizing and disrespectful to expect someone to fail to take responsibility for their own actions as a moral agent. In the final analysis, everything we do, every day, is a choice for which we must take ultimate responsibility.

Some of those choices will be the wrong choices. But taking moral responsibiltiy for those choices is never wrong.
posted by Ethereal Bligh at 3:27 PM on September 18, 2004

EB, you seem to be assuming that I or Hildy would restrain the pharmacist so that he or she is actually physically forced to dispense emergency contraception. But neither of us have said that.

I've never said that a pharmacist should be forced to do anything they don't want to do. Only that their moral choice is not between filling the prescription or not filling it. It's between filling the prescription or quitting (or being fired).

It's not up to you which prescriptions are moral enough to fill and which aren't -- that moral choice belong with the patient, and no one else. What's up to you, every day, is whether you're willing to be a pharmacist, and fill all of the valid, not-contraindicated prescriptions that come your way.

The pharmacist who refuses to dispense morning-after pills to the rape victim (or anyone) sincerely believes that contemporary morality on this issue has gone horribly, evily awry.

I don't doubt it. Their remedy is to quit pharmacy, or to accept being fired.

The pharmacists aren't trying to accept moral resonsibility for their choices and consciences. The whole point of these "freedom of conscience" laws is to allow them to duck that responsibility.
posted by ROU_Xenophobe at 4:09 PM on September 18, 2004

The pharmacist who refuses to dispense morning-after pills to the rape victim (or anyone) sincerely believes that contemporary morality on this issue has gone horribly, evily awry. To accomodate that conventional morality would be to participate in, be complicit, an act he/she finds abohorrent.

I am perfectly comfortable with that pharmacist refusing to dispense. I am even more comfortable knowing that he will be fired for his refusal. Because there can be no moral responsibility if there are no negative consequences.
Those people smuggling Jews out of Germany knew they'd be killed if caught. They were willing to put their life on the line, when these health care providers aren't even willing to risk their jobs. How strong can their conviction possibly be if they aren't even willing to spend a few weeks out of work for it?
posted by bashos_frog at 4:16 PM on September 18, 2004

> I am perfectly comfortable with that pharmacist refusing to dispense.
> I am even more comfortable knowing that he will be fired for his refusal.
> Because there can be no moral responsibility if there are no negative
> consequences.

If you leave it there, it's just too complacent--there's something important missing. Would you be equally willing to say you're perfectly comfortable with a Mississippi bus driver in 1956 refusing to make Negros ride at the back of the bus, and even more comfortable knowing he will be fired by his racist boss for his refusal? Yet I don't see any difference between the two cases (except, obviously, that you will agree with the moral stand in one case and not in the other.)
posted by jfuller at 4:38 PM on September 18, 2004

Because there can be no moral responsibility if there are no negative consequences.

That sounds good, but there's no reason that it must be true. And, in fact, it's not.

Basically, I agree with your point—but it's beside the point because it's not what we're arguing about.

Here is how I agree. This is what I believe about killing someone in self-defense, for example. Assuming that a person has a "right" to kill in self-defense, that doesn't mean that the burden of proving they were justified in doing so shouldn't still rest on them. That is to say, I believe that if you kill someone in self-defense, you should be charged with a crime and the burden is on you to prove that it was self-defense.

I'm fading so I can't articulate this any better and my ability to articulate any idea at all is retreating (I came down with shingles yesterday and since going to the hospital yesterday I've been all doped up on narcotics for the pain) but the point I was trying to work up to making was that while the above is all true, that doesn't preclude my "right" to or even the wisdom of trying to negotiate, in advance, an exemption so that I'm not fired for acting in accordance with my conscience.

What we keep coming back to here is that although ROU and others keep making the point about how the pharmacist is wrong about it being wrong to fill the scrip, the complaint against the pharmacist has always seemed to be completely indepdent of whether he/she was right or wrong in their principle. The argument seems to me have been all along that they are wrong to make that decision themselves. Or, alternatively, they can make that decision but not attempt to be or continue to be a pharmacist. Similar to an idea that I can decide I won't return dropped food to a customer's plate but making that decision means that I can't be a waiter. Well...why? Besides it being a convenient tautology to merely assert that that's "what a waiter is: someone who returns dropped food to the customer's plate", it's also the case that it simply is not self-evident that that particular activity is essential to being a waiter.

Sorry, I don't think I can maintain coherence, not to mention spelling, any longer. Too much Lortab for me.
posted by Ethereal Bligh at 4:49 PM on September 18, 2004

Similar to an idea that I can decide I won't return dropped food to a customer's plate but making that decision means that I can't be a waiter

You can't be a waiter there. You'll be fired, or should quit. Though in this case you might have some ammunition to threaten your employer with, or simply take to the relevant inspection agency.

If you refuse to kill people, stop being a hit man. If you're no longer willing to employ the various shady tactics, stop selling used cars, or accept that you'll be fired when your sales drop.

If you can negotiate a contract with your employer so that you're allowed to refuse to fill prescriptions, yay for you. So far, the pharmacies haven't been willing to do so, which seems reasonable to me given the possibility of lawsuits when they refuse to fill (or refer) prescriptions and people suffer as a result. I don't see any valid reason why the state should require them to accept pharmacists who refuse to fill valid prescriptions if they don't wish to.

If the fired pharmacists want to band together to form Holiness Tabernacle Pharmacy or First Baptist Pharmacy, well, I wouldn't stop them, but I'd hope the market would.
posted by ROU_Xenophobe at 5:11 PM on September 18, 2004

I'm fairly certain that serving customers food that's been on the floor is against some sort of by-law or other. I'm not sure an unwritten company policy counts in this context, EB.
posted by Hildegarde at 5:18 PM on September 18, 2004

Anyway, we've been working towards the principle of an anonymous civil society for a long time. When I hand over a prescription, I'm not me. I'm not black, or white, or queer, or straight, or anything more than a customer. You're not you, you're a pharmacist. My prescription isn't anything other than valid or invalid, contraindicated or not.

We've been requiring people engaged in commerce to do commerce with people they'd prefer not to, such as blacks, atheists, and homosexuals, for forty years now. If you won't sell a meal to a black man, or a mincing queen, or a biker, or whoever walks in with the money to pay and doesn't disturb others, don't open a restaurant. If you won't serve one, don't be a waiter.

I see pharmacists in this light. If you won't fill a valid prescription, do something else.
posted by ROU_Xenophobe at 5:19 PM on September 18, 2004

Can take on the job of President and then, because of one's "conscience," re-institute slavery? Take back women's sufferage? Kick out all citizens who don't belong to the Landover Baptist church? Invade other countries on false pretenses?
posted by five fresh fish at 7:15 PM on September 18, 2004

So, this means that ROU_Xenophobe, five fresh fish, Hildegarde, XQUZYPHYR and others all believe that Stanislav Petrov should have been court-martialed for failing to do his job?
posted by Ethereal Bligh at 8:46 PM on September 18, 2004

Did his duty include a clause to allow him to make a his decision based on his interpretation of available data?

If not then, yes, if his commanding officer wanted to go by the books, Petrov could have been terminated for dereliction of duty. Employer's choice.

One of the pharmacist's agreed-to duties was to provide an alternative for fulfillment of the prescription: that includes sending the woman away to another shop; it does not include withholding her prescription form from her.

Force qualified surgeons to perform abortions? Hell, no, unless it's part of his contract. In sole provider status his contract is with (a) the state or (b) the insurance providers or (c) the woman herself. In all three cases, abortion procedures are or may be part of that contract.

all 'his' above also 'her'
posted by five fresh fish at 9:18 PM on September 18, 2004

I don't know what Petrov's job was any more than you do, and for all I know what he did was well within his authority.

I'd applaud a missileer who refused to turn his key when the (it turns out false) alert came*. I'd applaud an executioner who refused to kill any more.

I'd expect all those people to be, at minimum, fired, though, and wouldn't see anything wrong with their being fired. Nor would I support legislation forbidding states to fire executioners who won't kill and missileers who won't fire their missiles. They're demonstrating that they don't want those jobs, which is a good thing to not want.

*or a real one, for that matter
posted by ROU_Xenophobe at 10:46 PM on September 18, 2004

The accounts I've read indicate that he was acting outside his authority in the sense that the procedures he was expected to follow were clear, there were no exceptions, it was not a matter of individual judgment, and there was no ambiguity about them (the procedures). In the purest sense, in the context we are arguing this, Petrov didn't do his job. He acted according to his conscience in direct conflict to his job responsibilities as they were explicitly defined. Exactly the sort of non-ambiguous situation you're looking for here. So by your reasoning, he should have been fired, or courmartialed, or whatever.

And, in fact, I agree. He should have. The rules were clear, he didn't follow them. I do think the assumed greater principle he was personally acting in accordance with was "right". But more to the point, I think that even if it wasn't, he was "right" to act in accordance with his principles, even though it conflicted with his duties. This is what we do. This is the essence of our nature as creatures capable of moral choice.

In his case, even more than in the case of the pharmacist, I find a punishment of him for failing to follow the rules acceptable. I find it acceptable because, as I argued earlier, the very ability of a military organization is dependent upon the respect for discipline and authority above amost everything else. Petrov was lucky (and so were we). In most military situations such as that one, the rules and procedures are determined, in detail, in advance, specifically because an individual in his situation (and similar) is likely to have very limited information and likely to make spurious judgments left to his/her own devices. Imagine if that phantom missile had been real.

I just don't get the necessity of your all-or-nothing formulation about this. That is, your apparent position that one can't object to a portion of one's job—it's either accept the whole thing or don't do it at all. Why?
posted by Ethereal Bligh at 1:43 AM on September 19, 2004

Secret Life of Gravy said (a long time ago)
I understand that if you are pro-life, you believe that life begins at conception and abortion (or the day-after pill) is murder. I fully sympathize with anyone wanting to stop murder. What I don't understand is why is it then ok to murder a fetus if the child's father is a rapist?

I'm sure you're head will explode if I say that I believe that life begins at conception and that abortion should be legal in nearly all circumstances.

Basically I agree with EB (who has stated things far more eloquently than I would). My morality should not constrain you but you have no more right to to constrain me. "Just quit your job" is not a solution, and numerous Supreme Court cases have upheld that. You can't make me choose between remaining employed and smoking weed if I am a Rastafarian in good and regular standing in my sect, as opposed to merely a guy who believes that Jerry Garcia is still alive.
If an employee refuses to perform a task because of laziness, incompetence or insubordination that is grounds for dismissal but if it's done out of a sincere moral belief then you as an employer are fortunate to have such a principled employee (she's probably not dipping into the till either).
posted by Octaviuz at 2:39 AM on September 19, 2004

You can't object to a portion of your job because the employment agreement is a contract of sorts. You agree to fulfill all the duties of your job in exchange for certain compensation.
If you negotiate away parts of the job description beforehand - great. Now those things will not be part of your job. Once you accept the job, your employer has every right to fire you for not living up to 100% of the resposibilities you knowingly accepted.

JFuller: Would you be equally willing to say you're perfectly comfortable with a Mississippi bus driver in 1956 refusing to make Negros ride at the back of the bus, and even more comfortable knowing he will be fired by his racist boss for his refusal?

Yes, I would. If that had happened, we might be celebrating Ralph Kramden instead of Rosa Parks, but the eventual outcome would likely have been the same.

In thinking about this a little more, I realize I am glad there were severe consequences for people like Rosa Parks, because it woke up more of society. What do you think would have happened if that one bus company had just changed its policy when Parks refused to move? Probably there would not have been much news, the company would have attracted more black business and less white business and a year later, instead of the laws changing, the buses would be segregated by company, insead of front/back.
posted by bashos_frog at 2:50 AM on September 19, 2004

You're objecting to the core of your profession in this case. You're not objecting to being asked to dance the rhumba while filling valid prescriptions, you're not objecting to having customers feel your ass as you fill valid prescriptions, you're objecting to filling valid prescriptions.

Imagine a waiter who will only take orders for vegetarian meals, and will only bring vegetarian meals back to the table, working at, oh, say Chili's or Bennigan's. Such a person's employment history is likely to consist of part of a single day, no matter how strongly they feel that meat is murder. Would you support a law that required Bennigan's to keep them on staff even though they'd only take and fill orders for a small portion of the menu?
posted by ROU_Xenophobe at 8:27 AM on September 19, 2004

I don't accept that that's a valid comparison.

A better comparison is that when I waited tables at one fine-dining establishment where this was expected, I would not carry a lighter and light a woman's cigarette for her. It was expected. It's something many waiters do and something waiters do in a particular kind of restaurant. But I wouldn't do it. And I don't think that that by itself means that I couldn't wait tables. As it happened, I got away with not doing it.

Filling a scrip for the morning-after pill is simply not the majority of what a pharmacist does. If that were the case, then there couldn't have been pharmacists before the morning-after pill became available. :)

I don't think we're going to agree on this matter.
posted by Ethereal Bligh at 9:07 AM on September 19, 2004

You're forgetting about birth control, which may well make up a large portion of prescriptions filled/refilled at any given pharmacy, EB. Many millions of women are on some form of it.
posted by amberglow at 9:19 AM on September 19, 2004

Well, I'm not forgetting about birth control, actually. But anyway.
posted by Ethereal Bligh at 9:50 AM on September 19, 2004

EB, if you read a little more closely and consult the previous thread about the pharmacy prick, you'll find that a general middle ground was discovered, in which the pharmacist refuses to prescribe the pills but hands the prescription back to the woman. She is now free to locate a better pharmacist.

To return to your analogy, then, to act as that pharmacist did you would not only not carry a lighter, but you'd confiscate the cigarettes and blockade the dispensing machine. In which case your boss would have fired your ass out the door.
posted by five fresh fish at 9:58 AM on September 19, 2004

How could a comparison be more apt? There's the menu of what the pharmacy has available, representing the core goods that that sort of store/restaurant provides, but the pharmacist refuses to take or fulfill orders that don't meet his moral standards.

Filling a scrip for the morning-after pill is simply not the majority of what a pharmacist does

Filling a prescription for Taxol or amoxycillin or insulin for any other individual item or task is not the majority of what a pharmacist does, so that doesn't make much sense to me as an objection.
posted by ROU_Xenophobe at 10:19 AM on September 19, 2004

In many cases, at least with abortion providers, telling the woman "Find another provider" because the clinic in question doesn't do them places an extremely large burden on a woman in a time-sensitive position. According to a Planned Parenthood report, 87% of US counties lack an abortion provider. Another study claims that 25% of New York City pharmacies don't carry emergency contraception, and don't have the legally required signs in their windows stating so -- how do you think rural Missouri's doing?

Refusing to dispense expected services can place an undue burden on a woman who is legally, morally, and emotionally capable of making her own decision regarding her body and doesn't need paternalistic pharmacists and doctors putting obstacles in her path.

Also, just to clarify - emergency contraception prevents an egg and sperm from joining, or from attaching to the uterine wall. It does not cause an abortion; if a fertilized egg is already attached to the uterine wall, EC won't harm it. In that way, it works exactly as the birth control pill does, and so any moral problems a pharmacist has with EC must necessarily extend to the Pill.
posted by occhiblu at 10:05 AM on September 20, 2004

Yes, but some of them may not be aware of this.

By the way, I don't think many people realize that the prophylactic use of the birth control really does work exactly like the morning-after use—that is to say, a significant portion of its effectiveness is thought to arise because of an interference with implantation after fertilization.

In no event do I think what we're talking about here is a human in any sense, so in the end it doesn't matter to me very much. But my own personal intuition is that the by far greatest qualitative change happens at fertilization, not implantation. Certainly the pro-life people seem to think this—that's when it becomes an ensouled human being, right? So I can see why they'd be opposed to any form of birth control that operated post-fertilization. But opposing the good ole' pill is a losing proposition for them, of course.
posted by Ethereal Bligh at 2:23 AM on September 21, 2004

But don't you think a pharmacist should be aware that EC and birth control pills are more or less the same thing? If he's making a moral stance on one based on faulty information about how it works, then he should be fired not because of the moral stance but because it would seem that he doesn't have a grasp of his job.

Picketers on the street may be able to make whatever specious connections they would like, but I would hope my pharmacist would at least understand the actions of the drugs he's not letting me have.
posted by occhiblu at 9:09 AM on September 21, 2004

...at least with abortion providers, telling the woman "Find another provider" because the clinic in question doesn't do them...

Er, an abortion clinic that doesn't do abortions? In what possible manner could they be considered an "abortion provider", then?

I'm confoosed about that statement. It makes no sense!
posted by five fresh fish at 9:36 AM on September 21, 2004

I look forward to the day when teachers can decide, based on their conscience, what to teach our children.
posted by five fresh fish at 9:40 AM on September 21, 2004