Monday, March 28, 2005

Conscience Clause, Take Three

This is the third post I've written on this topic which will not go away. Conscience clauses are provisions in state laws which allow health care providers to refuse to provide certain services and/or to treat certain patients for reasons of conscience. Four states currently have such clauses in their books and eleven others are considering adding them.

The Washington Post (via Atrios) introduces yet another article on this topic, this time with specific emphasis on pharmacists and their rights to refuse to fill certain prescriptions.

Well, not "certain" prescriptions. Let's state the obvious: Both the pharmacist conscience clauses and the hullabaloo about dispensing are about birth control pills, in either the usual form or the emergency form, and the conscience reasons that are the focus of legal protection are those of pro-lifers. But for obvious reasons the laws don't just single out this one group of believers for protection, and, in theory, at least, the conscience clause could be used to deny certain types of patients (such as alcoholics and drug-addicts) non-emergency services altogether. It could also be used to protect a provider who refuses to treat, say, gays and lesbians or anyone else the provider dislikes.

So far the actual cases of pharmacists refusing to dispense have all been about birth control pills:

An increasing number of clashes are occurring in drugstores across the country. Pharmacists often risk dismissal or other disciplinary action to stand up for their beliefs, while shaken teenage girls and women desperately call their doctors, frequently late at night, after being turned away by sometimes-lecturing men and women in white coats.

"There are pharmacists who will only give birth control pills to a woman if she's married. There are pharmacists who mistakenly believe contraception is a form of abortion and refuse to prescribe it to anyone," said Adam Sonfield of the Alan Guttmacher Institute in New York, which tracks reproductive issues. "There are even cases of pharmacists holding prescriptions hostage, where they won't even transfer it to another pharmacy when time is of the essence."

The "holding the prescription hostage" bit is essentially denying the patient the treatment indicated by his or her physician, and this is how it is justified:

Brauer, of Pharmacists for Life, defends the right of pharmacists not only to decline to fill prescriptions themselves but also to refuse to refer customers elsewhere or transfer prescriptions.

"That's like saying, 'I don't kill people myself but let me tell you about the guy down the street who does.' What's that saying? 'I will not off your husband, but I know a buddy who will?' It's the same thing," said Brauer, who now works at a hospital pharmacy.

Now you know. Never mind that no research exists that would prove the contraceptive pill works as an abortifacient. The pharmacist knows better, somehow. Never mind also the many cases where women are prescribed the contraceptive pill as the treatment of some medical condition such as ovarian cysts or endometriosis. The pharmacist knows better, again.

The majority of pharmacists will not refuse to dispense contraceptives anytime soon, but the pro-life movement does seem to have moved to the second stage of its plan: get rid of contraception, even before the first stage: ban all abortions, was completed. Sadly, this probably means that the number of abortions will go up. Maybe Brauer should have considered this, too, in her gun parable?

More generally, increasing the religious rights of health care workers (a favorite project of Rick Santorum, by the way) will mean reduced rights of patients to receive suitable and timely care. Or at least care that complies with their own values.

Isn't it interesting how the extreme right-wingers are all for conscience clauses in health care yet totally opposed to anything of the sort in higher education? Wingnuts want professors to teach all theories even if they don't like some of them, but pharmacists should be allowed to refuse whatever they find unsavory. I bet that we'd have conscience clauses in academia, too, if they could somehow be made to apply to only wingnut professors and their teaching.

Which brings to mind Mr. Horowitz and his website of student complaints about lefty professors. Why not take a leaf from the wingnut book and start compiling a similar website of pharmacists with scruples? This would help consumers in shopping for the provider who is most likely to help them. Maybe this is what Atrios has in mind with his post on this topic?