Saturday, October 20, 2012

Commentor bachfiend on forcing pharmacists to dispense contraception and abortion drugs

Commentor bachfiend believes that pharmacists should be forced to sell contraceptives and abortifacients, even if it is against their conscience.

His comment, with my reply:

Pharmacists are in a privileged position. They're health care professionals educated to university level, accredited to practice by boards regulated by federal government departments, dispensing prescription drugs.

So are doctors and nurses-- highly-educated government-licensed health professionals. In only one circumstance are licensed health professionals required to dispense a product-- in an emergency when the life or limb of the patient is at risk. 

Contraception is never an emergency ('I'm sooooo horny....!') and a morning-after pill or abortifacient is not required to save life or limb-- in fact, it's desired to prevent or deprive someone of life. 

If a drug is legal with a prescription then the pharmacist should provide it.

Bachfiend is entitled to his opinion. If a pharmacist doesn't provide a drug he wants, he may 1) Forgo the drug 2) Go to another pharmacist 2) Go to pharmacy school himself, get accredited, and provide all drugs himself.

He does not, however, have the moral or legal prerogative to use force to make others act against their conscience to provide him with a product, unless it is an emergency involving life or limb.
If the drug is so infrequently dispensed that the pharmacist doesn't stock it then the pharmacist should have a procedure of either obtaining it quickly from the supplier or should be able to find out if a nearby pharmacy stocks the drug.
Again, bach may shop around for a pharmacist who meets his needs. Free country.

The role of a pharmacist is little different to that of any health care professional, even Michael Egnor. 

My point exactly. I'm not required to prescribe contraception (patients actually have asked me on occasion). The only thing I'm required to do is to render emergency care. 

If I as a medical professional am not required to prescribe contraception, why should a pharmacist-- another medical professional-- be required to dispense it?

Michael Egnor isn't required to do abortions because he's not accredited to do so. 
Actually medical licensure "accredits" me to practice medicine, non-specifically. Hospitals credential me to do specific things on their premises. But the state does not specify the procedures I am "accredited" to do.

I could start an abortion practice now, if I were so inclined.  

In fact many abortionists are not ob-gyn's specifically trained to do abortions. Kermit Gosnell-- the Philadelphia abortionist who killed women and murdered babies-- is not trained in obstetrics or gynecology. George Tiller-- the infamous late-term abortionist-- was a family practice doctor. Abortions are not normally considered part of family practice. Just the opposite, if you think about it. 

Pharmacists are accredited to dispense all federally regulated prescription drugs.

But they are not required to do so, except for emergencies, like all health professionals.

A Jewish delicatessen refusing to sell ham sandwiches is completely different because food doesn't require a prescription and if you're hungry and the Jewish delicatessen is the only food store in town, then kosher food will satisfy your hunger just as well as non-kosher.

Bachfiend misunderstands professional licensure in the US. Professionals are not required to provide specific non-emergent services. I'm not required to offer specific operations, even if I am trained and capable of doing them. I am permitted by law to tell a patient 'sorry, I won't do that operation', unless it's a life-or-death emergency.

Contraception and abortion are not life-or-death emergencies, except in the sense that not providing them respects life.

Ask yourself this, dear reader: why is the Left so hell-bent on forcing other people to do their bidding, against their conscience? After all, contraception is available everywhere. Why not just say 'I'll go to the pharmacist who does dispense contraception'. Nearly all pharmacists do.

It's almost as if the Left forces people (Christians, to be specific) to do things because it is against their conscience.

That's what's happening here. Contraception is merely the pretext. 

28 comments:

  1. No. If a registered medical practitioner prescribes a drug on a prescription then the pharmacist should fill the prescription. The only role the pharmacist should perform is to check that the dose isn't obviously wrong or that the patient isn't on other medications which may cause drug interactions.

    The pharmacist has no moral responsibility in the transaction, which is actually between the patient and her doctor.

    Now, if it's an 'over the counter' non-prescription 'morning after' emergency contraception, then that's a different matter. It would be entirely acceptable for a pharmacy to not supply emergency contraception, provided they prominently display a notice that it's not supplied (and perhaps giving the location of a pharmacy which does supply them).

    A pharmacist employed in a pharmacy that dispenses emergency contraception (or oral contraceptives in general) doesn't have the right to refuse to dispense them regardless of their objections. It's a breach of their employment, and the employer has the right to terminate employment.

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  2. The pharmacist has no moral responsibility in the transaction, which is actually between the patient and her doctor.

    What if the pharmacist has reason to think the drugs being prescribed are harming the customer? Suppose someone kept coming in for narcotic drugs and was clearly developing a dependency - does the pharmacist have a moral responsibility to do something in that case? If so, what?

    How about a soldier who's given an order to do something he feels is immoral? Does he have a moral duty to disobey?

    It would be entirely acceptable for a pharmacy to not supply emergency contraception, provided they prominently display a notice that it's not supplied (and perhaps giving the location of a pharmacy which does supply them).

    I am guessing you would not suggest the same requirement for other types of drugs. For instance, if I ran a pharmacy and decided not to stock some other OTC medication - Zicam, for instance - should I be required to prominently display a notice that it's not supplied and give the location of alternate suppliers? Or would I be within my rights to simply answer requests for it by saying, "We don't sell that here?"

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    1. Good points John.

      What is particularly disturbing is the Left's insistence on compliance, and disrespect for conscience rights.

      Contraception is not the real issue here-- there is no threat to access, not even close.

      The real issue here is the Left's effort to force Christians to violate their consciences.

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  3. Why in the world would anyone even want to be a pharmacist if they know they will refuse to honor one of the most widely prescribed medications? It’s like being a cop who refuses to stop speeders, or a fire fighter who refuses to fight wildfires. It’s just unprofessional.

    Whenever a Christian complains about infringement of their religious liberty it is always about their ability to force their beliefs on others. It’s true that the vast majority of women can get their prescription elsewhere, so pharmacists who refuse to honor birth control prescriptions are really fighting for little more than the right to insult and inconvenience people who don’t share their parochial views.

    -KW

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    1. The only force here is your effort to use force against pharmacists. There is no statutory or moral requirement that pharmacists stock or dispense all drugs, anymore than there is a requirement that supermarkets sell all products or that surgeons perform all operations.

      And certainly the decision to not stock some products based on deeply held religious beliefs deserves greater protection than casual decisions, not less.

      Should there be a legal requirement that all doctors recommend abstinence and the Rhythm Method of birth control, along with other methods? Why can't Christians play the same 'I'm going to force you to do what I want' game?

      It's a free country. If you don't like a pharmacy's policy, go elsewhere.

      Why does fascism have such an appeal to you?

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    2. Then perhaps you could explain for us why some jurisdictions have enacted special "conscience clause" legislation to permit pharmacists to refuse to dispense drugs, if they aren't required to anyway? And trying to control other people's sex lives is much close to fascism than insisting that licensed professionals do their jobs.

      Boo

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    3. The laws are necessary because of people like you, who try to deny others their freedom of conscience.

      And not selling someone contraception isn't "trying to control other people's sex lives", any more than a Jewish deli owner not selling ham is trying to control other people's diets.

      It's just freedom, and it's a shame that we have to fight against assholes like you to have it.

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  4. And where does this act of conscience argument stop? Does it only apply to hot button social issues championed by powerful established religions, or can any bozo claim spiritual moral reason to avoid doing whatever it is they find distasteful without sanction or complaint? Should the pacifist cop be allowed to go without a gun because 99.99% of the time he can do his job without it? How about a firefighter who refuses to fight fires on Thursdays because his dead mother told him not to in a dream?

    I don’t know how pharmacists are licensed, but it certainly seems reasonable to me that state and/or municipal government licenses could and should prescribe the professional responsibilities of the pharmacist, including under what circumstances prescriptions can be denied.

    -KW

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    1. Cops and firefighters are employees of the state. Although reasonable accommodations should be made for conscience issues, employees of any sort do have responsibilities to their employers.

      Pharmacists are not employees of the state. They are licensed professionals, and licensure does not generally prescribe specific products and services to be offered. My medical license does not list the operations I am required to to. A lawyer's license does not list the cases he is required to accept. A teacher's license does not list the exam questions he must ask on the final. A license to operate a restaurant does not specify the menu.

      Why can't you just respect the beliefs of others, and accept that in a free society not everybody should have to give you your contraception.

      What is it about fascism that you guys find so irresistible

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    2. Licenses do require you to follow the laws and regulations of the licensing authority. It is well within the rights of states and municipalities to ensure licensed private citizens serving in vital public roles live up to the professional standards expected by that community, and it’s certainly reasonable that the law dictate under what circumstances a pharmacist can deny prescriptions for common drugs.

      If know that one of the things you absolutely can not do is dispense birth control, them why the hell would you think being a pharmacist was a good idea unless you specifically want to be in a position to deny people birth control?

      -KW

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    3. @KW:

      [Licenses do require you to follow the laws and regulations of the licensing authority.]

      Duh.

      [It is well within the rights of states and municipalities to ensure licensed private citizens serving in vital public roles live up to the professional standards expected by that community, and it’s certainly reasonable that the law dictate under what circumstances a pharmacist can deny prescriptions for common drugs.]

      The law already does. It dictates that emergency care be provided.

      What you are demanding is that contraception be given precedence that drugs like antibiotics and blood pressure medication and chemotherapy are not given. Pharmacists are not required to carry or dispense specific drugs.

      [If know that one of the things you absolutely can not do is dispense birth control, them why the hell would you think being a pharmacist was a good idea unless you specifically want to be in a position to deny people birth control?]

      Interesting question. Sounds a bit conspiratorial-- a guy goes to pharmacy school, gets certified, opens a pharmacy simply in order to deny Sandra Fluke her elephantine appetite for contraception. Hmmm....

      Here's another explanation: the pharmacist is a Christian who is pro-life, and he went into the pharmacy profession to help people, not prevent them.

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  5. If force and coercion are the issue here, would the two of you agree on the Libertarian position? Pharmacy owners can refuse to stock whatever they want, and fire pharmacists who refuse to dispense certain things - or not - as they choose, with no government imposition in either case.

    ?

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    1. Absolutely I agree. The government should not get involved.

      If the owner of the pharmacy wants to dispense contraception in his pharmacy, that's his business. I might suggest to him that he have an accommodation for conscience issues with Christian employees, but the decision is his alone.

      The government has no business using force in the matter.

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    2. What if the pharmacy is the only one in a small town, and the pharmacist refuses to stock oral contraceptives prescribed by the local medical practitioner?

      It's reasonable that a pharmacist who is licensed to fill doctors' prescriptions should be required to fill the prescriptions. It's not necessary for the pharmacist to stock all medications which could potentially be prescribed; all that's necessary is that the pharmacist has a means of getting the medication quickly from the supplier.

      Anything 'over the counter' is fair game. The pharmacist can refuse to stock whatever product he or she wants.

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    3. What if the pharmacy is the only one in a small town, and the pharmacist refuses to stock oral contraceptives prescribed by the local medical practitioner?

      Then we have the same situation as someone who needs (or wants) an OTC drug the pharmacy doesn't carry. Or we have the same situation as someone who gets a prescription but doesn't have a pharmacy in their town at all. The patient gets the drug online, orders by phone, or goes to the next town over where they can procure the drug. There's no legislating convenience; you can't just force people to sell things they don't want to sell because it would inconvenience people who want to buy it nearby.

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    4. John,

      Well, the government isn't forcing the pharmacist to take the OCs herself.

      I know about towns without pharmacies. About 30 years ago, I was seconded to the hospital in Port Hedland (a mining town about 2,000 km from the state capital) and once a week, I did a clinic in the next mining town, Goldsworthy, about 200 km over, which didn't have a pharmacy. The clinic had a small selection of medications, including OCs, and anything else had to come from Port Hedland.

      If a town has a pharmacy, then it should supply medications that are effective. OCs are VERY effective in accomplishing what they're designed for. A pharmacist refusing to stock Zicam is praiseworthy, because 1. It's not effective, like homeopathy, and 2. It's dangerous.

      Anyway, why is selling OCs immoral?

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    5. bachfiend,

      I'm going to answer your last question first.

      Anyway, why is selling OCs immoral?

      Leaving aside the immorality of contraception in general (which is an almost exclusively Catholic doctrine, and rests on a number of assumptions not shared even by many Protestants, let alone atheists) OCs have abortifacient properties. I believe that most pharmacists objecting to dispensing OCs are Protestants who don't want to be party to induced miscarriages.

      If I'm not mistaken you're also asking why, even supposing using OCs is immoral, dispensing them should be considered immoral. Most Mormons are now OK with selling caffeinated drinks in the stores and hotels they operate. They abstain for their part, but they recognize that the public expects a hot cup of coffee with their continental breakfast in the lobby, so they give their guests what they want, even if it's something they wouldn't do themselves. Why can't the pharmacists get on board?

      The short answer is that they shouldn't have to. It's nice that I can get coffee in my room at the Marriott, but it shouldn't be mandated by law.

      The long answer comes back to the fact that OCs can prevent implantation. If you believe that personhood begins at conception, then it is at the very least recklessly negligent to allow yourself to be complicit in anything that would cause that person to die.

      Here's an analogy: If I own a hardware store in the early 19th century and I'm an abolitionist by conviction, I might choose not to sell chains. Sure, chains are used for all kinds of purposes, but maybe in my area one of the things they're used for is making sure slaves don't escape in the night. Now, I recognize that I live in an ideologically diverse nation, and that some people may not believe their slaves are actual persons. I don't like it, but public opinion is pretty evenly divided right now; slavery is still legal, and most free people put up with it, so I go along quietly to avoid imposing my beliefs on others who may not share them. But I don't want to be complicit in it myself, so I don't sell chains.

      Most people would naturally expect to find chains for sale in a hardware store, and might be inconvenienced by my not carrying them. Those who own slaves might even guess my reasons for not selling them, and feel insulted and angry. My intent is not to insult or inconvenience anyone; it's to avoid complicity in something I believe to be evil.

      I've seen it argued that the final straw for abolitionists was the Fugitive Slave Act of 1850, which essentially made it illegal for Northern officials to not cooperate in efforts to track down and recapture anyone who had escaped from slavery and fled north. I can believe it. It's one thing to say "We disagree about the morality of X, so don't try passing any laws that might prevent me from doing X - that's forcing your personal beliefs down my throat!" It's another to then turn around and say, "Oh, by the way, I'm passing a law that says you are required to assist me with X."

      Well, the government isn't forcing the pharmacist to take the OCs herself.

      The Fugitive Slave Act wasn't forcing Northern officials to own slaves. If you passed a law forcing my hypothetical hardware store to sell chains, it's not like I would be forced to put them on people myself.

      If a town has a pharmacy, then it should supply medications that are effective.

      The question is whether the owner of said pharmacy has the legal right to not do so. I still don't get how a pharmacist refusing to sell OC is imposing her beliefs on others, but a law punishing her for not doing so isn't an imposition of beliefs on her.

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    6. John:

      [The question is whether the owner of said pharmacy has the legal right to not do so. I still don't get how a pharmacist refusing to sell OC is imposing her beliefs on others, but a law punishing her for not doing so isn't an imposition of beliefs on her.]

      Well said. The real issue here isn't contraception, but the legitimacy of the use of force by government.

      I'm pro-choice, when it doesn't involve killing people.

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    7. The Catholic teaching that contraception is immoral is, in my view, a carefully reasoned, even beautiful, doctrine.

      The church understands marriage as a sacrament, an earthly manifestation of transcendence. Sex and procreation are linked in God's will for us, and sex is a very good thing for a married man and woman in that context.

      Sex or procreation separated from God's will for us is not good, and will harm us spiritually and physically. Certainly our actual experience with the social consequences of contraception bears out the Church's view in spades.

      For the Church, contraception is to sex as bulimia is to nourishment. It is a perversion of the natural end of human sexuality, which is inherently directed to life-long marital commitment and to procreation.

      When I first became a Catholic (about a decade ago), I was dubious about the Church's contraception teaching. I have come to hold it in great esteem. It is deep wisdom, and in today's culture, quite courageous.

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    8. So sex without any possibility of procreation is immoral? Couples in which the woman is beyond the menopause should stop having sex? The rhythm method (ineffective though it is as a form of contraception) is immoral?

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    9. @bachfiend: No, but further explanation relies on these assumptions I mentioned. They don't always translate well out of "Catholicese" but I'll try to explain my understanding of them when I'm behind a real keyboard. You ask a good question, and I'll try to at least give you an explanation that makes sense, even if you don't find it convincing.

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    10. @bachfiend:
      OK, here goes. I'm giving you my understanding, which may not be perfect, and may not even be entirely reflective of Catholic dogma:

      We start with the assumption that human beings have a spiritual principle: a soul. This soul is immortal and eternal once it is created during conception: a cooperative process between a man, a woman, and God. Creation is by nature an act of love: part of loving something or someone necessarily involves desiring it to exist, and God loves everything he wills to exist. (Remember all the "it is good"s in Genesis?)

      By design, sex is an act of love. The Catholic understanding of love always involves sacrifice: love is real insofar as one is willing to sacrifice for the sake of the beloved. This is why the crucifix is so central to our faith; it's not that we're obsessed with death and torture, but a poignant reminder to us that God loves us literally to death, and that we are made to love one another in exactly the same way, laying down our lives for our brothers and sisters (whether this means spending your finite living hours serving them or literally dying for them, the point is to take the life that is given to you and give it away.)

      As an act of love, sex is very, very potent. It is one of the most miraculous things it is possible to experience, and it is so designed as to bind two people together for a lifetime and to create a third. That's the intended nature of sex.

      Human beings, having free will, are capable of choosing to thwart this intended nature: we are capable of having sex without love and commitment (e.g. fornication) procreating without sex (e.g. IVF) and intentionally sterilizing the sex act itself (e.g. contraception.)

      Each of these acts is a sort of lie because the sex act has an intrinsic meaning of its own, just as a scowl does, and just as words do. When I scowl at someone, I am expressing anger, and if I lie with my scowls (for instance, scowling at my wife when I am not actually angry with her) I risk (a) becoming more angry as my body and mind respond to the facial expression I am making and (b) confusing my wife as to my real feelings and upsetting her needlessly. There are internal and external consequences to my act that are dependent on the nature of the act itself - not just on my intentions when I perform it. By the same token, if I say the words "I love you" to someone, those words have an impact on my mind and on the person I'm speaking to.

      In short, my words and my actions shape me, and they shape the world around me.

      The contention of the Catholic Church is that intentionally sterilizing the sex act is a statement of its own - a statement that is not made when a couple has sex without intentionally making the act sterile. The statement being made when you put on a condom is not the same statement you make when you sleep with your post-menopausal wife. It puts a barrier between a couple, and turns an act of total self-giving ("I want to unite with you exactly as we are") into an act of taking pleasure without self-giving ("I want to experience an orgasm with you, but not to unite with you entirely as we are because I fear the consequences and sacrifices that might result.")

      It is the contention of the Church that using contraception or IVF are about getting what you want without giving of yourself, and they have internal and external consequences: they shape the souls of those who use them, turning them away from sacrificial love (and thus from God) and they shape the world around them, with detrimental consequences; we believe that the explosion of divorce, pornography, STDs, and broken homes is due in no small part to the prevalence of contraception. Sinful acts bear evil fruits, and there are all kinds of consequences to contraceptive use. A good place to read about them is 1flesh.

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    11. FWIW, I don't expect any of this to be convincing to you, but I hope it gives you a window into why we think the way we do. If you have any other questions about what I've said, I'll answer to the best of my ability.

      Another good place to check out this line of reasoning is Dr. Janet Smith's hour-long lecture. She says it all better than I can, albeit much less succinctly. :)

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    12. John,

      Beautifully explained.

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    13. John,

      Beautifully explained.

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    14. John,

      You're right. I don't find it convincing.

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  6. @mregnor:
    It sounds like you are opposed to conscience protection laws that prohibit pharmacy owners from firing pharmacists who refuse to dispense OCs, is that correct?

    Seems to me there's a fair and reasonable compromise here that would put the operations of a pharmacy (what gets sold, and how to handle HR decisions) in the hands of the pharmacy owner.

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    1. You are correct.

      The decision should be that of the pharmacy owner, and no one else.

      I sympathize with conscience protection laws, but they should apply only to government employees, not private employees.

      In the private sphere, the government should butt out. Selling or not selling contraceptives is a matter for the owner, the employee, and the customers to sort out, not for the government.

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