Text 11371, 190 rader
Skriven 2005-04-11 13:54:50 av Alan Hess
Ärende: pharmacists not dispensing 
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Here are two columns on the issue of pharmacists not dispensing "morning-after"
or birth control pills.  Personally, I think they should dispense whatever a
doctor prescribes.  What if a pharmacist decides he or she has something
against a med you're taking?  It's not a problem finding another pharmacy in
the city or suburbia, but that's not true in rural or sparsely populated areas.
 If part of their offends someone, they should find another job.
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Boston.com     THIS STORY HAS BEEN FORMATTED FOR EASY PRINTING
The Boston Globe
ELLEN GOODMAN
Whose conscience rules?

By Ellen Goodman  |  April 10, 2005

TO BEGIN with, I don't believe that anyone should be compelled to do work they
regard as unethical. History is full of heroes who rebelliously followed their
consciences. It's also full of people who shamefully followed orders.

For that matter, I believe that companies and institutions should have a code
of ethics. What is the alternative to corporate responsibility and public
morality? Enron?

So I approach the subject of conscience clauses rather gingerly.

The very first such laws offered an exemption for doctors in 47 states who
don't want to perform abortions on moral grounds. That seems to me a matter of
common decency. Doctors are not automatons who leave their beliefs at the
operating room door. It also seems like common sense. Who would want their
abortion performed by an opponent?

Gradually however, we have had the incredibly expanding conscience clause. In
10 states healthcare professionals can conscientiously refuse to provide
contraceptives. In 12 states they can refuse to do sterilizations.

Indeed, last year the government decided that entire hospitals and HMOs had the
right to deny these services without losing federal funding. Never mind that it
is not clear who owns the conscience of a hospital: A church hierarchy? A board
of directors? The doctors? The community? Or the taxpayers who foot the
hospital bills?

Now, we have gone even further. Conscience clauses are being proposed to
protect professionals who refuse to follow end-of-life directives and refuse to
use treatments from stem cell research. Most notably, we have bills in a dozen
states to include pharmacists who won't fill a prescription.

It's the pharmacists who are getting the most attention right now. In just six
months, there were about 180 reports of pharmacists who said no. One refused to
fill a college student's birth-control prescription. Another refused medication
to a woman who had suffered a miscarriage.

This has led to a counter bill in California that would make pharmacists tell
employers of their objections in advance and be prepared to make referrals.
It's led to a rule by the Illinois governor that every pharmacy -- though not
every pharmacist -- must fill prescriptions, ''No delays. No hassles. No
lectures."

Karen Brauer, who heads a group called Pharmacists for Life that claims 1,600
members, compares them to ''conscientious objectors." But it isn't that simple.

The pharmacist who refuses emergency contraception is not just following his
moral code, he's trumping the moral beliefs of the doctor and the patient.

''If you open the door to this, I don't see any place to draw a line," says
Anita Allen, law professor at the University of Pennsylvania and author of
''The New Ethics." If the pharmacist is officially sanctioned as the moral
arbiter of the drugstore, does he then ask the customer whether the pills are
for cramps or contraception? If he's parsing his conscience with each
prescription, can he ask if the morning-after pill is for carelessness or rape?
Can his conscience be the guide to second-guessing Ritalin as well as Viagra?

How much further do we want to expand the reach of the individual conscience?
Does the person at the checkout counter have a right to refuse to sell condoms?
Does the bus driver have a right to refuse to let off customers in front of a
Planned Parenthood clinic?

Yes, we want people to have a strong moral compass. But they have to coexist
with others whose compasses point in another direction. In the debate over
conscience clauses, Frances Kissling of Catholics for a Free Choice says
properly, ''There is very little recognition that the conscience of the woman
is as important, let alone more important, than the conscience of the
provider."

Pharmacists don't have the same claim to refuse filling a prescription as a
doctor has to refuse performing an abortion. But there are other ways to
exercise a private conscience clause. Indeed, in a conflict between your job
and your ethics, you can quit. It happens every day.

When Thoreau refused to pay taxes as a war protest, remember, he went to jail.
What pharmacists and others are asking for is conscience without consequence.
The plea to protect their conscience is a thinly veiled ploy for conquest.

This is not easy stuff. But in the culture wars we have become enamored of
moral stances. Have we forgotten that what holds us together is the other lowly
virtue: minding your own business?

To each his own conscience. But the drugstore is not an altar. The last time I
looked, the pharmacist's license did not include the right to dispense
morality.

Ellen Goodman's e-mail address is ellengoodman@globe.com. 
+ Copyright 2005 The New York Times Company
 
*****************


http://www.baltimoresun.com/news/opinion/bal-op.chapman11apr11,1,5226968.story
?coll=bal-pe-opinion
From the right to choose to the power to compel


By Steve Chapman

April 11, 2005

CHICAGO - Abortion-rights advocates cherish the right of choice. But not all
choices are created equal. People who uphold a woman's right to make her own
reproductive decisions want to deny others the right not to take part in those
decisions. The demand for freedom has been turned into a pretext for
compulsion.

The issue arises because some pharmacists, acting under the protection of state
laws, have declined to dispense "morning-after" pills and oral contraceptives,
which they see as a form of abortion. Women with prescriptions for these
medicines have to take them to pharmacists who feel differently.

But "pro-choice" groups think pharmacists have no right to choose. "The role of
a pharmacist is to dispense medicine, not morality," says Tracy Fischman, vice
president for public policy at the Chicago office of Planned Parenthood.

Illinois Gov. Rod R. Blagojevich couldn't agree more. He has issued an
emergency regulation that leaves little discretion to pharmacies, regardless of
the moral sentiments of their pharmacists. If a woman brings in a prescription
for morning-after pills or birth-control pills, he declared, "the pharmacy will
be expected to accept that prescription and fill it. No delays. No hassles. No
lectures." If that means a small pharmacy has to keep an extra pharmacist on
duty at all times, too bad.

Illinois, like several other states, has a Health Care Right of Conscience law,
which says doctors, nurses and other health care providers can't be required to
provide medicines, procedures or services that are "contrary to their
conscience." The language of the law is broad enough to suggest that
pharmacists are covered by it. But when a Chicago pharmacist declined on two
occasions to fill a prescription for morning-after pills, Planned Parenthood
staged a protest that gained attention well beyond Illinois.

In a free society, writers are allowed to write, and publishers to publish,
material that others find dangerous, immoral or offensive. But neither they nor
readers have a right to insist that bookstores carry what they produce. They
are obliged to find others who are prepared to cooperate with them. And if that
means their work goes unsold and unread, so be it.

The same principle of voluntary cooperation should govern this dispute. As long
as morning-after pills are legal, women are entitled to buy them from willing
sellers. But that shouldn't allow them to force transactions on sellers who are
not willing.

To impose this duty on pharmacists puts a unique burden on them. Doctors, after
all, aren't forced to write prescriptions for morning-after or contraceptive
pills. Even under the governor's order, pharmacy owners are free not to carry
such drugs. The only people denied all choice by the governor's regulation are
pharmacists.

But "pro-life" pharmacists and their supporters are guilty of the same offense
as their critics - forcing some people to accommodate their choices even if
they disagree. The conscience law compels drugstore owners to employ
pharmacists who refuse to perform some of the normal functions of the job.

Diversity is one of the celebrated values of modern American society. But in
this case, what each side demands is state-mandated uniformity. Abortion-rights
advocates want every pharmacy that carries oral contraceptives to dispense them
regardless of the moral view of the pharmacists. Abortion opponents want every
drugstore to let pharmacists decide what drugs they will dispense, regardless
of the moral views or business interests of the owner.

So here's a compromise: Let individual pharmacies decide what drugs to
dispense, and let pharmacists who disagree find other places to work. Let
patients who can't get their prescriptions filled at one pharmacy go to another
pharmacy with a different policy.

That would create some inconveniences, sometimes, for some people. But it's a
small price to pay for protecting the freedom of everyone.

Steve Chapman is a columnist for the Chicago Tribune, a Tribune Publishing
newspaper. His column appears Mondays and Wednesdays in The Sun.

Copyright + 2005, The Baltimore Sun

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