The pharmacist as conscientous objector
Pope Benedict XVI recently told the International Congress of Catholic Pharmacists that pharmacists have a right to be conscientious objectors if they are asked to dispense drugs that will be used in a way they regard as immoral. From an AP report:
Benedict told a gathering of Catholic pharmacists that conscientious objection was a right that must be recognized by the pharmaceutical profession.
"Pharmacists must seek to raise people's awareness so that all human beings are protected from conception to natural death, and so that medicines truly play a therapeutic role," Benedict said.
Benedict said conscientious objector status would "enable them not to collaborate directly or indirectly in supplying products that have clearly immoral purposes such as, for example, abortion or euthanasia.
The AP reports that the Pope also told the gathering that pharmacists have a responsibility to educate patients so that drugs are used ethically and morally.
The US hasn't been the only country dealing with this issue. It's also come up in Chile, where whole pharmacy chains have refused to sell morning after contraceptives, and in Italy, where pharmacists are required by law to dispense prescriptions regardless of their ethical objections. In response to the Pope's comments this week, the Italian health minister said, "I don't think his warning to pharmacists to be conscientious objectors to the morning after pill should be taken into consideration."
-Greg Dahlmann
Earlier on blog.bioethics.net:
+ The Illinois plan for Plan B and reluctant pharmacists
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It strikes me that conscientious objectors are normally and reasonably asked to fill roles other than the one requested if they won't carry out all of its duties (e.g. medic rather than soldier, rather than a soldier reserving the right to not follow all the orders)
- by emily on Oct 30, 2007 at 4:57 PM | link
It may come off as nitpicking the statement; but, birth control pills (which along with RU-486 top the conscientious objectors' list of medications which should not have to be dispensed) prevent conception...thus they wouldn't fall under the broad scope of the Pope's statement.
Further, being a conscientious objector is something that can and should be respected, but if it prevents one from filling their role then one must accept the consequences of the decision to object and find a different role. My issue with pharmacists who object to dispensing certain sorts of medications has nothing to do with disagreeing with their position that they shouldn't have to dispense it; rather, it has to do with the fact that they are not forced to be pharmacists. People who were drafted and pressed into military service could conscientiously object and face the consequences of doing so. It was not still conscientious objection if they agreed to serve, went to training and then in the middle of performing the job for which they were trained decided not to do a part of it.
To choose a profession for which one must pay significant money to gain schooling and training, become credentialed, get a job and then refuse to fulfill a basic duty of that position strikes me as altogether something different.
- by Chris on Oct 30, 2007 at 10:22 PM | link
Chris, I don't have a need for my pharmacist to dispense these sort of drugs. I'd prefer that my pharmacist not dispense them. Are you saying we should allow consumers to choose which sort of pharmacist they'd like to have? Or are you saying that a regulator should decide what it means to be a pharmacist? What is next--a requirement that all doctors be willing to perform abortions? Wait, scratch that, I understand that medical schools are doing what they can on that front.
- by Thomas on Oct 31, 2007 at 1:05 AM | link
Maybe the people who would use the law to force other people to act against their consciences should pay to move the cooperative pharmacists around - sort of an anti-pregnancy center - or set up a hot line if it's so important to them.
Instead of using their own resources, they'd use the law to force action.
The problem is that our medications and techniques have moved beyond healing and keeping the body healthy. Although I don't believe that Plan B is an abortifacient drug, it is one of the ways that this has happened.
To refuse to act is different from insisting on acting. Refusing is truly a personal decision. Forcing requires a lot more people, guns, prisons, courts.
There ought to be some way to make Plan B available without requiring the action of people who don't want to dispense it.
- by Beverly Nuckols on Oct 31, 2007 at 1:13 AM | link
Beverly is on the right track here. And there _is_ a way to make Plan B available without requiring dispensation by pharmacists who have moral objections. If the FDA followed the recommendations of its own expert reviewers, Plan B would be available over the counter. No prescription would be necessary. In short order you'd be able to purchase Plan B at your corner grocery store, where it would be stocked right next to the condoms.
- by bob koepp on Oct 31, 2007 at 8:00 AM | link
I have had that need while living in a rural area--I don't want the pharmicist, other customers or the Pope dictating that I not take advantage of a fully legal option, thank you very much. Their freedoms shouldn't trump my rights.
- by emily on Oct 31, 2007 at 9:13 AM | link
I believe the attempt to invoke conscientious objector status by pharmacists is deeply misguided. The traditional conscientious objector (CO) is someone compelled by the government to engage in a course of activity, e.g., military service. No one is forced to become a pharmacist. Second, the military CO is required to perform alternative service, something most of the objecting pharmacists are unwilling to do. Third, the military CO cannot obstruct the actions of others. We do not permit a miltary CO to block a convoy, for example, but the pharmacists are interfering with the healthcare decisions of others. No one is requiring the pharmacist to ingest a medication to which she objects, so the notion that somehow her personal integrity is violated is untenable. If dispensing a medication somehow converts that action into a healthcare decision of the pharmacist, will she pay for my drugs? The proliferation of conscientious exemptions for healthcare workers in this country is becoming a serious problem. And why are healthcare workers privileged? Minneapolis recently experienced a refusal by some Muslim cabdrivers to transport passengers carrying alcohol. Should the cabbies have been allowed to pick and choose fares based on their religious beliefs? If not, what makes healthcare workers so special? If anything, they have a greater obligation to serve the public.
- by Ronald A. Lindsay on Oct 31, 2007 at 9:23 AM | link
Bob, I believe that Plan B is "behind the counter" in the US. There's no prescription necessary - for over a year, now. But someone has to sell it.
Have you tried to buy pseudoephedrine in most states? Or how about alcohol or nicotine? Despite the withdrawal symptoms some nicotine or alcohol user might have in certain areas where they can't access or use these perfectly legal, although regulated, substances. I know lots of stores that sell sodas and coffee, but not alcohol or tobacco.
Ronald and Emily,
Plan B is newer than some pharmacist's and doctors' licenses. Couldn't you be tolerant enough to allow those men and women, at least, to be "grandmothered" in?
No one dies from lack of access. There is no "right" to access, as a matter of fact. I believe that the courts have recently ruled - in several cases - that even dying people don't have the right to medicines that are restricted. And, again, no one dies from lack of immediate, on demand Plan B or other contraceptives.
While you may feel that you have a right to some substance, you don't have a right to force someone else to act.
- by Beverly Nuckols on Oct 31, 2007 at 12:41 PM | link
A couple points.
In most circumstances, your right to express your own free choice is not violated by those who refuse to provide whatever assistance you might need to engage in that expression. You are free to seek out the needed assistance, but usually others are not duty bound to provide it.
When people talk about duties, obligations, responsibilites, etc. of pharmacists, they should be clear about whether they see these as applying to pharmacists qua pharmacists or whether they apply to pharmacists qua contractual employees. It does make a difference.
- by bob koepp on Oct 31, 2007 at 2:03 PM | link
I would argue that I do have the legal 'right' to buy that product and a reasonable expectation of being able to exercise that right at a pharmacy. The outcomes of blocked access are not immediately fatal in most cases but can be very significant.
I feel the taxi example is a great one except that alcohol is a far more trivial product. If you take up a professional mantle the needs of the served should be waited over that of the server. That is the basic nature of professional service and the reason why one pays the other money.
- by emily on Nov 1, 2007 at 3:00 PM | link
Emily - Does your "right" to buy a product obligate anybody to offer it for sale? Do the professional duties of pharmacists extend to providing access to products for non-medical purposes? As for "blocked access," again I suggest you place the blame with the FDA. But for their foot dragging (knuckle dragging?), Plan B (or equivalents) would already be available in any number of venues, not just pharmacies.
Getting clear about the ethics of this issue requires moving beyond a simple "Smith wants x, which is perfectly legal, but Jones thinks x is immoral." Among other things, we need a coherent account of the role of freedom of conscience in a liberal society, as well as a coherent account of the professional responsibilities of pharmacists.
- by bob koepp on Nov 1, 2007 at 7:48 PM | link