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Justin Chen Thought Paper #2: Pharmacists must be allowed to practice conscientious objection Daytime radio’s Dr. Laura Schlessinger is infuriated about the medical school admissions process. The vitriolic pro-life host of America’s second most popular radio talk show, who has compared physician-assisted abortions to having babies "sucked into a sink," claimed that would-be doctors are constantly being turned away from their chosen profession, simply for admitting that they would not be willing to perform abortions. Schlessinger, like most Americans, believes that doctors have an unimpeachable duty to protect human life—and that if an unborn fetus fits a particular doctor’s conception of a human life, he is morally justified in refusing to abort it. The pregnant woman will just have to find another physician with fewer ethical qualms to carry out the procedure. Simple, right? But more recently, as science has made great strides in its understanding of the biology of the human reproductive cycle, new drugs have been developed that complicate the issue tremendously. With the increasingly widespread availability of Preven and RU-486, hormonally based abortifacients that likely inhibit or reverse successful implantation of a fertilized ovum in the uterus, (1,2) part of the ethical burden has suddenly been shifted onto the pharmacists who must dispense these drugs. Should pharmacists be allowed to invoke the right to conscientious objection, or should such an option remain only in the hands of the doctors who must prescribe the drugs in the first place? Such questions are complicated by the emotionally charged rhetoric surrounding any debate about abortion—“the sanctity of life” versus “a woman’s right to choose.” But regardless of what one’s personal convictions about the actual definition of life may be, it is ultimately imperative that pharmacists be afforded the same right as physicians to abstain from performing morally troubling actions, because members of both professions ultimately share the same goal: to defend human life, however the individual pharmacist or doctor conceives of it. One of the main reasons that the debate over conscientious objection for pharmacists exists in the first place is the fact that most Americans do not consider pharmacists to be medical personnel. Like a supermarket cashier or bank teller, we expect a pharmacist to execute a narrowly defined function—in this case, to dispense medicine already prescribed by doctors. But this view of the pharmacist as nothing more than a technician is simply incorrect on several accounts. First of all, pharmacists, who are technically required to fully understand the chemical composition, clinical effects, and proper administration of drugs, often know more about the medication than the physicians who actually prescribed it. It would therefore be a mistake to equate pharmacists with unskilled labor. Second, according to the Department of Labor’s Occupational Outlook Handbook, pharmacists must “dispense medications and advise the medical staff on the selection and effects of drugs” as well as “assess, plan, and monitor drug regimens.” (3) This list of duties, though admittedly incomplete, nevertheless gives a good idea of the specialized type of service in question here. Far from being mere intermediaries, pharmacists are an intimate and essential component of the entire medicinal dispensation process. But what does it matter that pharmacists and physicians occupy allied professions? Shouldn’t the doctor still have the final say in the whole process? After all, it is medical school—and not pharmacy school—graduates who must swear by the Hippocratic Oath, which states: “It may…be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty.” (4) Given such an impressive edict, surely it is the physician who ultimately ought to make ethical decisions regarding abortifacients. Yet this reasoning is faulty; like doctors, pharmacists have a duty to minimize the occurrence of potentially harmful drug interactions and to discuss the risks of medication with their patients. Thus, they also have an implicit charge to defend human life, and must also necessarily confront significant ethical issues in the process. Furthermore, if a physician accidentally prescribes a drug that could react harmfully with a patient’s current medication, it would obviously be permissible—indeed, morally imperative—for the pharmacist to bring attention to the potential danger. If the pharmacist can supersede the doctor’s medical authority in this instance, it is clear that a simple prescription is by no means a sacrosanct, inviolable document. And if the ultimate goal of this whole process is to save lives, we must return once again to the conclusion that medical personnel, including pharmacists, must be allowed to hold their own views about the definition of a life. If doctors can claim conscientious objection to abortions, then pharmacists should be allowed to do the same with regard to abortifacients. But why give doctors this loophole out of performing abortions in the first place? Isn’t it the duty of the physician to attend to the patient’s demands above all else? For instance, if a hospital patient refuses to be intubated or resuscitated, his requests technically must be honored, even if there is a good chance that doing so may worsen the ultimate outcome. The answer to this provocative question can be found in America’s conscientious objection policies, as outlined by the Supreme Court: “Historically, Congress has provided for alternative service for men who had religious scruples against participating in either combat activities or in all forms of military activities.” (5) Though the abortion debate is not a military conflict, it does at its heart involve the ethics of killing against one’s moral convictions, and as such, falls under the powerful aegis of the First Amendment to freedom of religion. One final protest that could be raised is that allowing pharmacists to practice conscientious objection would restrict the public’s access to needed abortifacients drugs. Emilie Baratta, a spokeswoman for Planned Parenthood of New York City, even argues that “emergency contraception is extremely time-sensitive” and that “if a pharmacist refuses to dispense it, this could result in a woman having an unwanted pregnancy.” (6) And it is easy to imagine that certain regions in America—especially religious and socially conservative ones—would feel the affects of conscientious objection more strongly than others, resulting in overall uneven distribution of abortifacients. This is a compelling argument; after all, it seems somewhat unfair for the United States to knowingly allow unequal public access to perfectly legal drugs. But at the same time, given the many ethical arguments discussed above in favor of permitting pharmacists to follow their own moral convictions, it would not be a just compromise to forbid conscientious objection simply because of pragmatic concerns about distribution. If certain areas of the United States truly were disproportionately affected by prevailing regional attitudes toward abortion, and the government decided that it has some sort of duty to provide equal public access to new drugs, it would then be the government’s duty to purchase and market the drugs on its own. Forcing pharmacists to disregard their own beliefs is certainly not the correct or constitutionally sound way to remedy a problem of distribution and access. Whether or not one agrees with Dr. Laura about the horrors of abortion, then, is not nearly as important as understanding her point about the freedom to make independent moral decisions regarding life and death. What is at stake here is not the definition of life, but the importance of religious beliefs and the right of medical personnel to abstain from performing actions that they find morally repugnant. In allowing pharmacists to claim conscientious objection, the American government does not make any sort of judgment on the value or ethical soundness of abortifacients themselves. Rather, it demonstrates a commitment to defending the independent moral agency of those professionals whose duty it is to safeguard human life itself.
Sources 1. “RU-486: The Abortion Pill.” Childbirth by Choice Trust. Toronto, Canada. http://www.cbctrust.com/RU486.96.html. 2. Preven Emergency Contraception Kit webpage. http://www.preven.com/product/02-01-01.html 3. “Pharmacists.” Occupational Outlook Handbook. Bureau of Labor Statistics, U.S. Department of Labor. Washington D.C. 2000. 4. “The Hippocratic Oath Today: Meaningless Relic or Invaluable Moral Guide?” Translation by Louis Lasagna. NOVA Online. http://www.pbs.org/wgbh/nova/doctors/oath.html. 5. The Constitution of the United States of America: Annotations of Cases Decided by the Supreme Court of the United States. United States Government Printing Office. Washington D.C. 1998. http://www.access.gpo.gov/congress/senate/constitution/ amdt1.html 6. Vanderkam, Laura R. “More pharmacists refuse to sell morning-after pills; Some call them a form of abortion, but others disagree.” The Washington Times. 7/28/99. |