Do you think abc123's handle has anything to do with the Jackson 5?
Also, other than not handing the scrip back, I think the pharmacist here is otherwise within the bounds of acceptable behavior. Let's say I go to my local indie bookstore and ask for the Protocols of the Elders of Zion. I don't think they need to order it for me, or refer me a bookseller who does. Right?
Out of my desire for comity, I'll skip the "baa compares birth control to the protocols of zion" response.
In the current culture, it's surely not acceptable. It's not ok for someone to go to a pharmacy only to realize after she's arrived that, for moral reasons, her prescription won't be filled. This is particularly true where the morning-after pill is concerned, because, as I'm sure you know, it's probable effectiveness decreases substantially with time.
I would listen to arguments that, as long as pharmacies make it clear in advance that they will not honor certain prescriptions, they are allowed to refuse, but my own prejudice is that pharmacists ought to fill prescriptions or get out of the prescription filling business.
And I wonder how much our compromises assume easy urban access to several pharmacies, and how devastating they could be in communities in which just one pharmacy serves all the people.
According to some clowns on metafilter, it's within the guidelines of pharmacists' professional association to decline to fill a prescription out of moral concerns, so long as the customer is directed to where he or she can get it filled.
Hell, that may even be in the linked article, which I didn't bother to read here or when it was on metafilter.
The American Pharmacists Association, with 50,000 members, has a policy that says druggists can refuse to fill prescriptions if they object on moral grounds, but they must make arrangements so a patient can still get the pills. Yet some pharmacists have refused to hand the prescription to another druggist to fill.
Glad to see the working world is having the intended effect on your self-confidence. Go to grad school, it's great for making you feel good about yourself.
Leiter frequently posts about stuff like this, although primarily having to do with education issues, like moves to take evolution out of public school science textbooks.
Baa, Ogged: No, it isn't okay. If a person has a moral problem with providing basic medical services, then they can choose another profession. Saying that someone who is working as a pharmacist can refuse to dispense needed drugs because they disapprove is heinous.
Let's say you get an organ transplant. Let's say that I am a pharmacist, and I think organ trasnplants are disgustingly expensive, violate God's will (which is obviously for you to die), and waste medical resources (money) that can be spent on more cost-effective measures, like vaccination, say. Does that make it okay for me to refuse to dispense immunosuppressant drugs? Hell no. Do Christian Scientists become pharmacists? Hell no.
I teach for a living. Let's say I have "moral qualms" about helping the children of Republicans get college degrees (I don't, but let's say I did). Would it be okay for me to refuse to let them take my class? Okay to flunk them? Obviously not. I would be fired, and rightly so. Same goddamn diff.
Oh, and on your question about sites that catalog links of that nature--well I logged a few not too long ago. Including, I think, that story. Also see The Well-Timed Period
While I appreciate the comity-boosting, let me note that it was an analogy not an equivalence! Basically, I think this is a great example of respecting strongly held minority views. If someone thinks X is morally suspect, I don't want to go out of my way to force them to do it. And if this means that a person spends an extra 15 minutes finding a new pharmacy, it's a small price to pay for, I believe the word is, tolerance.
And yes, one can make internal critiques, and say that X really is morally suspect, while Y isn't. I certainly don't think birth control is on par with hate literature, at all. I was just picking something basically (I hope) uncontroversial.
But that's not the point. Tolerance isn't about subjecting our fellow citizens views to the Tribunal of Reason before we decide if we'll let them slide. It's about understanding that views we ourselves find batty must be given some space. Maybe you think a person who won't dispense birth control (or animal rights violating products, or whatever) shouldn't be a pharmacist. I'd rather let that person operate by their conscience, and lose business accordingly. This is always a balancing act, and I'm not trying to establish a bright line principle. But I do think this is a case where the tolerant path is pretty clear.
Come ON. In some small towns, there is one pharmacy. Or one all-night pharmacy, or one that's open on weekends. If you need emergency contraception, you need to use THAT pharmacy.
No one is forcing anyone to hand out birth control. I am saying, if someone has a problem dispensing drugs to women, they shouldn't become a drug dispenser. If providing a service violates your ethical code, don't take a job that requires you to do it. Duh.
Ok, so there would be cases, the small town, e.g., where accomodating a catholic pharmacist would inflict substantial costs. I wonder how frequent those situaions are, or if the case mentioned was one like that.
But again, it seems like your point (second paragraph) is, be an X on my terms, or don't be one. That doesn't sound like tolerance to me.
baa, do you see it as contradictory to express tolerance of persons qua persons and not express tolerance of persons qua professionality? (sorry for making up words) I believe you can tolerate a person's beliefs but deny them the right to alter their professional responsibility because of their beliefs. He can keep his beliefs, but if he cannot refrain from exercising them, he shouldn't be allowed to be a pharmasist. Bitch has provided some examples wherein it seems clearer that this is the case, and others are not hard to think of.
There's a reason that we license and regulate pharmacists and allow licensed pharmacists to have a monopoly on dispensing prescription drugs. And a reason we allow basically anyone who wants to do so sell books (or non-prescription drugs for that matter).
Are you really arguing that tolerance means allowing a practicing Jehovah's witness to be licensed as a trauma surgeon, and we'll just let the market sort it out?
So his right to choose a profession he can't practice in good conscience trumps my right to get the drugs I need?
Think about what you're saying here. The implication is that my rights as a woman to fill a legal prescription, written for me by a licensed physician, are limited by the rights of any man to choose a profession he is ill-suited for. Do I also need to ask permission of a cabdriver who drives me to the pharmacy to fill the prescription? What if the pharmacist disapproves of gluttony? Does he get to refuse to fill prescriptions for insulin or blood pressure medication or weight loss? Or is it just people with tits who have to be tolerant and allow their health care to be held hostage to other people's moral hangups?
I'm not saying "be an X on my terms." I'm saying, "be an X on the terms of the profession itself." If you can't in good conscience provide a prescription that almost all women use at some point in their lives, then I think it's ludicrous to become a pharmacist, and I don't think it's intolerant to say that, if you can't do the job, then don't. I think it's unethical to kill people. Therefore, I have not joined the military. Same damn difference.
So I think we all agree there's a point at which tolerance runs out. And there surely is a point where someone's beliefs make it wrong of them to go into a certain profession. I have no intention of pushing it to the extreme Mitch suggests with his trauma surgeon example. But there's a big grey area. And a pharmacist who refuses to fill one category of prescription, thereby inconveniencing someone the first time they walk into the store, does not seem like an extreme case.
On the larger point, I am afraid the answer is that just because something is legal, doesn't mean someone is obligated to provide the service. That you have a right to buy X doesn't mean anyone has an obligation to sell it to you. I have thought about this bitchphd, and I think it's basically what liberty means: your choices are held hostage to other people's hangups, which some call "beliefs."
I can imagine cases where this principle becomes a problem, and where the costs of tolerance run so high we buck the principle. This isn't one of them. Find another pharmacist.
I am afraid the answer is that just because something is legal, doesn't mean someone is obligated to provide the service. That you have a right to buy X doesn't mean anyone has an obligation to sell it to you.
This strikes me as a very odd statement. Odd, because I'm generally assuming the pharmacist is in the employment of some company, and therefore is not selling anyone a drug. He's providing the drug. You pay at the counter, and the money goes to the company - not the pharmacist. The pharmacist is an employee, and it's the definition of his job that is at issue. I think it's the average person's assumption that the job of a pharmacist is to fill prescriptions, not to impose his moral beliefs on others. If he does not perform his job, he should not hold it.
However, if you do contend that it is allowed in a pharmacists job that he is allowed to make moral judgements, what then? Suppose a pharmacist had some odd religious conviction which he followed so that he didn't believe in drugs at all. So he became a pharamcist strictly to put himself in the position of stopping the flow of drugs to people. Should he be fired? If so, what's the relevant difference? The obvious difference - that of the amount of drugs refused - seems to me to be irrelevant, unless you can come up with some argument, which I am unable to, that it's allowable to use your professional possition to impose your religious beliefs onto people, but only up to a point.
Michael nails it. CVS employs the pharmacist to dispense drugs. When the pharmacist picks and chooses which drugs to dispense, CVS sure as hell ought to be able to fire that pharmacist. The other way lies madness. It wouldn't surprise me one little bit if laws are passed protecting recalcitrant pharmacists, and then we have an army of righteous pharmacists trained just to interfere with the flow of birth control pills. What you're advocating, baa, is a special legal exemption for people opposed to birth control and abortion. Doesn't that seem strange to you?
Of course CVS can fire the pharmacist. And you can complain to CVS to get him/her fired. But if CVS approves the policy, tough. Or if the pharmacist runs his/her own store, tough. The idea is: that you, the consumer have a legal right to buy X does not impose an obligation on anyone to sell it to you. Jeepers, is this so hard?
The same point applies to: Wal-Mart and rap CDs, green food stores and veal, christian bookstore and "our bodies our selves," whatever. I am sorry if birth control is such a radioactive issue that it obscures the basic point above. So far I've seen lots of fiddling around the margin in the response: what about a surgeon who won't give blood transfusions, what about if CVS actually wants the employee to dispense, yada, yada, yada, but only bitchphd has basically said that on the fundamental issue, she does think that someone has an obligation to sell her products. I don't think that, and this belief has *zero* to do with the topic of birth control (something which, by the way, I have no problems with whatsoever). If 50% of the population thinks product X is immoral, expect that product to be expensive and hard to find. And don't try to get around this from forcing business owners to act against their conscience. Them's the breaks, guys.
No, because medical care is not simply a consumer product. Most professionals have explicit or implicit standards of professional conduct.
On the consumer question, which is separate: what you are saying is that business owners have more rights, as business owners, than women do. That we can't deny to business owners the right to make decisions about who they will sell to, but we can deny to women the right to make decisions about their own medical care. I'm absolutely gobsmacked.
One other point on birth control pills: They're not only used for birth control. I have known very devout, non-sexually active Catholic women who took BCPs to regulate irregular and/or painful periods. So a pharmacist who refuses to give out birth control pills is making an assumption about the pills' intended use that is not necessarily valid - and is in fact not really any of his/her damn business.
I am simply repeating the point made by others, but it is important enough to reiterate. A pharmacist isn't just someone selling something to customers. It is someone to whom the state has granted a larger than normal market share (through establishing onerous barriers to entry) in exchange for a committment to serve the public. Fulfilling this committment involves both meeting certain standards of competence *and* being prepared to meet all the obligations of the job.
You can't make an anaology between birth control pills and rap CD's, baa. Talking about moral majority rule, we recognize a right to health care in the country, not a right to party. Witholding these pills violates a recognized right.
bitchphd said something interesting above, when she suggested that the rights of businesses were being privileged *over* the rights of women. I don't think that's what's happening at all; rather it's that negative rights (not being forced by the govenrment to sell something) often preclude a strong sense of positive rights (someone must provide to me the thing I want). That's no surprise. It also shouldn't be a big surprise that the anglo-american concpetion of rights is largely negative. It seems -- although I'm not feeling the love for the negative rights of people with unpopular beliefs in this thread -- that most of you agree that, in general, we don't have a right to demand that certain people sell products they don't want to. Walmart doesn't need to sell rap CDs, whole foods doesn't need to sell eggs from caged chickens, etc. And usually, this position doesn't rely on metaphysical claims about what the inherent function of record or grocery stores. But this case, it seems, stirkes people differently. Why? I am hearing several arguments:
1.Rx drugs are regulated, pharmacists are regulated, therefore they must fill every scrip
I confess myself puzzled. If oral contraceptives became over the counter drugs, would it then be OK for CVS not to stock them? Would it be ok, on this view, for CVS not to stock condoms now? I don't really get why Rx status/government licensing makes such a key difference. Especially since govenrment involvement consists in imposing, and then selectively retracting, barries to entry. Rather this seems like a land grab to me, an opportunity to use government involvement, whatever it might be, to justify a preferred result.
2. Pharmacists as professionals must abide by their professional code of conduct.
This seems question begging. Why must a pharmacists' code of conduct stipulate that they fill every legal prescription?
3. Health care is different.
Why? Or rather, in what does the difference consists? Is it that it's very important to people? Is that a trump, so that any inconvenience, no matter how minor, cannot be born? Odd. [[And pace Michael, I don't think there's broad consensus that a positive right to health care exists. Certainly, no such right has the same status as the rights guaranteed in the bill of rights, or in most state consitutions (which are almost exclusively negative rights, I should add).]]
4. What if we're on a desert island with only one pharmacy?
I'm willing to believe that monopoly, high entry barrier situations great good arguments for regulation and coercion. As I've said above, there are shades of grey in this. If Fort Worth becomes surrounded by water and all 500 other pharmacies in the area close, there'd be a decent case here.
But what is the actual case we are talking about? I think it's one where allowing the pharmacist to practice according to her conscience imposes a minor inconvenience on customers seeking birth control. Why is this so intolerable?
Why? Or rather, in what does the difference consists?
Apparently you also think health care is different, at least once we get to the level of trauma surgeons. Why? And to be clear, I said there's a reason why pharmacists are regulated, not that the regulation itself is the reason that pharmacists should fill every prescription.
We don't let just anyone dispense prescription drugs because of the negative consequences that would ensue otherwise. And I think allowing pharmacists to decide which prescriptions they will fill would also lead to many negative consequences.
Are you arguing that birth control is a special case and so pharmacists should be able to decide whether or not to fill birth control prescriptions, or would you extend that further to any medicine that the pharmacist has moral objections to? Why?
Are moral objections a special case, or can the pharmacist refuse to fill prescriptions for other reasons? If only moral objections suffice, how to judge which objections are moral ones?
Most slippery slopes aren't as slippery or as steep as they seem, but I'm having a hard time in this case of thinking of a practical way to limit pharmacist discretion other than the nice bright line of: fill every prescription.
The sugeon example doesn't fail because of health care magic, it fails because you couldn't do *anything* surgeons do without blood products. If there are a whole class of blood-free trauma surgeries, maybe this doesn't apply.
I think the reason (if one can even talk of a reason) for regulating pharmacists has nothing to do with requiring that they fill every scrip. It's because we don't want them selling opioids on the street.
As for moral pharmacist objections, i'm inclined to take them at their word. It's not like there's any shortage of pharmcies in Fort Worth. If someone doesn't want to fill premarin because of horse exploitation, that's coll with me. Again, the point of tolerance is that I don't spend time assessing the internal consistancy of other people's moral beliefs before I decide whether I'm going to force them to act against their conscience. If they have other (non-moral) reasons not to fill a scrip, again, god bless.
I am still not seeing how it is coercion to say that a pharmacist should fill a prescription. No one is born a pharmacist. It is a profession. One chooses to practice it. If dispensing drugs is something one cannot, in good conscience, do, then it makes absolutely no sense to become a pharmacist. Oh sure, you have the "right" to become a pharmacist--but if for whatever reason you cannot fill the duties of the damn job, then, well, you can't fill the duties of the damn job.
Your entire argument seems predicated on the idea that people have the inalienable right to choose a profession that they themselves don't feel they can practice.
Mitch, I do think there are going to be cases where we will want to regulate. For example, we don't want firemen, or emts, or other people with time-sensitive jobs making ad hoc decisions about when they will choose to intervene. I don't think the pharmacist is one such case, nor do I think it represents an ad hoc decision making process. Again, I think there are shades of grey here, but my default would be to let people define and perform their jobs as they choose.
And bitchphd, it's this self-definition that's at issue. Today, a person could rent space in a store front and start stocking it with over the counter health products and gum. This is just freedom of action, right? It seems in your view that if anyone does this, but fails to stock condoms, the government should force him/her to do so. By contrast, I believe it's ok for a strict catholic to own a store that sells aspirin and shaving cream; I don't see any reason to reject this plan frivolously. There are going to be cases where it's a good idea to mandate certain services (e.g., the fire department can't make spur-of-the-moment decisions, etc.) but, in general, we should let people do what they want.
Some people are morally opposed to vaccination. If I took my child to the doctor's office to get a vaccination and the health care provider refused to provide said vaccination on grounds of personal belief or conscience, I would be nothing short of outraged. I would not accept the notion that there's some sort of free market in medicine, so that I should just look elsewhere for a health care provider who would give my son the vaccination. Instead, I would consider the vaccine refusal an unwarranted obstruction to the goal of ensuring my son's health. I would want the vaccine-refuser to face disciplinary action, and to be forced to choose: perform your job as health care provider, or go find another line of work.
As Mitch has pointed out several times above, this isn't a case of free markets: pharmacists (like doctors and other health care providers) have a social contract with the state: they have a monopoly on the provision of care and services in exchange for which they must adhere to some basic principles in the provision and distribution of these services.
Anyway, the druggist in this case is just being a weenie. He works for CVS, a huge pharmacy chain that dispenses, among other things, birth control pills. He wants to selectively impose his opposition to birth control pills on individual consumers, while continuing to work for a company that dispenses birth control pills to thousands and thousands of consumers. If his conscience won't allow him to fill such a prescription, why does it allow him to continue to work for a company that fills these prescriptions?
Once more, with feeling. About the pharamcist. CVS can fire her at will, or it could, in my view, have a no birth control policy, and support her. That's their call.
On the second point, just to be clear, if oral contraceptives weren't prescription, then pharmacies could not stock them? Peculiar. The government licenses lots of professions, and I'm not very sympathetic to arguments that use that fact to sanction coercion for some unrelated purpose.
I am a bit interested. Your doctor doesn't want to give a vaccine. Surely you then choose another doctor. Why must s/he be *punished* in addition to this? I agree the doctor should disclose it upfront, maybe you even should be recompensed for the time spent in the visit if s/he didn't disclose. But should the government force the doctor to give a vaccine? Should it force doctors to give other products (like human growth hormone to short, but healthy kids)? I personally find moral objections in the first case hard to understand, in the second easy to understand. But I would prefer the govenrment not make my understanding law.
They're moving to make it impossible to fire people for refusing to fill a prescription. You need to be able to fire such pharmacists and they need to face serious disciplinary action if they won't give it to another pharmacist on duty (if there is one) or give it back *immediately* (along with all other prescriptions being filled at the same time).
Thank you, wolfangel. baa, the proposed statutes are significantly loonier than even your wildly unpopular position. While this is a fine discussion, let's keep in mind that no one here is defending the laws that are at issue.
And let's try this another way with an analogy I hope will take some of the heat out of the issue--I really don't know which way this cuts, but it might be a good way to look at the problem. Suppose a pharmacist develops a severe allergy to certain drugs. He can dispense most drugs, but, for a few, he has to refer you to another pharmacist. Do we insist that he be fired, or do we think passing on the prescription is a reasonable accomodation for all involved? Alternatively, suppose someone with a severe allergy to some drugs wants to become a pharmacist. Ok? Or presumptively disqualifying?
Wolfangel's comment puts the point very differently: should people be protected from the consequences of their beliefs? I tend to think not. But again, I have the feeling that most everyone in this thread really doesn't think anyone who doesn't dispense OCs should be allowed to be a pharmacist, bringing the govenrment in on the other side entirely.
On your question, ogged, I say: let the man march! Hear ye! Hear ye! That is, let the allergic person become a pharmacist. think the ADA might even require this. Interesting if we, as a society, think we have less interest in making reasonable accomodationsfor religious beliefs than for disabilities.
baa, your position seems to be that an individual's right to act in accordance with his/her own morals trumps the right of the customer to expect her drugs for her health, as long as this does not wholly block the customer's options for receiving the drugs. I would assume that in the case where the pharmacist confiscated the woman's prescription, that he had overstepped the line. What if there happen to be 2 pharmacists behind the counter, and one blocks the other from filling the prescription? What if the customer has been coming to a particular pharmacy for years, and now suddenly there's a new pharmacist refusing to fill her prescription? What if the nearest other pharmacy is 20 minutes away? What if it's in a dangerous neighborhood? Suppose there's a conservative movement in a town with 10 pharmacies, how many of these pharmacies would have to refuse birth control pills before it would become a matter for the government? What if I ask too many what if's?
As to the difference between OTC and prescription. OTC drugs usually aren't needed in the same degree as prescription drugs. Not having an aspirin when you need it is annoying, not having a birth control pill is much more serious. Further, OTC drugs are operating on a market system - a customer needs one, the provider provides them. Prescription drugs are not. They are held in reserve, and let out only when a doctor orders them to be let out. I suspect that part of the reason we tolerate these drugs to be locked away in the first place is that we expect to be able to get access to them when we really need to. The disruption of that expectation by the pharmacist's unorthodox veto really seems like an abuse of the public trust in this regard, hence the outrage.
No, I am not saying that a corner store has to sell condoms: you misunderstanding (misrepresenting?) my position. A licensed health care provider has a duty to provide health care. Not moral counselling, not judgment, health care. To take your vaccine example: if a doctor refuses to provide a vaccine because he thinks it medically unadvisable, that is a very different matter than if he thinks it is immoral to meddle with the natural order of things, or whatever. To offer another example: a teacher of science has a professional obligation to teach science. If this teacher is a fundamentalist who refuses to teach about evolution, then they are not teaching science, they are teaching faith, and they should be fired.
And shifting the burden over to the drug store in order to turn it into a free market argument is disingenuous. Not anyone, I think, can just decide to sell narcotics, say. I believe pharmacies, like pharmacists, need to be licensed. The license implies, I am arguing, a duty to perform the responsibilities the license confers, which is to say providing drugs to people who need them.
Tolerance has nothing to do with this. I am perfectly happy to have people think women should not have birth control, and to argue with them about that on moral grounds. But I totally reject the idea that it's "intolerant" to expect people to perform the functions of their damn jobs.
I would agree that confiscating the scrip crosses the line. And I think, Michael, that you are asking the right what ifs. My answer, is, in general: "it depends."
Let us imagine that everyone in the Boston area converts to a strict catholicism, except for local boy Ben Affleck. Condoms vanish fom the shelves overnight. What is the right response? Should the government force the local walgreens, greatly against the wishes of the owner, and most customers, to stock condoms? Or should Affleck lump it and import condoms from New Hampshire? Seems like a tough question. But I would really start worrying about government regulation only when major problems emerge. I do think the right of people to choose how to behave (which profession to choose, how to perform that job, what products/services to sell) trumps my right to get a particular service I want from them. And that this is true almost all the time. The big exception -- which no one has raised here -- is racial discrimination. And I think there are great, compelling state interests in regulating commercial behavior in this regard.
As for OTC vs. Rx. I do not believe, frankly that urgency of need is what is at issue here. Otherwise I would imagine condoms and OCs would elicit the same response from people. Rx drugs filled at a pharmacy aren't exaclty used for emergency care (I need my viagra, stat!). The (stated) reason why we lock away Rx drugs is because we are afraid of unsafe use, the real reason is half that, half historical accident, with the desire to retain a monopoly underneath it all.
Sorry bitchphd, I posted before seeing your comment.
I am making the condom/OC distinction in order to highlight the importance some think Rx status makes. Basically, your average drug store pharmacy will stock both OCs (Rx), as well as male and female condoms (OTC).
I think a drug store/pharmacy should not be required by the government to stock either. You think (I believe) that they should be required by the government to stock OCs, but not condoms, and your reason for this is that in exchange for a license from the government, pharmacists must agree to fill every legal scrip. Whereas no equivalent licensing exists for OTC health products, it's OK for a store owner to exercise his moral judgment on stocking condoms. I don't get this at all; it seems to me to turn goverment licensing of pharmacists into a kind of sacrament. And in general my belief is: let's not use the fact that government is involved in a market in some way to justify coercing people to do things they don't want to do.
If by contrast, you think that the drug store should be forced to stock both OCs and condoms, it's clear that government licensing of pharmacists doesn't play a crucial role in your argument. Then, I would guess your basic view is that some services are so important that the government should mandate someone supplies them, even if it means coercing stores to sell products they otherwise wouldn't want to.
In either case, I guess I'd say this. The inconvenience we are talking about here is miniscule. And so I would be willing to make reasonable accomodation to allow people who hold beliefs I do not hold and consider misguided to be pharmacists or to own drugstores, and to perform those functions in concord with their moral beliefs. And yes, I do think that refusing, categorically, to make any such accomodation is intolerant.
It's partly b/c I place great weight on the idea of professional ethics and responsibility.
Also, though I haven't gotten into it, I'm not thrilled with the "the inconvenience is miniscule" argument. It's always a "minor" inconvenience when it applies to women, and right up front I offered several examples where the inconvenience is far from minor. I get kind of tired of having to undergo minor inconveniences like paying more for drycleaning or haircuts or having to be the one to provide the damn b.c. all the time or (theoretically) having to travel to obtain abortions, or be "counselled" about my own body (when I took Accutane years ago, I had to sign a jillion forms saying I knew about the birth defect problem, and even so the goddamn doctor patronized me every fucking time I came in for my monthly followup, and when I objected he offered me the bullshit rationalization that "well, not all women are as smart as you."
So I also kind of have a hangup about being told what is and isn't minor by people who don't actually have to suffer the inconvenience their own damn selves.
And I really am sorry for my tone here. I'm feeling shitty. Underneath the bitchiness, I'm just interested in the discussion.
Oh, and sorry, re. condoms, two things: one, w/r/t otc stuff, I really do think the free market will fill the need. Two, let's be honest: even a pharmacy that doesn't stock bcp or emergency contraception will almost certainly stock condoms. I believe Walmart stocks condoms but doesn't provide emergency contraception. You can't quite make this a purely abstract issue, divorced from the real-world fact that in the end, it isn't birth control per se that people have a problem with--it's women being the ones to exercise the choice.
When it comes to gum and soap and condoms, they're much less regulated than prescription drugs (basically only subject to consumer safety and truth-in-advertising requirements and whatnot), primarily because they're much less dangerous if misused so we really don't care who buys or sells these items.
So if I go into a store and they don't have the brand of gum I want, well, you really can buy gum almost everywhere, because basically anyone can sell it. The market works pretty damn well to make gum available to anyone who wants it.
Prescription drugs and their dispensation are regulated much more heavily, in part to prevent opiates in the streets, yes, but also (and I believe primarily) to protect consumers. Prescription drugs can cause great harm if they are misused, if they're mistakenly dispensed, if they're fake, etc. The licensing of pharmacists and prescription drugs (plus the law of torts) helps consumers be about as sure as they can be that they're not getting the wrong medicine or useless medicine or harmful medicine.
One effect of this greater regulation is that prescription drugs, and the pharmacies and pharmacists who sell them, are scarcer than would be the case if they weren't so regulated. You can't buy them just anywhere, only with a prescription at licensed pharmacies from a licensed pharmacist. Because of this market forces don't work quite as well to ensure an optimal supply.
In many areas, say Fort Worth for example, there are a lot of pharmacies around, so the inconvenience might be minimal, but that won't always be the case. Instead of trying to come up with some case by case analysis of how much inconvenience is too much, I think it's proper that the government requires that licensed pharmacists fill every prescription.
The "hand it off" rule seems a reasonable accomodation to moral concerns, but I think allowing pharmacists any more discretion as to which prescriptions they fill would be a mistake.
Beyond that I do think, and I think most people think, that health care is different from common commodities, and there's a legitimate government and societal interest in maximizing access and supply.
extensive comments would be overkill from me at this point. but i have to say a few things:
1/ i took OCs for medical reasons--an out of control 4 month long period-- and for every day i was delayed in getting them, i would have been bleeding, losing more and more iron.
This is a problem because in some localities, if pharmacists did not provide OCs, patients would suffer. (Others such as bitchphd have laid out how womens' rights would be violated in all kinds of ways besides this, but I add my example since it shows the pharmacist interfering with my health in a way that violates my rights to medical treatment as per my doctor's prescription.)
2/ The only way in which I could see baa's scenario--pharmacists refusing to sell certain Rxs--as even approaching "okay" in my mind is if they (a) publicly advertised the limits of their pharmacy (eg on the sign: "Pro-Life Prescriptions Only"), and (b) immediately returned all scripts they could not fill (and item (b) should be the _enforced_ law.
Pharmacies are often out of certain meds, so a pharmacy makes no guarantee of being able to sell you an RX when you walk in the door. But if there are to be two classes of pharmacies in America--those who do and do not do OCs--then practicality demands they advertise it. And then let the competition spring forth to grind them into the ground. Of course, what would have to happen if women could not get OCs quickly or locally, is that docs would have to find a way to provide a trial sample in their offices...
There's a precedent to this refusal--lots of doctors don't do abortions. I think this opens it up for pharmacists not to sell certain drugs. But not to their stealing my RX out of my hand.
Oh, I do not like the way this country is going...
On the pragmatic side of the argument, I'm now going to contend that all of those "what ifs" I mentioned make it just too damn complicated to allow for moral discretion on the part of the pharmacist. Protecting rights is important, but I believe the potential inconvenience to consumers, and to the law in trying to measure the inconvenience to consumers, should indicate that, pragmatically, the pharmacist should just not be allowed to veto doctor's prescriptions on moral criteria.
I also want to distinguish between a pharmacist refusing b/c, and a pharmacy not carrying them. These are two different arguments, I believe, and, I'm limiting myself to a pharmacist refusing in-stock b/c.
Third, I don't buy your objection that the distinction in need between OTC and Rx isn't significant. You argue that since Rx aren't typically "emergency" medication, they are not more important than OTC, which I would think are actually more likely to be for emergency use. I don't think emergency has any relevance here. Take heart pills for instance, or insulin. These are not typically used in case of emergency, but they prevent emergencies, and are surely much more important to the user than emergency bandaids and salve. More at point to the issue, b/c pills are more important to females than condoms are to males because of health issues, yet this importance is not going to bear out if you only look at "urgency."
I think bitchphd's argument is that "many affairs which are conducted in the interest of the community require a certain mechanism through which some members of the community must passively conduct themselves with an artificial unanimity, so that the government may direct them to public ends, or at least prevent them from destroying those ends. Here argument is certainly not allowed - one must obey. But so far as a part of the mechanism regards himself at the same time as a member of the whole community or of a society of world citizens, and thus in the role of a scholar who addresses the public (in the proper sense of the word) through his writings, he certainly can argue without hurting the affairs for which he is in part responsible as a passive member. Thus it would be ruinous for an officer in service to debate about the suitability or utility of a command given to him by his superior; he must obey. But the right to make remarks on errors in the military service and to lay them before the public for judgment cannot equitably be refused him as a scholar."
[I wouldn't be posting this except that part of the Public Reason comments thread reminded me of What is Enlightenment. I've no intention of starting this debate up again.]
[Sorry, abc123, but much as I enjoy your trolling, patently racist crap will be deleted.]
Posted by ogged | Link to this comment | 11- 9-04 4:35 PM
Do you think abc123's handle has anything to do with the Jackson 5?
Also, other than not handing the scrip back, I think the pharmacist here is otherwise within the bounds of acceptable behavior. Let's say I go to my local indie bookstore and ask for the Protocols of the Elders of Zion. I don't think they need to order it for me, or refer me a bookseller who does. Right?
Posted by baa | Link to this comment | 11- 9-04 4:41 PM
Out of my desire for comity, I'll skip the "baa compares birth control to the protocols of zion" response.
In the current culture, it's surely not acceptable. It's not ok for someone to go to a pharmacy only to realize after she's arrived that, for moral reasons, her prescription won't be filled. This is particularly true where the morning-after pill is concerned, because, as I'm sure you know, it's probable effectiveness decreases substantially with time.
I would listen to arguments that, as long as pharmacies make it clear in advance that they will not honor certain prescriptions, they are allowed to refuse, but my own prejudice is that pharmacists ought to fill prescriptions or get out of the prescription filling business.
And I wonder how much our compromises assume easy urban access to several pharmacies, and how devastating they could be in communities in which just one pharmacy serves all the people.
Posted by ogged | Link to this comment | 11- 9-04 4:53 PM
According to some clowns on metafilter, it's within the guidelines of pharmacists' professional association to decline to fill a prescription out of moral concerns, so long as the customer is directed to where he or she can get it filled.
Hell, that may even be in the linked article, which I didn't bother to read here or when it was on metafilter.
Posted by ben wolfson | Link to this comment | 11- 9-04 5:02 PM
From the article:
Posted by ogged | Link to this comment | 11- 9-04 5:06 PM
Hey! I'm a moron!
Posted by ben wolfson | Link to this comment | 11- 9-04 5:10 PM
Michael already knew that.
Glad to see the working world is having the intended effect on your self-confidence. Go to grad school, it's great for making you feel good about yourself.
Posted by ogged | Link to this comment | 11- 9-04 5:12 PM
I take great pleasure in being made small.
Posted by ben wolfson | Link to this comment | 11- 9-04 5:16 PM
Wow, then you'll be happy no matter what you pursue!
Though, frankly, I'm a bit disturbed by your mood lately. You should really call Unf for a drink or two.
Posted by ogged | Link to this comment | 11- 9-04 5:18 PM
Stoller over at BOPNews has americantaliban.org?com? registered. That seems like a good clearinghouse if one doesn't already exist.
Posted by paperwight | Link to this comment | 11- 9-04 5:24 PM
Racist?
This is a parody site.
Racist?
The ONLY way you could think that is if you are EUnichstanian.
Racist?
Either this is a parody site or you are the watermelon home world.
I have spent way too much time here.
My racist post/link:
http://www.yahoodi.com/peace/
Posted by abc123 | Link to this comment | 11- 9-04 5:30 PM
The character in your little tale said,
"I am not like you; we don't care about dying or making friends. We lie and sting. It is our nature, didn't you know that?"
Yup. Still racist.
Posted by ogged | Link to this comment | 11- 9-04 5:33 PM
http://www.rense.com/
http://www.rense.com/1.imagesG/onlyhadabrain.JPG
google moveon for pan-stupidity.
Racist? Hate? Me?
Not in any possible way.
Posted by abc123 | Link to this comment | 11- 9-04 5:34 PM
Not like you.
This is like the fogged, ogged, angry green mobbed.
http://www.rense.com/
At least I'm not like you.
Rense ???
Posted by abc123 | Link to this comment | 11- 9-04 5:37 PM
Leiter frequently posts about stuff like this, although primarily having to do with education issues, like moves to take evolution out of public school science textbooks.
Posted by Mitch Mills | Link to this comment | 11- 9-04 6:36 PM
Baa, Ogged: No, it isn't okay. If a person has a moral problem with providing basic medical services, then they can choose another profession. Saying that someone who is working as a pharmacist can refuse to dispense needed drugs because they disapprove is heinous.
Let's say you get an organ transplant. Let's say that I am a pharmacist, and I think organ trasnplants are disgustingly expensive, violate God's will (which is obviously for you to die), and waste medical resources (money) that can be spent on more cost-effective measures, like vaccination, say. Does that make it okay for me to refuse to dispense immunosuppressant drugs? Hell no. Do Christian Scientists become pharmacists? Hell no.
I teach for a living. Let's say I have "moral qualms" about helping the children of Republicans get college degrees (I don't, but let's say I did). Would it be okay for me to refuse to let them take my class? Okay to flunk them? Obviously not. I would be fired, and rightly so. Same goddamn diff.
Oh, and on your question about sites that catalog links of that nature--well I logged a few not too long ago. Including, I think, that story. Also see The Well-Timed Period
Posted by bitchphd | Link to this comment | 11- 9-04 7:08 PM
While I appreciate the comity-boosting, let me note that it was an analogy not an equivalence! Basically, I think this is a great example of respecting strongly held minority views. If someone thinks X is morally suspect, I don't want to go out of my way to force them to do it. And if this means that a person spends an extra 15 minutes finding a new pharmacy, it's a small price to pay for, I believe the word is, tolerance.
And yes, one can make internal critiques, and say that X really is morally suspect, while Y isn't. I certainly don't think birth control is on par with hate literature, at all. I was just picking something basically (I hope) uncontroversial.
But that's not the point. Tolerance isn't about subjecting our fellow citizens views to the Tribunal of Reason before we decide if we'll let them slide. It's about understanding that views we ourselves find batty must be given some space. Maybe you think a person who won't dispense birth control (or animal rights violating products, or whatever) shouldn't be a pharmacist. I'd rather let that person operate by their conscience, and lose business accordingly. This is always a balancing act, and I'm not trying to establish a bright line principle. But I do think this is a case where the tolerant path is pretty clear.
Ben W, don't listen to them! Join the dark side!
Posted by baa | Link to this comment | 11- 9-04 7:17 PM
Come ON. In some small towns, there is one pharmacy. Or one all-night pharmacy, or one that's open on weekends. If you need emergency contraception, you need to use THAT pharmacy.
No one is forcing anyone to hand out birth control. I am saying, if someone has a problem dispensing drugs to women, they shouldn't become a drug dispenser. If providing a service violates your ethical code, don't take a job that requires you to do it. Duh.
Posted by bitchphd | Link to this comment | 11- 9-04 7:26 PM
Ok, so there would be cases, the small town, e.g., where accomodating a catholic pharmacist would inflict substantial costs. I wonder how frequent those situaions are, or if the case mentioned was one like that.
But again, it seems like your point (second paragraph) is, be an X on my terms, or don't be one. That doesn't sound like tolerance to me.
Posted by baa | Link to this comment | 11- 9-04 7:48 PM
baa, do you see it as contradictory to express tolerance of persons qua persons and not express tolerance of persons qua professionality? (sorry for making up words) I believe you can tolerate a person's beliefs but deny them the right to alter their professional responsibility because of their beliefs. He can keep his beliefs, but if he cannot refrain from exercising them, he shouldn't be allowed to be a pharmasist. Bitch has provided some examples wherein it seems clearer that this is the case, and others are not hard to think of.
Posted by Michael | Link to this comment | 11- 9-04 8:30 PM
Baa,
There's a reason that we license and regulate pharmacists and allow licensed pharmacists to have a monopoly on dispensing prescription drugs. And a reason we allow basically anyone who wants to do so sell books (or non-prescription drugs for that matter).
Are you really arguing that tolerance means allowing a practicing Jehovah's witness to be licensed as a trauma surgeon, and we'll just let the market sort it out?
Posted by Mitch Mills | Link to this comment | 11- 9-04 8:32 PM
So his right to choose a profession he can't practice in good conscience trumps my right to get the drugs I need?
Think about what you're saying here. The implication is that my rights as a woman to fill a legal prescription, written for me by a licensed physician, are limited by the rights of any man to choose a profession he is ill-suited for. Do I also need to ask permission of a cabdriver who drives me to the pharmacy to fill the prescription? What if the pharmacist disapproves of gluttony? Does he get to refuse to fill prescriptions for insulin or blood pressure medication or weight loss? Or is it just people with tits who have to be tolerant and allow their health care to be held hostage to other people's moral hangups?
Posted by bitchphd | Link to this comment | 11- 9-04 9:08 PM
Sorry, i'm irked:
I'm not saying "be an X on my terms." I'm saying, "be an X on the terms of the profession itself." If you can't in good conscience provide a prescription that almost all women use at some point in their lives, then I think it's ludicrous to become a pharmacist, and I don't think it's intolerant to say that, if you can't do the job, then don't. I think it's unethical to kill people. Therefore, I have not joined the military. Same damn difference.
Posted by bitchphd | Link to this comment | 11- 9-04 9:14 PM
Well, no intention of irking. My apologies.
So I think we all agree there's a point at which tolerance runs out. And there surely is a point where someone's beliefs make it wrong of them to go into a certain profession. I have no intention of pushing it to the extreme Mitch suggests with his trauma surgeon example. But there's a big grey area. And a pharmacist who refuses to fill one category of prescription, thereby inconveniencing someone the first time they walk into the store, does not seem like an extreme case.
On the larger point, I am afraid the answer is that just because something is legal, doesn't mean someone is obligated to provide the service. That you have a right to buy X doesn't mean anyone has an obligation to sell it to you. I have thought about this bitchphd, and I think it's basically what liberty means: your choices are held hostage to other people's hangups, which some call "beliefs."
I can imagine cases where this principle becomes a problem, and where the costs of tolerance run so high we buck the principle. This isn't one of them. Find another pharmacist.
Posted by baa | Link to this comment | 11- 9-04 9:56 PM
I am afraid the answer is that just because something is legal, doesn't mean someone is obligated to provide the service. That you have a right to buy X doesn't mean anyone has an obligation to sell it to you.
This strikes me as a very odd statement. Odd, because I'm generally assuming the pharmacist is in the employment of some company, and therefore is not selling anyone a drug. He's providing the drug. You pay at the counter, and the money goes to the company - not the pharmacist. The pharmacist is an employee, and it's the definition of his job that is at issue. I think it's the average person's assumption that the job of a pharmacist is to fill prescriptions, not to impose his moral beliefs on others. If he does not perform his job, he should not hold it.
However, if you do contend that it is allowed in a pharmacists job that he is allowed to make moral judgements, what then? Suppose a pharmacist had some odd religious conviction which he followed so that he didn't believe in drugs at all. So he became a pharamcist strictly to put himself in the position of stopping the flow of drugs to people. Should he be fired? If so, what's the relevant difference? The obvious difference - that of the amount of drugs refused - seems to me to be irrelevant, unless you can come up with some argument, which I am unable to, that it's allowable to use your professional possition to impose your religious beliefs onto people, but only up to a point.
Posted by Michael | Link to this comment | 11- 9-04 10:20 PM
Michael nails it. CVS employs the pharmacist to dispense drugs. When the pharmacist picks and chooses which drugs to dispense, CVS sure as hell ought to be able to fire that pharmacist. The other way lies madness. It wouldn't surprise me one little bit if laws are passed protecting recalcitrant pharmacists, and then we have an army of righteous pharmacists trained just to interfere with the flow of birth control pills. What you're advocating, baa, is a special legal exemption for people opposed to birth control and abortion. Doesn't that seem strange to you?
Posted by ogged | Link to this comment | 11- 9-04 10:28 PM
Of course CVS can fire the pharmacist. And you can complain to CVS to get him/her fired. But if CVS approves the policy, tough. Or if the pharmacist runs his/her own store, tough. The idea is: that you, the consumer have a legal right to buy X does not impose an obligation on anyone to sell it to you. Jeepers, is this so hard?
The same point applies to: Wal-Mart and rap CDs, green food stores and veal, christian bookstore and "our bodies our selves," whatever. I am sorry if birth control is such a radioactive issue that it obscures the basic point above. So far I've seen lots of fiddling around the margin in the response: what about a surgeon who won't give blood transfusions, what about if CVS actually wants the employee to dispense, yada, yada, yada, but only bitchphd has basically said that on the fundamental issue, she does think that someone has an obligation to sell her products. I don't think that, and this belief has *zero* to do with the topic of birth control (something which, by the way, I have no problems with whatsoever). If 50% of the population thinks product X is immoral, expect that product to be expensive and hard to find. And don't try to get around this from forcing business owners to act against their conscience. Them's the breaks, guys.
Posted by Anonymous | Link to this comment | 11-10-04 6:28 AM
No, because medical care is not simply a consumer product. Most professionals have explicit or implicit standards of professional conduct.
On the consumer question, which is separate: what you are saying is that business owners have more rights, as business owners, than women do. That we can't deny to business owners the right to make decisions about who they will sell to, but we can deny to women the right to make decisions about their own medical care. I'm absolutely gobsmacked.
Posted by bitchphd | Link to this comment | 11-10-04 7:49 AM
One other point on birth control pills: They're not only used for birth control. I have known very devout, non-sexually active Catholic women who took BCPs to regulate irregular and/or painful periods. So a pharmacist who refuses to give out birth control pills is making an assumption about the pills' intended use that is not necessarily valid - and is in fact not really any of his/her damn business.
Posted by esme | Link to this comment | 11-10-04 9:17 AM
I am simply repeating the point made by others, but it is important enough to reiterate. A pharmacist isn't just someone selling something to customers. It is someone to whom the state has granted a larger than normal market share (through establishing onerous barriers to entry) in exchange for a committment to serve the public. Fulfilling this committment involves both meeting certain standards of competence *and* being prepared to meet all the obligations of the job.
Posted by pjs | Link to this comment | 11-10-04 9:40 AM
You can't make an anaology between birth control pills and rap CD's, baa. Talking about moral majority rule, we recognize a right to health care in the country, not a right to party. Witholding these pills violates a recognized right.
Posted by Michael | Link to this comment | 11-10-04 10:54 AM
bitchphd said something interesting above, when she suggested that the rights of businesses were being privileged *over* the rights of women. I don't think that's what's happening at all; rather it's that negative rights (not being forced by the govenrment to sell something) often preclude a strong sense of positive rights (someone must provide to me the thing I want). That's no surprise. It also shouldn't be a big surprise that the anglo-american concpetion of rights is largely negative. It seems -- although I'm not feeling the love for the negative rights of people with unpopular beliefs in this thread -- that most of you agree that, in general, we don't have a right to demand that certain people sell products they don't want to. Walmart doesn't need to sell rap CDs, whole foods doesn't need to sell eggs from caged chickens, etc. And usually, this position doesn't rely on metaphysical claims about what the inherent function of record or grocery stores. But this case, it seems, stirkes people differently. Why? I am hearing several arguments:
1.Rx drugs are regulated, pharmacists are regulated, therefore they must fill every scrip
I confess myself puzzled. If oral contraceptives became over the counter drugs, would it then be OK for CVS not to stock them? Would it be ok, on this view, for CVS not to stock condoms now? I don't really get why Rx status/government licensing makes such a key difference. Especially since govenrment involvement consists in imposing, and then selectively retracting, barries to entry. Rather this seems like a land grab to me, an opportunity to use government involvement, whatever it might be, to justify a preferred result.
2. Pharmacists as professionals must abide by their professional code of conduct.
This seems question begging. Why must a pharmacists' code of conduct stipulate that they fill every legal prescription?
3. Health care is different.
Why? Or rather, in what does the difference consists? Is it that it's very important to people? Is that a trump, so that any inconvenience, no matter how minor, cannot be born? Odd. [[And pace Michael, I don't think there's broad consensus that a positive right to health care exists. Certainly, no such right has the same status as the rights guaranteed in the bill of rights, or in most state consitutions (which are almost exclusively negative rights, I should add).]]
4. What if we're on a desert island with only one pharmacy?
I'm willing to believe that monopoly, high entry barrier situations great good arguments for regulation and coercion. As I've said above, there are shades of grey in this. If Fort Worth becomes surrounded by water and all 500 other pharmacies in the area close, there'd be a decent case here.
But what is the actual case we are talking about? I think it's one where allowing the pharmacist to practice according to her conscience imposes a minor inconvenience on customers seeking birth control. Why is this so intolerable?
Posted by baa | Link to this comment | 11-10-04 1:40 PM
3. Health care is different.
Why? Or rather, in what does the difference consists?
Apparently you also think health care is different, at least once we get to the level of trauma surgeons. Why? And to be clear, I said there's a reason why pharmacists are regulated, not that the regulation itself is the reason that pharmacists should fill every prescription.
We don't let just anyone dispense prescription drugs because of the negative consequences that would ensue otherwise. And I think allowing pharmacists to decide which prescriptions they will fill would also lead to many negative consequences.
Are you arguing that birth control is a special case and so pharmacists should be able to decide whether or not to fill birth control prescriptions, or would you extend that further to any medicine that the pharmacist has moral objections to? Why?
Are moral objections a special case, or can the pharmacist refuse to fill prescriptions for other reasons? If only moral objections suffice, how to judge which objections are moral ones?
Most slippery slopes aren't as slippery or as steep as they seem, but I'm having a hard time in this case of thinking of a practical way to limit pharmacist discretion other than the nice bright line of: fill every prescription.
Posted by Mitch Mills | Link to this comment | 11-10-04 8:50 PM
The sugeon example doesn't fail because of health care magic, it fails because you couldn't do *anything* surgeons do without blood products. If there are a whole class of blood-free trauma surgeries, maybe this doesn't apply.
I think the reason (if one can even talk of a reason) for regulating pharmacists has nothing to do with requiring that they fill every scrip. It's because we don't want them selling opioids on the street.
As for moral pharmacist objections, i'm inclined to take them at their word. It's not like there's any shortage of pharmcies in Fort Worth. If someone doesn't want to fill premarin because of horse exploitation, that's coll with me. Again, the point of tolerance is that I don't spend time assessing the internal consistancy of other people's moral beliefs before I decide whether I'm going to force them to act against their conscience. If they have other (non-moral) reasons not to fill a scrip, again, god bless.
Posted by baa | Link to this comment | 11-10-04 9:15 PM
So there's no health care magic. Huh. So that trauma surgeon can decide not to treat a patient for whatever reason they want to come up with?
Seriously, you don't think there's something different about health care that would require stricter scrutiny?
Posted by Mitch Mills | Link to this comment | 11-10-04 9:24 PM
I am still not seeing how it is coercion to say that a pharmacist should fill a prescription. No one is born a pharmacist. It is a profession. One chooses to practice it. If dispensing drugs is something one cannot, in good conscience, do, then it makes absolutely no sense to become a pharmacist. Oh sure, you have the "right" to become a pharmacist--but if for whatever reason you cannot fill the duties of the damn job, then, well, you can't fill the duties of the damn job.
Your entire argument seems predicated on the idea that people have the inalienable right to choose a profession that they themselves don't feel they can practice.
Posted by bitchphd | Link to this comment | 11-10-04 11:14 PM
Mitch, I do think there are going to be cases where we will want to regulate. For example, we don't want firemen, or emts, or other people with time-sensitive jobs making ad hoc decisions about when they will choose to intervene. I don't think the pharmacist is one such case, nor do I think it represents an ad hoc decision making process. Again, I think there are shades of grey here, but my default would be to let people define and perform their jobs as they choose.
And bitchphd, it's this self-definition that's at issue. Today, a person could rent space in a store front and start stocking it with over the counter health products and gum. This is just freedom of action, right? It seems in your view that if anyone does this, but fails to stock condoms, the government should force him/her to do so. By contrast, I believe it's ok for a strict catholic to own a store that sells aspirin and shaving cream; I don't see any reason to reject this plan frivolously. There are going to be cases where it's a good idea to mandate certain services (e.g., the fire department can't make spur-of-the-moment decisions, etc.) but, in general, we should let people do what they want.
Posted by baa | Link to this comment | 11-11-04 4:19 AM
Some people are morally opposed to vaccination. If I took my child to the doctor's office to get a vaccination and the health care provider refused to provide said vaccination on grounds of personal belief or conscience, I would be nothing short of outraged. I would not accept the notion that there's some sort of free market in medicine, so that I should just look elsewhere for a health care provider who would give my son the vaccination. Instead, I would consider the vaccine refusal an unwarranted obstruction to the goal of ensuring my son's health. I would want the vaccine-refuser to face disciplinary action, and to be forced to choose: perform your job as health care provider, or go find another line of work.
As Mitch has pointed out several times above, this isn't a case of free markets: pharmacists (like doctors and other health care providers) have a social contract with the state: they have a monopoly on the provision of care and services in exchange for which they must adhere to some basic principles in the provision and distribution of these services.
Anyway, the druggist in this case is just being a weenie. He works for CVS, a huge pharmacy chain that dispenses, among other things, birth control pills. He wants to selectively impose his opposition to birth control pills on individual consumers, while continuing to work for a company that dispenses birth control pills to thousands and thousands of consumers. If his conscience won't allow him to fill such a prescription, why does it allow him to continue to work for a company that fills these prescriptions?
Posted by mcm | Link to this comment | 11-11-04 7:12 AM
Once more, with feeling. About the pharamcist. CVS can fire her at will, or it could, in my view, have a no birth control policy, and support her. That's their call.
On the second point, just to be clear, if oral contraceptives weren't prescription, then pharmacies could not stock them? Peculiar. The government licenses lots of professions, and I'm not very sympathetic to arguments that use that fact to sanction coercion for some unrelated purpose.
I am a bit interested. Your doctor doesn't want to give a vaccine. Surely you then choose another doctor. Why must s/he be *punished* in addition to this? I agree the doctor should disclose it upfront, maybe you even should be recompensed for the time spent in the visit if s/he didn't disclose. But should the government force the doctor to give a vaccine? Should it force doctors to give other products (like human growth hormone to short, but healthy kids)? I personally find moral objections in the first case hard to understand, in the second easy to understand. But I would prefer the govenrment not make my understanding law.
Posted by baa | Link to this comment | 11-11-04 10:13 AM
They're moving to make it impossible to fire people for refusing to fill a prescription. You need to be able to fire such pharmacists and they need to face serious disciplinary action if they won't give it to another pharmacist on duty (if there is one) or give it back *immediately* (along with all other prescriptions being filled at the same time).
Posted by wolfangel | Link to this comment | 11-11-04 10:32 AM
Thank you, wolfangel. baa, the proposed statutes are significantly loonier than even your wildly unpopular position. While this is a fine discussion, let's keep in mind that no one here is defending the laws that are at issue.
And let's try this another way with an analogy I hope will take some of the heat out of the issue--I really don't know which way this cuts, but it might be a good way to look at the problem. Suppose a pharmacist develops a severe allergy to certain drugs. He can dispense most drugs, but, for a few, he has to refer you to another pharmacist. Do we insist that he be fired, or do we think passing on the prescription is a reasonable accomodation for all involved? Alternatively, suppose someone with a severe allergy to some drugs wants to become a pharmacist. Ok? Or presumptively disqualifying?
Posted by ogged | Link to this comment | 11-11-04 11:09 AM
Wolfangel's comment puts the point very differently: should people be protected from the consequences of their beliefs? I tend to think not. But again, I have the feeling that most everyone in this thread really doesn't think anyone who doesn't dispense OCs should be allowed to be a pharmacist, bringing the govenrment in on the other side entirely.
On your question, ogged, I say: let the man march! Hear ye! Hear ye! That is, let the allergic person become a pharmacist. think the ADA might even require this. Interesting if we, as a society, think we have less interest in making reasonable accomodationsfor religious beliefs than for disabilities.
Posted by baa | Link to this comment | 11-11-04 11:39 AM
Couldn't the pharmacist wear gloves?
baa, your position seems to be that an individual's right to act in accordance with his/her own morals trumps the right of the customer to expect her drugs for her health, as long as this does not wholly block the customer's options for receiving the drugs. I would assume that in the case where the pharmacist confiscated the woman's prescription, that he had overstepped the line. What if there happen to be 2 pharmacists behind the counter, and one blocks the other from filling the prescription? What if the customer has been coming to a particular pharmacy for years, and now suddenly there's a new pharmacist refusing to fill her prescription? What if the nearest other pharmacy is 20 minutes away? What if it's in a dangerous neighborhood? Suppose there's a conservative movement in a town with 10 pharmacies, how many of these pharmacies would have to refuse birth control pills before it would become a matter for the government? What if I ask too many what if's?
As to the difference between OTC and prescription. OTC drugs usually aren't needed in the same degree as prescription drugs. Not having an aspirin when you need it is annoying, not having a birth control pill is much more serious. Further, OTC drugs are operating on a market system - a customer needs one, the provider provides them. Prescription drugs are not. They are held in reserve, and let out only when a doctor orders them to be let out. I suspect that part of the reason we tolerate these drugs to be locked away in the first place is that we expect to be able to get access to them when we really need to. The disruption of that expectation by the pharmacist's unorthodox veto really seems like an abuse of the public trust in this regard, hence the outrage.
Posted by Michael | Link to this comment | 11-11-04 11:41 AM
No, I am not saying that a corner store has to sell condoms: you misunderstanding (misrepresenting?) my position. A licensed health care provider has a duty to provide health care. Not moral counselling, not judgment, health care. To take your vaccine example: if a doctor refuses to provide a vaccine because he thinks it medically unadvisable, that is a very different matter than if he thinks it is immoral to meddle with the natural order of things, or whatever. To offer another example: a teacher of science has a professional obligation to teach science. If this teacher is a fundamentalist who refuses to teach about evolution, then they are not teaching science, they are teaching faith, and they should be fired.
And shifting the burden over to the drug store in order to turn it into a free market argument is disingenuous. Not anyone, I think, can just decide to sell narcotics, say. I believe pharmacies, like pharmacists, need to be licensed. The license implies, I am arguing, a duty to perform the responsibilities the license confers, which is to say providing drugs to people who need them.
Tolerance has nothing to do with this. I am perfectly happy to have people think women should not have birth control, and to argue with them about that on moral grounds. But I totally reject the idea that it's "intolerant" to expect people to perform the functions of their damn jobs.
Posted by bitchphd | Link to this comment | 11-11-04 12:57 PM
I would agree that confiscating the scrip crosses the line. And I think, Michael, that you are asking the right what ifs. My answer, is, in general: "it depends."
Let us imagine that everyone in the Boston area converts to a strict catholicism, except for local boy Ben Affleck. Condoms vanish fom the shelves overnight. What is the right response? Should the government force the local walgreens, greatly against the wishes of the owner, and most customers, to stock condoms? Or should Affleck lump it and import condoms from New Hampshire? Seems like a tough question. But I would really start worrying about government regulation only when major problems emerge. I do think the right of people to choose how to behave (which profession to choose, how to perform that job, what products/services to sell) trumps my right to get a particular service I want from them. And that this is true almost all the time. The big exception -- which no one has raised here -- is racial discrimination. And I think there are great, compelling state interests in regulating commercial behavior in this regard.
As for OTC vs. Rx. I do not believe, frankly that urgency of need is what is at issue here. Otherwise I would imagine condoms and OCs would elicit the same response from people. Rx drugs filled at a pharmacy aren't exaclty used for emergency care (I need my viagra, stat!). The (stated) reason why we lock away Rx drugs is because we are afraid of unsafe use, the real reason is half that, half historical accident, with the desire to retain a monopoly underneath it all.
Posted by baa | Link to this comment | 11-11-04 1:04 PM
Sorry bitchphd, I posted before seeing your comment.
I am making the condom/OC distinction in order to highlight the importance some think Rx status makes. Basically, your average drug store pharmacy will stock both OCs (Rx), as well as male and female condoms (OTC).
I think a drug store/pharmacy should not be required by the government to stock either. You think (I believe) that they should be required by the government to stock OCs, but not condoms, and your reason for this is that in exchange for a license from the government, pharmacists must agree to fill every legal scrip. Whereas no equivalent licensing exists for OTC health products, it's OK for a store owner to exercise his moral judgment on stocking condoms. I don't get this at all; it seems to me to turn goverment licensing of pharmacists into a kind of sacrament. And in general my belief is: let's not use the fact that government is involved in a market in some way to justify coercing people to do things they don't want to do.
If by contrast, you think that the drug store should be forced to stock both OCs and condoms, it's clear that government licensing of pharmacists doesn't play a crucial role in your argument. Then, I would guess your basic view is that some services are so important that the government should mandate someone supplies them, even if it means coercing stores to sell products they otherwise wouldn't want to.
In either case, I guess I'd say this. The inconvenience we are talking about here is miniscule. And so I would be willing to make reasonable accomodation to allow people who hold beliefs I do not hold and consider misguided to be pharmacists or to own drugstores, and to perform those functions in concord with their moral beliefs. And yes, I do think that refusing, categorically, to make any such accomodation is intolerant.
Posted by baa | Link to this comment | 11-11-04 1:29 PM
It's partly b/c I place great weight on the idea of professional ethics and responsibility.
Also, though I haven't gotten into it, I'm not thrilled with the "the inconvenience is miniscule" argument. It's always a "minor" inconvenience when it applies to women, and right up front I offered several examples where the inconvenience is far from minor. I get kind of tired of having to undergo minor inconveniences like paying more for drycleaning or haircuts or having to be the one to provide the damn b.c. all the time or (theoretically) having to travel to obtain abortions, or be "counselled" about my own body (when I took Accutane years ago, I had to sign a jillion forms saying I knew about the birth defect problem, and even so the goddamn doctor patronized me every fucking time I came in for my monthly followup, and when I objected he offered me the bullshit rationalization that "well, not all women are as smart as you."
So I also kind of have a hangup about being told what is and isn't minor by people who don't actually have to suffer the inconvenience their own damn selves.
And I really am sorry for my tone here. I'm feeling shitty. Underneath the bitchiness, I'm just interested in the discussion.
Posted by bitchphd | Link to this comment | 11-11-04 5:21 PM
Oh, and sorry, re. condoms, two things: one, w/r/t otc stuff, I really do think the free market will fill the need. Two, let's be honest: even a pharmacy that doesn't stock bcp or emergency contraception will almost certainly stock condoms. I believe Walmart stocks condoms but doesn't provide emergency contraception. You can't quite make this a purely abstract issue, divorced from the real-world fact that in the end, it isn't birth control per se that people have a problem with--it's women being the ones to exercise the choice.
Posted by bitchphd | Link to this comment | 11-11-04 5:23 PM
When it comes to gum and soap and condoms, they're much less regulated than prescription drugs (basically only subject to consumer safety and truth-in-advertising requirements and whatnot), primarily because they're much less dangerous if misused so we really don't care who buys or sells these items.
So if I go into a store and they don't have the brand of gum I want, well, you really can buy gum almost everywhere, because basically anyone can sell it. The market works pretty damn well to make gum available to anyone who wants it.
Prescription drugs and their dispensation are regulated much more heavily, in part to prevent opiates in the streets, yes, but also (and I believe primarily) to protect consumers. Prescription drugs can cause great harm if they are misused, if they're mistakenly dispensed, if they're fake, etc. The licensing of pharmacists and prescription drugs (plus the law of torts) helps consumers be about as sure as they can be that they're not getting the wrong medicine or useless medicine or harmful medicine.
One effect of this greater regulation is that prescription drugs, and the pharmacies and pharmacists who sell them, are scarcer than would be the case if they weren't so regulated. You can't buy them just anywhere, only with a prescription at licensed pharmacies from a licensed pharmacist. Because of this market forces don't work quite as well to ensure an optimal supply.
In many areas, say Fort Worth for example, there are a lot of pharmacies around, so the inconvenience might be minimal, but that won't always be the case. Instead of trying to come up with some case by case analysis of how much inconvenience is too much, I think it's proper that the government requires that licensed pharmacists fill every prescription.
The "hand it off" rule seems a reasonable accomodation to moral concerns, but I think allowing pharmacists any more discretion as to which prescriptions they fill would be a mistake.
Beyond that I do think, and I think most people think, that health care is different from common commodities, and there's a legitimate government and societal interest in maximizing access and supply.
Posted by Mitch Mills | Link to this comment | 11-11-04 6:08 PM
extensive comments would be overkill from me at this point. but i have to say a few things:
1/ i took OCs for medical reasons--an out of control 4 month long period-- and for every day i was delayed in getting them, i would have been bleeding, losing more and more iron.
This is a problem because in some localities, if pharmacists did not provide OCs, patients would suffer. (Others such as bitchphd have laid out how womens' rights would be violated in all kinds of ways besides this, but I add my example since it shows the pharmacist interfering with my health in a way that violates my rights to medical treatment as per my doctor's prescription.)
2/ The only way in which I could see baa's scenario--pharmacists refusing to sell certain Rxs--as even approaching "okay" in my mind is if they (a) publicly advertised the limits of their pharmacy (eg on the sign: "Pro-Life Prescriptions Only"), and (b) immediately returned all scripts they could not fill (and item (b) should be the _enforced_ law.
Pharmacies are often out of certain meds, so a pharmacy makes no guarantee of being able to sell you an RX when you walk in the door. But if there are to be two classes of pharmacies in America--those who do and do not do OCs--then practicality demands they advertise it. And then let the competition spring forth to grind them into the ground. Of course, what would have to happen if women could not get OCs quickly or locally, is that docs would have to find a way to provide a trial sample in their offices...
There's a precedent to this refusal--lots of doctors don't do abortions. I think this opens it up for pharmacists not to sell certain drugs. But not to their stealing my RX out of my hand.
Oh, I do not like the way this country is going...
Kate
Posted by Anonymous | Link to this comment | 11-11-04 6:17 PM
Man, for a dead horse, it sure can take a beating!
Posted by Mitch Mills | Link to this comment | 11-11-04 6:25 PM
On the pragmatic side of the argument, I'm now going to contend that all of those "what ifs" I mentioned make it just too damn complicated to allow for moral discretion on the part of the pharmacist. Protecting rights is important, but I believe the potential inconvenience to consumers, and to the law in trying to measure the inconvenience to consumers, should indicate that, pragmatically, the pharmacist should just not be allowed to veto doctor's prescriptions on moral criteria.
I also want to distinguish between a pharmacist refusing b/c, and a pharmacy not carrying them. These are two different arguments, I believe, and, I'm limiting myself to a pharmacist refusing in-stock b/c.
Third, I don't buy your objection that the distinction in need between OTC and Rx isn't significant. You argue that since Rx aren't typically "emergency" medication, they are not more important than OTC, which I would think are actually more likely to be for emergency use. I don't think emergency has any relevance here. Take heart pills for instance, or insulin. These are not typically used in case of emergency, but they prevent emergencies, and are surely much more important to the user than emergency bandaids and salve. More at point to the issue, b/c pills are more important to females than condoms are to males because of health issues, yet this importance is not going to bear out if you only look at "urgency."
Posted by Michael | Link to this comment | 11-11-04 7:05 PM
Edward on Obsidian Wings has a roundup of recent stuff regarding public schools.
Posted by Mitch Mills | Link to this comment | 11-14-04 6:38 AM
I think bitchphd's argument is that "many affairs which are conducted in the interest of the community require a certain mechanism through which some members of the community must passively conduct themselves with an artificial unanimity, so that the government may direct them to public ends, or at least prevent them from destroying those ends. Here argument is certainly not allowed - one must obey. But so far as a part of the mechanism regards himself at the same time as a member of the whole community or of a society of world citizens, and thus in the role of a scholar who addresses the public (in the proper sense of the word) through his writings, he certainly can argue without hurting the affairs for which he is in part responsible as a passive member. Thus it would be ruinous for an officer in service to debate about the suitability or utility of a command given to him by his superior; he must obey. But the right to make remarks on errors in the military service and to lay them before the public for judgment cannot equitably be refused him as a scholar."
[I wouldn't be posting this except that part of the Public Reason comments thread reminded me of What is Enlightenment. I've no intention of starting this debate up again.]
Posted by ben wolfson | Link to this comment | 11-17-04 10:58 AM