Conscience For Me But Not For Thee: The Case for Pro-Life Docs and Pharmacists

August 22, 2008

In two recent threads over at Pharyngula, one about a poll and the other about some recent comments from HHS Secretary Mike Leavitt, I’ve gotten myself caught up in some pretty heated exchanges over the issue of pro-life doctors, and their impact on reproductive choice and access to health care.

This controversy has been building for some time, as legislatures and now licensing boards are increasingly confronting the question of whether, and to what degree, the consciences of anti-abortion doctors should be protected. More and more women are startled to find local doctors and pharmacists refusing what they had assumed were basic and perfectly legal prescriptions.

Now, as far as the original issues go, most of the things that anti-abortion docs, pharmacists, and their advocates are currently pushing for are indeed overboard. The idea that a doctor can refuse to refer a patient to another doctor, or refuse to even give them information, is unjustifiable. And if a CVS pharmacy wants to offer the pill to its customers, then it has all the cause in the world to only hire and retain staff that are willing to dispense it. It’s simply not unjust discrimination to fire someone if their conscience prevents them from doing what the employer needs done, and no reasonable (reasonable on the employer’s terms) accommodation can be found.

Unfortunately, many of my pro-choice compatriots have, I think the wrong idea themselves, asserting principles of their own that go far beyond the right of employers to set the conditions of employment. When it comes down to it, it seems that many people believe that doctors who refuse on ethical and/or religious grounds to prescribe birth control pills, pharmacists that refuse to fill such orders, or even, it seems ob/gyns that resist performing elective abortions should either ignore their consciences or essentially leave their chosen professions. But the justifications given for this harsh ultimatum are, I think fatally flawed.

Two principles in particular are, I think twisted or misapplied to this situation: the idea that pro-life doctors are forcing things on their patients, and the idea that pro-life doctors and pharmacists aren’t doing “their job.”

Doctors Have No Right To Force Their Choices on People

As general principle, this idea Is central to most cannons of medical ethics and medical license boards. And justly so. It’s based, first and foremost, on the idea that people of sound mind have an absolute right to accept or refuse medical care, and to pick the treatment plans they are comfortable with under the advice of the physician. It’s based on a laudable ethic of not forcing something on someone without their consent.

The problem is that this ethic seems to fall by the wayside whenever people start considering the views of people they don’t like. Or it gets implausibly twisted, so that the “forcees” are claiming to be the victims. It takes a true mangling of language to assert that someone not doing something for you constitutes forcing you to do anything. But that appears to be precisely what it going on here.

Consider the common assertion that doctors who refuse to prescribe birth control, especially when they practice in far-flung areas and stats that offer little choice in doctors to begin with, are “forcing” their own preachy choices on the patient. But are they?

When a family doctor sets up a shingle in a small town, people’s access to health care improves in real terms. But now suppose that the doctor refuses to prescribe birth control or perform elective abortions. Has the doctor actually “forced” anything on anyone? His or her values? His or her services?

In virtually all routine situations, no. The people in the town are certainly no worse off than they were before the doctor arrived. The doctor’s existence provides some benefits, but perhaps not all the benefits they’d want. Demand that the doctor violate his or her conscience or else find another profession, and you might well end up with no nearby doctor at all. The same goes for a hypothetical “pro-life” pharmacy.

Yes, people in that situation lack access to things they want and need, and are protected by law. But that’s the exact same situation they were in before the anti-abortion/anti-pill doctor set up shop.

So what’s the solution? Well, if we really care about access to birth control, if that’s really something we consider to be a moral value or even an assured, positive right, who has the responsibility to supply it? Does that responsibility fall almost entirely on the doctor who thinks it’s immoral, just because he happens to be the most local? Or does it fall on all the people who think it’s a basic right? If you answered the former, I have to admit that I’m simply flabbergasted.

The situation here is a little like the often confused outrage at “scalpers” who, during a disaster, offer things like water bottles for sale at ridiculously inflated prices. These people are routinely condemned as greedy, and they certainly are. But somehow it never occurs to all these outraged moralists that, if people in a disaster have some sort of positive right to receive water (free or cheaply), that this right cannot possibly be a burden and a responsibility that falls on some people more than others. At least the scalpers are offering water for sale at all. Rarely have any of the outraged people rushed over to offer even a drop of their own water, at any price. If the scalpers are as greedy as their inflated prices, then the moralists shaking their heads are themselves infinitely greedier.

Blaming the scalpers for a lack of available water, or blaming pro-life doctors for lack of available abortion services and birth control, is, in the end, nothing more than crude scapegoating. It takes the focus, rather conveniently I might add, off of the collective failure for which the moralists themselves are implicated.

And the further irony is that the moralists’ proposed solutions often wouldn’t really help anyone overall. Scalping only works when there is an extremely limited water supply: i.e. there’s too little water to go around in the first place. If scalpers simply gave away all their supplies for free, there would still be too little water: in fact, in the end, there would be exactly the same number of people with and without water. All that would be different is the method by which these people would be chosen (and the usual alternative, first come=first serve, is arguably no more “fair” than rationing the supply by price, which at least has some built in mechanism for assessing people’s relative need for the water).

Likewise, if anti-abortion/anti-pill physicians and pharmacies left the business, as their foes seem to suggest they should, there would still be the same shortage of medical care and lack of access to birth control that we started with.

From where I sit, that makes this issue look a heck of a lot more like an act of partisan revenge than a sound policy or pro-patient principle.

If They Don’t Want to Do What (I Say) the Job Entails, They Should Find Another Job!

This second principle, uttered as if it were an obvious truism, is in fact an utterly bizarre essentialism. Obviously, if we are talking about an employer defining what “the job entails” and finding someone wanting, there’s no problem. But this isn’t the sense in which some people mean “the job.” They mean it in a more cosmic sense: turning mere convention into Platonic form.

Who says that the role of being an ob/gyn, a family doc, or a pharmacist must involve prescribing or dispensing contraceptives? What defines that role such that it’s supposedly essential to this or that specialty? Is this some sort of immutable law of the universe? No. To the extent that they are set and regulated at all, the required roles of various professions (and the permitted variations) are set by committee or political process, not fate. And those debates have to deal with the very political and ethical questions we’re already considering.

Thus, asserting that elective birth control must be part of the role of certain doctors is little more than a begged question. If you regard a fetus or even a fertilized embryo to be a being with moral rights, then harming it without dire need would not legitimately be part of the role of any physician. Reject that idea, and it’s a legitimate part of reproductive health and choice. I certainly have my opinions, but I also have a respect for the importance of social pluralism. And we cannot simply presume anyone’s opinion from the get go when determining what medical ethics demand or deny.

A more reasonable question is: can anti-abortion doctors be reasonably accommodated into our medical system with their existence causing serious additional harm to anyone? I think the answer is yes.

My opponents disagree. They imagine Jehovah’s Witnesses as ER docs who then refuse to transfuse blood to car accident victims. But these examples are absurd. No one would hire such a doctor to such a position in the first place, and if one did, it’s unlikely it could be licensed to accept emergency patients (who are often in a very different situation than a person seeking a physician or going to a pharmacy). On the other hand, plenty of people in the United States not only would have no problem with seeing an anti-abortion ob/gyn, but would favor going to one. Is denying the possibility of this choice even in keeping with the respect for autonomy that underlies pro-choice politics in the first place? I think not.

The early pioneers of reproductive choice knew that making it a reality meant actually physically and financially getting doctors and products out to women everywhere. If choice is a positive right and not just a negative one (i.e. not merely something that the government cannot ban, but something that must actively be ensured, presumably by society itself) then it’s going to take a tall order of money, time, and resources to supply it. Butting heads with anti-abortion doctors and pharmacists, or demanding they conform or go out of business, isn’t even remotely the same thing.


Wafer Desecrated: PZ Myers Makes Good on His Threat & More Besides

July 24, 2008

Well, for better, and probably for worse, PZ Myers has done as he promised and treated a communion wafer in a manner unbecoming of the sacred, all to definitively demonstrate that, indeed, he doesn’t think these things are sacred. For good measure, he trashed not only the wafer, but also some torn pages of the Koran, and even torn pages of Dawkins’ writings.

This is one of those odd situations in which I know what other people will likely think far better than I know what to think.

Read the rest of this entry »

The Creationist Claptrap Jindal Wants in Public Schools: Luskin’s Missed Wrist

July 15, 2008

As you are probably already aware, thanks to Republican Governor and sometime amatuer exorcist Bobby Jindal, the 4th wave of creationism is now officially underway in the great state of Louisiana.

As with every other wave, this movement involves simply recycling the usual stable of crappy creationist claims, but this time without any explicit title (not even “Intelligent Design”) or even any explicit unity between the arguments, let alone any hint of a specific alternative conclusion that they are all pointing towards. Instead, creationist standards are to be repackaged as “scientific criticisms,” divided up, and sprinkled liberally throughout textbooks and idiosyncratic classroom curricula. And politicians like Jindal are meant to abet the effort by passing “academic freedom” bills that curiously target the teaching of evolution, and only evolution, as needing special protection for the teaching of “critical views.”

The obvious trick inherent in all of these bills is that they never specify a standard of accuracy that such criticisms have to meet, and they are often vague as to who is going to evaluate or enforce that standard in any case.

Read the rest of this entry »

Double standard: Andrew Sullivan on Catholic Wafer Controversy

July 14, 2008

Blogger and liberal Catholic Andrew Sullivan was a hearty defender of the infamous Danish cartoons that depicted and poked fun at the Islamic prophet Mohammed. But now, the sacred cow is, er… on the other foot, or something. Sullivan Sullivan tells a very different story when it comes to the recent hubbub about PZ Myers merrily threatening to desecrate Catholic communion wafers:

It is one thing to engage in free, if disrespectful, debate. It is another to repeatedly assault and ridicule and abuse something that is deeply sacred to a great many people. Calling the Holy Eucharist a “goddamned cracker” isn’t about free speech; it’s really about some baseline civility. Myers’ rant is the rant of an anti-Catholic bigot. And atheists and agnostics can be bigots too.

“Atheists and agnostics” is just another word for “some people,” and yes, people can be bigots, especially towards groups of which they are not a part. Whether or not you think Myer’s jab is bigoted or not depends quite a bit on whether you think attacking and parodying beliefs can be a form of bigotry or not. I’m open to the argument that it can be in some cases.

But I’m not so open to the argument that it’s bigotry when done against Catholics, but not when basically the same thing is done against Muslims.

Sullivan, however, thinks he can dig his way out of this double-standard:

Thanks for the defenses. My objection to PZ Myers – even as I defended his right to say whatever he wants and wouldn’t want him punished in any way – is not, in my view, a double standard. Printing a cartoon for legitimate purposes is a different thing than deliberately backing the physical desecration of sacred objects. I’d happily publish a Mohammed cartoon if it advanced a genuine argument, but I would never knowingly desecrate a Koran purely to mock religion.

But Sullivan’s distinction here is nonsense. In Islam, creating images of their prophet is inherently very much a form of physical denigration, no different than physically denigrating a consecrated wafer (in this case, oddly, by NOT destroying it!), or improperly treating a written name of God is for some observant Jews. All of these are, of course symbolic acts done to unfeeling objects, and it is a matter of religious belief as to whether it causes any real harm to anything other than people’s feelings or not.

Sullivan’s definition of “legitimate purposes” is also a form of special pleading. Myers and the Danish cartoonists were both seeking to mock religion for precisely the same reasons: to puncture presumptions of special authority in matters metaphysical. Either you think that’s a legitimate purpose or not: but you can’t have it both ways depending on how much you like the target.

I certainly think it fair to object to these sorts of showy, trolling criticisms as unproductive, or rude, or aggressive. But as even Sullivan’s readers have pointed out, the same can be said about people, himself included, attacking or making fun of Scientology. If it were really “about baseline civility” as Sullivan claims, he’d treat this incident as a case of reconsidering his own bigotry when it comes to anything but Catholic doctrine, rather than trying to pin it exclusively on Myers.

Update: Commenter Terry points out that Sullivan’s concern for the desecration of the host is potentially problematic for him. For any number of reasons, if Sullivan himself has taken communion in what his church could consider a state of sin (i.e. unrepentantly defending and/or engaging in gay sex), then he himself would have desecrated the Host.

Dueling Hypocrisy Update: Andrew Sullivan still hasn’t addressed his own lame defense of his cartoon blasphemy apologia, but he has thought to check in on PZ Myers’ take, and implies that Myers wasn’t as enthusiastic about bashing Muslim beliefs as he was about Catholics. But Sullivan is pretty clearly quote-mining here. Myers says immediately after the supposedly damning quote:

So on the one hand I see a social problem being mocked, but on the other—and here comes the smug godless finger-wagging—I see a foolish superstition used as a prod to mock people, and a people so muddled by the phony blandishments of religion that they scream “Blasphemy!” and falsely pin the problem on a ridiculous insult to a non-existent god, rather than on the affront to their dignity as human beings and citizens. Religion in this case has accomplished two things, neither one productive: it’s distracted people away from the real problems, which have nothing at all to do with the camera-shy nature of their imaginary deity, and it’s also amplified the hatred.

In short, there doesn’t seem to be any less willingness to attack sacred beliefs here. Myers’ reservations were, if you read his post, mainly about his feeling that the cartoons traded in racial stereotypes of what he saw as a powerless minority.

Student “Kidnaps” Eucharist: Catholic Controversy Conundrum

July 9, 2008

As Webster Cook, a student at the University of Central Florida, tells it, he was attending a Catholic Mass with a friend, was given the communion wafer, and wanted to show it to the friend in order to help explain Catholicism. He was accosted as he attempted to walk back to his seat with the wafer uneaten, and in defiance decided to leave the service with it (he later gave it back). Church officials tell it differently: Cook was never physically restrained, and he basically absconded unprovoked with what they believe is the body of Christ, holding it hostage just to make point about the public funding of religion (the service was held at a publicly funded school).

Worldwide controversy ensues. Bill Donahue calls his act “beyond hate speech.” The local priest calls it “kidnapping.”

PZ Myers has his usual blistering take of course, mostly agog at the seeming absurdity of the whole matter: it’s just a cracker!

I guess I have more sympathy for the outraged Catholics than he allows. Read the rest of this entry »