I know that the headline of this post sounds like an oxymoron, but it’s not. Arizona recently passed a law that allows health care workers and pharmacists to refuse women access to reproductive health care if they feel that it goes against their conscience. The state’s bill is no different than the federal guidelines that say the same thing. If a pharmacists feels that it is immoral to fill a prescription for birth control or emergency contraception, they can do so. And if a doctor feels that it’s immoral to prescribe birth control to a woman, they can do so. USA Today has a story of one doctor who did just that.
Faced with a request to give an unmarried female patient a prescription for birth control pills, Dr. Michele Phillips looked to her conscience for the answer.
“I’m not going to give any kind of medication I see as harmful,” said Phillips of San Antonio. The drugs would not protect her patient from “emotional trauma from multiple partners,” Phillips reasoned, or sexually transmitted diseases. “I could not ethically give that type of medication to a single woman.”
Which brings me back to my question: are conscience clauses ethical? I don’t think they are. If I go to a pharmacy to fill a prescription, the pharmacist should fill the prescription – that’s their job. If I ask for an over the counter medicine like Plan B, they should give it to me – no questions asked. If I, Goddess forbid, were to get raped and wind up in an emergency room, they sure as hell better give me emergency contraception if I ask for it. It’s not the business of doctors, nurses, or pharmacists to impose a sense of morality on the world. If that’s what they want to do for a job, they should have gone into the ministry instead of the health care industry.
The USA Today article offers a different point of view.
Bioethicist Holly Fernandez Lynch said consistency is crucial to prevent patients from facing discrimination based on race, religion or sexual orientation.
“A consistent objection to a service, I think, is totally appropriate as long as there is someone available to provide that service at a reasonable distance,” said Lynch, author of Conflicts of Conscience in Health Care: An Institutional Compromise.
But, she acknowledged, “the phrase ‘reasonable distance’ is really a difficult one to figure out.”
While larger communities and hospitals have the luxury of a range of practitioners, conscience quandaries are trickier in smaller communities, said Leslie LeBlanc, managing editor of The Journal of Clinical Ethics.
“It’s a very difficult question because you can’t compel someone to do something they think is morally wrong and, by the same token, clinicians make a promise to help people in need,” said LeBlanc, who attended the bioethicists’ meeting.
By taking an oath to “do no harm,” a doctor has an ethical responsibility to do whatever is in their patients’ best interest. Birth control is in a woman’s best interest – it puts the control of her reproductive destiny in her own hands. That same ethical obligation applies to a pharmacist. If you don’t want to dispense emergency contraception, go into some other line of work. I don’t want to build bridges for a living, so I’m not an engineer. I don’t want to spend my days roping cows, so I’m not a rodeo cowgirl. I do love to write and get up on my soap box, so I blog.
What’s your opinion? Should health care providers be allowed to deny medical care based on their moral beliefs? Or do conscience clauses violate ethical codes of behavior?