http://nej.sagepub.com/cgi/pdf_extract/14/3/277

Refusing to perform unnecessary c-sections is different than using your personal beliefs to influence my morality. There are branches of medicine you can go into or places you can work as an OBGYN if you don’t want to perform abortions. Fine. But a pharmacist who doesn’t want to dispense birth control should work for a Catholic pharmacy, or suck it up and deal.

I don’t visit my local Walgreens because I am interested in the beliefs of the pharmacist–In fact, I expect a degree of professional detachment that precludes an assertion of the pharmacist’s rights over mine. If I go to St. Joseph’s hospital pharmacy (a private, Catholic facility), expecting the same, then I am doomed to disappointment.

If you are a member of almost any other profession, your personal ethical concerns are always superseded by the rules that govern your job.

If you are a police officer who believes it is morally wrong to arrest non-violent drug offenders, you can’t refuse to do it if you catch them. You would then be aiding and abetting a criminal and you would lose your job (or worse). Even if you think a particular act should or shouldn’t be illegal, you don’t get to decide, no matter what your ethical position is. You have to enforce the law, for good or ill.

And…it is especially important to point out that there isn’t a big ruckus over doctors refusing to remove gallbladders or do appendectomies. Instead, what is at stake is the degree to which doctors and pharmacists have the right to interfere with the bodily autonomy of women.

Given this dimension, the question becomes always already one of the degree to which they should have the power to use their professional position to control my body. This means that their ‘morality’ is simply one more weapon they can use to oppress women. It is a cheap excuse used to perpetuate women’s subjugation.

Just like you shouldn’t be a Magistrate/Justice of the Peace if you don’t want to perform marriage ceremonies for mixed-race couples, you shouldn’t be a doctor if you don’t want to prescribe/fill prescriptions for birth control.

@ PhilospherP – Your point about being the only provider in town is a very real issue for most women in the US. 87% of American women live in a country that has no abortion provider. I’m not sure what the statistic is for birth control access, but I would venture to guess it’s in the same ball park.

@ Rachel – In Arizona, a pharmacist does not have to facilitate a referral if they refuse to fill a birth control or EC prescription. I think that the federal guidelines say that facilitation is required. But so far in AZ since the conscience clause passed, Planned Parenthood is reporting a marked increase in the number of women calling in for emergency contraception because they haven’t been able to get it at a pharmacy.

@ Anne – you raise some very valid questions, especially the one about life support. I personally do not want to be on any machines. If I can’t breath and function without the aid of technology, it’s time to pull the plug. I seriously hope that I don’t end up in a hospital where some doctor or nurse has an ethical problem with my medical wishes. If I’ve got it in writing, then they need to put their own personal feelings aside and pull the plug. The patient should have the final say.

@ Sarah – excellent point! Lots of people take birth control for acne, regulating heavy periods, treating PCOS, and other health reasons.

@ MomTHF – all valid arguments. I think it’s awesome that you are unwilling to schedule births to facilitate your schedule. Babies come into this world when they are good and ready. Your classmate who takes condoms for disease control really blows my mind. I think the Catholic church has something to say about promiscuity, and it ain’t just for the ladies.

I strongly believe in conscience clauses and plan on refusing to perform certain procedures and to dispense certain medications when I am a physician. I think every physician follows her conscience, and am afraid anti-choice activists are using this important part of medical ethics to refuse to provide services that are in the best interest of the patient.

I plan on refusing to perform unnecessary procedures that are requested all the time as an ob/gyn. I will not perform any genital mutilation, male or female. This includes any routine newborn male circumcision, or elective vaginoplasties. This of course does not extend to any medically indicated procedures, which would be in the patient’s best interest.

I will refuse to do labor inductions because a mother is sick of being pregnant or because I am going on vacation. I will refuse to do non medically indicated cesarean section because a mother is afraid of the birth process or wants to have her baby on a certain date, or because I want to get home in time to have dinner with my family on a day I am being paid to be on call.

I think practitioners that are truly ethical do not use conscience clauses as an excuse to deny medical treatments to their patients or clients because of some idea that premarital sex is immoral. It is easy to find work in an area that does not involve refusing to provide necessary medical care. Most of these people who are refusing reproductive health care want to make an issue out of their refusal to control women’s sexual autonomy, not to support their own ethics, and it’s a shame.

There are two students in my medical school class who have stated they will refuse to prescribe birth control. Both identify as Catholic. One was more than happy to take handfuls of condoms our club was passing out for when he has sex with strippers (I wish I was kidding). He said he is using them for disease prevention, not birth control, so he is not a hypocrite.

I hope he goes into radiology, or urology.

The other is a Jesuit priest. He is planning on going into psychiatry, so most likely won’t be in a position to be a birth control prescriber often. He is also honest and out in regards to his homosexuality, and is an activist to change the Catholic position on homosexuality. So, he thinks some rules are meant to be changed.

The point of these two stories is to say, ethics mean different things to different people. Physicians and other health care practitioners are too diverse a group to force into one group of practices. However, we can encourage responsible application of conscience clauses and try to make sure essential health care does not get refused in the process.

Personally I was on it from the time I was 20 until about two years ago (age 28) when I started trying to get pregnant, because of terrible periods and symptoms (I have endometriosis and polycystic ovaries, and birth control pills are the best way to keep the awful symptoms at bay). For several of the years I took it, I was not sexually active at all, but I *needed* that medication.

Like others have said, if you don’t want to dispense medication to patients, prescribed by a doctor, perhaps you should re-think your profession.

What I fear will happen next is something as drastic as a doctor working in an ICU of a hospital not allowing a family to remove life support on a brain dead patient because it is against their morals.  Or an obstetrician denying an emegency cesarian because anything but natural birth is against their morals.  Where is the line drawn?