Thursday, April 21, 2005

Comments on Conscience Clauses

I had some great comments on my first and second posts on conscience clauses, along with (gasp!) an outside critique. I argued that businesses should decide whether or not to allow their pharmacists to refuse to fill certain prescriptions, and the government should just butt out. There were disagreements with what I said from both sides of the aisle. I'll start with the very thoughtful comment from La Lubu:
I have to disagree with you on this one drumgurl, for several reasons:

1. We're not talking about frivolous products here, but medical prescriptions necessary for one's health. Pharmacies should be required to have at least one pharmacist on duty at all hours of their businesses operation in order to fill all legal prescriptions, or have their pharmacy license pulled. This is a public health and public safety issue, and as such, the state has an interest in protecting the public.

2. Transportation is a big problem in many areas of the country. The coy "oh, we'll help you get this scrip filled across town" isn't going to help a woman who rode the bus to get her scrip filled, and the bus service ends before her chance to get across town. There are many other cities that have no bus service at all. The woman who walked a mile to get her scrip filled probably does not have the time in her day to walk another five miles to the next pharmacy. Again, I don't think it's asking too much for a business that is licensed to sell medicine to be required to have at least one person on board during hours of operation that is willing to fill all prescriptions. And yeah, there is the pesky issue of certain pharmacies being the only game in town for a thirty mile (or more) radius.

3. Most insurance plans require that a person use a specific pharmacy or pharmacies; it is entirely possible that a person could be left without a way to afford their prescription, even if they could theoretically access another nearby pharmacy. I'm allergic to several classes of antibiotics. I have insurance, which means I get to pay $15. If I had to pay out of my own pocket for the more unusual prescriptions I require to battle infection, it would cost me over $100.

4. The idea that there is a natural force in 'competition' that is a leveller amongst businesses is bogus. It sure didn't (and doesn't) work that way in regards to racism and sexism. Businesses are run by people, with all of their foibles. People do not always operate in a rational manner. Some of them insist on racism and sexism, highly irrational forms of behavior that not only have a high cost to society at large, but have a high cost to those businesses that practice them....and I'm not talking about lawsuits, but the everyday losses incurred by the refusal to treat their female and of color employees and customers equally and with respect. It costs them. They don't care. And if there are enough businesses in the area that operate in the same manner, that will be the status quo. Laws were needed to battle racism and sexism, and unfortunately laws are needed to get our damn prescriptions filled.

I am all for Gov. Rod Blagojevich taking the hard line here in Illinois. This is a public health issue. Fuck pharmacies that aren't concerned with women's health. Maybe they'll get concerned if their license is yanked. This isn't any different from a lunch counter refusing to serve black folks...keep your sorry racist ass at home if you can't serve everyone!
These are all great points. But Mary from Compound Interest sees it another way. This is her response to letting businesses decide:
I see the fundamental American-ness in this argument. And yet ... Despite my pro-choice stance on reproductive rights, it doesn't quite work for me.

I am still sympathetic with the discomfort that some pharmacists feel about being expected to do something that they find morally repugnant to keep their jobs. My empathy for them comes not out of respect for their stance on E.C. (with which I strongly disagree), but a keen sense of the coercive nature of the employer-employee relationship in the absence of a union.

The delivery of health care is qualitatively different from most of the goods you'd pick up at Target. For one, unlike most consumer goods and services, the points of distribution for health care are highly regulated -- and those points of distribution are becoming fewer in number as drugstore chains merge and Wal-Mart muscles its way into small towns. In some towns, Wal-Mart is the only game in town. If you're looking to buy E.C., and they don't sell it, you're up the proverbial creek.

Now imagine that you are a pharmacist in the reverse situation. There's only one pharmacy in town, and they sell E.C., which you oppose for religious or ethical reasons. You sell it or you're out.

At one time it was perfectly feasible for a pharmacists just to run their own shops. Like doctors, though, pharmacists are finding themselves less and less a member of a profession, and more like regular workers. Except we get unions to stick up for us; they get Republicans. Yeah, I'm a little jealous.
While I can empathize with both La Lubu and Mary, I think La Lubu has the better argument. Customers and businesses have more at stake here than pharmacists. If I had to choose a state action, I would choose to force pharmacists to fill prescriptions, rather than force businesses to lose customers and customers to lose prescriptions. And I also agree with La Lubu that this is a public health issue. Some women need prescription birth control for health reasons other than preventing pregnancy. (I realize preventing pregnancy in itself is a health issue, but I'm trying to think like a looney-lifer here.)

But the thing is, I don't want the state involved at all. I certainly wish I could wave a magic wand and make discrimination disappear. But I can't. And I don't trust the government to protect me. The government that protects can also turn around and oppress. I'm not willing to invite the state into my life like that. Because once we give them that power, our rights are subject to the whims of whatever party is in office.

And right now, I think it's more likely that a "conscience clause" bill will pass, rather than a bill to protect women. The latter just isn't going to happen with looney-toons running the show. So the goal should be to protect women from these government lunatics. Whether we like it or not, we need Republican support against conscience clauses. Are they going to support the left's idea of forcing pharmacists to dispense birth control? No. But we might be able to convince the few Republicans with libertarian leanings to keep the state from supporting mandatory conscience clauses.

It's so easy to fall in line over the issue of pharmacists who refuse on grounds of conscience to fill birth control prescriptions. I'm more interested in those who come at this as if they want to understand it rather than criticize what others have decided. I've linked to your post from Across the Great Divide.
If you live in a small town and the grocery store is morally opposed to organic produce and you really love cruelty-free arugula, you should consider why you would live in such a town.

For the analogy-challenged, if you like sex, don't move to Religious Extremist Town.

But also, don't let your fundie pharmacist make the call. Get a prescription for lots and lots of regular birth control, which can be used as emergency contraception. Here's how.

Also, they've just concluded that emergency contraception absolutely does not "abort" a fertilized egg. In a country that helps an eighty-year-old man get his dick up, this should SO not be controversial.
Jami, I hadn't heard about the new findings on EC. That's great news.

What's sad is that some pharmacists are also denying women their traditional birth control pills. The lifers claim they cause abortion as well.
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