freedom of conscience: pharmacists and county clerks

I am jubilant, absolutely jubilant, about marriage finally being opened up to gays in California, although my happiness is tempered by a concern I share with many folks about gay marriage's current legal limbo. Not knowing the outcome of the constitutional amendment proposition on the November ballot makes for turbulent emotions, and I worry about a repeat of what happened with San Francisco Mayor Gavin Newsom's bold activism. Still, I can't help but feel that love is in the air. And love, I hope, is stronger than the hatred embodied by opponents of gay marriage.

But then, there's Ann Barnett, the Kern County Clerk whose office suspended officiating services. That's right: no weddings for you! Straight or gay, although licenses will be issued as required by law, $30 civil ceremonies are out. If it seems fishy, that's because it is. Her reasons for suspending officiation services - insufficient funds to handle the supposed overload of weddings - are suspect at best, and the conclusion that she is letting her own personal preferences interfere with her public job is hard to deny. (Read about it here and here.) Given the nature of her job - serving the public in a specific legal framework - I would argue that her freedom of conscience ultimately manifests itself in a relatively simple choice: do the job or resign. Or get fired.

There's an interesting contrast to this situation in the private sector: "pro-life" pharmacies that refuse to stock contraceptives like the pill, or emergency contraceptives like the morning-after pill. An umbrella organization called Pharmacists for Life International have, on their website, a quote from Pope Benedict XVI that summarizes their stance:

"It is not possible to anesthetize the conscience, for example, when it comes to molecules whose aim is to stop an embryo implanting or to cut short someone's life... I invite your federation [of pharmacists] to consider conscientious objection which is a right that must be recognized for your profession so you can avoid collaborating, directly or indirectly, in the supply of products which have clearly immoral aims, for example abortion or euthanasia..."

-Pope Benedict XVI, address to Catholic Pharmacists, 29 Oct 2007 AD

As far as I'm concerned, the ethics of contraception is concerned is a non-issue. Contraception is not abortion, an embryo is nothing more than a collection of cells, and this every-sperm-is-sacred viewpoint works against the very real personal and social problems associated with unplanned pregnancies. But a more interesting question involves whether or not pharmacists really are entitled to conscientious objection in the conduct of their profession.

On the one hand, pharmacists are not government employees subject to the necessity of serving the whole taxpaying public; however distasteful their own personal views, they should be free (like everyone else) to act in a manner consistent with their conscience provided they cause no harm. But here's where it gets tricky. Suppose a pro-life pharmacy is the only pharmacy in town. Could the pharmacist's refusal to stock contraceptives interfere with a woman's ability to choose for herself, to control the sexual and reproductive aspects of her life? If there's another pharmacy in town selling the pill, the issue is moot. A woman can choose which drug store offers her what she needs. But without that choice, a woman is left without options. I have to agree with critics of pro-life pharmacies that they represent a obstacle to women's own freedom of conscience.

Of course, the pro-lifers wouldn't feel too sorry. They'd be happy if a woman, whether she accepts it or not, can't use contraceptives. In their view, this would be "saving a life." And so we're back to that pesky right of individuals to act according to their conscience. The nature of freedom dictates accepting that some pharmacists will not dispense the pill and other contraceptives. If they can't be obligated to offer medicing in the first place, then there isn't much basis for obligating them to offer a particular medicine. Or is there?

Pharmacology as a profession doesn't exist in a vacuum. In essence, it is a support to medicine. Pharmacists do not prescribe medicine; they carry out the prescriptions determined by doctors, and they carry out these prescriptions with the knowledge necessary to ensure patient health and safety. This is why there are licensing requirements, academic requirements, and so on. This means that the practice of pharmacology isn't a strictly individual affair. It's not up to individual pharmacists to act as they see fit. For public safety and trust, pharmacists must adhere to a professional standard. The argument would hold true even if we were to leave governmental regulation out of it. In an unrestricted market in which meaningfully informed consumers exert credible influence over product/service providers, voluntary certification through guilds or professional associations would be a badge of professionalism not shared by uncertified individuals. We see this in practice already with the various professional associations that exist, many having code of ethics that members - who are free to join the association or not - must adhere to. As consumers, we'd be mostly like to trust the association-certified pharmacist than the lone operator.

And so the choice facing pro-life pharmacists in a quasi-private capacity is ultimately not all that different from the choice Ann Barnett faces in a public role, given the nature of pharmacology as a profession: do the job or don't do it. It's still a choice. There is still freedom to act according to one's consicence, even if isn't a middle ground preferred by pharmacists who love their job - you know, handing out blood pressure pills and viagra for impotent men - but don't want to deal with contraception.

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