Who has the right to refuse?

Dahlia Lithwick has a great op-ed about how pharmacists who refuse to fill emergency contraception prescriptions are different from doctors who won’t participate in executions.

The similarities between the doctors and the pharmacists are striking: Both are refusing to participate in the performance of services acknowledged to be lawful — capital punishment and abortion/contraception. Both cite as grounds for refusal their professional interest in promoting, as opposed to ending, human life.

Then she notes two reasons why the pharmacists can’t refuse but the doctors can. One is that doctors have taken a Hippocratic Oath to “do no harm.” The other?

One reason doctors have generally been kept away from lethal injections is the historical anxiety about the past participation of physicians in state executions, from the guillotine to Nazi experiments. When medical expertise was pressed into aiding government murder, physicians became accomplices of the worst sort. Pharmacists, on the other hand, have no such history.

Not to mention that the two doctors that refused to participate in the execution were volunteers who initially agreed to perform a task outside the realm of their profession, and later changed their minds.

Dr. Michael Sexton, president of the California Medical Association, said, “Legal execution is not a medical procedure, it’s not a medical task.”

Indeed. Whereas filling a valid doctor’s prescription is a pharmacist’s task. The bottom line?

The law recognizes that doctors’ special relationship with their patients warrants a legal privilege: Their discussions are kept secret. You may like and trust your pharmacist. You may even trust him with intimate details about your yeast infection. But your pharmacist has neither the tools nor the right to probe details about rape and abuse, incest and health risks.

Lithwick doesn’t get into this, but another issue here is that even though some pharmacists may consider dispensing EC to be taking a life, it actually doesn’t work at all if a woman is already pregnant. In the vast majority of circumstances, EC prevents fertilization, not implantation. There’s a big moral difference between preventing fertilization of an egg and killing a living adult.
Is there a way to compromise on this issue?

Legal regimes that balance an individual’s right to opt out against safeguards for patients (like making it the pharmacy’s responsibility to provide timely alternatives) are good compromises. Similarly, if physicians cannot supervise executions consonant with their professional obligations, we may need to devise some new form of capital punishment that does not require a doctor’s intervention to ensure against violent, painful death.

This makes some sense. It led me to think that there may be an acceptable compromise possible on the pharmacist refusal issue. For example, would you object to a pharmacy employing a pharmacist who refused to dispense EC– as long as that person would only be on duty alongside a pharmacist who was willing to dispense EC?

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