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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8 Comments

  1. Scarbo
    Posted February 27, 2006 at 6:49 pm | Permalink

    How about this: can doctors be set up to dispense prescriptions themselves, and leave the pharmacists out of it?
    If it truly is a decision between a doctor and her patient, then why not limit the people involved to a quantity of two, and not involve others in the patient’s business? Especially on a topic so emotionally-charged as this one.
    Yes, I know, this solution avoids the principle of the argument you are making. But I do think it’s a practical solution. And, it would even cut down the time and number of stops it would take to get the drug in the first place.
    Patient: “Doc, I need the MA pill.”
    Doctor: “OK, here it is.”
    Patient: “Thanks, doc.”
    See how easy that was?
    Why can’t doctors give out medications?

  2. Posted February 27, 2006 at 8:46 pm | Permalink

    In the vast majority of circumstances, EC prevents fertilization, not implantation.
    The progestin-only ECP (Plan B) prevents ovulation, not fertilization.

  3. Not true
    Posted February 28, 2006 at 6:04 am | Permalink

    Well capital punishment is just barbaric! Of all industrialised nations, only the US and Japan retain the death penalty.

  4. Kyra
    Posted February 28, 2006 at 11:19 am | Permalink

    Ema—”The progestin-only ECP (Plan B) prevents ovulation, not fertilization.”
    Which very effectively prevents fertilization as well, as you can’t fertilize what isn’t there.
    As for letting conscience-clause pharmacists work alongside the pharmacists who are actually willing to do their jobs, only if there’s a sign posted telling EC/birth control patients which pharmacist to go to and which one NOT to go to, or else a flat-out ban on any lecturing or other impoliteness.

  5. Not true
    Posted March 1, 2006 at 8:54 am | Permalink

    Kyra … what!!! you mean they actually have the audacity, not only inform they don’t stock your prescription, but to moralise as well. Unfuckingbelievable!!!!

  6. Posted March 7, 2006 at 6:30 pm | Permalink

    On the pro-life blogs, you still hear people saying over and over and over that EC works by preventing implantation (I try to enlighten them when I can). For a very long time people have heard that hormonals might work by preventing implantation, so I would understand if that thinking remains in the public mentality for a while, but there is no excuse for pharmacists to be ignorant of the current research on pharmaceuticals.

  7. Courtney Gidts
    Posted May 19, 2006 at 4:36 pm | Permalink

    I’ve managed to save up roughly $64643 in my bank account, but I’m not sure if I should buy a house or not. Do you think the market is stable or do you think that home prices will decrease by a lot?

  8. Sonya Klarson
    Posted July 31, 2009 at 7:17 pm | Permalink

    In the countries of the developed capitalism this tablet is on sale only under the recipe of the doctor, and in its Europe it is possible to buy without ceremony in any drugstore.

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