Rule of Conscience?

The mortar and pestle is an international symb...Image via WikipediaOne of the last acts that President Bush took in the past few months was to issue a "health care conscience rule" that would shield individuals from performing functions of their jobs that they found "morally objectionable."  Sounds pretty decent, right?  I'd hate to be told that my job involved neutering dolphins or that I would be forced to drink alcohol as a pastor?  That would be good, right?

Well, it would be, except in the following cases this kind of "conscience" shield are at the intersections of religion and morality.

  • As a small case, a Christian bus driver refused to drive a bus that had an atheist advertisement on the side.  I think s/he missed a great opportunity to provide a different sort of witness while on the job!
  • As a scarily-more-common case, Pharmacists can refuse to dispense birth control or morning-after pills because of their religious beliefs about abortion or contraception.
  • And on the ridiculously extreme front, a nurse admitted removing an IUD because considered them to be a type of abortion.  Um, besides the medical facts, this is scary!
But under the "conscience" legislation, and under legislation being pushed in a dozen states, these acts are all legal and have been called "moral" because they do not force practitioners to do things against their religious beliefs. 

I beg to differ.

So tell me what is moral about this scenario: What if you are the only pharmacist in a rural town...and you refuse to give out birth control?  What sort of moral choice are you forcing on people who then have to drive to the next town or county?  We in urban America don't have this difficulty, but it is very real in rural America.

I've got a dozen other scenarios, but the round point is this: if you are in a profession, then you have an obligation to act professionally.  Any medical person now knows that part of the job of being a pharmacist is dealing with birth control and RU-486s, so if you find that morally-objectionable, work in another field!  Because your "morals" are getting in the way of patients' rights:
"This ['conscience rule'] is a very significant threat to patients' rights in the United States," said Lois Uttley of the MergerWatch project, who is helping organize a conference in New York to plot a counterstrategy. "We need to protect the patient's right to use their own religious or ethical values to make medical decisions."

In short, pharmacists have a level of control over their patients' lives.  By choosing to control their actions by refusing to fill prescriptions one finds "morally objectionable" you are exerting power-over a person, which is not the power that Christ calls us to.  The Apostle Paul calls us to be made perfect in weakness, in offering ourselves as powerless. This is none of that.

Thoughts on this controversy?  If you found yourself in a profession that forced you to make morally-objectionable actions, would you get out of the profession or just stop offering care to those in need? 



Stresspenguin January 23, 2009 at 10:13 AM  

Could a person in payroll refuse to deduct an employee's income tax if he or she believed that that tax revenue would go toward something immoral?

Just trying to find a way that this could bite the gov in the butt.

Rev. Jeremy Smith January 23, 2009 at 12:06 PM  

LOL @Kurt, such as an anti-war person not deducting income tax because that tax would fund the war in Iraq? I would stand behind anyone that wants to try it!

Matt Shafer January 23, 2009 at 3:41 PM  

interestingly, there is a movement to allow people to do just that...

Anonymous,  January 24, 2009 at 4:13 PM  

Just to be clear, "morning-after pills" (emergency contraception) and "RU-486" are not the same. Plan B (FDA-approved emergency contraceptive) is a synthetic progesterone that acts by preventing ovulation, and therefore, preventing pregnancy. It will not interrupt or harm an established pregnancy. Mifeprex (formerly known by it's research name RU-486) is FDA-approved for medication abortion up to 63 days from the last menstrual period. It is dispensed only by abortion providers, not retail pharmacists. - OB/GYN Physician

karla January 25, 2009 at 9:14 PM  

Hey Jeremy, interesting food for thought.

I AM a pharmacist. Anonymous OB/GYN is correct in stating that pharmacists don't actually have that ethical choice before them; we don't dispense RU-486 (Mifeprex).

Having said that, it's still interesting to ponder. And of course, we have those nutjobs (pardon my lack of charity there!) that refuse birthcontrol to women, one of which even refused to transfer her prescription to another willing dispensing pharmacy. (ARRGGH?!?)

What would I do? I'd like to say I would uphold the expectations of my profession or take a hike and find a new job. It's not that simple though, in a certain sense. Consider for example, that pharmacists who were trained many years ago could never have dreamed that such a pharmaceutical would exist? Should they be asked to change professions after many years of faithful, good service to their patients and profession? I mean, physicians can select their specialty, the services they will provide, etc., etc. Hmm. (??)

I guess overall, I'm typically more on the side of public health and rights, and professional unity than I am for individual beliefs/rights of a vowed member of a profession that can be a barrier to access to legal legitimate care. Exercise your beliefs and rights all you want as a private, protesting citizen - in a different line of work. But pepper that with my complicating consideration. As I said, food for thought... Interesting topic!

Larry B,  January 25, 2009 at 9:35 PM  

Interesting that you would take the stand that one should leave a profession if the morality of certain actions dictated by a professions rules and regulations will cause conflict with your personal morality, yet you yourself serve as an eample of someone who continues in your chosen profession even though you disagree and label as immoral certain rules inherent to the Methodist Denomination.

Is there room for at least some reasonable accomodation for personal morality in something like this, or should it be an all or nothing as you propose?

Rev. Jeremy Smith January 26, 2009 at 6:56 AM  

@Anonymous, thank you for the clarification. It's important that we are accurate with what we are talking about, so thank you, I will update the original post.

@karla, like you said, food for thought! It's helpful for me to get feedback from people in the industry, so thank you.

@Larry B, you've hit one out of the ballpark with that insight, Larry. Thanks for holding me accountable for when I apply different standards to others than to myself.

I think if I can moderate my original tone, perhaps the balance needs to be reasonable accommodation. For an urban Pharmacy where variety of choice is easy, then referring persons to another pharmacy and going out of your way to accommodate them would be a valid compromise. However, in rural settings where they are the only pharmacy for several miles/towns, then such accommodations are rarely fair. To those rural pharmacists whose beliefs rise above their care for the other's health, a change in profession or location may be justified.

I think reasonable accommodation is applicable to my own setting as well. I feel strongly that the great diversity of the UMC is an asset rather than a hindrance, so accommodation by both the UMC leadership in allowing this diversity, and by myself to respect situations where diversity is touchy, is a path towards health and wholeness.

Thanks Larry. I appreciate your candor.

Larry B,  January 26, 2009 at 7:25 PM  

Rev. Jeremy,

I kind of sensed from other posts that you usually strive for "reasonable accommodation" and was just a bit surprised by your post on this one.

I'm glad you didn't take my question as an attack, as I was really just looking for clarification on what I thought you might be saying here. Thanks for clarifying.

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