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Jill has been blogging for Feministe since 2005.
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58 Responses

  1. Sally
    Sally February 3, 2006 at 12:18 pm |

    I guess I’m a bit worried that there will be unintended consequences if we declare that doctors have to do any procedure, whether they have moral objections to it or not. These discussions tend to focus on stuff having to do with punishing female sexuality, but doctors might also have moral objections to gastric bypass surgery or hymen reconstruction surgery or plastic surgery designed to “correct” ethnic features. It’s legal to perform lipsuction on a 13-year-old: do we want to mandate that every plastic surgeon must be willing to do so as long as the kid’s parents sign a consent form? I think we need to procede with some caution here, I guess, even though I’m on board with your basic goals.

  2. Thomas
    Thomas February 3, 2006 at 12:20 pm |

    Will virulent opponents of abortion be permitted to refuse emergent care to women who have attempted to self-abort? Can a group of doctors and nurses turn away an ambulance in the middle of the Mississippi delta because they’re horrified at what the woman has done? Can they simply send her to another hospital 45 minutes away, and hope she makes it?

  3. Michael
    Michael February 3, 2006 at 2:01 pm |

    Sally, with all due respect, you’re completely missing the point. No one is proposing legislation that every healthcare professional and every doctor must perform every possible procedure for their field. Rather, this legislation is aimed at protecting individuals who morally oppose services their employer provides. I would like to reiterate this key block:

    “We live in a culture where more and more people are on opposite sides of these basic issues,” said Manion, who has represented an ambulance driver who was fired after she refused to take a patient to a hospital for an abortion, a health department secretary who was not promoted after she objected to providing abortion information, and a nurse who was transferred after she refused to provide morning-after pills.

    These people are not being forced to “do any procedure, whether they have moral objections to it or not.” They are imposing their moral decisions on their employers by refusing to perform their duties. When someone applies for a position to drive an ambulance for a hospital that performs abortions, they are making a choice to accept that employment. If they morally disagree with abortion, they should choose not to accept the position. Rather, they can seek employment at a Catholic hospital, where they do not have to act in ways that they find morally objectionable. That is what freedom of conscience is about.

    “[D]octors might also have moral objections to gastric bypass surgery or hymen reconstruction surgery or plastic surgery designed to “correct” ethnic features.” Yes, and those are perfectly valid moral views. However, if such a doctor accepts employment at a hospital where these procedures are offered, that doctor must accept that he/she will either have to perform those procedures or face disciplinary actions. The doctor can speak with his/her superiors about these moral objections and the employer could work to find a mutually agreeable resolution. But if the employer decides that the doctor must perform the procedure if requested, the doctor must accept that and either resign or face disciplinary action for refusing to do their job.

    One other point to consider is that, in a lot of these cases, there is a time factor involved. The morning-after pill will not be effective taken a month later. These employees refusing to do their jobs are contributing to the possibility that these patients will not receive their care in an appropriate time frame. I have never heard of someone going to the emergency room for an urgent gastric bypass or hymen reconstruction.

    If you morally disagree with the duties you are required to perform as part of your employment, then the burden is on you to find appropriate employment.

  4. Sally
    Sally February 3, 2006 at 2:07 pm |

    I would say that I’m not so much missing the point as responding to Jill’s post, rather than the piece of legislation that inspired it. I don’t expect there to be a lot of controversy here about the legislation. But I’m not on board with the idea that doctors have a responsibility to “do their jobs” without considering moral implications. I think we need to find a different language with which to respond to conscience clauses.

    Have you ever noticed that when someone says “with all due respect,” they’re about to talk to you as if you’re a moron?

  5. Catty
    Catty February 3, 2006 at 2:13 pm |

    Plastic surgery for the most part is elective. Most plastic surgeons work independently- those that work in hospitals are more often reconstructive surgery specialists, and not the run of the mill plastic surgeons.

    The lipo of a 13 year old is a really bad example… you’re missing the point completely.

    Doctors that have their own practice can refuse a lot of services already. I have lots of friends in the medical field and they agree that this “right to refuse” concept is ludicrous.

    How about this:

    Should a fundamentalist christian fireman be able to refuse to put out a fire in a muslim house?

  6. Tanooki Joe
    Tanooki Joe February 3, 2006 at 2:19 pm |

    Will virulent opponents of abortion be permitted to refuse emergent care to women who have attempted to self-abort? Can a group of doctors and nurses turn away an ambulance in the middle of the Mississippi delta because they’re horrified at what the woman has done? Can they simply send her to another hospital 45 minutes away, and hope she makes it?

    Good question. Should doctors be allowed to turn away someone in serious condition simply because they disapprove of how someone got in that condition? Should a doctor be allowed to turn away someone with alcohol poisoning, for instance?

  7. Sally
    Sally February 3, 2006 at 2:55 pm |

    Plastic surgery for the most part is elective.

    I’m not sure what that has to do with anything. If doctors should do their jobs, who cares if the procedure is elective or not?

    Most plastic surgeons work independently- those that work in hospitals are more often reconstructive surgery specialists, and not the run of the mill plastic surgeons.

    My doctors work out of a large teaching hospital. There are several doctors there who list their specialities as “cosmetic surgery.” I bet that the hospital likes their clients very much: they’re all paying customers, unlike the people who go to cardiology or otolaryngology. It seems highly likely to me that hospitals or large practices could pressure cosmetic surgeons to do procedures with which they’re not comfortable.

    Should a doctor be allowed to turn away someone with alcohol poisoning, for instance?

    I’m pretty sure that doctors aren’t allowed to turn away anyone in mortal peril (and of course this mostly comes up when the reason they’d turn someone away is the person’s inability to pay.) If not, our first priority should clearly be establishing that doctors must treat life-threatening illness or injury no matter what.

  8. Anne
    Anne February 3, 2006 at 2:56 pm |

    Jill (and Michael) – all well said as usual.
    I think part of what is missing from the debate, particularly yours Sally, is whose morals and whose conscience. There are certain fundamental things that we as a society agree are wrong, such as cheating, stealing, etc. The problem here is that these doctors and other employees are taking their personal morals/values – in most cases stemming from religion – and placing them onto other people. The choices they are making go beyond just themselves and their own beliefs and force other people to accept their values. The problem is, not everyone does. Which leads directly to controversy about this type of legislation. While you suggest a ‘different language’ – the bottom line is that this kind of legislation is dangerous because it allows individuals to enforce their personal beliefs on others.

  9. R. Mildred
    R. Mildred February 3, 2006 at 3:04 pm |

    isn’t there some law about this already? I can’t imagine that a situation invovling white doctors refusing to provide help to black people hasn’t come up before, or was that all covered with jim crowe?

  10. Kim
    Kim February 3, 2006 at 3:22 pm |

    I’ve had some personal experience with this topic: a little over a year ago, I had an abortion. Actually, I went for an abortion and the doctor decided that she would not perform the procedure because I was “young and had never had children.” (Which, in my mind, were the exact reasons WHY I needed an abortion.)

    To this day, I’m still not sure what her objections were really– I wonder if my being black had anything to do with it? — but the nurses rolled their eyes and apologized, saying that she was tempremental like that. Personally, I feel like she should be in another line of work. It wasn’t life threatening or anything, but abortions are not the walk in the park that the right tries to make them out to be. (If you make them legal, women will be doing it ALL THE TIME. Because we like shelling out several hundred bucks and enduring the lovely physical aftermath.) Emotions are often running high: it’s daunting to be told that you have to come back next week when you were probably doing it scared– and maybe alone– the first time. Doctors should be making it easier, no? (And on a practical note, they don’t allow you to eat the night before or morning of, and doing that to a pregnant woman is fairly cruel the first time, let alone the second.)

  11. Sally
    Sally February 3, 2006 at 3:28 pm |

    I think part of what is missing from the debate, particularly yours Sally, is whose morals and whose conscience. There are certain fundamental things that we as a society agree are wrong, such as cheating, stealing, etc. The problem here is that these doctors and other employees are taking their personal morals/values – in most cases stemming from religion – and placing them onto other people.

    But the argument here assumes that some people have the right place their personal morals on other people. You’re just assuming that hospital administrators have the right to place their morals on doctors, rather than doctors on patients. That might be perfectly legitimate, but I think you’re assuming, rather naively, that in general hospital administrators will agree with your morality. But it could just as easily work the other way. You could just as easily have a hospital administrator demand that a psychiatrist try to “cure” a gay patient of his or her gayness and fire the psychiatrist when he or she voiced moral objections to that kind of “treatment.”

  12. Norah
    Norah February 3, 2006 at 3:32 pm |

    Didn’t Bessie Smith die of injuries sustained in a car crash, because the white doctors at the whites-only hospital had a moral objection to treating a black woman?

  13. Sufficient Scruples  » Blog Archive   » “Conscience Clauses” - All That Need Be Said

    [...] bal/Community Health, Theory Jill at Feministe hits the nail on the head with this post on healthcaregiver “conscience clauses” – wi [...]

  14. Sally
    Sally February 3, 2006 at 3:42 pm |

    Didn’t Bessie Smith die of injuries sustained in a car crash, because the white doctors at the whites-only hospital had a moral objection to treating a black woman?

    I believe that’s an urban legend (as is the similar one about Charles Drew), although of course there’s a kernal of truth. Certainly, the facilities available at a white hospital would have been better than what either received at a black hospital. But here’s the thing: segregation was the law of a land. A white doctor who had a moral objection to segregation and tried to treat Bessie Smith at a white hospital would have been breaking the hospital’s rules. And according to people here, the hospital would have been well within its rights to fire that doctor. Hospital policy trumps doctors’ morality, remember?

    But as I said above, one way or the other, we need to establish that doctors don’t have a right to turn away critically ill or injured patients for any reason. Because while I realize that most people here probably don’t care about medical issues that don’t involve sex, the most common reason that people are going to be turned away while critically ill is that they don’t have insurance and can’t pay up front.

  15. Dianne
    Dianne February 3, 2006 at 4:05 pm |
    If your patient says, “Don’t give me CPR,” then don’t give them CPR.

    Never give CPR to anyone who’s talking to you, even if they’re telling you go give them CPR: their hearts are obviously beating and so they don’t need it. (Yeah, I know what you really mean, but it’s been a long day already and I couldn’t resist the cheap shot.)

    Conventional medical ethics, BTW, is that you can not turn away a patient who is in immediate need, no matter what. If Osama bin Laden stumbles into an ER clutching his chest and complaining that he can’t breathe, the doctors there are obligated to give him nitroglygerin, oxygen, and a trip to the cath lab before calling the cops. Anyone unwilling to follow this rule does not belong in medicine. If the situation is less critical then it is ethically permissable to refer the patient to someone who is willing to do the procedure or treat the patient. But even then it is NEVER ethical to leave a patient untreated and without options for obtaining treatment, no matter how much you disapprove of them or their request.

  16. Pax Nortona - A Blog by Joel Sax
    Pax Nortona - A Blog by Joel Sax February 3, 2006 at 5:19 pm |

    Making the World Unsafe

    We all become targets.

  17. Joel Sax
    Joel Sax February 3, 2006 at 5:22 pm |

    Jill, well said. I refuse to dedicate my life to preparing for killing people, so I’m not in the military. My stand of conscience has brought me much grief and missed job opportunities outside the armed forced. If this is a true stand of conscience, they should be ready to pay the same price.

  18. evil_fizz
    evil_fizz February 3, 2006 at 5:58 pm |

    It’s not just conventional medical ethics that requires physicians treat those with medical emergencies. It’s federal law. (It’s called EMTALA, Emergency Medical Treatment and Active Labor Act, 42 USCS § 1395dd (2005) for those who want to check it out in Lexis.)

    Regarding the hospitals with discriminatory practices: the employer gets to set the standard. It’s not that their morality trumps. It’s that there’s a job to be done, the standards for which have been clearly articulated. If you don’t like whatever policies your boss sets, the solution is another job, not demanding to be excused.

  19. Caja
    Caja February 3, 2006 at 6:17 pm |

    How timely. I just saw this piece on conscientious objection in the British Medical Journal (through EurekAlert). The guy quoted also has a longer piece on the BMJ’s website. I wonder how much impact it will have. Excerpt:

    A doctors’ conscience has little place in the delivery of modern medical care, writes Julian Savulescu at the University of Oxford. If people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors. (Conscientious objection in medicine; BMJ Volume 332, pp 294-7)

  20. Julie
    Julie February 3, 2006 at 6:28 pm |

    I think you nailed it perfectly Jill… no one is saying you can’t be a pharmacist, they’re saying you can’t be a pharmacist and refuse to sell a product that your employer stocks. Or like you said, no one’s saying you have to perform abortions, they’re saying if you have a problem with it, don’t work for an abortion provider. I don’t understand what the problem with this very simple reality is.

  21. PLN
    PLN February 3, 2006 at 6:44 pm |

    While I’m basically on the side of everyone here on this issue–pharmacies should have the legal right to fire those who refuse to file prescriptions, even if they are doing so for reasons of conscience, and most of the cases in question are cases of people who don’t actually understand what it is they’re refusing and/or hold unreasonable beliefs–I do think that attention to broader questions about organizational structure is important here. I think liberalism means a commitment to a social order that does not heavily ‘tax’ conscience, that does not insist that one must violate one’s deeply held beliefs simply because one wishes to dispense medicine. Just as liberals ought to be–as this website is!–eager to criticize organizational practises that encourage sexist distributions of household labor and childrearing (rather than limit their comments to “if you don’t like it, work elsewhere”), we should acknowledge that there’s nothing in the deep structure of the universe that makes it -necessary- for someone who wants to be involved with medicine to go against their conscience. It’s a contingent and emergent property of the system that we have in place concerning medical care–a system that, among other things, heavily regulates and restricts entry. How to get from there to here is a good question, but I think it’s important not to let one’s reaction to -these- cases turn one against claims of conscience more generally, or think that just because the claims ought not override competing rights in these cases, that therefore the claims are illusory to begin with. Some of these people, at least, feel that they are forced to choose between their livelihood and their deep convictions–that’s a tragic choice we should acknowledge and mourn, rather than dismiss, even if it does arise only out of ignorance.

  22. kate
    kate February 3, 2006 at 6:45 pm |

    If Osama bin Laden stumbles into an ER clutching his chest and complaining that he can’t breathe, the doctors there are obligated to give him nitroglygerin, oxygen, and a trip to the cath lab before calling the cops. Anyone unwilling to follow this rule does not belong in medicine. If the situation is less critical then it is ethically permissable to refer the patient to someone who is willing to do the procedure or treat the patient. But even then it is NEVER ethical to leave a patient untreated and without options for obtaining treatment, no matter how much you disapprove of them or their request.

    Absolutely Diane and to the other poster who posted the federal laws on the issue of turning away persons in dire need of emergency care.

    Presently (or in the past?) the common reason for hospitals to turn away patients is lack of health insurance. I know that as when (if I may share an anecdote here) a young woman (18ys. old) with child and without insurance, even though I was part of a teenage pregnancy group, I was not given the regular ‘tour’ through the hospital prior to the birth as others were because it was known I would not be able to enjoy the benefits of modern birthing procedures (birthing chair; comfortable rooms). I was also told that no ‘reservation’ would be made for me by my physician as he didn’t want the hospital to think he was pushing uninsured patients on them. I had the pleasure of an embarrassing wait in the emergency waiting area while they prepared a barren tile room, a cot and a large clock for thirteen hours of hellish labor while an old nurse made cursory snide remarks about my age.

    Just the same, they did their duty and I had the child. And I believe it was federal law that kept them from banishing me to having the child at home with no medical care like so many poor women did prior to such laws.

    I have to say it again and again and again. Fundamentalist christianity places a high value on evangelism and non-conformity to a society they see as ‘inferior’ to their ideal. They see their actions — or non actions as their fullfillment of their god given duty to point up the ‘sin’ of the rest of us. Their believes and behaviors run counter to tolerance and individual rights and they don’t give a hoot. Their reward waits at the pearly gates and our suffering is well, deserved.

    Fact is that their behavior should not be tolerated when it is allowed to impinge on the ability of others to exercise their legally granted individual freedoms. Period. They attempt to win points by bullying.

  23. Amy Bo Bamy
    Amy Bo Bamy February 3, 2006 at 7:29 pm |

    Awesome post, Jill! With you all the way on this one.

  24. Kate
    Kate February 3, 2006 at 8:11 pm |

    About half of the proposals would shield pharmacists who refuse to fill prescriptions for birth control and “morning-after” pills because they believe the drugs cause abortions.

    These pills are not designed to cause abortions, they just slightly decrease the chance of implantation when fertilization occurs. Dozens of things might prevent implantation and/or cause miscarriages (after all about 1/3 of pregnacies end in miscarriage). When I was pregnant, I was told not to take any medications except tylonol without contacting the doctor first, not to eat soft cheese or pate, not to drink caffinated or alcoholic beverages (these are just the ones I remember) in part because they “might” contribute to a miscarriage during the first trimester – when of course pregnancy is invisible. The only way for people to be truly safe from “causing” an abortion, by these standards, would be to refuse all of these things – and probably many others – to any woman of childbearing age. Prohibition of activies with risk of falling, such as skiing, horseback riding and others could also be added. Am I paranoid? Women’s fragility used to be an excuse for massive restictions on women’s rights. Now that we have demonstrated that we’re not so fragile, doesn’t it make sense to fall back on the demonstrated fragility of the fertilized eggs and embryos that we may or may not be carrying?

  25. Gordon K
    Gordon K February 3, 2006 at 8:24 pm |

    No physician should be required to participate in an assisted suicide? For those readers that aren’t aware of the distinction, PAS (physician assisted suicide) refers to prescribing lethal drugs at the patient’s request; euthanasia is when someone other than the patient takes the final step of pushing the button or w/e.

    Why is PAS not something that a doctor should be required to do? After all, this is an issue of autonomy, is it not? I hardly see the difference between arguing that PAS gives patients control over their bodies and their lives, and arguing that abortion gives women control over their bodies and sexuality. In fact, pro-choice though I am, I would argue that the case is even more clear-cut for PAS, as there isn’t a potential future life involved, and PAS in its current incarnation (as in Oregon) is only legal when the patient involved will die in 7 months.

    So why is it that you argue for abortions, and against “conscientious objector” pharmacists, then deny that “conscientious objection” to PAS by a doctor is something to be concerned about? Just like Caja’s quote says, “A doctor’s conscience” is irrelevant. The patient’s desires are paramount in all but a few cases. I could go on here to draw an analogy between the interference of doctors and other authority figures in the lives of their patients, and the control exerted over women by the patriarchy, but I think I’ve made my point.

  26. zuzu
    zuzu February 3, 2006 at 10:25 pm | *

    Once you start creating exceptions for one kind of drug on moral grounds, it’s a short step to allowing exceptions for other drugs. For instance, at the time the pharmacist-refusals in Illinois were happening, someone — a man, no less — wrote into the Salt Lake City paper that he’d been refused a prescription for Antabuse (used to treat alcoholism) by a Utah pharmacist because he shouldn’t be drinking as a Mormon. There are some strains of fundamentalists who believe that mental illness is a sign of sin, or of demonic possession — what’s to keep them from refusing to dispense antidepressants, or antipsychotics?

  27. karpad
    karpad February 4, 2006 at 12:54 am |

    I’m waiting for some Scientologist to refuse to dispense Zoloft, and instead hand them a copy of some Hubbard book.

    When the crazy person the pharmacist follows isn’t White Aryan Jesus, I imagine the fundy support will dry up pretty quick.

  28. Robert
    Robert February 4, 2006 at 1:02 am |

    If pharmacists are to have a purely ministerial role in the dispensing of drugs, then why go to the trouble and expense (and it is considerable) of pharmaceutical education and training? Why not just let the drug companies dispense the drugs directly to consumers, and cut out the middleman.

    The Internet already makes that possible for anyone who cares to take that route; why not go whole hog and just empower the citizenry to make their own health care decisions without gatekeeper professionals? We aren’t children, after all.

  29. Nymphalidae
    Nymphalidae February 4, 2006 at 1:33 am |

    We also don’t all have the expertise in human physiology/biochemistry to know exactly how all the drugs work and what they will interact with.

  30. Robert
    Robert February 4, 2006 at 2:19 am |

    We also don’t all have the expertise in human physiology/biochemistry to know exactly how all the drugs work and what they will interact with.

    So ask someone.

    If we’re free, then we don’t need the permission of some gatekeeper, right? That’s a consistent principle, right?

  31. Jo
    Jo February 4, 2006 at 5:37 am |

    I am a nurse, and I work under a conscience clause. The thing that bugs me about the legislation discussed here is this: it doesn’t go as far as the existing clause in my state does.

    Here’s the breakdown of what the nursing conscience clause I work under says: If you have a moral objection to performing a certain procedure, you don’t have to. But what you *do* have to do is find somebody else to do/assist with that procedure, right there and then, so that the patient doesn’t have a poor outcome from your refusal. Can’t find somebody to take over for you? Then you get to suck it up and deal.

    The primary difference between the existing CC I work under (and haven’t had to use, incidentally) and the new ones is this: The new clauses make no provision for the protection of the patient. Existing clauses recognize that patient welfare and safety are our primary goals as health care workers, and as such, we sometimes have to do things we disagree with in order to ensure that the patient’s okay at the end of the day.

    The new clauses, the ones that allow folks to refuse services but don’t require that they put the patient’s welfare above their own morality, are nothing but a bunch o’ wingnut whining.

  32. JeffL
    JeffL February 4, 2006 at 11:27 am |

    We also don’t all have the expertise in human physiology/biochemistry to know exactly how all the drugs work and what they will interact with.

    So ask someone.

    Someone like a pharmacist?

    If we’re free, then we don’t need the permission of some gatekeeper, right? That’s a consistent principle, right?

    Exactly the point — Pharmacist aren’t gatekeepers. The job is to properly dispense medicines, ensuring that the meds remain safe and effective. Nothing more, and nothing less.

  33. Sally
    Sally February 4, 2006 at 11:46 am |

    I don’t know that expertise usually comes with a mandate to be a gatekeeper. I mean, auto mechanics have expertise, and I don’t think they get a conscience clause that allows vegetarian mechanics to refrain from fixing trucks that will take cows to slaughter or gives atheist car mechanics the right to tell their bosses that they won’t fix a minister’s car, since he might use it to spread the Gospel.

    But I’m still wondering how the comments here jibe with the comments on Piny’s plastic surgery thread. Isn’t a doctor exercising his or her conscience when he or she decides not to perform plastic surgery on a paying customer who clearly has some sort of compulsion to “fix” things that aren’t broken?

  34. zuzu
    zuzu February 4, 2006 at 1:08 pm | *

    If pharmacists are to have a purely ministerial role in the dispensing of drugs, then why go to the trouble and expense (and it is considerable) of pharmaceutical education and training?

    Patients who get scrips from multiple doctors (particularly the elderly) often run the risk of interactions, which the pharmacist is supposed to be aware of. The pharmacist is also responsible for mixing certain drugs and for suggesting generics where available.

    But I’m still wondering how the comments here jibe with the comments on Piny’s plastic surgery thread. Isn’t a doctor exercising his or her conscience when he or she decides not to perform plastic surgery on a paying customer who clearly has some sort of compulsion to “fix” things that aren’t broken?

    That would fall under medical judgment, I would think, and the idea of “first, do no harm.” Plastic surgeons often refuse to treat certain patients because what they’re asking for can’t be achieved with the techniques available. Also, it’s important to remember that plastic surgery is an elective procedure, and the consultation occurs prior to the establishment of a doctor-patient relationship. Someone presenting to a doctor for an emergent procedure, or already under the care of a hospital, is in a different relationship with the medical establishment than one who’s trying to find a doctor for an elective procedure.

  35. Robert
    Robert February 4, 2006 at 1:20 pm |

    I want some Vicodin. It makes my head stop hurting after all the drinking I did Friday night. Why can’t I have it?

  36. Sally
    Sally February 4, 2006 at 1:36 pm |

    That would fall under medical judgment, I would think, and the idea of “first, do no harm.”

    Ok, see, I think this is what my issue is. I am really, really aware of the power relations between doctors and patients and the potential for doctors to abuse their power and authority. But I think there’s something to be said for preserving the idea of medical judgement and the imperative to do no harm. And that’s an ethical imperative. What constitutes “harm” is an ethical question. I don’t think it’s possible for doctors to practice medicine in a values-neutral way, and I think that demanding that they do so just obscures the ethical issues that come up in any medical practice.

    I’m further really disturbed by the idea that medical ethics can be reduced to a question of employment relations. I just don’t see any reason to think that large corporations are any more likely to share my values than individual doctors are.

    I don’t really have the same qualms about pharmacists, though. I don’t have a personal relationship with my pharmacist, and I’m not asking him or her to make decisions about my treatment. I really do think pharmacists should just dispense drugs, alert me and my doctor to possible interactions, and keep their values out of it.

  37. zuzu
    zuzu February 4, 2006 at 1:45 pm | *

    But Sally, it does come down to employment relationships. You need to be under a doctor’s care before the doctor has a duty to you. If you’re brought into an ER, the doctor can’t refuse to treat you, because the treatment relationship starts once you get in the ambulance. A plastic surgeon in a consultation hasn’t yet agreed to treat you, and so therefore isn’t bound to do any procedure you ask for. You’re also free to go consult with someone else, something you’re not really free to do when you’re put on an ambulance (which is one reason emergency contraception is a big issue with Catholic hospitals — if you’re brought in by ambulance after being raped, you may not have a choice of where you’re brought, so the care given to you will differ based on chance. Several states, therefore, are trying to ensure that EC will be offered by Catholic hospitals).

  38. Stacy
    Stacy February 4, 2006 at 2:29 pm |

    I can’t really agree with “protecting” the pharmacists that refuse to dispense meds on moral grounds.

    It doesn’t seem to be fair to the business owner. For instance, let’s say that I own a pharmacy, and one of my pharmacists refuses to dispense birth control. However, birth control might bring in a lot of business for me. So I have two options: Lose customers who are upset with this pharmacist and thus take their business elsewhere, or have an additional pharmacist (that I might not need otherwise) on my payroll for the sole purpose of babysitting in case someone comes in to have a birth control prescription filled.

    Look, if it’s my business, and you aren’t doing the job I hired you to do, I have every right to fire you.

    However, I feel it’s the same on the opposite opinion also, I don’t think you can “make” a business owner sell a product that they do not wish to, or “make” them fire employees that they otherwise would keep.

    I think this is a situation that the marketplace should figure out, I don’t know if government should be involved. If you disagree with a company’s policy, stop giving them your dollar. Write a letter and let them know why you will no longer be their customer. It just so happens that the group that uses birth control is the same that makes up the largest group of consumers – women. And maybe if we show these companies that the amount of money they stand to lose based on thier offensive policies, they might have a change of heart. It worked with Target.

  39. Sally
    Sally February 4, 2006 at 3:03 pm |

    I’m not sure I’m following you. There are a whole lot of medical situations in between the consult for totally elective surgery scenario and the rushed into an emergency room scenario. That’s the medical space I inhabit: I’m under the care of a bunch of doctors, and I know that down the line we’ll have to make decisions about my treatment. I don’t think that my doctors are required to do anything I demand of them. If I come in and say “my ear really hurts and I want oxycontin,” they’re not required to say “well, that’s addictive, and there are other things we can do for ear pain, but it’s your call, so here you go.” Nor do I think that their bosses should dictate the kind of care they give me. If someone on the financial side of things tells one of my doctors that it would be good to order a lot of extra tests, because the hospital could use the money, I expect my doctor to say no, not to say “you’re the boss, and if I don’t like it, my only recourse is to quit.”

    And that last scenario is what I mean when I talk about reducing medical ethics to an employment relation. People here seem to think that it’s a good idea to give administrators all the power. They’re the employers; doctors are employees; if the doctors don’t like what the administrators tell them, they can quit. And that, frankly, scares me. I don’t think that administrators are any more equipped than doctors to deal with the messy ethical issues that come up in the practice of medicine.

  40. Sally
    Sally February 4, 2006 at 3:04 pm |

    erm, that last post was directed to zuzu.

  41. zuzu
    zuzu February 4, 2006 at 3:21 pm | *

    Medical care, once a treatment relationship has been established, should be consistent with good medical care and good medical ethics. And part of good medical care and good medical ethics is making decisions based on treatment, not religion or some outside consideration. So if you want oxycontin for an ear infection, the doctor isn’t obligated to give you oxycontin, but *is* required to treat the infection consistent with good medical practice. Or, in the odd event that the doctor considers your ear pain to be your own fault and that therefore he won’t treat you, he’s obligated to find you another doctor who *will* treat you. And if he doesn’t, he’s just committed malpractice because he agreed to take on your care and then didn’t give you care consistent with good medical practice.

    So doctors do have some consequences for not providing care once a treatment relationship is established. Pharmacists who are trying to get out of having to provide service or to ensure that the customer gets service without delay are trying to escape any consequences for their refusal, something not accorded to doctors.

    I mentioned the plastic surgeon because you had brought that up.

  42. JeffL
    JeffL February 4, 2006 at 5:43 pm |

    I want some Vicodin. It makes my head stop hurting after all the drinking I did Friday night. Why can’t I have it?

    If you get a doc to write you a ‘scrip, you can. And if you present said ‘scip, it’s not up to the pharmacist to decide wether or not you should get the medicine.

    Or are you trying to say something about the doctor’s role?

  43. Robert
    Robert February 4, 2006 at 6:04 pm |

    I’m asking why there’s a gatekeeper on my right to the health care of my choice.

  44. evil_fizz
    evil_fizz February 4, 2006 at 7:02 pm |

    Because you have absolutely no training that would enable you to choose appropriate care. Fundamentally, it’s unsafe. The role of the physician is to present you with the medically appropriate alternatives given your situation. You have no idea if what you need is Vicodan, a lot of water to rehydrate after your Friday night bender, or treatment for menigitis. Nor do you have the tools to figure this out on your own. Google is not going to help with “why does my head hurt?”

  45. La Lubu
    La Lubu February 4, 2006 at 7:08 pm |

    I’m asking why there’s a gatekeeper on my right to the health care of my choice.

    I’m not sure I’m following you Robert; are you asking “why isn’t the doctor handing me the medicine—why do we need pharmacists to begin with?” or are you asking “why can’t I prescribe medicine for myself—at my own risk if I do it wrong?”

  46. zuzu
    zuzu February 4, 2006 at 8:00 pm | *

    I’m asking why there’s a gatekeeper on my right to the health care of my choice.

    Because you’re trying to get your drugs through a doctor, not a dealer. Go find a dealer. You might want to talk to Rush Limbaugh’s maid for advice.

  47. Robert
    Robert February 4, 2006 at 9:07 pm |

    So fizz, my bodily autonomy – my right to control what goes in and out of the ol’ corpus – is contingent upon my TRAINING?

    Lubu, I’m asking why I can’t decide for myself what to do with my body.

    Zuzu, thanks for the advice that I can achieve my rights through the black market if civil society won’t respect them.

    Doesn’t anybody want to stand up for the principle of bodily autonomy?

  48. La Lubu
    La Lubu February 5, 2006 at 10:44 am |

    So fizz, my bodily autonomy – my right to control what goes in and out of the ol’ corpus – is contingent upon my TRAINING?

    No, this is not the case. Your ability to access certain substances that may or may not harm your body (depending on how/how often/in what quantity they are used) is limited depending on your training. Of course, you don’t really have to pay attention to this; you are free to access prescription meds (for good or ill) from foreign countries via the Internet—although illegal, it’s doubtful you would ever be prosceuted for obtaining these meds for your own use, even if it was to feed your addiction.

    I guess you could compare this situation with the right to obtain an abortion from a physician, rather than attempt it on your own. You wouldn’t be prosecuted for a DIY abortion, but it isn’t advisable.

    You can decide what to do with your own body, see? You just may not be able to do it yourself. (And if you really want that Vicodin-as-a-hangover “cure”, if you want it badly enough, you’ll find the doc willing to prescribe it for you.)

  49. ginmar
    ginmar February 5, 2006 at 10:50 am |

    Doesn’t anybody want to stand up for the principle of allowing Robert to be transparent yet again?

  50. Tony
    Tony February 5, 2006 at 2:58 pm |

    Stacy said:
    I can’t really agree with “protecting” the pharmacists that refuse to dispense meds on moral grounds.

    I can’t either. If you refuse to do something your employer wants you to do, you should be fired. There are times when you have to choose between doing the right thing and remaining employed.

    If I own a pharmacy, nobody should be telling me what medicines I have to stock and dispense. If I don’t stock the kind of medicine you want, you are welcome to find another pharmacy that will provide you the medicines you want and your doctor prescribed.

    All the rhetoric about emergency rooms, and treating dying people are just that, rhetoric. Pregnancy isn’t a life threatening condition (at least in the pre-implantation stage). As a matter of fact, it isn’t even an illness. So comparing it to Osama bin Laden walking into the emergency room is somewhat incorrect.

    There are doctors who refuse to perform abortions. Nobody has proposed forcing them to do that (though they are talking about that in the EU).

    I would imagine that once the number of doctors who will perform abortions shrink to unsustainable levels, there will be an outcry, but then people who have a problem with certain procedures simply will not become doctors.

  51. La Lubu
    La Lubu February 5, 2006 at 5:35 pm |

    If I own a pharmacy, nobody should be telling me what medicines I have to stock and dispense.

    The only medicines that seem to be “problematic” for certain pharmacists, or pharmacies, to stock and dispense are those medicines that just happen to be the ones that prevent pregnancy in women. Funny, that.

    If I don’t stock the kind of medicine you want, you are welcome to find another pharmacy that will provide you the medicines you want and your doctor prescribed.

    Spoken like someone who lives in a large city where there is a pharmacy on every block. Rural and small town women don’t have the luxury of “pharmacy shopping”. Also, refusal to fill prescriptions isn’t generally something that a pharmacy promotes as a business strategy. You won’t know a pharmacist isn’t going to fill your prescription until you go up to the counter, and your pharmacist rips up your prescription on “moral grounds”. Perhaps pharmacies should be required to post on their front doors whether they are a “full-service” pharmacy (“we provide birth control”) or a partial-service pharmacy (“we provide every medication under the sun except birth control”). That way, the pharmacist would have right-of-conscience, and so would the customer—the customer would have the ability to vote with his or her wallet, which pharmacy to spend money with, no?

  52. Gordon K
    Gordon K February 5, 2006 at 7:44 pm |

    The only medicines that seem to be “problematic” for certain pharmacists, or pharmacies, to stock and dispense are those medicines that just happen to be the ones that prevent pregnancy in women. Funny, that.

    Nope. Antabuse was mentioned above, for example; it’s a drug used to treat addiction; naltrexone, a similar drug, has been involved in similar disputes, as have buprenorphine and methadone. So has Valtrex, used to treat herpes. And guess what the American Pharmacist’s Association’s “conscience clause” policy was in reaction to? Yup, physician assisted suicide in Oregon, where the issue has come up in court multiple times.

    On a personal note, I went through a period immediately after major leg surgery where I would have excruciating leg spasms late at night that would keep me up for hours. I was eight at the time, and it was so bad that I made my mother call the doctor immediately (yes, at 3 in the morning) after the first time it happened – and I have an incredibly high pain threshold. Over the course of the next two or three weeks, I switched from drug to drug, as none of them worked – I believe I tried valium, codeine, percocet, morphine, and one or two others. We became familiar faces at the pharmacy … I honestly believe that the only reason they filled the later prescriptions was that I was there, clad in a cast from my sternum to my toes, and that we were your stereotypical white suburbanite mother and son.

    This is a serious issue for women *and* for men. Women may be subject to more judgment based on their sexual choices, and they may have more at stake (medically, at least) when there is a potential for pregnancy. But access to prompt and honest medical care is important enough that there’s no need for hyperbole. And the right-wingnut pharmacists who refuse to fill BCP and EC prescriptions don’t need to be given any ideas with respect to Viagra, Valtrex, condoms, or anything else along those lines …

  53. zuzu
    zuzu February 5, 2006 at 9:21 pm | *

    Zuzu, thanks for the advice that I can achieve my rights through the black market if civil society won’t respect them.

    Babydoll, I’d love to be able to achieve my rights to bodily autonomy by having cannabis readily available, but I can accept that I need other sources for that.

    BTW, what do you think of pennyroyal tea?

  54. zuzu
    zuzu February 5, 2006 at 9:46 pm | *

    Heh. Kurt knew his shit.

  55. Robert
    Robert February 5, 2006 at 11:01 pm |

    You handled yourself very graciously, Jill. But you’re still wrong about everything.

    Does pennyroyal need permission from me to exist?

    My point with all this is that feminists don’t appear to be arguing for bodily autonomy, except as a rhetorical device. Instead, you’re arguing for a specific, gender-based, one-off privilege under a hierarchical system of other-dominated health care. The government and civil society can make all kinds of rules that restrain our right to treat our health as we wish – but they can’t make ANY rule or regulation of this one, particular thing, because it violates the right to privacy! An amazingly specific privacy which somehow covers no other medical issues.

    This is statist feminism, that wants a dominating centrum that disperses power, but grants women a special privilege and power. Which is fine, I guess (you fascists) – but you’d get a lot more support from (for example) libertarians like me who would have a very difficult time arguing against an abortion-rights case presented on the grounds of positive universal liberty.

  56. evil_fizz
    evil_fizz February 6, 2006 at 12:38 am |

    So fizz, my bodily autonomy – my right to control what goes in and out of the ol’ corpus – is contingent upon my TRAINING?

    In some cases, yes. Do you know enough to be able to take Tylenol without a problem? Sure. Do you know enough to be able to diagnose anti-biotic resistent staph and to get your hands on floroquinolones? I seriously doubt it. If you’d like to try and figure out what pills you need, go right ahead and try. Personally, I don’t think the average person has enough information or ready access to enough information to make those choices safely.

    (Incidentially, your right to bodily autonomy is tempered by public health concerns. This means not taking penicilin for every sniffle and not being strung out on Oxycontin 7 days a week.)

  57. Donna
    Donna February 6, 2006 at 3:01 am |

    but they can’t make ANY rule or regulation of this one, particular thing, because it violates the right to privacy! An amazingly specific privacy which somehow covers no other medical issues.

    Huh? Do you assume that women can just march up to the pharmacist and DEMAND birth control? Not quite. As far as I know, it requires a doctor’s permission and prescription same as any other controlled medication. So we’re not talking about some ‘amazingly specific privacy’ here and I can’t for the life of me figure out how you are concluding that. We just think we should be able to get our duly prescribed birth control in the same manner that you can get your duly prescribed Vicodin (or Viagra). Your gatekeeper straw issue is irrelevent to this discussion.

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