Customer isn't always right on issues of conscience

The Province, 13 June, 2001
Reproduced with permission

. . .As radical "medical therapies" are legitimized by law, health-care providers are increasingly being asked to violate their moral convictions by catering to the wishes of "the consumer." . . .

Reading today's papers, one might assume that all of our modern health-care battles revolve around issues of fair pay. After all, nurses, paramedics and, depending on the day, any other group of healthcare workers are holding back services to force higher wages.

But beyond the picket lines, a very different kind of healthcare debate is brewing over conscience -- and what role individual moral convictions should have in performing daily duties.

For example, the NDP government felt that the so-called morning after pill (MAP), a known abortifacient, was so integral to bettering women's health that it legislated the pill be dispensed -- without prescription or doctor's consult -- by pharmacists.

Women who may be pregnant now go to the pharmacy counter, fully expecting that their right to freedom of abortion (as implied by Canadian law) will be respected. But there are a host of pharmacists who believe that their right to freedom of conscience (and perhaps allegiance to the Hippocratic Oath) dictates that they not dispense medication that will contribute to abortion or death.

Whose rights should supersede the others?

Welcome to Sticky Issues 101 -- the new prerequisite for health-care workers in the 21st century.

In B.C., the ethical dilemma has been bureaucratically simplified -- pharmacists who currently refuse to dispense the drug or who refer the patient to another pharmacist who will are in breach of their provincial association's newly (and conveniently) altered code of ethics.

But it doesn't stop there. As radical "medical therapies" are legitimized by law, health-care providers are increasingly being asked to violate their moral convictions by catering to the wishes of "the consumer." RU-486 (an abortion pill that works up to 49 days post conception) pushes the limits of conscience even further, as do the growing availability of increasingly radical reproductive technologies and the very real possibility that euthanasia drugs will soon hit the market.

Some may think I'm being melodramatic. Yet, last year, Canada Safeway issued a directive to its pharmacists stating that they are legally obligated to fill all requests for legal drugs and outlining its expectations that pharmacists (against their conscience if no other pharmacist is available) fill "certain prescriptions, e.g. euthanasia drugs, RU-486 ('morning-after pill')" in a timely and courteous manner. After all, it's all about customer service.

Safeway may be pushing the common sense behind customer service a bit too far by extending its offerings to euthanasia pills -- after all, won't that rather dramatically diminish the customer base? But pharmacists in Oregon are already handing out do-it-yourself suicide pills.

The B.C. College of Pharmacists also issued a paper stating that services which, at present, may cause moral objection but must still be provided, include "high doses of narcotics to control pain that might hasten death in the terminally ill, and medications for terminal sedation." Once again illustrating what the future holds, it says that mandated services "might expand to include preparation of drugs to assist voluntary or involuntary suicide, cloning, genetic manipulation or even suicide."

So let's not kid ourselves in saying that conscience issues are limited to the abortion debate. How we legislate matters of conscience now could ultimately (and intentionally) pave the road to drone-like response to customer-driven requests for chemicals and technologies that are highly controversial, deadly and/or have more to do with scientific and social experimentation than legitimate health care.

Forget the philosophers and ethicists -- suddenly it is the former chemistry geeks who stand at the gateway to the Brave New World. Knowing this, Dr. Will Johnston, President of Canadian Physicians for Life says, "Do we really want them to 'dispense on demand?' Or would we prefer that they act like the independent health professionals that they are trained to be?"

It is ironic that Canadians welcome diversity and tolerance, but tend to reject or suspect people who act on conscience. We let health-care workers strike over monetary issues, yet demand silence on conscience issues.

According to Dr. Paul Ranalli, a neurologist at the University of Toronto, the idea that "the customer is always right may be a winning ethic for a fast-food franchise, but it is ill-suited to be the guiding principle (for healthcare.)"

Courtesy of The Province newspaper.

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