A Tough Call
Does conscience protection excuse a health professional from providing
after-abortion care?
11 February, 2011
MercatorNet
Reproduced under a Creative Commons Licence
Last November a Planned Parenthood nurse in Idaho
rang a local pharmacist and asked for methergine --
a drug used to prevent bleeding after childbirth or
an abortion. Considering the source of the request
it is quite likely to have been the latter, and the
pharmacist, who has a conscientious objection to
abortion, asked whether that was the case. The
caller refused to say, citing federal privacy law,
and the pharmacist refused to fill the prescription.
The caller then asked for a referral to another
pharmacy and the pharmacist hung up on her.
[Related: Idaho Case of
Pharmacist Refusal]
For a year now,
conscience legislation has been extended to
Idaho pharmacists, giving them the right to refuse
to provide any health care service or dispense any
drugs that violate their conscience. The freedom to
decline services applies to abortion, emergency
contraception, stem cell treatment, and end of life
care and treatment. It is a right not meant to
restrict or limit, in any way, health care
services.
Yet there are some who wish that conscience
protection laws could be abolished, and this
incident has helped their cause. Planned Parenthood
has complained to the state about the pharmacist,
alleging that she was not covered by the law.
Whether she acted legally is not for me to decide
but for the proper tribunal. My concern is with the
ethics of refusing to dispense methergine in those
circumstances.
Reports of the case portray the pharmacist as
having acted in an uncaring, unprofessional, and
discriminatory manner -- behaviour which is never
justified. And yet this is the sort of mess any
healthcare provider could get herself into if she
has only got as far in her ethical reasoning as,
"abortion is evil and I don't want anything to do
with it".
So, what are the broad ethical
principles that underpin decision making in
these fraught situations?
In order for a healthcare provider to make a good
moral decision, there is an obligation to be
familiar with the relevant facts and recent research
on a given issue, as well as the obligation to work
out beforehand the practical consequences of one's
beliefs. I call this intelligent foresight.
First the facts. Did the pharmacist not know what
the drug was for? After all, methergine is not used
as an abortifacient but is meant to stop post-partum
or post-abortion bleeding. If it was a drug she was
unfamiliar with, did she not have easy access to the
drug company website or other information source? If
so, she could have readily asked the nurse to wait
while she did a quick search.
Next, the application of principles to the
situation. Wesley Smith has done an excellent
exercise of this on his
blog, Secondhand Smoke
In his analysis, he surmises that the pharmacist
thought the patient had an abortion. She found that
morally repugnant. But refusing the prescription for
that reason, he explains, is no more acceptable than
refusing to dispense cancer treatment medications to
a lung cancer patient or the anti bleeding
medication for a bank robber who was shot. "Such
moral judgments about patients are unacceptable. It
is the procedure that must be objectionable."
In the Idaho case there certainly appears to be a
lack of understanding as to what cooperation with
the act of abortion entails. Even assuming that the
drug were a necessary part of an abortion protocol,
without which no abortionist would dare to proceed,
the ethical principle of double effect would come
into play, meaning that the pharmacist intends to
prevent harm to the mother should haemorrhaging
occur, even though she foresees that providing the
drug will have the unintended effect of enabling the
abortion to go forward.
The care offered to the sick can never be
judgmental in nature. In the case of HIV, a person
may have contracted this virus via an immoral
lifestyle or by accident but we do not distinguish
between causes when we give them medication or care.
We do not reject the person who has acquired the
disease through IV drug use or sexual promiscuity --
although we would certainly be showing care for the
person if we offered counselling against such poor
lifestyle choices. The most telling application of
this principle is the fact that the
Catholic
Church cares for one in four people
living with HIV around the world.
But what if I refuse to sell the morning after
pill to a woman in my pharmacy? Am I not then
breaking my own rules of preventing harm and not
judging the person?
To this I answer that not dispensing the drug in
this case is more in keeping with my mission
statement of first doing no harm than would be
dispensing it. The judgement I make is not based on
the values or behaviour of the woman, but on my own
ethical values, which proscribe participation in a
potential abortion at its earliest stages -- even
before the woman is aware that she may be pregnant.
Furthermore, the assumption that not dispensing
the wanted drug is harmful to the patient is based
on social considerations, not her health. The case
is quite different to refusing a drug that stops
haemorrhaging. If I refuse to dispense the morning
after pill a woman's health will not be harmed. On
the contrary. To dispense a potent dose of steroids
for the purpose of eradicating a new life at its
earliest stage can also turn out to
harm women in ways we had not fathomed, not
taking into account some little-explored benefits of
motherhood, even when unplanned.
While I cannot force a woman to carry her child,
neither will I be forced to help her terminate. Once
again, not providing the morning after pill is a
million miles away from refusing to provide a
lifesaving drug.
Returning to the
Idaho incident, I agree with Wesley Smith that
it does not appear to be a proper conscience clause
case. The pharmacist was undoubtedly
well-intentioned, but not sufficiently informed at
the ethical level. In another way, the incident as
reported -- ending with the pharmacist hanging up on
the caller -- seems to have more to do with a rude
reaction to a request; whether sparked by
professional incompetence or panic reflex, I cannot
judge.
But I do think it was a lost opportunity. After
all, it's not every day a principled pharmacist gets
to deal with a renowned abortion provider.