Media Commentary
January-March, 2001

With a little prodding, the Equal Employment Opportunity Commission bought the dubious argument that "conscience clauses" are violations of antidiscrimination law. 

So far the public and the news media have paid little attention to the debate, because contraceptive funding seems like a ho-hum issue. Most people, including many Catholics, do not consider contraception immoral. But some religious leaders think this is a slippery slope. The slide could lead to mandatory funding of the abortion pill, euthanasia, and assisted suicide. So, many churches feel they have to make a stand here, before they are dragooned into funding new abortion medicines, cloning, and suicide pills.

Joe Loconte of the Heritage Foundation wrote: "It is no whimsy to worry when people are forced to bankroll whatever reproductive practices are in vogue­today chemical abortion, tomorrow cloning." 

Forced doctrine? Last summer the Washington, D.C., City Council tried to force all District employers to provide coverage for contraceptives and some abortifacients, with no exemption for conscience. With a burst of Ted Turner-style Catholic baiting, a councilman angrily waved around a picture of the pope, railing about dogma and the folly of "surrendering decision on public- health matters to the church." The National Association of Evangelicals expressed sympathy for Catholic leaders, saying that "requring birth control coverage is a veritable assault on the integrity of their religious institutions."

The D.C. council passed the bill unanimously, but when Congress threatened to intervene, D.C. Mayor Anthony Williams pocket-vetoed the bill. 

In New York, the state Catholic Conference has a lot of clout on the basis of its massive spending on the poor and the sick. The group says flatly it will not be implicated in delivering services it considers immoral. But it is open to the idea of having the employees of Catholic institutions get these services directly from the state. The health bills affect millions of women, but only 10,000 to 20,000 would be affected by the conscience clause. The Catholic Conference says it would cost the state $4 million or $5 million a year to pick up the cost of contraception for these women. 

So far, the strangest outcome of a struggle over a conscience clause has been in California. The state passed a law allowing only narrow use of the clause. It can be claimed by religious organizations that hire only adherents of their faith and devote their efforts to religious training. This turns Catholic charities, colleges, and hospitals into "secular" institutions, which must therefore provide coverage the church considers immoral. It is a nonsolution that makes little sense. If Catholics wanted to bar non-Catholics from their institutions in order to qualify for the exemption, they would have to violate state and federal antidiscrimination laws. Besides, even core institutions like seminaries and individual churches and rectories commonly have non-Catholic employees. More broadly, the California law reflects the elite notion that religion should be driven from the public square. If religious attempts to serve and change the culture can be separated out as somehow secular, faith isn't much more than an offstage pastime. 

The central issue here is an attempt to use state power to force churches to violate their own principles. Jean Bethke Elshtain of the University of Chicago Divinity School calls this an example of "liberal monism," an enforced monoculture created by people who talk expansively about freedom and pluralism but who, in fact, work to erase pluralism and bring private groups into line with state orthodoxy. The "conscience clause" issue has obvious implications for a government alliance with faith-based social action groups. If we want a partnership, forcing churches to compromise their moral beliefs is not a great start. 

ADVISORY BOARD
<sup>Janet Ajzenstat, BA,MA,Ph.d
Associate Professor,
Dept. of Political Science,
McMaster University,
Hamilton, Ontario, Canada

Dr. Shahid Athar, M.D.
Clinical Associate Professor
of Medicine & Endocrinology,
Indiana School of Medicine,
Indianapolis, Indiana, U.S.A</sup>..

1 February, 2001

The Editor,
Pharmacy Practice (on-line)

Dear Sir/Madam:

Freedom of conscience and religion enjoy privileged status in Canada and are "fundamental" goods guaranteed by the Charter of Rights, but the Charter does not similarly guarantee professional or economic self-interest. Frank Archer’s claim that this observation implies an unrestricted "right to act on all matters of conscience and religion" is at least extravagant ("Whose Rights Are They, Anyway?" Pharmacy Practice, 8 January, 2001).

No one pretends that freedom of conscience is absolute, but there is a duty to accommodate conscientious objectors in the exercise of that freedom. The extent of accommodation required depends upon the facts of the case and the law, not upon Mr. Archer’s code of ethics. This does not mean that his code of ethics is irrelevant, but it does not trump the Charter in evaluating conflicting claims in the workplace. The power of self-governance is not granted to the professions so that they can declare a "Charter-free zone" and deprive their members of fundamental freedoms.

Mr. Archer also accuses a conscientious objector of "imposing her own moral views" because she declines to help someone do something she considers immoral. Change the scenario: a worker with friends who mock an old man wearing a turban. He may be afraid to protest because, as Mr. Archer notes, he may have to "pay a price" for acting "contrary to the consensus view" of his peers. But if he disassociates himself from racism by walking away, would Mr. Archer complain that he is ‘imposing his moral views’?

 What is at stake in such situations is personal integrity, that ‘wholeness’ of the person that is violated when one is forced to live in contradiction to the core of one’s being. That is the concern of the worker who refuses to be associated with racism, and a pharmacist who, for reasons of conscience, refuses to be associated with certain services or products.

Granted: Mr. Archer does not accept the moral outlook of the conscientious objector, and would deprive the objector of freedom of conscience simply because her viewpoint differs from his own. He is supported in this by the College of Pharmacists of British Columbia. But neither he nor any college of pharmacy in Canada has yet demonstrated that his ethics are superior to that of his dissenting colleagues. Perhaps he will make a start in this direction by explaining why his College deems it ethical to refuse to dispense Preven because the price isn’t right, but unethical to refuse because it may cause the death of the early embryo.

Sincerely,

Sean Murphy,
Administrator
 

ADVISORY BOARD
<sup>Janet Ajzenstat, BA,MA,Ph.d
Associate Professor,
Dept. of Political Science,
McMaster University,
Hamilton, Ontario, Canada

Dr. Shahid Athar, M.D.
Clinical Associate Professor
of Medicine & Endocrinology,
Indiana School of Medicine,
Indianapolis, Indiana, U.S.A</sup>..

29 January, 2001

The Editor,
Canadian Pharmaceutical Journal,
1785 Alta Vista Drive,
Ottawa, Ontario
K1G 3Y6

Dear Sir:

The January editorial ("Compromise") in the Canadian Pharmaceutical Journal is a welcome invitation to reflect more deeply on the serious obligation to accommodate freedom of conscience within the profession.

Is there, in fact, anywhere in Canada, a community in which a single pharmacist is the only health-care professional able to supply the ‘morning after pill’? The editorial describes such a situation as "hypothetical"; "mythical" seems more appropriate. The main point, in any case, is that adequate access to the drug can be arranged without forcing dissenting pharmacists to assist in providing it.

The issue of referral (‘pre-arranged access’) is correctly identified as a key point in the disagreement between conscientious objectors and their opponents. The problem is that dissenting pharmacists have a visceral sense of wrongness that their opponents do not share, and the absence of that sense of wrongness makes it genuinely difficult for their opponents to appreciate their concerns.

A satisfactory resolution to this problem can be achieved with patience, perseverance, good will and, as the editorial suggests, some creativity and flexibility. Surely these virtues are not lacking in the profession.

Sincerely,

Sean Murphy,
Administrator

ADVISORY BOARD
<sup>Janet Ajzenstat, BA,MA,Ph.d
Associate Professor,
Dept. of Political Science,
McMaster University,
Hamilton, Ontario, Canada

Dr. Shahid Athar, M.D.
Clinical Associate Professor
of Medicine & Endocrinology,
Indiana School of Medicine,
Indianapolis, Indiana, U.S.A</sup>..

17 January, 2001
The Editor,
The London Free Press,
369 York St., P.O. Box 2280
London, Ontario
N6A 4G1

Dear Sir/Madam:

Sharon Osvald’s op/ed piece (Can Workplace, Conscience, Co-exist? 16 January, 2001) refers to a difference in belief about conception. The controversy about the ‘morning after pill’ actually begins to swirl around the definition of conception. Traditionally, science has defined conception as the union of sperm and egg (fertilization). Standard texts on human embryology continue to use this definition, and describe this as the point at which a new human individual begins to exist. The existence of the individual is not a matter of belief, but can actually be observed in the case of in vitro fertilization.

Only with the fact of this existence does belief enter the picture, and then, indeed, the controversy begins to blow a full gale. Some believe that this human individual deserves the same protection and respect due to individuals who have been born, and others do not. The disagreement is not about the existence of a human individual, but about what moral obligations are called forth by that existence.

Dissenting health care workers have every reason to challenge the competence of their employers or professional associations to adjudicate this disagreement, which is not about science, but about morality.

Sincerely,

Sean Murphy,
Administrator

Can Workplace, Conscience Co-exist?
by Sharon Osvald, Freelance Writer (London, Ontario, Canada)
The London Free Press, 16 January, 2001 (Editorial/Opinion)
(Reproduced with permission)

It's something most people will have to face at least once in their lives.  Whether it is being asked to work in a dangerous environment or operate a vehicle that is not safe, it can be difficult to balance your convictions and responsibilities at work without affecting your job. 

The first time it happened to me, I was pressured into working a shift under-staffed in a group home and therefore had to diffuse a violent situation alone.  It was then I realized an employee's rights on paper and rights in practise are two different things. 

Perhaps it was struggling with the morality of removing a feeding tube that would end a patient's life or being asked to assist in abortions, but up until now it was mainly doctors and nurses that had to walk this tightrope when it came to matters of ethics and conscience in the workplace. 

Recently, more and more pharmacists are finding themselves involved in the battle of professional expectations versus conscience. 

A current controversy surrounds two emergency contraceptives, Preven and Plan B, nicknamed the morning-after pill. Both have been approved in Canada and recently have become available without a doctor's prescription in British Columbia. 

In actual fact, it is not new. Celeste McGovern of Pharmacists for Life says, "Doctors have given women fearing unwanted pregnancy concentrated birth control hormones within 72 hours of sex ever since Albert Yuzpe observed their effect on the endometrium (lining of the womb) in the 1970s: the hormones make the womb a hostile environment for a newly fertilized egg." 

Some medical professionals believe conception does not occur until the egg is implanted in the uterine wall, thus making this another form of birth control, while others believe conception occurs when the egg is fertilized. For them being forced to prescribe these drugs is a violation of their conscience. 

Other pharmacists are concerned promoters and marketers of Preven and Plan B have misled the public about the effects of the drugs, (one columnist compared it to taking an aspirin), especially if taken repeatedly at a time when manufacturers are trying to reduce the hormone content of oral contraceptives due to side-effects and health risks. 

Those pharmacists are reluctant to hand a customer (soon, without a doctor's prescription) a drug that is four times the dose of a birth control pill and, in the case of Plan B, a chemical composed of Progesterone, 20 times the dose in some birth control pills. 

It's not only the morning-after pill that will challenge convictions. 

With current and imminent advances in medical and pharmaceutical knowledge, things that once were medical procedures are being replaced by a pill. 

Post-coital interception, abortive drugs, controversial reproductive medications and euthanasia drugs are some examples. 

Concerned Pharmacists for Conscience, a Canadian organization, says physicians and pharmacists in Oregon are already offering assisted suicide with drugs. 

The Ontario College of Pharmacists code of ethics allows a pharmacist to refer the patient to another pharmacist when ethics are at stake, but many Canadian pharmacist groups feel the conscience clause is not strong enough. 

They are asking that no one be denied employment or be discriminated against in the workplace due to acting on his or her conscience. 

A Canadian group, the Protection of Conscience Project, claims many professionals have been denied employment, dismissed or penalized for acting on their ethics. 

Unlike pharmacists who have some protection, the London pharmacy technician I spoke to recently did not and is still feeling uneasy after being pressured into dispensing the morning-after pill, despite voicing concerns of conscience. 

Those in the medical field deserve the right to serve the public without doing a disservice to themselves. 

[Letter to the Editor]

ADVISORY BOARD
<sup>Janet Ajzenstat, BA,MA,Ph.d
Associate Professor,
Dept. of Political Science,
McMaster University,
Hamilton, Ontario, Canada

Dr. Shahid Athar, M.D.
Clinical Associate Professor
of Medicine & Endocrinology,
Indiana School of Medicine,
Indianapolis, Indiana, U.S.A</sup>..

11 January, 2001

The Editor,
The Star Phoenix,
205 5^th Avenue North,
Saskatoon, Saskatchewan
S7K 2P1

Dear Sir/Madam:

The Star Phoenix editorial in favour of pharmacists dispensing the ‘morning after pill’ reflects some confusion about the controversy surrounding the drug (Time to give more authority to pharmacists 5 January, 2001).

The editorial assertion that pregnancy exists only when the blastocyst is "fully attached to the lining of the uterus" accurately reflects marketing literature and many advertisements, but is scientifically accurate only in the case of in vitro fertilization.

Embryologist Bruce M. Carlson, for example, referring to natural conception, states pregnancy begins "with the fusion of an egg and a sperm"(Human Embryology and Developmental Biology. St. Louis, MO: Mosby, 1994, at p. 3). Other standard medical texts are equally clear in identifying the union of sperm and egg as the point at which a human individual comes into existence (O'Rahilly and Fabiola Müller, Human Embryology & Teratology. New York: Wiley-Liss, 1994, p. 19-20; Keith L. Moore and T.V.N. Persaud, The Developing Human. Philadelphia: W.B. Saunders Company, 1998, p. 2).

Thus, it is a matter of fact - not belief - that a human individual exists following fertilization. Whether or not this individual has a ‘right to life’ is a matter of belief, not fact. Conscientious objectors believe that it is wrong to destroy or harm this individual, while their opponents do not. Both, however, are believers, and no reason has been advanced to explain why objectors’ beliefs are less worthy of respect than those of their colleagues.

It is thus disturbing to read comments from the Registrar of the Saskatchewan Pharmaceutical Association to the effect that the SPA expects dissenting pharmacists to refer patients for the ‘morning after pill’, even if they have moral objections to referral. Does the Registrar assert that the SPA’s morality is superior to that of conscientious objectors? If not, why should they be forced to accept it? And if the moral outlook of the SPA is superior to that of objecting pharmacists, why should it be necessary to force it upon them? Surely, a convincing display of moral superiority by the Registrar would make coercion unnecessary.

Many members of the SPA believe that the ‘morning after pill’ should be made widely available. The Registrar named other professional medical associations with the same opinion. That being the case, they can - if they choose - see that the drug is distributed efficiently, without trampling their colleagues’ freedom of conscience.

 Sincerely,

Sean Murphy,
Administrator

Introduction:
The following commentary offers the personal perspective of a Catholic physician on the situation facing conscientious objectors in the United States.

UPDATE REPORT
ON FREEDOM OF CONSCIENCE
IN HEALTHCARE DELIVERY
10 January, 2001

Richard A. Watson, M.D.
Co-Chairman, New Jersey Physicians' Resource Council
Past President, Catholic Medical Association

ISSUE: Protection of the freedom of conscience for pro-life physicians, nurses, pharmacists and healthcare professionals has long been an issue of concern, with respect to distancing ourselves from cooperation in performing surgical termination of pregnancy. Additionally Catholic (as well as many other) healthcare workers have traditionally had strong compunctions against prescribing or dispensing artificial contraceptive agents. More recently, the availability of the "morning after" pill and RU-486 -- chemical abortifacients, have acutely raised concern in this area.

STATUS: This threat is immediate and real. Thirteen states have already passed legislation mandating such coverage. Conscience-protection clauses in these laws have been weak or, in many cases, nonexistent. At the meeting of the American Medical Association, last June, Resolution 218 (“Access to Comprehensive Reproductive Health Care”), which would have mandated such universal coverage nationwide, was defeated by the AMA House of Delegates, but only after impressive, last-minute testimonies by Francis Cardinal George and by Father Michael D. Place of the Catholic Heath Association. Currently before the US Congress is similar legislation, labelled the "Pill Bill." For details, visit the American Life League WebSite .

PERSONAL OBSERVATIONS:  The active involvement of many enthused leaders from prestigious, national organizations raises the hope that we may actually be able to effect a meaningful change in the direction that legislation has been taking. The inauguration of a new, more receptive administration in Washington bodes well for our success. Most encouraging is the fact that we are now receiving strong encouragement from leadership at both the NCCB/USCC and the CHAUSA, who are planning to give support for Freedom of Conscience legislation very high priority throughout this coming year.

Thinking Positive: Catholic leadership is wisely taking a positive, pro-active approach to addressing this issue. Father Place has suggested the slogan, "Freedom to Serve." If radical legislation, imposing the promotion of contraceptives and abortifacients, drives us Christian healthcare professionals from the marketplace, we will be denied the opportunity to continue serving those most in need of our care. Our stance is not reactive or exclusive, we are defending our right to serve, freely and without compromise of conscience.

Doctor John Haas of the National Catholic Bioethics Center makes the point eloquently that the manner in which we present our case may prove decisive. Words do make a difference. We should reject, for instance, use of the word "services," when it comes to discussing sterilization or abortion. If we allow the use of this term, then we place ourselves in the position of denying women "services." Rather, we should be bringing home the point that to attack the essence of a woman's biological uniqueness or to wilfully destroy the baby living within the protection of her womb is the antithesis of service!

Natural Family Planning: As Catholic healthcare providers and administrators, we need to be promoting Natural Family Planning vigorously -- not as a peripheral consideration, but as the centerpiece in our case against artificial contraception and sterilization.

In merger negotiations between Catholic and secular hospitals, the issue of sterilization and artificial contraception is frequently a sticking point. But how does the gynecology clinic in our Catholic hospital differ from that in the secular hospital? If the two are essentially identical, save for the fact that artificial contraception and sterilization are banned in our Catholic hospital, then we will be hard put to avoid the appearance of moralistically "denying services" -- a negative image that plays heavily against us in the eye of the public.

We do little to advance our credibility by citing the option of Natural Family Planning, if that option has been relegated, in the given Diocese, to a far-distant office in the back of some parish hall. Actions do speak louder than words. If Natural Family Planning is, as we claim it to be, our positive, pro-active, life-affirming alternative -- it should be given pride of place in the Gynecology and Women's Health Clinics of every Catholic Medical Center. And Natural Family Planning should be required learning in every Catholic medical school. Well, we're not quite there yet.

Heal Thyself: Our credibility is sure to take a dive, if we are ever confronted with an outrageous circumstance in which our "Catholic" hospital is renting purportedly independent space within its own building for performing sterilizations and providing artificial contraception, or when physicians and support staff from a "Catholic" hospital run back and forth across the street, escorting their patients to abortion and sterilization "services" provided within easy walking distance.

If the issue's merely "locus"; they'll dismiss our claims as "bogus"!

Another major vulnerability for Catholics in defending our position lies with the fact that, in several instances, medical insurance policies, funded by Catholic Dioceses for their diocesan workers and/or for healthcare workers within their Catholic medical centers, reportedly include provision for artificial sterilization, artificial contraception and abortion. What hope do we have of convincing legislators that the funding of these activities is a matter of grave moral repugnance for the Catholic faithful, if our very bishops themselves are serving as the designated policy-holders of such health-insurance programs for their dioceses and medical centers, without a whisper of protest or concern? The truth is that many bishops would not ordinarily (as it were) be aware of many specifics regarding the medical insurance policies under their immediate aegis. Now more than ever, it is urgent that they do make themselves aware and undertake remedial action expeditiously.

Beyond the issues of integrity and moral leadership -- profoundly important as these concepts are -- is a realization of the power of the pocketbook. If all -- or even a handful -- of the Catholic bishops across the United States were to go onto the open market in a determined search for healthcare policies which exclude morally offensive activities, the buying power which these prelates could bring to bear, would open doors that will not easily close. And through those doors of access, which their dollars have opened, individuals and small businesses could find their way home.

Clearly, we still have a long way to go in cleaning up our own act. And we don't have forever to get started! The nation is waiting for the Catholic hierarchy and for us Catholic healthcare professionals to take the lead in this issue.