Protection of Conscience Project
Protection of Conscience Project
Service, not Servitude

Service, not Servitude

A Tough Call

Does conscience protection excuse a health professional from providing after-abortion care?

11 February, 2011
Reproduced under a Creative Commons Licence

Cristina Alarcon*

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.

creative commons licence

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