Another Perspective

Freedom to Choose to Refuse

What about pharmacists who won't fill prescriptions for birth control and "morning after" pills?

By 6.9.05

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Abortion, gay rights and marriage, euthanasia, and the like are among today's most contentious political issues. They tend to inflame people's worst emotions.

Choosing sides often isn't easy. For instance, no one should feel comfortable about having the state rebuff a woman's desire for an abortion, but the procedure destroys a human life. The government should not discriminate against gays, but marriage plays a unique role in providing a framework for child-rearing and family life.

What should be a simple decision is allowing people to say no, irrespective of the government's stance. If abortion is legal, no doctor should have to perform it. If assisted suicide is permissible, no medical professional should have to participate.

If gay relationships are left untouched by the authorities, no apartment owner should have to rent to a same-sex couple. If contraceptives are available like other medicines, no doctor should have to write a prescription nor any pharmacist have to fill one.

In short, if "choice" is a virtue, it should be a virtue for everyone. Unfortunately, however, many liberal interest groups seem to believe that choice means allowing them to choose for everyone else.

THE LATEST CAUSE CELEBRE involves pharmacists who won't fill prescriptions for birth control or the "morning after" pill. Before that it was insurers who wouldn't provide contraceptive coverage and employers who wouldn't offer marital benefits to same-sex partners.

Earlier controversies surrounded doctors and hospitals who wouldn't perform abortions. Even before that were cases of religious property owners who didn't want to rent to unmarried couples.

The political battle has been joined, with many states approving "conscience clauses" allowing doctors and hospitals to opt out of abortions and pharmacists to refuse to dispense some drugs. But Illinois Gov. Rod Blagojevich prefers coercion over conscience, and has required pharmacies to fulfill birth control prescriptions. Three states are considering legislation to do the same.

Even the supposedly freedom-loving American Civil Liberties Union tends to favor forcing people to set aside their moral sensitivities to provide politically correct "reproductive" services. States the ACLU: "religious objections should not be allowed to stand in the way" of care in many cases.

THE REAL ISSUE APPARENTLY is fear of citizens acting on their beliefs. Worries columnist Ellen Goodman, "how much further do we want to expand the reach of individual conscience?" Apparently the primary social problem today is too many people caring too much about virtue. We'd all be better off if we dropped our silly moral inhibitions.

In this view one set of moral presumptions should trump all others. Someone engaging in an activity thought to be morally wrong, or at least suspect, has a right to aid and support from others. Do whatever you want while forcing everyone else to give you whatever you want.

What of someone who desires to, say, heal others, but believes that abortion or contraception contradicts that commitment? In Goodman's view, they are asking for "conscience without consequence."

There's no real moral conflict, she suggests, since they could just quit their jobs. Which in the case of doctors and pharmacists presumably means leaving their professions. Property owners should just sell off homes in which they aren't living. And so on.

If people don't follow Ms. Goodman's advice? Coerce them. Chris Taylor of the Planned Parenthood Advocates of Wisconsin demanded "a strong penalty" for pharmacist Neil Noesen who refused to fill a birth control prescription.

What is this but allowing people to ignore conscience without consequence? Protecting people from the impact of public disapproval eliminates one of the most important social tools for imparting and shaping morals.

Moreover, using government to impose a conscienceless amorality on everyone threatens a true culture war. Ms. Goodman gets it entirely wrong when she writes: "the plea to protect their conscience is a thinly veiled ploy for conquest."

A legal prohibition on abortion, or contraception, or homosexuality would be an attempt at "conquest." Simply saying "I opt out, but I won't stop others" seeks to resolve moral conflict without prohibiting or mandating conduct. It is the best strategy for promoting social harmony in a diverse and free society.

Otherwise, there is no middle ground for coexistence: whatever government decides determines everyone's behavior. Prohibiting something means penalizing those who provide the practice or product. Allowing something means penalizing those who do not offer the service or good. Everyone has an added incentive to seize power and impose their beliefs on others.

The best strategy is to leave government rule-making at a minimum, limited to important issues which only government can decide. Then, as Ms. Goodman suggests, "what holds us together is the other lowly virtue, minding your own business."

OPEN MARKETS ALLOW EVEN disagreeable people who disagree to live with a minimum of confrontation. A Chicago Planned Parenthood official argued: "A pharmacist's personal views cannot intrude on the relationship between a woman and her doctor." They don't. The woman can go elsewhere to fill a prescription.

The refusal of any one doctor, landlord, or pharmacist may be inconvenient to the customer involved. But in America today there are more than 16,000 hospitals and 51,000 retail pharmacies. Government could further increase access to contraceptives by relaxing prescription requirements.

In such a system everyone is able to choose. And everyone bears the cost of his or her choice.

A person desiring an abortion or contraceptive has to shop around. A hospital or pharmacy that refuses to offer certain services or products will lose business.

A doctor or pharmacist who won't abide by his or her employer's rules must look for another job. But life goes on, without constant legal and political battles.

Frances Kissling of Catholics for a Free Choice argues that "There is very little recognition that the conscience of the woman is as important, let alone more important, than the conscience of the provider." They are both important, and neither should a priori trump the other.

Are some choices simply illegitimate? Rachel Laser of the National Women's Law Center contends: refusing to fill a prescription is "outrageous. It's sex discrimination."

Actually, many of the pharmacists who say no to the abortion pill and contraceptives are women. Peggy Pace of Glen Carbon, Illinois, is one of two pharmacists suing Gov. Blagojevich over his order.

Judy Waxman of the National Women's Law Center argues that the refusal to fill prescriptions is "based on personal beliefs, not on legitimate medical or professional concerns." But the same could be said of a person desiring contraceptives or an abortion.

The belief that such products or procedures are legitimate is intrinsically no more valid than the belief that they are illegitimate. Surely the moral beliefs of medical professionals should be respected by people who emphasize the importance of "choice" and "controlling one's own body."

UNFORTUNATELY, THE ISSUE IS generating widespread political war. In most states doctors have no obligation to perform an abortion. But states split over hospital provision of the procedure. A dozen states allow health professionals to refuse to offer sterlizations.

Four states authorize pharmacists to refuse to dispense contraceptives and a dozen more states are considering similar bills, while a few are threatening to go the other way. Senators Hillary Clinton (D-NY), Rick Santorum (R-PA), and John Kerry (D- MA) have introduced the Workplace Religious Freedom Act, which would offer some federal protection for dissenting pharmacists.

Few agree on all of these issues: I oppose abortion but see no moral objection to contraception or sterilization. Some people support or oppose all three. Government should leave employers, employees, and consumers free to sort out who provides what service to whom.

Public officials should remember the virtues of neutrality. The best way to avoid social conflict is to respect everyone's conscience whenever possible. That's what free choice should mean in a liberal democracy like our own.

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About the Author
Doug Bandow is a senior fellow at the Cato Institute. A former Special Assistant to President Ronald Reagan, he is the author and editor of several books, including The Politics of Plunder: Misgovernment in Washington (Transaction).