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Provider conscience?

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Before everybody gets all wound up about how great "provider conscience" clauses are, please remember that the refusal to administer abortions is not the only medical service covered under such clauses.

"Neil Noesen was filling in as a back-up pharmacist at the Menomonie, Wis., Kmart when college student Amanda Phiede came in to refill her prescription for birth-control pills.

Noesen is a devout Catholic who believes that birth-control pills can cause what he regards as early-stage abortions. Noesen — the lone pharmacist on duty that day — refused to fill Phiede's prescription.

“I explained to her that I couldn't give it to her with a good conscience,” Noesen said. “I did not direct her to another pharmacy.” [Catherine Lynch, M.D., “Emergency Contraception: An Update,” found at http://www.contraceptiononline.org.]

Phiede went to a nearby Wal-Mart, but when the pharmacist there asked Noesen to transfer her prescription, he refused. Two days later, the Kmart pharmacy manager — who had been out of town — finally filled Phiede's prescription. By then, she had missed a pill and had to take two pills to catch up, increasing her risk of unintended pregnancy. The incident occurred in 2002.

...Noesen has remained firm in refusing to have any part in dispensing birth control pills. Using the pills is “evil,” under God's moral code, he told the disciplinary hearing last October. He would not transfer a contraceptive prescription because “it would be a sin to induce another to sin” [3]and would make him “part of a bucket brigade, just another step in facilitating the end result.” [American Pharmacists Association, “Emergency Contraception: The Pharmacist's Role,” 2000.]

...But emergency contraception is not the only birth-control method stirring controversy. Some doctors, pharmacists and hospitals will not dispense or prescribe any birth control on the grounds that artificial contraception itself is wrong. Others object only to giving birth-control pills to single women who plan to use them for contraceptive purposes rather than for health reasons, such as regulating menstrual periods.

Health-care workers and hospitals that refuse on moral grounds to provide certain contraception services argue strongly that their constitutional right to religious freedom should protect them from employer sanctions, even if they refuse to refer patients elsewhere for birth control. “It [is] unethical to force practitioners to participate in specific actions involving what they believe would be a cooperation with abortions,” Noesen told the Wisconsin legislature in 2003, when it was considering a conscience clause. [Kristi van Riper, et al., “Emergency Contraceptive Pills: Dispensing Practices, Knowledge and Attitudes of South Dakota Pharmacists,” Perspectives on Sexual and Reproductive Health, March 1, 2005, p. 19.

The issue is almost always framed as one of honoring — or not honoring — the pharmacist's conscience. But, says Rosemarie Tong, distinguished professor in health-care ethics at the University of North Carolina at Charlotte, there are always at least two consciences involved — the pharmacist's and the patient's. “Whose moral decision should be captive to the other person's in this situation?”she asks.According to Tong, the person who risks less potential harm should yield right of conscience. In the case of emergency contraception, “the person who's going to bear the brunt of the pregnancy” risks harm that's “much greater” than the potential damage to a pharmacist who reluctantly violates his or her conscience.

Proponents of strong conscience clauses disagree. A woman seeking emergency contraception generally has plenty of other options, says physician David Stevens, executive director of the 17,000-member Christian Medical and Dental Associations. “Sign up for mail order, get a referral to another pharmacy,” he suggests. But the pharmacist has only one conscience, and “conscience is the most sacred of all property.”

[From: CQ Researcher online. "Birth Control Debate." June 24, 2005]

Refusals to provide requested treatment have gone far beyond mere refusal to perform abortions. Emergency room physicians in religiously affiliated hospitals have refused to provide rape victims information about or provide emergency contraception pills. Pregnant patients have been denied sterilization in religiously sponsored hospitals. Even cancer patients seeking information about egg or sperm harvesting have been denied information about and access to available procedures.

This right to refuse medical attention based on one's personal beliefs has expanded over the years and now includes the right to refuse to provide sterilization and contraceptive services. According to The Alan Guttmacher Institute's State Policies in Brief, "almost every state has a policy explicitly allowing some health care professionals or institutions to refuse to provide or participate in some types of reproductive health care, such as abortion, contraceptive services or sterilization services."6 Twelve states are currently cited as having specific state laws allowing health care providers to deny contraceptive services.

Significantly, what antiabortion legislation requires of women is quite different from what child-support legislation requires of delinquent fathers. To be sure, such fathers must pay child support, but they are never forced to what lawyers call “specific performance.” They aren’t required by law to change diapers, give baths, prepare and serve meals, help with homework, or take their children to soccer practice. All unwilling fathers have to do is pay up every month. Specific performance, in fact, is seen as a form of servitude that may lawfully be required only of conscripts when there is a clear and present danger to the state. It may not be imposed even on convicted felons. If a drunk driver smashes into your house, he might have to go to prison or (under certain victim compensation laws) pay for damages, but he doesn’t have to repair your brickwork or replace your broken door with his own hands. If your architect breaks her contract with you by failing to produce the agreed-upon blueprints, the court can impose a fine, but it can’t make her sit down at her drafting table and do the promised work.

And that, when all is said and done, is the difference the South Dakota legislators want to draw between actual fathers and expectant mothers. They want to hold pregnant women – who are innocent of any wrongdoing – to a punitive standard of specific performance, sentencing them against their will to the many kinds of hard work, physical discomfort, and outright danger that my daughter has undertaken to bring her wanted child into the world. No other class of people is held to this standard in peacetime. No woman should be held to it either.

[From: "To Be A Mother," Hilda Lindemann. http://www.bioethicsforum.org/]

"Despite recent judicial rulings that struck down a law requiring parental consent for teenage abortion, Rep. Bill Sali, R-Kuna, intends to introduce a measure to bring the law back.

Though he held off on introducing the proposal Monday pending further legal consultation, Sali said the majority of parents know what's best for their children."

"I'd take a bad parent over an abortionist any day," he said.

In other words, you can refuse to provide abortions for unwanted pregnancies, and you can refuse to fill birth control prescriptions to prevent those unwanted pregnancies in the first place. You can also refuse to provide sterilization services to make sure no unwanted pregnancies ever occur, and you can refuse to fill morning after prescriptions in case the unthinkable happens.

Just slap the incubator label on my ass right now, because obviously my only purpose in life is to grow babies. And if I don't want to, I'd best just get over it, I suppose.

More good commentary over at BitchPhD, including one mention of my favourite Margaret Atwood quote:

The fertile do not owe the infertile pregnancy by proxy.

[crossposted to my LJ]
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