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Archive for Wednesday, April 13, 2005

Can conscience override common sense?

April 13, 2005

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— To begin with, I don't believe that anyone should be compelled to do work they regard as unethical. History is full of heroes who rebelliously followed their consciences. It's also full of people who shamefully followed orders.

For that matter, I believe that companies and institutions should have a code of ethics. What is the alternative to corporate responsibility and public morality? Enron?

So I approach the subject of conscience clauses rather gingerly. The very first such laws offered an exemption for doctors in 47 states who don't want to perform abortions on moral grounds. That seems to me a matter of common decency. Doctors are not automatons who leave their beliefs at the operating room door.

It also seems like common sense. Who would want their abortion performed by an opponent?

Gradually however, we have had the incredibly expanding conscience clause. In 10 states health care professionals can conscientiously refuse to provide contraceptives. In 12 states they can refuse to do sterilizations.

Indeed, last year the government decided that entire hospitals and HMOs had the right to deny these services without losing federal funding. Never mind that it is not clear who owns the conscience of a hospital: A church hierarchy? A board of directors? The doctors? The community? Or the taxpayers who foot the hospital bills?

Now, we have gone even further. Conscience clauses are being proposed to protect professionals who refuse to follow end-of-life directives and refuse to use treatments from stem cell research. Most notably, we have bills in a dozen states to include pharmacists who won't fill a prescription.

It's the pharmacists who are getting the most attention right now. In just six months, there were about 180 reports of pharmacists who said no. One refused to fill a college student's birth-control prescription. Another refused medication to a woman who had suffered a miscarriage.

This has led to a counter bill in California that would make pharmacists tell employers of their objections in advance and be prepared to make referrals. It's led to a rule by the Illinois governor that every pharmacy -- though not every pharmacist -- must fill prescriptions, "No delays. No hassles. No lectures."

Karen Brauer, who heads a group called Pharmacists for Life that claims 1,600 members, compares them to "conscientious objectors." But it isn't that simple.

The pharmacist who refuses emergency contraception is not just following his moral code, he's trumping the moral beliefs of the doctor and the patient.

"If you open the door to this, I don't see any place to draw a line," says Anita Allen, law professor at the University of Pennsylvania and author of "The New Ethics." If the pharmacist is officially sanctioned as the moral arbiter of the drugstore, does he then ask the customer whether the pills are for cramps or contraception? If he's parsing his conscience with each prescription, can he ask if the morning-after pill is for carelessness or rape? For that matter, can his conscience be the guide to second-guessing Ritalin as well as Viagra?

How much further do we want to expand the reach of the individual conscience? Does the person at the checkout counter have an equal right to refuse to sell condoms? Does the bus driver have a right to refuse to let off customers in front of a Planned Parenthood clinic?

Yes, we want people to have a strong moral compass. But they have to coexist with others whose compasses point in another direction. In the debate over conscience clauses, Frances Kissling of Catholics for a Free Choice says properly, "There is very little recognition that the conscience of the woman is as important, let alone more important, than the conscience of the provider."

Pharmacists don't have the same claim to refuse filling a prescription as a doctor has to refuse performing an abortion. But there are other ways to exercise a private conscience clause. Indeed, in a conflict between your job and your ethics, you can quit. It happens every day.

When Thoreau refused to pay taxes as a war protest, remember, he went to jail. What the pharmacists and others are asking for is conscience without consequence. The plea to protect their conscience is a thinly veiled ploy for conquest.

This is not easy stuff. But in the culture wars we have become awfully enamored of moral stances. Have we forgotten that what holds us together is the other lowly virtue: minding your own business?

To each his own conscience. But the drugstore is not an altar. The last time I looked, the pharmacist's license did not include the right to dispense morality.

-- Ellen Goodman is a columnist for Washington Post Writers Group.

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