Tuesday, March 3, 2009

Your Conscience Doesn't Belong in My Health Care

I was pretty excited to read the news Saturday that Obama has decided to void the health workers' conscience rule enacted by Bush. Of course the people who want to keep this rule in place have framed the decision as a pro-abortion move, and unfortunately the people who support removing the rule have engaged them at this level. This rule is really about so much more than abortion.

It's not enough that we need to research our primary care doctors and try to find one whose medical approach most closely matches how we would like our health care managed. But under this rule, we also need to research and seek out and equally appropriate pharmacy.

If my doctor decides to prescribe marinol, a synthetic marijuana derivative, as part of a pain management plan or as an anti-nausea drug, but my pharmacist doesn't believe in prescribing marijuana, where does this leave me, the patient? (This is not a hypothetical question, it has happened—though I wasn't the patient; I was the caregiver and had the lovely task of dealing with the pharmacy.)

Either I need to go back to the doctor (schedule another appointment, take more time off from work to go to the appointment, and add another $20 office visit co-pay) and get a different prescription, despite the fact that my doctor has already considered the options and felt that marinol was the best option, or I need to seek out a pharmacy that will fill the existing prescription.

In a metropolitan area, the second option (while still a hassle) is doable. That is, of course, assuming the pharmacist will give the prescription slip back to you. But in a rural area, a person may only have one or two options available.

The doctor is my health care provider, not the pharmacist. The pharmacist is a service provider and should not be able to dictate the direction of my health care based on his or her beliefs.

If the pharmacist has a moral objection to dispensing medications as prescribed by a doctor, then the pharmacist clearly chose the wrong career—because that is exactly what a pharmacist is supposed to do.

Aside from refusing to fill a prescription due to dangerous drug interactions, unfortunately common when different doctors are prescribing for the same patient, the pharmacist should fill any and all prescriptions.

Aside from the marinol example, which admittedly only a relative few people would encounter, there's also the birth control issue. I have actually been in a Safeway pharmacy in San Jose, CA that refused to stock or sell all forms of birth control, including condoms.

Granted, you don't need a prescription for condoms, not even they cherry flavored kind—but come on, they're condoms! If I were a randy teenager, do you really think the fact that you won't sell me a condom is going to stop me from doing whatever it is I wanted the condom for?


  1. Thank you for your response. My concern is to limit the degree to which government is able to punish people for withholding their participation in policies they find morally objectionable. Since government now controls so much of our health care system, and soon will control more or possibly all, people's consciencious objections need to be accommodated there, just as we have always done in the military. And that's what the rule did that Obama just rescinded: It required health care institutions that received federal funds to make reasonable accommodations to the conscientious objections of their employees.

    It's ironic that, even when we had the draft, and even in wars for our national survival, such as WWII, we found it possible to accommodate people's consciences, but we now allow "inconvenience" to override people's most deeply held beliefs, or require them to sacrifice their livelihoods.

    I know that there are many inconveniences and burdens that attend serious medical problems, having experienced them (more than our share, perhaps) in my own family, but I hope my own needs never leave me so insensitive to the essential humanity of others that I demand of them that they surrender it to serve me.

  2. I think one of the points on which we differ is that you want to limit the government's ability to punish people and for you, the removal of this rule is tantamount to punishment. I too want to limit the government's role, but I don't see this as a punishment--any employer should make "reasonable accommodations to the conscientious objections of their employees," not just pharmacies. The rub for me is that there's a law telling employers to do something that should be common sense.

    The other piece that bothers me is how I actually encountered this rule in action. I wasn't told, "I'm sorry, I cannot fill this prescription. Please come back when Bob is on shift." I was told, "No, we won't fill it."

    And I'm sorry, I absolutely do not agree with your statements about the military. Our military has not always made room for people's conscientious objections, and certainly not with the draft. I think the military is better about making room for objections in the day-to-day military today; but as for the draft, we haven't had one since 1973(?), so who can really say.

    I am sorry that you seem to feel my opinion makes me insensitive to the essential humanity of others, I just don't feel that the rule, as written and practiced, is the answer. As I said, there needs to be some middle ground.