Thomas Aquinas said that conscience comes from God — a noble thought when all in a community embrace the same divinity, the same ethics. But a pluralist society allows for different interpretations of conscience. Mine versus yours versus theirs.
Our society has honored divergent consciences. In World War II, when most Americans accepted the need to take up arms, we allowed for conscientious objectors. Those who supported the war, yet could not enter into combat, filled non-combat roles. Others, who could not countenance participating in this war at all, regardless of the rationale, went to jail. The war in Vietnam similarly drew objectors: some did not fight, but participated in the effort; some went abroad, renouncing their citizenship; some went to jail. All accepted the consequences.
Now we have pharmacists and physicians citing “conscience” when confronted with abortions, abortifacients, even contraception. Physicians assert that their conscience keeps them from participating in abortions, even if the woman, as well as her own physician, as well as the state legislature, has accepted the legitimacy of the abortion. Indeed, the physicians arguing in the Supreme Court to block the abortion pill, contended that if a woman who took the pill ended up in their hospital, they could not in conscience treat her (an unlikely occurrence since abortion is almost illegal in those states where the physicians practice). Some physicians refuse to prescribe birth control. Their consciences preclude them from that sinful pill.
Pharmacists, for their part, cite “conscience” when they refuse to fill a prescription for contraception. Presumably if a woman needed medication post-abortion, a pharmacist might also refuse to fill that prescription. Arkansas, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Pennsylvania and South Dakota have enacted conscience clauses to protect those professionals whose consciences forbid them from doing what they — not necessarily the state or their professional societies or patients — deem sinful.
To date, it is easy to yell “conscience.” Physicians do face the risk of lawsuits, if an “unnecessary delay in care” causes harm. A patient can file a malpractice suit against a specific physician, as well as the hospital. Already lawyers are advertising their services on-line.
But that is a risk most conscience-troubled physicians may willingly take. The road from harm to malpractice to settlement is long.
As for pharmacists, they are obligated to question, and refuse to fill, a prescription they suspect is harmful or illegitimate. (In court, states are arguing that pharmacists filled prescriptions for opiates too willingly.) But contraceptives are legal. The large retail establishments are supposed to excuse a conscience-laden employee and find one willing to fill a prescription. Again, if a patient suffers harm — for instance, must travel miles to a pharmacy to fill a prescription, that chain risks litigation.
So we have an anomaly: conscientious objectors who face no consequences for their stance. They can cite “conscience” with impunity,
How about adding some consequences?
Community service remains an option. An obstetrician who refuses to perform abortions, even in cases of ectopic pregnancy, rape, incest and fatal fetal anomalies, now can walk away. Why not require 10 hours a month pro bono in a rape crisis center? Or in a center for the children languishing in the foster care system? Those conscientious objectors value life: let them give some non-billable hours to treat the women and children in this country who live mired in poverty. Add money into the payback, asking those physicians, in the upper echelons of earners, to contribute financially to the care of the patients they do not see.
For pharmacists, the current solution is hardly workable. Employers must excuse employees who cannot fill prescriptions for contraceptives, and find alternative employees — a challenge in small establishments. As for making a patient drive to a pharmacy that can fill a prescription … that risks harming patients, especially those in rural counties. The solution to the conscientious objector problem demands common sense. Let those pharmacists find other professions. Just as we do not expect pacifists to enroll at West Point, we should not admit people who cannot fill specific prescriptions, legal and prescribed, into pharmacy training programs. We have many professions that allow people to serve others without violating their consciences.
A pluralist society allows for conscientious objectors, but those objectors should not simply refuse to participate, or force the larger society to bend to their beliefs. Instead, they should contribute to the wellbeing of our nation. In short, we should insist on consequences.
Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email joan.retsinas@gmail.com.
From The Progressive Populist, May 15, 2024
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