|
Volume 4 Number 8 March
31, 2006 |
|
Just what the doctor ordered Medicine, not religious beliefs, should hold sway in
the pharmacy A regular reader writes: "I know
you deal in ethics, not the law. You and I also both know that when the two
conflict it can lead to peculiar results, like pharmacists refusing to fill
prescriptions for birth control pills (want to take that one on?)." I pointed out to the reader that I had covered the matter quite a while ago -- "Personal beliefs and community needs." In going back to look at the column I realized that it was almost exactly two years ago, at which time I thought the issue was probably an anomaly. I also realized that my answer, while being simple, was probably a little simplistic. I suggested that someone who couldn't fulfill all the expected duties of a job should probably look for other employment. I still believe that, but the problem seems to be growing, and perhaps needs a deeper exploration. We can approach this in several ways. The employees who refuse to fill the prescription, according to their argument, are refusing to participate in something their personal religious beliefs consider "sinful." That seems to have some intuitive appeal. After all, we don't want to make people do things that are contrary to their deeply held beliefs. However, we need to look deeper and see if that's what's really going on. Everyone is entitled to his or her beliefs in the private arena. And they need no justification other than that's what they believe. However, when they try to act on those beliefs in the pubic arena in a way that adversely affects other people in significant ways, they need to have some justification for their actions -- a justification that withstands scrutiny in the public arena -- and not just their idiosyncratic beliefs. Many moral principles we hold, and which some people hold as religious beliefs, can also be justified by secular, non-religious reasoning. All credible ethical systems, whether religious or not, hold that the unjustified killing of an innocent person is wrong. That is something that can be argued without resorting to religious beliefs. The same hold for stealing, lying in important matters, and even adultery. In these cases, we expect ethical people to not only refrain from the activity, but also to refrain from aiding others in the activity. So, we see accessories to murder as sharing in the guilt. When it comes to idiosyncratic beliefs, the situations changes markedly. Doing X is wrong for you because your religious beliefs command it. However, it doesn't follow that X is necessarily wrong for people who don't share your particular belief. Suppose you join a sect that requires its members, for whatever reason and under penalty of sin, to sleep on a hard wooden plank every night without mattress, sheets, or blankets. Unless you can build a strong non-religious argument, one that most people would accept, that sleeping in comfort on a mattress is morally wrong, it's not unethical for me or anyone else to do so. Now, let's say that you drive a furniture delivery truck, and that part of your job is to deliver mattresses to customer's homes. Are you within your right to refuse to deliver those mattresses based on the argument that you would be participating in their "sin?" That seems a little far-fetched, primarily because, since these customers don't share your peculiar religious beliefs, there is no "sin" in which you can participate. To claim that the whole world must adhere to your beliefs, which you can't justify in any meaningful way to non-believers, is both arrogant and unrealistic. It's the same with birth control. If my spiritual beliefs allow me to practice artificial birth control, then it's not wrong for me -- no matter how much it may distress you. And, since it's not wrong, there is no "sin" in which the dispensing pharmacist would participate. Also, what makes artificial birth control wrong in the eyes of some religious sects is the act of having sex, while using birth control pills or devices. Possessing the devices -- or even using them -- isn't in and of itself wrong, until the sexual act takes place. So, those who assume that people who buy the devices or drugs are themselves engaging in a morally dangerous practice -- sitting in judgment on the consciences of other people. At least to Christian thinking that is an extremely grave moral failing. But let's assume that we're willing to allow pharmacists to dispense medicine according to their own whims of the moment, instead of the traditional practice of following directions from the physician. I think this is dangerous and potentially chaotic, throwing the pharmacy world into a tizzy every time some preacher gets a bug up his bum and decides to issue a fatwah against one or another medicine. Ultimately, the pharmacy owners, whether individuals or corporations, have the obligation to fulfill the needs of the patients. If a patient cannot get a legally prescribed prescription filled at a pharmacy in a reasonable time and with a minimum of effort, then the pharmacy and its owners are guilty of unethical behavior. This may sound harsh, because we don't feel this way about other retailers, but pharmacies aren't like other retailers. If I go to Max's Haberdashery to find out that Max has stopped carrying clothes made of natural fibers and instead stocks only garments made of varying grades of Styrofoam, I can simply shop around until I find the type of clothes I want. There are, after all, plenty of stores to choose from, and, even if I don't, having just the right fiber in my trousers isn't critical to my overall welfare interests. It may annoy me, but it doesn't infringe on my life in any significant way. Pharmacies are different. Having the right medications at the right time is critical to ensuring that my welfare interests are respected. Pharmacies, and by extension pharmacists, have restricted the supply of medications. I can't go into any retail store and simply buy my medication off the shelf. I need to go through the pharmacy and pharmacist. They have made themselves, through lobbying and great political pressure, the gatekeepers of medication. I am at their mercy. In fact, if I get medication from anyone other than them, and without a prescription from a physician, the government would like to see it as a crime. Once you put yourself in that position, you incur great responsibility. In fact, any time, you make yourself the gatekeeper of another person's well-being, you incur that obligation -- even if it means subordinating your own well-being. For example, if I were to take your children from you - -whether for legitimate or illegitimate reasons -- I now have a very strong obligation for the safety and well-being of those children. I can't simply abandon them if the going gets rough or I develop some whim that tells me I no longer want to care for them. This means that pharmacies have the obligation to ensure that patients get their prescribed medications in a reasonable amount of time and with a minimum of effort on their part. Patients shouldn't have to wait days, make repeated trips to the pharmacy, or carom around town trying to figure out whose peculiar religious beliefs hold sway at which pharmacy at which time. If pharmacies are willing to indulge their employees in forcing their idiosyncratic beliefs on people who don't share them, then the pharmacies should, at the very least, accept the prescription, have it filled in a timely manner and, if necessary, deliver it to the patient at the pharmacy's expense. Having said that, I still think it's dishonest for someone to take a job, when his personal religious beliefs prevent him performing the full range of expected functions. An ethically honest person would find other work. |
|
© Copyright 2006 Carlton Vogt |