Conscience Clauses: The Flip Side of Medical Futility

"Conscience Clause" laws that would permit pharmacists to refuse to fill birth control pill prescriptions or doctors to perform abortions, are growing in political prominence. By way of push back, some states are passing laws requiring pharmacists to dispense birth control pills, and New York City requires all doctors training in city hospitals in the specialty of Ob/Gyn to perform abortions during their medical training.

Now, a Montana pharmacist, whose state laws are silent about such matters, has decided to quit dispensing birth control pills. From the story:

Pharmacist John Lane believes he has a responsibility to serve humankind through his profession.

Lane, who converted to Catholicism 10 years ago, also believes the "humankind" he pledged to protect includes fertilized eggs that, because of oral contraceptives, are not able to implant in a woman's uterus and grow into a baby. There's more to it than that. But faith is clearly a big reason that, come Jan. 1, Lane will no longer dispense birth-control pills to his customers in Powder River County, Mont.

That decision wouldn't have much effect if Lane worked in Rapid City or surrounding towns, where dozens of other pharmacists and pharmacies are available and willing to fill prescriptions for birth control. But in a town of 450 people, Lane's decision will force customers to either get oral contraceptives by mail order or drive 80 miles to the nearest pharmacy...

There is another reason Lane decided to stop dispensing birth control pills. Three states--California, Illinois and New Jersey--require pharmacists to fill prescriptions for oral contraceptives. Other states, including South Dakota, have "conscience clauses" that protect pharmacists who choose not to fill certain prescriptions.

This issue is the flip side of Futile Care Theory, which would permit doctors to refuse wanted life-sustaining treatments based on their consciences and moral values. Proponents of medical futility should think about this when pushing their agenda--as should proponents of conscience clauses.

That being said, I think that a crucial distinction can be made between refusing to provide medical services based on conscience that are not optional--meaning when life is literally at stake--and refusing desired services the withholding of which would not threaten a patient's life. Thus, I don't believe any doctor should be permitted to refuse to terminate an ectopic pregnancy, even though that is technically an abortion. At the same time, I don't believe that any doctor should be forced to help kill a patient via assisted suicide or euthanasia--nor to participate in the act in any way such as by giving a list of referral sources who would kill a patient. However, if a new doctor asked for the medical records, the refusing doctor would have to comply even if he or she knew that the requesting physician was consulted for purposes of assisted suicide.

This is all very controversial and the anger and acrimony is only likely to increase in coming years. But such are the consequences that befall a society that is atomizing and losing common moral values. As this ongoing loss of commonality continues, expect increasing loss of comity in medicine and science.

Should Doctors Have the Right to Say No to Abortion?

We hear from some, such as Dr. Sherwin Nuland, that what a doctor does or does not do at the bedside should be determined by the individual practioner's personal conscience. This usually cuts from the side of permitting acts such as euthanasia--as Nuland asserted in the New England Journal of Medicine--and to justify futile care theory.

On the flip side, some have said that pharmacists should be able to refuse to fill a prescription for contraception and RU 486. Along this line, there is a growing revolt among doctors in the UK about performing abortions. From the story in the Daily Mail:

Rising numbers of doctors are refusing to carry out abortions, leading to a crisis in NHS provision. The stance by staff, taken on ethical grounds, has led to a doubling of abortions carried out by private clinics, according to the Royal College of Obstetricians and Gynaecologists.

The swell of medical staff joining the unprecedented moral revolt means that there may soon not be enough doctors to carry out sufficient terminations to meet the public demand...

James Gerrard, a GP in Leeds, said: "Out of the six doctors in our practice, three of us object to abortion. I had made up my mind on abortion before entering the medical profession. I feel the foetus is a person and killing that foetus is wrong."...

Staff at the Hospital of St John and St Elizabeth in North London is introducing a code of ethics for its resident GPs and other staff. Anyone working there will not be able to offer any service which conflicts with Catholic teaching on the value of human life or sexual ethics.

If this spreads to the USA, expect a huge battle with some advocating that doctors be required to perform abortions or not practice medicine--or at least ob/gyn--which I believe is already proposed in New York. Others will promote professional "choice" in all aspects of care, from assisted suicide to acceding to the requests of "amputee wannabes."

In a morally polyglot society, it is hard to know what the right answer is. As for my opinion, if a medical procedure is legal--it is legal. At the same time, I support conscience refusals so long as notice is given to patients in advance--unless doing so would endanger life (as in an ectopic pregnancy) or lead to serious health risks for the patient. What say y'all?