Thursday, May 05, 2005

Pharmacists, Protestors and Popes

con • science — the internal sense of what is right and wrong that governs one’s thoughts and actions, together with a feeling of obligation to do right or be good. From Latin conscientia, from conscient-, consciens, present participle of conscire to be conscious, be conscious of guilt, from com- + scire to know

con • science — against science

It's so easy to fall in line over the issue of pharmacists who refuse on grounds of conscience to fill birth control prescriptions. Step right up, the lines form here: reproductive rights, free exercise of religion, the obligations of professional practice, opposing government intervention in the marketplace. (For a good series of libertarian-oriented posts on the subject, start with Ryne McClaren. For a Redneck Feminist viewpoint, start here.)

If the lines don't cross and I can only stand in one, which should it be?

As someone who is pro-choice, I reflexively rise up in favor of those denied lawful prescriptions by state-licensed professionals. But as someone who is also pro-conscience, I say, not so fast. What ought to be the rules governing exercise of conscience? By what right can we judge another's internal sense of what is right and wrong? And if we deny a retrograde pharmacist's stand based on conscience, where do we stand when our own beliefs dictate resistance?

This isn't simply a matter of respecting each other's free speech. As I've written before, there's a difference between moral words and actions.

Professional Ethics
For the professional viewpoint, I asked my wife — an Ob-Gyn who is pro-choice and prescribes birth control pills for a variety of reasons, but who has also elected not to perform abortions. Pharmacists who refuse to fill prescriptions for birth control are going against their professional training, she says. Why, she asks, is this a moral issue for them now, and not when they chose their profession? She suspects this sudden swell of refusals is less a product of conscience and is more likely being orchestrated politically to serve as just one more example of how religious rights are being 'trampled" by government.

I can't speak for pharmacy training, but as part of my wife's entry into medical school, we attended a long session designed to help break down the medical students' preconceptions of what was normal or acceptable sexual behavior, so they would not have their professional judgment clouded by personal judgments of their patients. The orientation included spouses and significant others under the assumption that our shared experiences and attitudes toward sexuality influenced what our partners viewed as acceptable, moral and normal.

Our session for featured discussions of attitudes toward sexuality, exercises in sensuality, and jointly viewing a multimedia presentation that ranged from pornography, to a handicapped man masturbating, to elephants copulating. [Note: Link is to a poem, not a picture.] I can only say that if you have a chance to witness elephant insemination, don't miss it. Four Stars. Two Thumbs Up!

But we were talking pharmacy.

Did early training also impress upon Future Pharmacists of America that the exercise of their profession should involve suspending their personal judgments? Even if not, wasn't there an inkling the job might involve dispensing such common pills or occasionally running condom packages through the scanner?

Entering a profession in which standard practice goes against a deeply held personal belief is a bit like enlisting in the Marine Corps, going through basic training, and then later protesting the possibility you might actually have to carry a loaded weapon: You should have enlisted as a medic or joined the Peace Corps. Next time, exercise your moral outrage a little farther upstream.

Yet I don't want to hold fast to that position, because it denies the possibility that someone's moral reasoning can evolve.

The pharmacist's contrary position also goes against science — it is con-science — but conscience isn't obligated to follow reason. By definition, it is an inner belief, and both professional ethical standards and scientific consensus are external systems.

Obligations to the Employer
So what about the pharmacist's employment contract? Typically, businesses expect employees to serve their customers appropriately and not make independent judgments about them. As business owner, I have had a writer who was a strong environmentalist work on an account that promoted ATVs and snowmobiles. I've personally worked for a company whose policies my wife does not support. I've approved work for a beer company and accepted a pro bono project for Planned Parenthood, but would not expect employees who disagreed with either to work on the account. I've done work for a defense contractor but would refuse work from a cigarette company.

When you're the boss, you get to make those choices, and within reason, I believe individual employees should be able to request the flexibility to make choices when work conflicts with personal beliefs. But if accommodating the request would reduce or deny service to the company's customers, it's time for the employee to suck it up or find another job.

This is where I finally must draw my own line. You cannot claim conscience and expect to escape the consequences. The moral authority of resistance comes from the willingness to suffer for your beliefs; it does not come from being willing to make others suffer. It was not the draft dodgers in Canada or the Weather Underground who helped end the Vietnam War. It was the people willing to risk arrest and imprisonment for their stand, just as it was the civil rights protestors who faced police dogs and the possibility of a one-way night ride to a levee.

The Anonymous Protestor
In 1966 in my Colorado town, the Vietnam War was only the occasional subject of two-inch back-of-the-paper stories about a bombing run or a fighter being shot down. Somehow, through independent reading and a fierce anti-dogmatic streak, I had formed anti-war views, but knew not a single person in my high school or town that year who had expressed the same beliefs. Thanks to a special two-day-a-week study hall, I had relatively unrestricted movement for one period, and used it for awhile to post unauthorized anti-war handbills in the restrooms and hallways. The object of these anonymous posters was to kindle more general outrage at what I saw as an immoral war that was killing civilians.

One of my posters managed to stay on a bulletin board outside the cafeteria until lunch time, and I remember standing behind two classmates as they read it. I was shocked to hear them impugn the patriotism and morals of the person responsible — not for the war, but for the protest. I did not step forward to take credit.

I realize now that my protest allowed me to feel morally superior, without having to take a strong moral stand. And it had no impact whatsoever on my peers. Had I been willing to risk my personal credibility and position as a school leader, perhaps it might have.

I don't know what sacrifices the individual pharmacists have made. Maybe they expect to retain their jobs. Maybe they expect their victims to bear the brunt of their protest. Maybe they expect to be rewarded in heaven. But some may have reasoned it through, anguished, prayed over the decision, and taken a stand that made them quake.

For those latter protestors, if there are any, I don't want to repress their inner voice just because I happen to disagree with what it is saying. Denial of conscientious objection can cut both ways. People who integrated lunch counters, who resisted the Vietnam War and who stood up against totalitarianism in Tianamen Square were also exercising conscience, opposing legal authority and going against the grain of society.

I respect any pharmacists who put their employment on the line for their beliefs, but I don't respect any employer who will allow customers to suffer as a result. I don't think a protestor who breaks the law and then runs for the woods has done anything worthy. A protest that hurts innocents is bullying at least, terrorism at worst.

The Living Pope and the Martyred Archbishop
There's one more dimension of principled protest I'd like to draw into this discussion. It's quite simple to criticize the stands taken by others, just as it is to expect others to make sacrifices we ourselves would not make.

The new Pope Benedict (Joseph Ratzinger ) was a member of the Hitler Youth, joining at age 14 when membership became compulsory. I don't believe any teenage acts should disqualify someone from a future position of trusted authority. Indiscretions and mistakes are to be expected. What is important is what they take away from the experience. Do they learn from it? Or do they make excuses for it?

I guess the point I'm scrabbling toward is this: Most of the time people think they are taking moral stands, they are taking positions of convenience, of cowardice, of self-preservation or self-exaltation.

At Body and Soul there's an excellent post on this subject, comparing Ratzinger's choices with the choices of the assassinated archbishop Oscar Romero, whose liberation theology movement in Latin America was effectively eradicated by the future pope.

"Clearly, when Ratzinger and his brother (who is also a priest) say that anti-Nazi resistance was 'impossible,' they're lying. And it's not an insignificant or harmless lie. Denying the option of resistance insults, indeed, denies the existence of, a lot of people who made far braver and more difficult decisions than the Ratzingers. Failing to exhibit extraordinary courage is human and understandable. Denying the extraordinarily courageous their due is shameful. Denying moral agency is surely unworthy of a man who would be pope.

?The Ratzingers lie about this because if they admit that moral choices were involved, they'd have to explain their choice. In fact, I would suggest that anyone who cared about moral agency would recognize the need for self-reflection, for either admitting moral failure, or asserting moral principles."

–The German Shepherd and the Salvadoran Pastor, Body and Soul


Blogger drumgurl said...

Thanks for the link. I pretty much agree with you on the conscience clause issue. I think the employer has the right to set the rules.

"You cannot claim conscience and expect to escape the consequences."

Dang, I wish I would have said it like that. I will link you from my blog!

9:19 PM  
Blogger Charlie Quimby said...

Here's another view on young Ratzinger. He nails it on whether the boy should be held responsible. It's less clear whether we agree on what the man should have learned from his experience.

9:24 PM  
Blogger Thomas Nephew said...

I appreciate your comment above about my post, Mr. Quimby.

But if the boy Ratzinger can not really be held responsible, what should the adult Ratzinger have learned from his experience? D'Arc accuses him and his brother of lying that resistance was impossible; what I found his brother said was that resistance was impossible for them. (That counterexamples existed, even in their community, does not disprove the statement; it's unlikely such examples included boys or girls.)

As I try to argue in my post, once I arrive at the position that the boy Ratzinger can not be held responsible, there's little left for the adult Ratzinger to reflect about, at least based narrowly on his personal experiences. He was a victim of an evil regime. Aside from opposing forcing minors into military service and its dilemmas, I don't know what lessons the adult Ratzinger should be expected to draw from his personal failure to be as saintly a boy as bloggers 60 years later would have liked.

To try to return to the general point of your post: I think this is a case of "great cases make bad (moral) law" -- the details undo the point one (myself included) would have otherwise liked to make.

11:20 AM  
Blogger Charlie Quimby said...

This comment has been removed by a blog administrator.

9:58 PM  
Anonymous Charlie Quimby said...

Good question. So much time has passed since my original reading and post that I'm not sure I have a good answer — or the energy to find one.

However, I don't think the boy Ratzinger has to be responsible in order to have learned something about how powerful institutions may wrongly press young people into service — or how boys confused about their urges get used.

I can't speak for the Catholic church today, but it certainly operated that way when I was growing up. My brother ended up in uniform for year before he "deserted" the minor seminary he attended. Maybe he should answer the question for me.

10:00 PM  

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