"Moral Values" In Tucson

by hilzoy

Via AmericaBlog, a story in the Arizona Daily Star:

"Although it is safe, effective and legal, emergency contraception - the "morning after" pill - can be hard to find in Tucson.

After a sexual assault one recent weekend, a young Tucson woman spent three frantic days trying to obtain the drug to prevent a pregnancy, knowing that each passing day lowered the chance the drug would work. While calling dozens of Tucson pharmacies trying to fill a prescription for emergency contraception, she found that most did not stock the drug. When she finally did find a pharmacy with it, she said she was told the pharmacist on duty would not dispense it because of religious and moral objections.

"I was so shocked," said the 20-year-old woman, who, as a victim of sexual assault, is not being named by the Star. "I just did not understand how they could legally refuse to do this." (...)

Women who report sexual assaults to police receive treatment, examination and the immediate offer of emergency contraception at a local emergency room, according to the policy of most Tucson hospitals.

But, like many sexual assault victims, the 20-year-old woman did not report the assault because she felt traumatized and guilty she had put herself in a situation that left her vulnerable. She was mistakenly locked outside a gathering at a friend's house and accepted the offer of a neighbor to stay at his place. "This (sex) was with someone I did not even know and did not want to have intercourse with, and I am in no place now to have children," she said. "I just don't think this should be the pharmacist's decision." (...)

To be taken within three to five days of unprotected intercourse, emergency contraception - also known as "Plan B" - prevents pregnancy by stopping ovulation, fertilization or implantation of a fertilized egg. The sooner the emergency contraception is taken after intercourse, the more effective it is. More widespread use of emergency contraception could prevent as many as 800,000 surgical abortions a year, according to family-planning groups such as Planned Parenthood."

Pharmacists should not be allowed to refuse to fill a prescription on moral grounds. If they think that their moral principles prevent them from filling certain prescriptions, they should find another job, just as pacifists should not serve in the army, and Jehovah's Witnesses should not take jobs that will predictably require them to give blood transfusions. If a pharmacist were a Jehovah's Witness and refused, on those grounds, to fill a hemophiliac's prescription for clotting factors, we would find that completely unacceptable. I cannot imagine why the same principle does not apply in this case. And anyone who opposes abortion should prefer drugs that act by suppressing ovulation and preventing implantation, not by killing an embryo.

Rape is hard enough to deal with without having to spend three days roaming around trying to find a pharmacy that will let you get Plan B. And last time I checked, heartlessness was not a moral value.

Comments

[Jackmormon]

Was it Belle Waring who called the proposed law to protect pharmicists who didn't want to prescribe Plan B or the pill "The Christian Scientist Total Employment Act"?

(How's that grant proposal coming along?;))

[Phil]

A similar story from Cleveland earlier this year. Words cannot express how angry these stories make me. The pharmacist in this story should, by the way, be sued into oblivion.

[Jeff Eaton]

I think it's perfectly reasonable that a pharmacist should be able to refuse medication based on religious principles. By the same token, atheists should be able to become pastors of churches and encourage congregation members to leave the church. They are, after all, only doing so out of personal conviction and a legitimate concern for the well-being of churchgoing people.

[hilzoy]

Jeff: the even better analogy would be to allow atheists to become priests and pastors, and then decline to participate in any church service on grounds of "principle". After all, the pharmacist has the right to try to convince rape victims not to take Plan B; he just should not have the right (according to me) not to sell it to her.

[John Thullen]

" .... heartlessness was not a moral value."

Well, Dickens agreed with you. However, Gertrude Himmelfarb does not. And the last time I looked, the first was dead and the latter is still with us, so lack of heart has won the day.

I wonder what would have happened had the young woman had a stroke during the rape. No doubt that would be one stroke this particular pharmacist would have lovingly preserved, diapered, and sent to college.

I predict that one day there will a news story along the following lines: Young, religious pharmacist, having failed to marry and sustain his bloodline, resorts to the rape of young females on his pharmacy's patient list, somehow finding language in the Old Testament justifying this behavior. When the young women solicit the morning-after-pill at his pharmacy, he denies their prescription, citing a verse on the next page.

Solutions: Break the law. Start a prescription-free black market. Also, bring the rapist's child to term and leave it on the pharmacy's steps with a loving note attached addressed to the loving step-father behind the counter.

Who says we are the Party of "No"? 8

[hilzoy]

According to Leon Kass, rape is just one more problem attributable to the deterioration of Western sexual mores:

"Ogden Nash had it right: "Hogamus higamus, men are polygamous; higamus hogamus, women monogamous." To make naturally polygamous men accept the conventional institution of monogamous marriage has been the work of centuries of Western civilization, with social sanctions, backed by religious teachings and authority, as major instruments of the transformation, and with female modesty as the crucial civilizing device. As these mores and sanctions disappear, courtship gives way to seduction and possession, and men become again the sexually, familially, and civically irresponsible creatures they are naturally always in danger of being. At the top of the social ladder, executives walk out on their families and take up with trophy wives. At the bottom of the scale, low-status males, utterly uncivilized by marriage, return to the fighting gangs, taking young women as prizes for their prowess. Rebarbarization is just around the corner. Courtship, anyone?"

[xanax]

See all the fun you're missing out west hilzoy...(Tucson's getting ever nearer the provincial backwater as previously described).

Meanwhile, for those of us who live here, how embarrassing.

[Elmo]

Stop making sense (main post).

Course, nothing wrong with monogamy in middle in age, for retired range riders like myself (comment). Sport fookin went into decline when AIDS came into ascendency

[Anderson]

I look forward to the pharamacist's adopting the baby and reimbursing all medical expenses, plus an appropriate sum for the burdens of pregnancy.

Any stories of refusals to prescribe Viagra without proof of marriage?

[Jeff Eaton]

the pharmacist has the right to try to convince rape victims not to take Plan B; he just should not have the right (according to me) not to sell it to her.

Indeed, hilzoy. The craven double-standard is what bothers me. Organizations like the Salvation Army are allowed to exclude people who want to do good and help others because they might not toe the party line, philosophically. But a pharmacy has to employ someone who will refuse to do their job because of their beliefs. The intersection between those who argue in favor of the Salvation Army, and also argue in favor of this pharmacist's right to keep his job, is what burns me up.

[Morat]

I believe Target managed to capture the sheer wrong-headedness of the situation nicely. I believe the story is also on Americablog, but in short, Target believes:

1) Forcing a pharmacist to fill a legal prescription he is morally against would be a violation of his religious rights.
2) Forcing a pharmacist to find some other store to fill your prescription is, oddly, NOT a violation of his religious rights. Despite the fact, of course, that he is aiding you in doing something against is religious views.

[trilobite]

Yes, well, what do you expect of a movement that routinely elects representatives who don't believe in government and who appoint officials opposed to the existence of the department they are to run or ambassadors to institutions they despise?

The truly horrid thing is that if the pharmacy tried to fire this prig, he'd probably be able to win a lawsuit for religious discrimination.

He might lose on appeal--unless we end up with a few more Supreme Court Justices who don't believe in judicial review...

[Phil]

trilobite: Amazingly, some states have specific legal protections for pharmacists who refuse to fill prescriptions on the basis of their religious beliefs.

I wonder how far this extends. I wonder if I were to become a pharmacist, then refuse to fill prescriptions for antipsychotics or SSRIs because I claim to be a devout Scientologist, if the people who support this goddamned stupid "conscience laws" would be cool with that.

[Gromit]

I think Target is being overly cautious in its interpretation of the law, Morat, but I'm not sure that their solution is so problematic. Target is accommodating both the employee and the customer. This is how I'd prefer to see these sorts of conflicts resolved. Am I missing something?

[Morat]

Gromit: Yeah -- the part where they're still forcing their pharmacist to violate his religious beliefs.

Since they're going to do that ANYWAYS, they might as well fill it in-store.

Frankly, I think there's a very simple solution to all of this: If Person X presents a valid prescription to you, you FILL IT.

The pharmacist is not my doctor. He is not my priest, my pschyologists, or my moral compass. He or she is simple the person who hands me my freakin' medication.

If they find themselves unable to actually do their job (take my prescription, turn it into medicine, and hand it back to me) then they need to find another job.

No one said holding religious beliefs was free. If you feel you can't, in good conscience, do your job, you should be fired.

And no, Target isn't accomadating the customer. Filling the customer's prescription would be accomodating the customer, especially since FILLING THE PRESCRIPTION is the actual purpose of Target's pharmacy. It's not like the customer wandered in looking for high-grade pot or a Cadillac or something.

Now, I realize you're all for compromise and stuff -- but you need to bear in mind that not everyone lives in the big city. A lot of people live in small towns or rural communties -- places where you don't exactly have a lot of choices regarding "Where I get my pills".

This sort of idiocy needs to be nipped in the bud. You think if I walked into work tomorrow and told my boss I had religious objections to doing my job, I'd still have one? They're quite accomodating to religious holidays and such, but if your religion prevents you from doing your job, it's bye-bye job.

If it helps, I think Target should politely fire the pharmacist in question.

Perhaps send him a nice card.

[Catsy]

I'm with Morat on this. If you have a religious belief that doing X is wrong, don't take a job that would require you to do X. It's that simple. If you do, then you have placed yourself and your duties in an inevitable conflict.

To put it another way: what happens if a Quaker joins the Army? If someone converts to that religion after joining the Army? Should their freedom of religion entitle them to continue to have a job after they refuse to perform essential duties of that job on religious principles?

What about a police officer? Do you think a cop who refuses on principle to use his weapon should be patrolling the streets? Would one who refused to stop the assault of a gay man because of strict Levitican views on homosexuality still have a job?

[hilzoy]

I'm with Morat and Catsy (obviously, given the original post). I think that if there's another pharmacist on duty, and "accommodating someone's religious beliefs" just means letting them say: hey, Joe, would you fill this one? -- then fine. But if it involves asking a rape victim to go elsewhere, it's not fine.

I think it's relevant that pharmacists are licensed by the state. If they want the privilege of being licensed to fill prescriptions, they should be able to do their job. And this involves not just knowing which medicine is which, but also being able and willing to fill prescriptions as needed.

[Gromit]

First things first. If you think I'm in any way defending the folks who want to be pharmacists but don't want to actually fill the prescriptions their customers hand them, you are getting the wrong impression. I'm not in favor of any compromise that leaves the patient without her medicine when she needs it. But, according to Target, neither are they. Granted, Target could be misrepresenting the situation, but assuming I can take it at face value, I'm not going to get up in arms over the policy.

Morat: Now, I realize you're all for compromise and stuff -- but you need to bear in mind that not everyone lives in the big city.

Sure, but how does this apply to Target? Target isn't Wal-Mart. I doubt you'll find any towns in Nebraska where the only pharmacy in town is in the Target, and even if such a place existed, or if a situation like the one above arose, the stated policy would have the pharmacist disciplined if she was unwilling to do what was necesary to get the prescription filled in a timely manner (which, in the Missouri incident, involved referring the customer to a nearby pharmacy that would fill the prescription). If you want to talk about the responsibilities of the only pharmacist for miles in Podunk, USA, or about the situation Hilzoy describes above, I bet you'll find there is no distance between us. But for Target to give some reasonable accommodation to the pharmacist, doing so only under the condition that the patient ultimately gets the drug when she needs it, seems to be a reasonable enough policy.

If the actual policy is different from the one Target describes, then all bets are off, of course.

[me2i81]

"But for Target to give some reasonable accommodation to the pharmacist, doing so only under the condition that the patient ultimately gets the drug when she needs it, seems to be a reasonable enough policy."

No, it's not, sorry. Someone who was just the victim of a sexual assault shouldn't have to shop their prescription around just because the pharmacist is unwilling to do his job.

[dr ngo]

I usually avoid "me too" posts, but in this case I want to make it as clear as possible that I endorse the above comment (by me2i81) and reprehend any effort to make an excuse for Target's indefensible position. They are wrong; the pharmacist is wrong. If he is unwilling to do his job, which is to fill the doctor's prescription, he should find some other line of work. Full stop.

[ral]

I concur with dr. ngo and and hilzoy as to the specific case, but I have to ask a question: how is a pharmacist different from a doctor? Different in kind or only in degree? They are both professionals, licensed by the state, providing health-related services.

If the difference is only one of degree, what do we say to a doctor who, for example, refuses to perform an abortion?

[ral]

[*arrgh* how did two "and"s get in there? I have had a long journey and may have miscounted.]

[Anna in Cairo]

I agree with those who don't want to compromise on this. You should not be a biology teacher if you refuse to teach the theory of evolution. You should not be a pharmacist if you have some sort of moral qualm with filling prescriptions. You should not join the army if your religion is pacifist. Period. It is not OK to have one of these kooks working alongside a pharmacist who is actually OK with DOING ALL OF HIS JOB. They should not have chosen this field in the first place.

[John Thullen]

I would add to Anna Cairo's list that people shouldn't hold positions in government, either elected or appointed, who despise government.

Tom Delay's original occupation of pest-control dude poisoning rats and other vermin was simply not acceptable either, considering the fact that he is a rat and/ or other vermin.

He ought to start a cockroach orphanage and help out for a change.

[Slartibartfast]

Interesting. Should a pharmacy be permitted to not stock a drug simply because they have moral issues with it? After all, the end result is the same.

[Gromit]

Hold up, folks. Unless I'm sorely mistaken, Target wasn't involved in the Tucson incident. The Target incident happened in Fenton, Missouri, and any mention of sexual assault was absent from the accounts I have found of the woman in Missouri. I welcome any correction, but last I checked, Tucson is in Arizona. If I am incorrect, and Target was in some part responsible for a rape victim being unable to obtain emergency contraception (or if Target refused to fire an employee who contributed to such a circumstance), I'll be glad to join the boycott.

My knowledge of both cases is limited to what I've read on the internet, but I can see some important differences in the stories:

In Tucson, the woman was unable for three days to obtain a time-critical drug due to pharmacists' "freedom of conscience". In Arizona, the woman was directed to a nearby pharmacy that would (I presume, based on the account) fill the prescription. I can't stress enough how important this difference is, since the end result of one story is the woman going without the drug, and the end result of the other is the woman being referred to another easily accessible store where she, presumably, was able to get the drug. I would consider neither outcome ideal, but only one sets off my "dereliction of duty" alarm.

It sounds to me as if folks here are conflating these two stories, which appear to have radically different outcomes. I prefer to focus my anger at the cases where women are unable to get the drug, period, rather than at the cases in which women have to walk across the street to get it. Rape victims or not, women should be able to get the medicines they need. All I'm arguing for is a modicum of flexibility in circumstances where reasonable accommodation does not preclude this outcome. The Target policy is more deferential than I would choose to be (were I the manager, I'd insist that the patient walk out of the store with the prescribed drug, period) but it doesn't pass the threshold of what I'd consider unacceptable. The vitriol directed at policies like the one put forth by Target only feeds the perception that secular liberals (like me) will give religious views no quarter.

And, again, if I've got the facts wrong, please do set me right.

[Jesurgislac]

ral: If the difference is only one of degree, what do we say to a doctor who, for example, refuses to perform an abortion?

Medicine is a big field. Doctors who feel strongly that they should not perform abortions should go into an area of medicine where they are unlikely to have to do so. Should they be asked to do so, and it's a choice between their private religious beliefs and the health of their patient, I would think better of a doctor who put the patient's well-being above their own spiritual satisfaction.

Slarti: Should a pharmacy be permitted to not stock a drug simply because they have moral issues with it?

Who is the "they" in that sentence, Slarti? The owner(s) of the pharmacy? The manager? The pharmacists who work there?

Short answer, anyway: If it's an essential medication, as birth control certainly is, no, they should not have the option of just "not stocking it" if they are a licensed pharmacy. If they take on that obligation, they cannot pick and choose: they may not refuse to stock medication used by HIV+ clients because their religious beliefs tell them that AIDS is a punishment from God and the HIV+ deserve to die, and they may not refuse to stock birth control because their religious beliefs tell them that women shouldn't get to use it.

[Phillip J. Birmingham]

Interesting. Should a pharmacy be permitted to not stock a drug simply because they have moral issues with it? After all, the end result is the same.

If I am denied a Big Mac in McDonald's because the counter jockey is a member of PETA, or if I go to Subway and order a hamburger, the result is the same as well -- no burger.

There's a big difference between saying that the PETA member should keep out of my personal dining choices and do his or her freakin' job, and saying that Subway should be forced to sell hamburgers.

[Slartibartfast]

Who is the "they" in that sentence, Slarti? The owner(s) of the pharmacy?

Hee hoo makes decisions regarding what drugs to stock, natch.

I have no idea whether pharmacies can be required to stock anything at all, J. Maybe true, but I just don't know. I know there's licensing for pharmacists, but I don't know what requirements exist for pharmacies.

And regarding Target question, the pharmacy in question was actually Fry's.

[LizardBreath]

The Target policy is more deferential than I would choose to be (were I the manager, I'd insist that the patient walk out of the store with the prescribed drug, period) but it doesn't pass the threshold of what I'd consider unacceptable.

Generally, I'm not sympathetic to slippery-slope arguments, but I think Target's policy is an example of where they're useful. Sure, it's not a huge deal if the woman can take her prescription back and walk into the pharmacy next-door, where she'll be cheerfully served. But:

Is Target going to insure that all its objecting pharmacists know where the MAP is available?

That they know that there isn't an objecting pharmacist on duty at the other pharmacy? If there is, what happens?

How are they going to enforce clear communication from the objecting pharmacist? "He wouldn't sell me the MAP I was prescribed," is clear. "He didn't tell me where I could go to get it"? That's much more ambiguous. A pharmacist with moral problems with the use of the MAP doesn't have a lot of incentive to be helpful here.

How far away is all right? Is it okay to expect a woman to drive ten minutes to get to the next pharmacy? An hour? Where's the line?

If the Target policy is okay (and if it's okay for Target, it's okay for any other pharmacy), it can become significantly more difficult for women to get the birth control that's been prescribed for them. I think that is worth some vitriol.

[Slartibartfast]

If I am denied a Big Mac in McDonald's because the counter jockey is a member of PETA then you have but to report it to the manager on duty and that counterperson will be toast. I'm not sure how well that translates to pharmacies, though, but I'm not a big fan of the fast-food/Plan B analogy to begin with.

[Jackmormon]

Factual question:
Is there an expiration date for emergency contraception pills? Would a pharmacy have to restock them regularly even if demand was low?

[Barry]

"Any stories of refusals to prescribe Viagra without proof of marriage?"

Posted by: Anderson

Forget proof of marriage - if you can't get it up, must be Will of God.

Same way for heart medicine - the heart failure is due to sloth and gluttony, unnatural practices such as smoking (not biblically approved, please note!), or God's Will.

[John Thullen]

All great questions.

What happens if you go to Wal Mart and you want to buy a Pandora's Box containing two slippery slopes and the clerk refuses your request because there happens to be a can of worms in the box, too?

I like Gromit's point: the problem with me is that vitriol is available over-the-counter without a prescription.

[Anarch]

I'm not sure how well that translates to pharmacies, though, but I'm not a big fan of the fast-food/Plan B analogy to begin with.

I am when it's packaged in the form of a delicious burrito.

[Slartibartfast]

Mmmmmm...burritos.

[Jeremy Osner]

Regarding the Target's pharmacists telling customers where to get the pills they are unwilling to dispense -- if there is not another pharmacy nearby I suppose they could also tell them when to get the pills, i.e. "Come by at 3 pm -- that's when Phil comes on duty, he's not a nutcase like me and will give you medication."

[Jackmormon]

If "where" is far away and "when" is 24 hours away, then a woman hoping to take the pills before the deadline could be in real trouble. AFAIK, emergency contraception usually comes in two doses, one taken immediately and the other 12 hours later. You're not out of the woods until you've taken, and held down, both pills. I'm a little surprised by the original article's claim that it could be taken as late as five days after sex: I'd heard that three days was the outside limit.

My point is that the timing is important, and having to wait until non-nutcase Phil comes on duty at the pharmacy could make the difference between a non-implantation of a fertilized egg and a surgical abortion of one.

If the pharmicists feel tainted by handling Plan B, maybe they should consider a dispensing machine.

[LizardBreath]

And it's not as though it's a hard deadline, where the pills will work if you take them before 24 hours after but not if you miss that deadline. They just get less effective the longer you wait. So "Wait until 3 pm" means "Rather than having a 2 percent chance of accidental pregnancy, have a 5 percent chance." (Numbers invented due to laziness, lack of research.)

maybe they should consider a dispensing machine.

Maybe the FDA could release them for over-the-counter sale? That'd be a cool idea, wouldn't it?

[Anna in Cairo]

Birth control pills are over the counter in developing countries. (for emergency contraception it is effective just to take a bunch of birth control pills at once.) Largely because USAID has subsidized their manufacture. The US totally does not practice what it preaches.

[liberal japonicus]

Not directly related, but a factoid to register is the use of misoprostol to induce abortions in the 3rd world. If Roe is overturned, rather than the reemergence of backroom abortion clinics, we would probably see this drug used as it has come to be used in South America. The article lists some of the problems with that.

[Barry]

"If I am denied a Big Mac in McDonald's because the counter jockey is a member of PETA then you have but to report it to the manager on duty and that counterperson will be toast. I'm not sure how well that translates to pharmacies, though, but I'm not a big fan of the fast-food/Plan B analogy to begin with."

Posted by: Slartibartfast

The biggest differences that I can see are (1) fast food places are much more common than pharmacies. Where I live, if there's one there're probably several more on that block; (2) there aren't any state laws to protect that PETA person that I've ever heard of, while there are state laws to protect the pharmacist.

[Slartibartfast]

Yeah. And the bit about controlled substances.

So, other than the two being ALMOST completely different, they're suitable for analogy.

Not defending pharmacists deciding for their employers what is and what is not acceptable for sale, just noting a poor analogy. I look at it like this: either this is an internal issue between the store and its employee that is being repeatedly underscored by exposure to public opinion, or it's a legal issue. Or maybe both, if the store decides that employees can make their own policy, they may find themselves at the business end of a lawsuit. Because what's being freely executed by employees is policy, official or not (at least as far as the law is frequently concerned).

[dutchmarbel]

Largely because USAID has subsidized their manufacture. The US totally does not practice what it preaches.

It practises what it preaches, but as usual without long-term planning or looking at facts.

So now the EU pays the contribution of the US.

About the pharmacists: I agree with other posters who point out that lots of people have religious idea's that might prevent them from filling specific kinds of prescription (I liked phil's example of scientologists who refuse to give anti-depressants). Since the pharmacists do not PRESCRIBE the drugs they should fulfill prescriptions IMO.

[Phillip J. Birmingham]

Lizardbreath:

Maybe the FDA could release them for over-the-counter sale? That'd be a cool idea, wouldn't it?

You may already be aware of this, but the FDA is sitting on this action right now, and an assistant commisioner of the FDA has resigned, claiming that the stonewalling is a political decision from higher up in the administration. The usual suspects are opposed.

http://www.washingtonpost.com/wp-dyn/content/article/2005/08/31/AR2005083101271.html

[John Thullen]

What if this particular pharmacist changed careers and opened a gun store?

He could sell big-clip automatic weapons over-the-counter and those slippery teflon bullets that Dick Cheney carries in his bandolero.

The former pharmacist's religious and constitutional convictions would remain intact, his conscience would be clear, and the rape victim could buy weapons from him to force the new nut-cake pharmacist to sell her the stinking morning-after pills.

There, another quandary wrapped in a conundrum solved by the remarkable alternative media.

Next question, please!