Dark Bilious Vapors

But how could I deny that I possess these hands and this body, and withal escape being classed with persons in a state of insanity, whose brains are so disordered and clouded by dark bilious vapors....
--Rene Descartes, Meditations on First Philosophy: Meditation I

Home » Archives » April 2005 » As the grandson of a Catholic pharmacist....

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04/27/2005: As the grandson of a Catholic pharmacist....

who declined either to stock or sell contraceptives in his drugstore on conscientious grounds back in the '60s, I've been watching the recent brouhaha over pharmacist refusals to sell contraceptives, and the associated calls for conscientious refusal laws, with a degree of interest. Over at Slate, William Saletan has an interesting article on the subject: False Pregnancy: Who really wants to debate the morning-after pill? (on the Slate table of contents page, this one was listed as "The Conservative Crusade that Liberals Love")

"Moral battle rages in pharmacies," cries the front page of Sunday's Dallas Morning News. It must be true: Just a week ago, the front page of the New York Times warned, "Pharmacies Balk on After-Sex Pill and Widen Fight in Many States." A couple of weeks before that, the front page of the Washington Post declared, "Pharmacists' Rights at Front of New Debate." Supposedly, armies of pro-lifers are coming over the hills to fight for the right of pharmacists not to fill prescriptions for morning-after pills.

Don't count on it. This is a lousy issue for pro-lifers. That's why pro-choicers and the media are pumping it up and most pro-lifers are sitting it out.

The Times' front page touts "a growing battle" in "at least 23 states" that has "prompted much of the same intensity as the fight over abortion." But look at the fine print on page A16. At press time, only seven states were considering bills for pharmacists' rights, whereas 10 were considering bills to make hospitals offer morning-after pills to rape victims. Contrary to the headline, pro-choicers, not pharmacists, were trying hardest to widen the fight.


Who's fighting hardest for pro-life pharmacists? Pharmacists for Life. Now, there's a shocker. According to the Post, the group "claims 1,600 members on six continents." Come on. That's less than 300 members per continent. Pharmacists for Life may be doing the Lord's work, but its Web site is politically insane—constantly referring to the Serbian-American governor of Illinois, for example, as "Slobodan" Blagojevich. The two other leading advocates for pro-life pharmacists are the Christian Legal Society and the American Center for Law and Justice. That's another sign of a losing issue: The legal purists are out front, while the political groups lie low.

Go to the Web sites of the major pro-life players, and run a search for anything related to pharmacists. I got three hits from the National Right to Life Committee, none since 2001. I got eight hits from Concerned Women for America, none on pharmacists' rights since 2002. Even the U.S. Conference of Catholic Bishops, characterized in some reports as a big campaigner for pharmacists' rights, hasn't touched the subject in four months. The Senate and House majority leaders haven't mentioned it. It's been raised at the White House just once—by a reporter—and the president's spokesman ducked it.

Why the silence? Because from a strategic standpoint, it's a stinker of an issue for pro-lifers. In recent years, they've gained the upper hand by focusing relentlessly on late-term fetuses that look like babies. Notice what's featured on NRLC's home page today: a Bush administration directive to protect "infants who had been born alive after unsuccessful abortions." A fight over morning-after pills would push the abortion debate backward, not just to the beginning of pregnancy, but beyond it, to the stage between conception and implantation. Pro-lifers can't even agree among themselves that a pre-implantation embryo is sacred—most such embryos spontaneously miscarry—and they'd have a hell of a time persuading people that this microscopic entity, which looks nothing like a baby, should be treated like one.

This is why the small groups willing to fight for pro-life pharmacists argue for choice, not life. They say pharmacists should be free to refuse prescriptions for pills they deem lethal to human life. It's a noble argument, and a doomed one. In this case, time is crucial. To work, the pill must be taken soon after sex. In a town with a single drug store, one pharmacist's refusal can effectively block a woman's choice. Furthermore, the pharmacist isn't defying just the woman; he's defying the doctor who prescribed the pill. This is why some state medical societies have come out against giving pharmacists the same freedom of conscience doctors demand. A couple of weeks ago, Arizona's governor vetoed a pharmacists'-rights bill, saying pharmacists "have no right to interfere with the lawful personal medical decisions made by patients and their doctors." Historically, doctors have sometimes supported abortion laws and sometimes opposed them. The only constant is that the doctors always win.

Even if you favor freedom of choice for pharmacists, the pro-lifers' position is weak. The bills and regulations they're fighting allow a pharmacist to refuse a prescription as long as she makes sure another pharmacist is on hand to fill it. (In Illinois, the central battleground, they're free not to stock contraceptives at all.) The American Pharmacists Association backs this policy as a reasonable compromise. Only the pro-life pharmacists and their legal advocates insist on the right to refuse even to refer a patient to an alternative supplier.
It'll be interesting to see how this fight eventually turns out, but it's nice to see the "pro-life" contingent potentially stepping on their own dicks for a change.

Personally, I'm still working out my own position here. Certainly, the accident of my ancestry is a strong influence; I'm naturally very unwilling to take a position that would require me to criticize my grandfather (who, owing to my parents' legal separation for approximately a decade when I was very young, was pretty much my father figure in that critical developmental period). I suppose that's why the A.Ph.A. "compromise" proposal seems to me to be eminently reasonable, since that's exactly what my grandfather did--he informed the physicians and patients that he regularly dealt with that he did not stock or dispense contraceptives, and he did nothing either to condemn those physicians or patients, nor did he do anything to prevent patients from receiving contraceptives elsewhere.

But ultimately, I'll be surprised if the fringe pro-lifers win this one. Meaning no disrespect to pharmacists (who are consistently at or near the top of the lists of most trusted professionals in the United States, unlike lawyers and politicians), they are still at best second tier players in the health care industry. Physicians run the show, and if pharmacist conscience laws are seen as infringing on the rights and prerogatives of physicians, they'll be pretty well doomed.

Len on 04.27.05 @ 08:16 AM CST

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