Opting Out

Some doctors don't want to assist the state in killing prisoners, and some pharmacists don't want to fill prescriptions they think will kill fetuses. Doctors, within limits, get to decide who they will treat — should pharmacists have that same right when it comes to filling prescriptions? Dahlia Lithwick says no.

The law recognizes that doctors' special relationship with their patients warrants a legal privilege: Their discussions are kept secret. You may like and trust your pharmacist. You may even trust him with intimate details about your yeast infection. But your pharmacist has neither the tools nor the right to probe details about rape and abuse, incest and health risks. Which is why pharmacists who interpose between decisions made by a doctor and her patient are overstepping not just moral but legal boundaries — and undermining another professional relationship that is fundamentally different from their own.

Dahlia Lithwick is right. But if we take this approach, do we need to consider the "law of unintended consequences" when it comes to staffing pharmacies? Leon Wolf at Red State says yes.

In other words, if you force the sole pharmacist in rural South Dakota to provide the morning after pill, that conscientiously objecting pharmacist is at least as likely to opt for early retirement or a move to more conscience hospitable climes than he/she is to just cast aside deep objections to the morning after pill. The result? NO pharmacist for everyone in that rural South Dakota town — including the woman who wants her morning after pill as well as the grandmother who wants her heart medications.

Leon Wolf is wrong. First, one would have to seriously question the moral conscience of his hypothetical "sole pharmacist in rural South Dakota" who would decide to pack up shop and deny lots of people their live-saving medicine because he or she doesn't want to fill a legal prescription for another drug. One would also have to quantify the risk of such a thing happening, something that Wolf doesn't attempt. It's easy to say "at least as likely"; it's harder to back that claim up, and he doesn't even try.

Second, basing heath-care policy on the playground ethic of "I'm taking my ball and going home if I don't get my way" is itself morally repugnant. If there is any area, anywhere and for any reason, that is without a means of delivering prescription drugs to patients, then the solution is to provide those services, either directly through the doctors' offices or via public clinics. If pharmacies are unwilling to meet the health-care needs of a community then other organizations need to step up to the plate. The unreliability of private pharmacies shouldn't be used to justify making private pharmacies even more unreliable.

But third, and most important, Wolf avoids the key question of where to draw the line when it comes to allowing pharmacists (or other professionals) to opt out of providing services on moral grounds. I've addressed this question before, and the answer seems clear — the line needs to be drawn in a way that mandates the fulfillment, without delay, of any legal prescription. Pharmacists don't have the credentials to be making these kinds of medical decisions for their customers, and they shouldn't be allowed to.