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Tuesday, April 12, 2005

The Trouble with Conscience

One of liberalism's biggest challenges is accomodating tensions among equality principles, private ordering and dilemmas of conscience.  The recent debates over whether pharmacists should be able to decline filling a particular prescription (e.g., contraceptives to unmarried women) are instructive.  I'm just beginning to feel my way around this, so the following analysis may be off. 

But at least with this issue, I think Ellen Goodman's column is right.  Why should conscience be given special protection? If you want to be in a particular business, then you have to realize that business is subject to certain state regulations ensuring equal access.  Just as Denny's shouldn't fail to serve blacks, drug stores shouldn't deny medicine to some people when it is available to other people, when the relevant neutral criteria  (ie, a prescription) link the two classes of people. 

People with consciences that make them squeamish about anti-discrimination laws can pursue avocations and jobs that don't present these apparent conflicts.  The state doesn't compel you to be a pharmacist after all.  Go be a poet.

How should the limits of this principle be carved out?  To take it further, does the state do wrong by accomodating the conscience of the dissenting pharmacists and protecting their jobs when they refuse to dispense (particular drugs, or only particular drugs to particular persons)?  When the state legislature protects the dissenting pharmacist, is it protecting private ordering principles or undermining them?  How does this relate, if at all, to the early (and misguided?) law and economics critique of civil rights laws that said that they were wasteful regulations? 

I present this question with an open mind.  One starting point.  It seems that at least in those instances where the state does conscript you to take some action, there should be some accomodations of conscience. Thus the state that requires kids to be in school until a certain age shouldn't insist that kids recite prayers to deities they don't believe in while they're there.  Even this should have some limits. Conscripts in an army should be extended some accomodations (wearing turbans if that doesn't comprimise combat missions; eating kosher).

But where else does this take us?

Posted by Administrators on April 12, 2005 at 09:41 AM in Law and Politics | Permalink


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Thanks Paul and Ariela, I agree with your points wholeheartedly.

"I also agree with you that the practice of refusing to sell birth control to unmarried women is downright dumb."

It's not actually only unmarried women who are being denied birth control. One of the first incidents coming out of Texas was that of a married couple who went into a pharmacy together. The wife had just miscarried and it would have been very dangerous for her to conceive again. They had to drive to another pharmacy about an hour away to get the prescription filled. The religious tenet that these pharmacists proport to be following is the injunction against abortion, not premarital sex. Of course, by all the best medical research it's pretty clear that contraception is not abortion - but these pharmacists aren't going to let facts get in the way of their religios crusade. In the end these pharmacists are trying to deny all women the right to have sex without consequences, ie. pregnancy.

"Your argument about discrimination in any form is somewhat valid, but let me ask you this: By refusing to allow someone to refuse duties that go against his/her religion, aren't you practicing a form of discrimination? I suspect the answer I would recieve from most people would be that "Well, those people can find another job, and eventually companies will start up where religious views are tolerated." Some people would insist on making laws that prevent the firing of, say, employees who refuse to work on the sabbath, claiming this was the only way to end religious discrimination."

This is point that I addressed directly in the blog post that I linked to upthread. The quick and dirty version is this: the right to medical care trumps the right to freedom of religion because being denied medical care can end in death and being denied freedom of religion can't. However, there's no reason to actually have to make this an either or situation. So long as a pharmacist's religious beliefs can be accomodated without inconvenience or lack of service to the customer. The pharmacist could work only when other pharmacists are working at the same store, and hand off any birth control prescriptions that come his/her way. The pharmacist's hours would be limited to those times when it makes sense to have two pharmacists on staff so that there would be no delay in dispensing the medication. The same thing works for sabbath observers - if your job would typically require shifts that included shabbas you could arrange with your employer not to work those hours but take on other, less convenient hours, to make up for those you would miss due to religious observance. This way the customer is never denied service, the employer wouldn't lose business or have to take a loss due to the employee's religious beliefs, and the employee doesn't have to violate his/her beliefs.

Posted by: rivki | Apr 14, 2005 8:34:46 AM

As to the above discussion between rivki and amosanon1, I think we can clarify what's at stake further by getting away from birth control altogether (even if it's not "only women," it's still "only sex," which often boils down to the same thing rhetorically, your reference to the male birth control pill notwithstanding). Soon enough (let's posit), pharmacists who oppose stem cell research will be able to refuse to dispense treatments for diabetes, Parkinson's disease, heart disease, and other diseases if these laws gain ground. If I oppose research that relies on embryonic stem cells and my conscience tells me that therapies derived from such research are unethical or violate my religious beliefs, I can refuse to sell them, right? Would the free-market fans among you feel comfortable telling the Parkinson's patient that no legal fix is necessary as long as he can pick up his prescription across town? I would not. I am also hesitant to rely on the free market to protect geographically dispersed medical (or sexual) minorities. If I am the only diabetic (or unmarried sex-haver) in a particular county in Georgia who needs that medicine, how is the market going to help me? The whole point of equal-access and antidiscrimination laws is that the market isn't always enough to protect disempowered minorities. In many ways, I think that the free market will probably work AGAINST access to controversial medicines. Just as many communities pressured WalMart into refusing to sell certain music CDs that offended mainstream local sensibilities, I can imagine intense lobbying by local comunities that would put pressure on certain pharmacists or family-owned pharmacies not to sell certain medicines at all. If it comes down to one lonely diabetic against an entire town full of angry churchgoers urging the pharmacy to refuse to dispense the Stem-Cell Medicine, the market is not going to be much help to the diabetic, unless his disease (or more important, his medicine) is very popular and can command its own market/political contingent.

On an unrelated note, I've been curious whether the anti-animal-testing folks have gotten excited about these laws. Wouldn't they love to be able to refuse to sell anything that has been tested on animals? On the other hand, I'm not sure how big the population of animal-rights pharmacists is.

Posted by: Ariela | Apr 14, 2005 8:08:03 AM

Also, what's the fundamental difference between pharmacies and lunch counters? I'm sure that there were lunch counter owners who held genuine beliefs that it was morally wrong for black folk to be allowed to sit there. Congress said tough shit. The public accommodations laws covering said lunch counters don't violate freedom of association, so why would similar public accommodations laws covering pharmacies violate freedom of religion? I tend to think that all First Amendment rights are roughly equal in scope.

Posted by: Paul Gowder | Apr 13, 2005 8:24:55 PM

I'm not sure one of those pharmacists COULD get fired as a result of the practice. I suspect such pharmacist would immediately lawyer up and suggest that they were denied a religious accommodation in violation of Title VII. All the more reason for the state, which is not bound to make accommodations to generally applicable laws (since the RFRA was struck down) to take on the job.

Posted by: Paul Gowder | Apr 13, 2005 8:17:54 PM

I also agree with you that the practice of refusing to sell birth control to unmarried women is downright dumb. As well, I agree that a law saying that those who discriminate in this way cannot be punished is blatantly silly.

However, I simply don't feel that the proper response to legislation one disagrees with should be to try and push the opposite legislation, unless there is a grave danger that needs to be addressed. I don't believe there is in this case. (But I might if shown valid evidence.)

Your argument about discrimination in any form is somewhat valid, but let me ask you this: By refusing to allow someone to refuse duties that go against his/her religion, aren't you practicing a form of discrimination? I suspect the answer I would recieve from most people would be that "Well, those people can find another job, and eventually companies will start up where religious views are tolerated." Some people would insist on making laws that prevent the firing of, say, employees who refuse to work on the sabbath, claiming this was the only way to end religious discrimination.

The only solution to either problem that seems right to me, is to not make any laws until I am sure the market/society can't handle the problem by itself. It's not that I don't see the injustice, just that I think it is prudent to balance those injustices with the ramifications of the solution.

Posted by: bitterman | Apr 13, 2005 6:07:21 PM

Amosanon1, my remark about "it's only women" was directed at a large portion of the blogosphere, and I still believe that if someone was denied medication for a racially charged reason there'd be a much bigger and more vociferous response. A few of these pharmacists have already been fired, but that hasn't caused to back down. It's caused more people to pop up crying for their right to freedom of religion and laws to be proposed protecting pharmacists who refuse to dispense birth control.

Perhaps it all comes down to this, I have no faith in the free market to do anything for me. I have no faith that if the US had just let well enough alone the Jim Crow laws would have just disapeared or contraception would have been made available to women or Jews would have been allowed into higher education. Institutionalized discrimination remains deeply intrenched and the people who control that free market of yours are the people who profit from maintaining the status quo. And considering the fact that this matter is already going to state legislatures (and Federal ones - Congress has already passed a law protecting people from the horrors of having to give rape victims emergency contraception) on behalf of those poor, oppressed pharmacists I'm not willing to sit around and assume that the free market is going to save me.

Posted by: rivki | Apr 13, 2005 5:22:24 PM

I'm sorry if you feel that my attitude is "it's just women," but that is by no means a fair description of my stated position.

Indeed, I'd feel the very same way if male contraceptives were at issue here. When the pill for men becomes available, I am quite certain that the same issue will arise. I am further certain that my attitude will be the very same: let's see evidence that the market can't correct this problem, and then move forward through government.

The interesting thing is that you and I agree: the practice of denying women medication is odious. The difference is that I will feel so much more vindicated when the phoolish pharmacist is fired than I will if some congressional subcommittee issues a report and recommendation.

Posted by: amosanon1 | Apr 13, 2005 5:06:08 PM

But how much inconvenience is too much inconvenience? If a woman has to go five minutes out of her way, an hour, a day? And would you feel the same way if it was a black man being denied medication? Is it perfectly fine to discriminate on any basis so long as there may be somewhere else that does not discriminate? And isn't there a difference between the medical community (who are generally held to a much higher standard) and the legal community?

To tell you the truth I think that denying someone his/her legally prescribed medication for any reason other than A)it's not in stock or B)in combination with other medications that that patient is taking it would be fatal. I feel that a patient's right to regulate their health far outweights a pharmacist's right to discriminate. I wrote about the freedom of religion arguments that are being thrown around to justify this discrimination on my blog at http://rivkiworld.blogspot.com/2005/04/pharmacists-v-women-excercise-in.html.

At heart I feel like this is outright and undeniable discrimination being perpetrated against women and everyone is just looking around saying, "oh well, it's just women, why did they think they had a right to regulate their reproductive health anyway?"

Posted by: rivki | Apr 13, 2005 4:56:29 PM

The first question to ask is not whether there is a right to medication; it is whether people are being denied medication such that we even have to decide whether to define it as a right. That we read stories of pharmacists refusing to fill these prescriptions does not mean that women cannot get them filled relatively easily.

I've already agreed that if the facts demonstrate that women aren't able to get them filled in a reasonably smply manner, then legislation would be appropriate. So it is simply a question of facts.

As a philosophical matter, I'm not willing to deny someone the rights to live according to his conscience (a conscience I strenuously disagree with, by the way) if his conscience doesn't impose much of a price on anyone else.

Declaring medication a "right" doesn't answer this question. Every criminal defendant has a right to an attorney; it does not follow that I am required to represent a Matthew Hale.

Posted by: amosanon1 | Apr 13, 2005 4:20:59 PM

I'm hearing a lot about this trend of pharmacists denying women birth control being an inconvenience or an annoyance. And I have to ask, what is your (Bitterman, Amosanon1) opinion as to someone's right to get medicine? Does anyone have an absolute right to get his/her prescription filled? Or does he/she only have the right to get said prescription filled if he/she isn't offending anyone by getting it filled? And so, if the patient can't find anyone to fill that prescription for whatever reason, is it fine for his/her health to suffer due to a lack of medical care because the "free market" has done its duty? At what point, if any, does the right of an American citizen to medical care trump the right of pharmacists to refuse to dispense medication?

Posted by: rivki | Apr 13, 2005 3:56:35 PM

See what happens when I post something before all of the morning coffee trickles through my bloodstream. My belief in the market righting social inequities is limited. If you are going to support the market theory that there should be no duty for a pharmacist to fill a valid and legal scrip, then you must agree that there should be disclosure of that personal limitations. Furthermore, shouldn't the parmacist be required to tell them where there is a pharmacist who will fill such a valid and legal scrip? If we look at this with respect to the least economically advantaged and mobile members of society, the one pharmacist refusing to fill the scrip may have a greater practical effect then being discussed.

Posted by: Joel | Apr 13, 2005 12:00:33 PM

We aren't giving them a monopoly, like a public utility or a common carrier. Almost anyone can become a pharmacist, or a hairdresser, or a gun dealer, or other licensed businessman. The license is an attempt to make sure the pharmacist is competant, but it isn't a publically supported monopoly, thus there is no need to regulate the market in that fashion. It's possible that in a very few places the pharmacy has a local monopoly, but there are always plenty of other options (condoms are readily available, internet phrmacies carry the pill). The only one I can see being essential is the morning-after pill, but again, that should be available at least semi-locally.

Personally, I am not sure that regulations and lawsuits are the best way to solve this problem. The behavior might be annoying, but it's not much more than annoying, certainly not enough to trump a person's right to run his private business the way he wants. Likewise, we shouldn't mandate a belief system the other way by preventing a business from punishing employees who don't follow the rules, again, because a business has a right to do what it wants within reason.

Posted by: Bitterman | Apr 13, 2005 11:07:18 AM

Paul, your comments are well-received. But the cases you site may not present similar facts. If an ER or power company does not provide the service, then the patient or home will not get the service. Assuming that a woman can relatively easily procure the contraceptives, either from a different pharmacist at the same pharmacy or at some other pharmacy, then it is not at all the same. I am an attorney; I am not required to accept whatever case comes my way.

So we need to consider the empirical question first, which is what I have been saying all along.

Further, wouldn't it be wonderful to watch one of these pharmacists get fired as a result of market pressure?

Thus, perhaps the market can take care of this in one of two ways: (1) by offering efficient alternatives; and/or (2) causing the offending pharmacies and pharmacists to change their policies and practices.

If one of these conditions is met, I don't see any need for legislation (though I also wouldn't support legislation that explicitly permits a pharmacist to refuse to fill a prescription). But I'd be more than happy to look at evidence that these conditions are not met, and then legislation would be appropriate.

I suppose you could say I'm the kind of person who likes to see the evidence before changing the rules.

Posted by: amosanon1 | Apr 13, 2005 10:56:44 AM

I don't see why we can't just treat pharmacists as something like common carriers or public utilities and require them to serve all paying legitimate customers. After all, we do give them an exclusive right to the provision of pharmacy services. That right, which is no doubt profitable to them, can be balanced by a duty just like the power company has a duty to flow juice to all connected households that pay and the emergency room has a duty to stabalize all patients that come in.

Posted by: Paul Gowder | Apr 13, 2005 10:04:44 AM

This is downright bizzare. If someone has an interest in firing the offending pharmacist, it is the pharmacy--and it surely is the pharmacy's right to do so. Just as it would be the bar's right to fire the offending LDS bartender. Does the law mandate that the bar MUST fire the offending bartender? Hardly, so long as the bartender does not discriminate based on any protected classification.

Posted by: amosanon1 | Apr 12, 2005 7:53:09 PM

I think Rebecca's last point is a very interesting one - we are now telling companies that you can't fire people for not doing their job. CVS or Rite-Aid has determined that they want to sell a particular item - birth control - and has hired an employee to dispense it. The fact that the employee has to be state licensed is a government requirement, but fundamentally, the pharmacist is still an employee of the store, and is there to do their job.

Consider an analogous situation: If I am LDS (Mormon), and don't drink, but am employed as a waiter by a restaurant that sells alcohol, can I object on the grounds of "conscience" not to take orders for alcohol? No, because as an employee of the restaurant, I am required to fill all (legal) duties of my job description.

Now, the free market works both ways - can I start my own restaurant that sells no alcohol? Yes. Can I start pharmacy that doesn't have contraceptives? Sure (or, at least, I should be able to.) If enough pharmacists don't want to sell contraceptives, than they can work there. But if you sign up to work for a store that you know sells a legal product, than you should be required to sell that product. If you don't want to, you can work somewhere else.

Posted by: Rishi | Apr 12, 2005 6:59:24 PM

"I concede that if a pharmacy carries condoms or other contraceptive devices used by men, then there is a serious equality issue presented by refusing to carry or provide birth control pills and other contraceptives used by women. Do we know if this is the case?"

Well, I'm assuming it's the case since male contraception (condoms) are not dispensed or sold by pharmacists. The issue is that pharmacists, not pharmacies are making these decisions. So the pharmacy still stocks and sells contraception to both men and women, a pharmacist then comes on shift and denies women birth control. Condoms, being over-the-counter contraception, remain available so long as the pharmacy still stocks them, and considering that some of these pharmacies are CVS and Walgreens I'm pretty sure that they do. But female contraception is not over-the-counter and can therefore be denied by pharmacists. So, to answer your question, yes. In these pharmacies men can get condoms and women can't get the pill.

And yeah, women can't always go elsewhere. In some of the original stories that brought this issue to light women were forced to drive to nearbye towns, or not so nearbye towns to get to a pharmacy that would fill their prescription. Considering that many insurance companies won't pay for a prescription until a day or two before it's needed that doesn't leave women with a lot of time if they're refused. Plus it's not right to just say, well just go elsewhere. Why is it that a pharmacist's right to refuse to fill a prescription is more important than a woman's right to get her medicine without hassles? And, you also have to consider emergency contraception (EC). It becomes less effective the longer you wait to take it after the unprotected sex. So it's very important that women have access to it when they need it, which is immediately. And while every woman deserves access to both birth control and EC we have to take into consideration that a large number of rape victims will try to procure EC. Are we really willing to tell them to go find another pharmacy?

In re: free market. In this controversy one must seperate the pharmacy from the pharmacist. CVS carries condoms and birth control pills. Pharmacist XYZ, who works the nightshift, refuses to sell those birth control pills to women. Now if CVS didn't carry birth control pills at all then this would be a different issue. But CVS does carry them and does expect its pharmacists to dispense them to women carrying a valid prescription for them. What's happening is an attempt to make it a legal right for pharmacists to deny women birth control. They're trying to get a "conscience clause" passed to that effect. And they're doing it so that a pharmacist can't get fired for refusing to dispense birth control. This speaks directly to your third point. If these laws get passed (and they already have been in a few states) then the free market gets shat on. CVS can't fire its employee for not doing their job - and since birth control is one of the most often prescribed medications that could really effect their bottom line.

Posted by: Rebecca | Apr 12, 2005 2:57:10 PM

I don't see that a law or rule that forces a pharmacist to fill any valid prescription is needed, and in some cases may not be appropriate. There are other situations where such a rule could cause a conflict with a business owner's moral views. For example, if there were legal euthanasia, a pharmacist might have qualms about filling a prescription for potassium chloride, or if there were a controversial drug that might or might not carry severe health risks, but has not yet been ruled dangerous by the FDA, a pharmacist may have a valid belief that the drug should not be used. (If recent reports have shown that drug X causes strokes in 50% of patients after 5 years of use, etc.) In this case, where there doesn't seem to be much harm other than annoyance, I think it would be better to allow the market and public pressure to correct this type of thing rather than making laws which may have effects far beyond the intended scope.

Also, from my experience in rural Kansas, most towns have a public clinic where one can get contraceptives (usually much more inexpensively), as well as several phamacies. It seems highly unlikely that a person would not be able to fill a prescription.

Posted by: Bitterman | Apr 12, 2005 2:44:33 PM

I concede that if a pharmacy carries condoms or other contraceptive devices used by men, then there is a serious equality issue presented by refusing to carry or provide birth control pills and other contraceptives used by women. Do we know if this is the case?

If, however, a pharmacist carries no contraception, and if contraception is readily available elsewhere, then I'm not convinced.

What it would take to convince me is evidence that (1) women are being denied contraception, but men are not; or (2) contraception is not readily and conveniently available; or (3) the private sector can't work this out.

I have no data on the first. As for the second, I also have no data, and having traveled through the rural south extensively, I believe that the picture you present of the lack of pharmacies is not borne out by reality--and also remember that most people, whereever they live, have access to the internet and the myriad pharmacies it provides access to. With respect to the private sector, we'd just have to wait and see.

And I still don't understand why there is a "right" to pills anymore than there is a right to condoms simply because pills are regulated by the government. You also state that birth control pills are in the possession of the pharmacist. I'm not sure what difference that makes, but isn't it equally possible that the pharmacist simply doesn't order birth control pills?

I think what you want is for the FDA (or whatever body regulates pharmacists) to state that if you become a licensed pharmacist, you have to fill any and all prescriptions in a timely matter. I don't really have a beef with such a rule, I'm just not certain it is necessary.

Posted by: amosanon1 | Apr 12, 2005 11:44:14 AM

"Let me be clear: If there truly is a problem of access to legal contraception, then a law may be necessary. But I just haven't seen that evidence, and I think the burden is on those who favor governmental intrusion into private contracting."

While I can't give you quotes on how many women have been denied birth control, I can tell you that one woman denied birth control is one too many. Just the same as if it was one black man, or one cancer patient, or one queer. And cases of refusal to dispense have popped up in at least twelve states so far, and considering that this is an incident unlikely to be reported, I'd say that these incidents are not anomolies.

I also have to disagree with you that this is a private contracting. The government is already involved in this issue. The government limits the way in which drugs are prescribed and dispensed and then licenses pharmacists to dispense them. It would be different if it was an issue of pharmacies not carrying birth control, but as it stands it's just pharmacists refusing to dispense the birth control in their possession. Additionally, many legislatures are in the process of writing laws explicitely granting pharmacists the right to refuse to fill a prescription that they object to. So the government is already getting involved, I just want it to make sure that women have their rights respected and protected.

Posted by: rivki | Apr 12, 2005 11:28:26 AM

Rivki's points are empirical. If they are true, then I agree with her. Do we know if they are true? How many pharmacists choose not to fill these prescriptions? How many have confiscated prescriptions? I have no idea. But I've only heard of a couple of cases, and they are getting bad enough press that I imagine the free market (which includes the use of advocacy groups and public relations/media campaigns) would have taken care of it. I'f I'm wrong, then I would agree that a law is necessary.

As for the claim about rights, I'm a bit mystified. You have the right to buy pretty much whatever you want. But do I have to sell it to you? Certainly I can't sell it to Mitsy but refuse to sell it to Rivki; but aren't I allowed to choose not to stock the item? Can't Apu choose not to stock condoms at his Quick-E-Mart? How is this different?

I'll also note that Rivki changes the issue by stating that pharmacists confiscate prescriptions after refusing to fill them. There should certainly be a law against THAT, and there probably already is one. Perhaps it is something we generally call "Theft." In this case, it would be pretty easy to prosecute and prove, too. If your point is that some pharmacists will ignore the law against theft and face the consequences, then why wouldn't they also ignore the law requiring them to fill all prescriptions?

(Note that I also favor a law requiring pharmacists to be honest and open about their willingness to provide contraception. This would avoid a pharmacist claiming that he'll fill the prescription and then delaying or refusing to do so. But again, I think we already have such a law, and it goes under the name "Fraud.")

Let me be clear: If there truly is a problem of access to legal contraception, then a law may be necessary. But I just haven't seen that evidence, and I think the burden is on those who favor governmental intrusion into private contracting.

Posted by: AmosAnon1 | Apr 12, 2005 10:50:23 AM

Aside from Rivki's look at the reality of the situation creating impediments that the free market may be unable to right, the issue is simply that someone of their own volition is denying another person something to which they have a right. This is akin to viewpoint discriminatory speech regulations. I, as a pharmacist, do not like what drugs you get to take so I won't give you the drugs you have a valid and legal prescription to take. I, as the government having created a limited public forum, do not like the what you want to say so I won't let you speak equally in this forum despite the First Amendment.
This is not something for the market. The market is not the protector of rights and leavint the market to determine which majority will enforce its will is, IMHO, antithetical to our democracy.

Posted by: Joel | Apr 12, 2005 10:35:16 AM

I just don't think that the free market is going to get it done. Sure, on the whole women will still have access to birth control in your scenario, but there are far too many women who would still be denied it. (Though I vigorously deny that a woman should have to shop around to find a pharmacist who's willing to fill her perfectly legal prescription.) And that's the problem with allowing pharmacists to deny medicine in the first place. Sure, women living in cities or large towns will have their pick of pharmacies, most of which will dispense birth control at will. But it's the women living in rural areas that are going to be hardest hit by this. First of all, those rural areas are more likely to be populated by pharmacists who think that it is their moral duty to deny birth control. Secondly, pharmacies in rural areas are few and far between. It's not inconcievable that the same de facto problems that make abortion unavailable to many women in rural areas will push birth control similarly out of reach. If no doctors in a county will provide abortions and no pharmacists will dispense birth control than Roe and Griswold won't matter.

There are also issues of pharmacists who confiscate prescriptions after refusing to fill them. At that point it doesn't matter how many pharmacies are open nearbye, a woman will still be at a loss to fill her birth control. Women have rights, including a right to regulate their health as they see fit, and no one has a right to interfere with that. The government has a stake in ensuring that all its citizens have access to legal medications and medical treatments and it can't allow a self-apointed group of moralizers to interfere in that access.

Posted by: rivki | Apr 12, 2005 10:09:09 AM

Pharmacists denying birth control is deeply troubling, but I don't think we need laws to address it. This is something that the free market should be able to work out.

Unlike in the case of refusing to serve blacks at a diner, there appears to be no shortage of pharmacists willing and able to provide contraceptives. Let one pharmacist decline, and let the consumer take her business elsewhere. Also let advocacy groups arrange boycotts and other forms of pressure that may make the pharmacy fire the offending pharmacist or force him to change his personal policies.

For now, the only thing the law should require is that the pharmacist honestly state at the front end whether--and when--he will fill the prescription. That will give consumers the opportunity to find another pharmacy or pharmacist and to organize a boycott of the offending pharmacist.

Posted by: AmosAnon1 | Apr 12, 2005 9:25:25 AM

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