Friday, March 04, 2005

The Conscience Clause

This is an interesting piece of news about the sort of events that the conscience clause for health providers might cause to become much more common:

Wisconsin Administrative Law Judge Colleen Baird on Monday recommended that the state... Pharmacy Examining Board reprimand and limit the license of a pharmacist who refused to refill a woman's oral contraceptive prescription because of moral objectives to birth control, the Milwaukee Journal Sentinel reports (Forster, Milwaukee Journal Sentinel, 2/28). Neil Noesen in July 2002 refused to fill university student Amanda Phiede's oral contraceptive prescription while he was working as a substitute pharmacist at a Kmart pharmacy in Menomonie, Wis. When Phiede confirmed that she was using the drug for birth control, Noesen told her that he would not fill the prescription. Phiede then asked him where else she could get the prescription filled, but Noesen refused to provide her with that information. Phiede later went to a Wal-Mart pharmacy, but when the Wal-Mart pharmacist called Noesen to have him transfer the prescription, Noesen refused, saying again that artificial contraception is against his personal beliefs. Noesen continued to refuse to fill the prescription even after two police officers and the Kmart assistant manager spoke with him. The police took no further action, and the managing pharmacist filled Phiede's prescription when he returned to work on Monday (Kaiser Daily Reproductive Health Report, 10/13/04).

I am a vegetarian. If I got a job at a supermarket, could I refuse to sell people meat or refuse to tell them where to find it? Probably not. Even if I decided to act this way (during the short time before I'd be kicked out) not much harm would be done as there are lots of supermarkets and most people know where the meat department is. But pharmacists have quite a different kind of control over their inventory and sometimes there is no other nearby pharmacy that could step in. Also, if the pharmacist refuses to transfer the prescription the consumer could be in deep trouble. And I'm not even mentioning the possibility that a health care provider might act in this way in a medical emergency.

We are vulnerable when we need the help of health care providers. What would conscience clauses do to the trust that patients must have in their providers? Should each of us demand to see the list of things that a particular provider might oppose, and should we demand to see it while we are still healthy and strong enough to find another provider if necessary? Maybe providers could be color-coded? Those who oppose birth control could wear scarlet coats or something and so on.
Thanks to Kimberst for the link and many others for some of the ideas.