What Happens When Conservative Morality and Medicine Climb Into Bed Together?

A recent flurry of controversial refusals by health care providers to do their job could put your health on the line.

By Emily Brochin

Ethics and medical care have always been necessarily intertwined. But, as of late, the relationship between the two has become rocky as controversy has erupted over issues like stem cell research, the availability of emergency contraception, the right to die, and the right to live. For the majority of college students, these matters exist only in the ether—something to debate in the classroom or over a beer. However, thanks to the diligent work of the religious conservative movement, the moral values and medical treatment debate is poised to puncture the bubble of academia and possibly affect the health care you receive.

In the last few weeks, there has been a flurry of activity on the state level surrounding the right of pharmacists to refuse to fill prescriptions for contraceptives and the morning-after pill due to religious and moral objections. The New York Times reports more than 180 refusals in the last six months. On April 1st, Illinois Governor Rod Blagojevich approved an emergency rule that would require pharmacists to fill prescriptions for birth control pills after receiving complaints that a Chicago drug store was refusing to do so on moral grounds. "The pharmacy will be expected to accept that prescription and fill it," he said. "No delays. No hassles. No lectures."

Just last month, the health care of college students was threatened when controversy broke out on the University of Wisconsin campuses over a spring break ad that the University Heath Services placed in student papers advising women to carry condoms and to have emergency contraception on hand over the vacation. In response, Republican Wisconsin State Representative Dan LeMahieu announced that he had begun to pen legislation banning any university health center in Wisconsin from advertising or even distributing emergency contraception. "I think it’s offensive that the university is trying to tell young women to be prepared and to plan ahead so they can have promiscuous activities on spring break,” Rep. LeMahieu said. “I don’t think that it’s the role of the university to promote that type of activity, and I believe that’s what their ad is asking young people to do.”

University Health Services countered LeMahieu’s statement, saying, "UHS stands by its current practice of prescribing emergency contraception to students on this campus should they desire it. We believe this is a preventive action; [we are] not encouraging promiscuity — there is no evidence that women use this in that way." Indeed, if LeMahieu had his way, even a married graduate student could be denied the morning-after pill. Moreover, while the availability of the morning-after pill is important for students whose primary form of contraception has failed during consensual sex with their partner, it is critical for those students who have been sexually assaulted.

University of Wisconsin Sex Out Loud program facilitator Ann Slabosky commented: "Advertising the morning-after pill does not promote ‘promiscuous sexual relations’ any more than supplying air bags promotes reckless driving.” Similar legislation was vetoed last year by Wisconsin Governor Jim Doyle, on the basis that: “The personal ideological beliefs of scarce health-care providers in rural or other underserved parts of the state should not dictate the legitimate medical options available to citizens. . . .A clinic’s doors are not truly open to the community if the services available within the clinic are limited to anything less than the full range of needed treatments.”

However, the image of hot-blooded naïve coeds gone wild after reading an ad in the school newspaper might just prove too inflammatory to resist. How might LeMahieu go about banning a legal drug from being lawfully distributed to women with prescriptions? He plans to draw on legislation pressed by the Michigan Catholic Conference. The legislation, a collection of four bills called the Conscientious Objector Policy Act, was passed last year by the Michigan House of Representatives. Its purpose is to prevent health care professionals, insurers, or facilities from being fired or sued for refusing to provide services contrary to their moral, ethical, or religious beliefs. Under COPA, if a health care professional files an objection within 24 hours of the objectionable procedure, he or she will be protected by the act. Only in emergency situations does COPA not apply. As for Michigan’s pharmacists, under COPA they still must fill birth control prescriptions, but they can opt out of providing the morning-after pill.

Sure, providing legal protection for an individual’s right to object to personal involvement in something he or she finds morally wrong is necessary in some circumstances. (The typical example used is doctors or nurses refusing to perform or assist with abortions or sterilizations.) However, the Conscientious Objector Policy Act presents glaring problems and conflicts of interest. Vague wording within the act allows it to be extended way beyond abortions and sterilizations. The litany of procedures (primarily affecting women and LGBT people) that providers might find objectionable is endless: gender reassignment surgery, hormone therapy, in vitro fertilization for same-sex couples, post-abortion checkups, or safer sex counseling for HIV/AIDS prevention. And since the act has no proviso requiring health care professionals to refer patients to other doctors, these treatments can be denied all together, particularly in rural areas with few doctors and nurses. Further, under this legislation, doctors could refuse to treat groups with which they have “moral” problems, so a gay man with a cold might be out of luck.

South Dakota, Arkansas, Mississippi and Georgia have already passed legislation that allows pharmacists to refuse to fill prescriptions, and Wisconsin is now included along with Indiana, Tennessee, Texas, Arizona, Vermont, and Rhode Island in considering the adoption of such laws. Simultaneously, a few states, including California, New Jersey and Missouri are considering legislation that would, in fact, require pharmacists to fill prescriptions.

According to Adam Sonfield of the Alan Guttmacher Institute in New York, which monitors reproductive issues: "There are pharmacists who will only give birth control pills to a woman if she’s married. There are pharmacists who mistakenly believe contraception is a form of abortion and refuse to prescribe it to anyone … There are even cases of pharmacists holding prescriptions hostage, where they won’t even transfer it to another pharmacy when time is of the essence." Recent instances of pharmacists refusing to fill prescriptions have been cropping up more frequently, and in states that do not have specific laws dealing with the conscientious objector rights of the pharmacist, the matter is left to the discretion of the pharmacy. So if you live in a rural area where options are limited to a Wal-Mart, which does not stock the morning-after pill, emergency contraception might as well be illegal.

Indeed, a unified movement of health care providers armed with their righteous moral indignation could slowly and systematically undermine the availability of some commonly-used drugs and create an environment of intimidation in the medical world. And for college students who are away from home, without cars, and often in strange new locations, having their medical choices denied by health care professionals who have pledged to “first do no harm” certainly constitutes a threat to their medical wellbeing.

Why are these issues coming up now? The confluence of the increasingly influential religious right’s pro-life, anti-gay agenda coupled with the Republican dominance in state and national government is creating an environment where public policy is being reshaped to reflect their ideology. Is denying care exercising freedom of religion or a violation of the Hippocratic Oath?

A visit to the doctor or pharmacist is often nerve wracking enough without having to confront a lecture on religion, sin, and your sexual lifestyle. It is not within the job description of a pharmacist to deny or delay the receipt of important medication to a patient that has a legal prescription. Perhaps, none of these issues will be resolved until healthcare itself becomes an inalienable right. But placing the fate of vulnerable citizens in the hands of individuals who are legally allowed to conduct business according to their particular set of moral values poses enormous dangers to the health of individuals and the integrity and effectiveness of our health care system.

Illustration: Matt Bors