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Jabari Asim

Conscience Behind the Counter

By Jabari Asim
Monday, April 4, 2005; 10:56 AM

WASHINGTON -- "Ladies and gentlemen, thank you for riding the commuter express. Please remember to take your newspapers and belongings when leaving the train. Customers on the platform, please stand aside until disembarking passengers have passed safely through the doors. Also, be aware that our transportation service is not available to anyone who may be headed to Fred's Steak House.

"Or Melissa's Meat Emporium. Or anywhere else you despicable carnivores care to congregate.

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"You see, I'm a vegetarian, animal-rights activist and member in good standing of TOOL -- Train Operators Organized for Livestock. Consequently, I cannot in good conscience allow you to board my train. Take your business elsewhere."

I don't really drive a train, and, as far as I know, TOOL exists only in my imagination. But the scenario I've described isn't as farfetched as it may appear at first glance.

Consider Pharmacists for Life International, whose 1,500 members are unwilling to fill prescriptions with which they are uncomfortable, such as those for birth control and "morning after" pills. Adam Sonfield, who studies reproductive issues at the Alan Guttmacher Institute in New York, told The Washington Post that actions by such pharmacists have taken many forms. "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," he said. "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."

Where some pharmacists see a fundamental moral conflict, Anita L. Allen sees a collision between personal ethics and the privacy rights of patients. Allen is a professor at the University of Pennsylvania and author of "The New Ethics: A Guided Tour of the Twenty-First Century Moral Landscape." "A lot of drugs have different purposes," she said. "Birth control pills are used to treat severe acne and menstrual pain. Should a pharmacist say, 'What are you using this for? If you're using it for pain I'll give it to you; otherwise I won't'?"

The American Pharmacists Association (APhA) tried to devise a way around such conundrums by allowing its 50,000 members to decline to serve patients as long as they make other arrangements for them. But people on both sides of the issue have expressed problems with that attempted compromise. Reproductive-rights proponents have argued that it is impractical in places where there are few pharmacies, and problematic for women who have to take time off from work to get prescriptions filled.

Karen Brauer, president of Pharmacists for Life International, raised strong objections as well. "I refuse to dispense a drug with a significant mechanism to stop human life," she told USA Today. "That's like saying, 'I don't kill people myself but let me tell you about the guy down the street who does,"' she told the Post. Brauer's group is calling for states to adopt "conscience clauses" that would protect pharmacists who refuse to fill prescriptions that they disagree with for moral or religious reasons. Arkansas, Mississippi and South Dakota already have such laws.

It is probably still too early, however, to call such developments a trend. Many Americans continue to regard sensitive health-care issues as personal matters in which basic privacy rights should be honored. In the Terri Schiavo case, for example, 82 percent of respondents to a CBS News poll in late March opposed government involvement of any kind -- a sentiment shared by many judges of both conservative and liberal bents. And while some states are considering "conscience clause" legislation, others are debating laws that will specifically obligate pharmacists to fill all prescriptions.

As APhA's efforts make clear, finding acceptable middle ground will prove extremely difficult -- always the case where reproductive issues are concerned. While I support a woman's right to choose, I can't help but take very seriously the concerns of those who oppose abortion. In the African-African communities where I've spent most of my life, abortion is an option pursued in epidemic proportions. But my sympathy for others' beliefs clashes with an equally entrenched reluctance to pass judgment on others with whom I disagree by denying them goods and services to which they are reasonably entitled. That seems morally objectionable too, not to mention illegal.

Will female air travelers who carry contraceptives on board eventually be required to carry parachutes, just in case a pilot's conscience finds their presence objectionable? If your personal beliefs hinder your ability to do your job, it may be prudent to look into another line of work.

© 2005 washingtonpost.com