Special ethical systems

Irreligiosity writes about the ethics of pharmacists and whether they should follow their personal conscience in fulfilling or not fulfilling certain prescriptions, such as birth-control pills. Irreligiosity believes "the entire situation can be boiled down to two conflicting views about when life starts," but I think he's missing a larger point.

We have a large, complicated society, and there are no small few domains where we demand that one's personal conscience take a back seat to socially constructed processes. These domains, law and law enforcement, the military, emergency services and medicine, address issues too large and too complicated for any individual's conscience to effectively resolve issues. Furthermore, in these domains, we have to go beyond individual good faith to eliminate bias and prejudice.

The pharmacist issue can be boiled down to the social and professional ethics of medicine, which hold that everyone in the profession must act in the patients' best interests, regardless of their own interests. Full stop. In just the same way, a defense lawyer must represent her clients' legal interests, regardless of how she personally would see justice done: Justice is the outcome of a process where each person in the process takes a specialized role.

This ethical view is supported not only by rational analysis and rationalization but also by thousands of years of social evolution. We permit such a dramatic change in our medical ethics at the extreme peril of unintended and unforeseeable consequences.

The rationalization for this view of medical ethics is straightforward: We permit not only physicians but everyone in the medical profession to do dangerous, dramatic and most importantly, incomprehensible things to our bodies. We trust them with our very lives, and we can trust them only if we are confidently assured that they will act completely in our own best interests. I don't want to have to inquire into my physician's religious views, or her views on race, class, drinking, drugs, sexuality, etc.; I want to know that she'll suspend her own views and treat me according to my own views. I don't want to worry that she'll slip saltpeter into my pills because she disapproves that I'm married to a brown woman. And I certainly don't want to worry that she might want to kill me because I'm an atheist.

This is the bigger problem with allowing pharmacists freedom of their personal conscience. If you want to have such individual freedom of conscience in specific cases, don't go into a profession which requires that you submit your beliefs to the demands of the system. Don't go into criminal defense if you don't want to defend to the best of your ability people accused of crimes regardless of your personal judgment of their guilt. Don't go into the military if you're not willing to shoot people when ordered to do so.

And don't go into the medical profession if you're not willing to do what's best for the patient, regardless of what you think is best.

I want to be able to trust my physician, my pharmacist, my nurse, my EMT, my physician's assistant, and everyone else to whom I entrust my health and life. If we permit people in medicine to allow their own beliefs to override what's best for the patient in one respect, we set a precedent, and where does it stop? Do we allow pharmacists to withhold all forms of birth control? Do we allow physicians to deny care to criminals? Nazis? Atheists? Blacks? Jews? Catholics? Democrats? It becomes an issue of simple fairness: If he isn't compelled to violate his conscience, why should I be so compelled?

We don't want anyone to use our medical care as instruments of social policy. Not physicians, not pharmacists, not legislators or governors or presidents.