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It should make you really angry. This makes me see red. I am pissed off, not for myself, but for any woman who is now faced with having her trust in an institution that is part of our primary health care system betrayed.

We go to a doctor for our health. We invest trust in that relationship. Inextricably tied to that trust is the relationship to a pharmacy that will fill a prescription from that doctor. We trust that the pharmacy may even catch an error.  

Who could have possibly foreseen a time when the pharmacist would abnegate his or her part of the health partnership, and work against our health instead of protecting it?

This unethical blight is spreading across the nation. It has been years in the making but is perhaps finally beginning to sink in to our consciousness, and I am posting the RX sign blood red as a flag of danger.  


You can no longer trust certain members of the profession to uphold their ethical oaths.

Last week it was Kansas, where senators voted 23 to 16 to approve a bill that would give pharmacists the right to refuse to fill a prescription for anything they "believe" may terminate a pregnancy. The bill's language is so loose that it gives license to pharmacists to refuse to dispense the morning after pill, which is not an abortifacient. Frankly, I wouldn't give a damn if it were.

In recent years, the proliferation of right-wing zealots who are pharmacists is on the rise. There are pharmacies in the U.S. that will not sell condoms or anything related to birth control. The state legislatures that have adopted "conscience clauses" are growing in number.

This goes hand in hand with the betrayal in medical schools, many of which fail to teach OB/GYN students how to do certain crucial procedures related to pregnancy termination. Pushing back against this are groups like Medical Students for Choice, but they need our help.

Years ago I warned my students that their right to birth control was under attack. Few heeded that warning at the time. Now that it is coming to pass, will we be able to reverse these betrayals?

(Continue reading below the fold)

What exactly are the ethics of pharmacists?  We are far more likely to know a little about the physician's ethical codes than those of pharmacists. They swear this oath:

"I promise to devote myself to a lifetime of service to others through the profession of pharmacy.
In fulfilling this vow:
• I will consider the welfare of humanity and relief of suffering my primary concerns.
• I will apply my knowledge, experience, and skills to the best of my ability to assure optimal outcomes for my patients.
• I will respect and protect all personal and health information entrusted to me.
• I will accept the lifelong obligation to improve my professional knowledge and competence.
• I will hold myself and my colleagues to the highest principles of our profession’s moral,
ethical and legal conduct.
• I will embrace and advocate changes that improve patient care.
• I will utilize my knowledge, skills, experiences, and values to prepare the next generation of pharmacists.
I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.”
I read an interesting piece of philosophy on ethics recently, Dissent in professional communities, by Dr. Janet D. Stemwedel, which applies directly to this question of rogue pharmacists. This part of her argument was key:
A dissenting member has the option of leaving the profession over the disagreement. Or, the dissenting member can stay in the professional community and try to work it out, either figuring out how to embrace the value in question or working to persuade the professional community to change that value. I don't think pretending to your professional peers that you embrace the value in question -- either going through the motions of letting it guide your professional actions while doing so eats away at you, or skulking around and doing the opposite of what a professional guided by that value would do -- is a good idea. Both options require being dishonest with your peers in the profession, and the latter can also involve being dishonest toward the people your profession serves. (For example, the professional code says you'll do X when called upon to do so, but you won't. Yet, given that you're a part of the profession committed to doing X, the client has every reason to believe that you'll do X.) If the dissenting member of the profession isn't committed to trying to work through the disagreement, she isn't fully committed to the community.

None of this is to say that professional codes always articulate sets of values that are internally consistent, or that there might not be good reasons to change those professional codes from time to time.* Some values may be integral to what the profession is all about, while others may be dispensable. Members of a profession who engage in dialogue to identify commitments of the community that are dispensable can be good for the community. Imagine a professional code for scientists that specified that members of the profession must be white, male, and heterosexual. Surely it would be a good thing for members of the scientific profession to pipe up and say that this requirement of the profession is not in any way a requirement for the overarching goal of science (i.e., applying a particular approach to making sense of phenomena). If all the members of the profession who thought this was a stupid value to enshrine in the professional code simply left the community, how would the profession ever move past this unfortunate requirement?

If the conflict is about a value integral to what the profession is about, however, there may not be room for negotiation. The member dissenting from that value will have to make the case to the community that the disputed value really can be excised or changed without totally changing the nature of that profession. And, if the community is not persuaded, the dissenter has to expect that she won't be regarded as a real member of the community any more, no matter how much she feels the other values shared by that professional community to be her own.

The societal pact between pharmacist and consumer is well defined. The same way lawyers can be disbarred for violating ethics, I feel strongly that pharmacists playing God with our lives should be censured by their professional association and boycotted by the consuming public.

This is not simply a matter of finding another pharmacy that is willing to fill a scrip or sell a latex prophylactic. Professional ethics should supersede personal religious beliefs or political affiliations. Can't abide by that contract, get the f**k out of the profession. Period.

My period is my business. My womb is my business. Your job is to abide by my health needs.  

I am neither a physician nor a pharmacist. But since I have worked for the public health as an applied medical anthropologist, I adhere to a code of ethics from my discipline. Having spent so many years of my life battling HIV/AIDS, imagine my horror at the spectre of a pharmacy not vending condoms.

As a young woman who had birth control prescribed to regulate widely fluctuating menses, I realize that "birth control" pills are a health necessity for many women, beyond the fact of simple contraception, but I am not fooling myself about the vicious campaign that has been mounted to deny access.  

This is about control. Women are not two-legged incubators. Our lot in life is not simply to produce children. Those women who choose pregnancy should be able to plan them. Those who don't should be able to prevent them. And those who opt to have an unlimited number of progeny have that right as well—but they, along with their spouses, pastors and politicians, cannot, and will not, restrict other women's choices and condemn some of us to death.  

Yes, death. The same way we used "Silence equals death" as a slogan to fight back against HIV/AIDS, we need to think long and hard about women who still die in childbirth, and the rising rates of infant mortality right here in the U.S.  

No man has a womb. No man has the right to govern mine. It is just that simple.

Those men who view woman as equal partners in this society must step forward to join with us, as brothers in this struggle. Because this is a battle for our health—as individuals and as a nation.  

Though readers here are well aware of the forces arrayed against Planned Parenthood, and have supported them, there are other organizations that are also engaged in this battle for reproductive justice. One that interests me is focused on marginalized young people:

The Pro-Choice Public Education Project is dedicated to engaging young women on their terms around the critical issue of reproductive freedom. Historically, the reproductive rights movement has marginalized young women, women of color, and low-income women, among other groups.
They have downloadable materials that are useful for distribution to students and community groups.

The Feminist Majority Foundation's Choices Campus Program has launched an Emergency Contraception Campaign.

I also champion Loretta Ross and her organization SisterSong Women of Color Reproductive Justice Collective. She told her story as a rape and incest survivor, and of being sterilized, during her keynote speech at the Our Bodies Ourselves 40th anniversary symposium held Oct. 1, 2011, at Boston University.

The most important person in all of this is you. Few Americans have never been in a pharmacy, or never had to fill a prescription. Next time you go into one, raise these issues. Have a chat with your pharmacist.

The right wing has an organized online campaign to push for more "conscience laws." They are not simply limited to reproductive concerns. States advance "conscience clause" bills in mental health.

What's next?

Originally posted to Daily Kos on Sun May 06, 2012 at 02:00 PM PDT.

Also republished by Pro Choice, Sluts, and Abortion.

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