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Monday, February 20, 2012

Conscientious Objection

There is currently a political debate in the United States spurred on by Republican and Catholic histrionics regarding access to contraception. In an increasingly common marriage of convenience, Republicans and Catholics (along with several other misogynistic religious groups, but the Catholic influence here is particularly overt) have joined forces to try and prevent contraception from being provided as part of regular health coverage.

Along with the fight over whether or not access to contraception should be part of regular health care (short answer: it should) this debate has prompted the resurgence of the idea that health care workers, particularly those at religious health care institutions, should be allowed to refuse to provide contraceptive services to patients on the grounds of conscientious objection. This is just ludicrous, and I'm not sure how it keeps coming up.

1.) Refusing to provide contraception is not making a personal decision

The standard line in support of contraception is that the health care worker is personally against the use of contraception, and therefore cannot condone providing it. The thing is, this is not comparable to the conscientious objectors in wartime. The original conscientious objectors are refusing to physically go off to war, risk death, and shoot people themselves. No one is asking the health care worker to pop a pill or throw on a condom.

For the particularly thick-headed who cannot seem to understand this difference, try this: imagine going into a grocery store, waiting in one of those horrible cashier lines, and discovering once you finally get to the front that the cashier is a member of the International Society for Krishna Consciousness* (more widely known as a Hare Krishnan). The cashier informs you that he cannot in good conscience sell you your meat, eggs, cola, tea, or coffee, as the consumption of those are against his religious beliefs, but he will be happy to ring your apples and lettuce through for you. If you want to buy the rest of your groceries, you'll have to wait in a different line. If he happens to be the only cashier on hand at the moment, you'll just have to put your groceries back and go to a different grocery store, or come back later when another cashier is on hand. Now imagine try and take that indignant response to call the manager and explain that the cashier can refrain from eating whatever the hell he wants, but he has no right to tell you what food you can buy, and imagine how much greater than indignation must be for something far more personal than what you are going to be eating for dinner that night.

2.) Not all contraception is about birth control or even sex

This is really simple: just because oral contraception can be used to drastically reduce the chances of pregnancy from unprotected sex does not mean that is the only reason for taking it. In fact, a report released this past November (link to the pdf) by Rachel K. Jones of the Guttmacher Institute claims that over 1.5 million women use birth control pills exclusively for non-contraceptive purposes. Even though it is not up to the health care worker to judge whether women should be having sex for non-reproductive purposes in the first place, refusing to provide contraceptive pills can put the health of women at risk for reasons entirely unrelated to sex.

3.) Health care has standards of practice

Health care workers are not like employees in all fields. Health care (and here I am referring to real health care, not alternative medicine nonsense) has standards of practice that are not optional for very good reasons based on an understanding of human health and physiology. The decisions for what constitutes standards of care can only reasonably be expected to be developed by health experts themselves, and legislating exceptions or specific procedures by an assembly largely made up by individuals ignorant of medical knowledge is nonsensical and potentially even dangerous.

* Obviously this could work with a variety of religions and products.