Conscience clauses guilty of overkill

Breaking a law that one believes is unjust or immoral is an American tradition of sorts. Whether as a public act of protest or a private statement of values, those who’ve taken a proverbial seat in the front of the bus sometimes earn a special place in the national pantheon of heroes.

But I have a hard time equating Rosa Parks with Neil Noesen.

Noesen has become a household name among those debating “conscience clauses” – that is, whether professionals can refuse to perform certain services because they violate personal beliefs. Working as a pharmacist in Wisconsin, he would not fill a college student’s birth-control prescription, nor would he transfer the prescription to another pharmacy because of his religious objections to contraception.

For this, he’s been reprimanded and his license limited; his story also has become a rallying cry as the Wisconsin legislature considers various measures to protect the rights of those who wish to opt out of professional duties without incurring any punishment.

Wisconsin has become only the latest state to confront the demand that individual rights trump communal obligation. According to the National Women’s Law Center, “refusal laws” have been introduced in 28 states, and they’ve already passed in three others. There’s been the inevitable counter maneuver: Lawmakers in five states (including New Jersey) have introduced bills to require pharmacists to fill prescriptions, and there’s legislation pending in Congress to do so, as well.

Meanwhile, the American Medical Association – whose members, after all, are the ones writing the prescriptions – last month enacted a policy that recognizes pharmacists’ right to refuse but insists on a system to ensure that patients receive medical services “without harassment and interference.”

As well they should.

Conscience clauses have been around since Roe v. Wade put Roman Catholic hospitals in an impossible position by legalizing most abortion. Congress responded in 1973 with a provision to allow health care providers and institutions to refuse to perform abortions or sterilizations because of moral or religious convictions.

This straightforward compromise has become complicated as those hospitals have received more government funding, with understandable strings attached.

Still, the compromise works, by granting the health care provider the freedom to say no, while allowing the patient to go elsewhere.

But sometimes there aren’t alternatives available. Or, as in Noesen’s case, sometimes a professional will step in the way instead of stepping out of the way, preventing a patient from receiving the health care she deserves.

Such acting upon a personal agenda, whether religious or not, cannot be allowed to interfere with the duties of the professional and the obligations of citizenship. What is civilized life, anyhow, but a collection of compromises we make to live peacefully with one another?

If the compromises are too onerous, there is always the opportunity to opt out entirely. No one is forcing Neil Noesen or anyone else to fill prescriptions, but if he chooses to be a pharmacist – with all the protection a government license bestows – then fill prescriptions he must.

“Conscience is a tricky business,” writes R. Alta Charo, a lawyer and bioethicist at the University of Wisconsin, in a recent edition of the New England Journal of Medicine. “Some interpret its personal beacon as the guide to universal truth. But the assumption that one’s own conscience is the conscience of the world is fraught with dangers.”

I hope none of us wants an America where a Neil Noesen or a Rosa Parks or a conscientious objector during a wartime military draft is prevented from expressing his or her beliefs or is forced into a situation that violates a personal code of morality.

But civil disobedience isn’t free. There is a cost to society when a person’s health may be endangered, or when its military effort is weakened; there are consequences. And the one who disobeys must be willing to deal with them.

The conscience clauses now being legislated do more than allow someone to forgo professional or communal obligations by following the dictates of their conscience. They allow someone to forgo those obligations with impunity. Lawmakers should think hard before they permit some people to put rights before responsibilities under the guise of faith.