Uppity Pharmacists

The Thinker by Rodin

From today’s Washington Post:

Some pharmacists across the country are refusing to fill prescriptions for birth control and morning-after pills, saying that dispensing the medications violates their personal moral or religious beliefs.

To that small minority of pharmacists out there incapable of doing their jobs professionally: it’s time to get another profession. You are in the wrong business. Find some profession where your personal and moral beliefs won’t be so challenged. Sunday school teacher perhaps. Maybe Randall Terry will pay you to stand outside abortion clinics and heckle women going in and out all day. One thing is for sure: if you can’t put your convictions aside and do your job you must not be a pharmacist.

News flash: lots of us are called on to do things every day that violate our personal and moral beliefs. I am a federal civil servant. I find the policies of my ultimate boss, President Bush, to be reprehensible. Still, when it comes time to act on one of his dubious and unconstitutional policies like giving tax money to religious charities I follow his instructions. No, it’s not because I like them. Yet I do it anyhow. Why? Not just because I took an oath, but also because it is part of my job. It is my obligation. I cannot pick and choose which parts of my job I will and will not do. Neither can you, Mr. Pharmacist. So either suck up your personal beliefs like the rest of us or get out of the profession. But don’t tell some paying customer that you won’t fill their perfectly legal prescription. And especially don’t confiscate the prescription in the process, as apparently at least some of you have done.

We have a process in this country. It’s called the law. And part of the law delegates to certain professionals what drugs may be prescribed. The doctor who wrote the prescription has already exercised his legal and professional judgment that the medicine is appropriate for the patient. In many cases, like the woman in the article, they can’t spend days running from pharmacy to pharmacy looking for a pharmacist who will fill their prescription. They may need the medicine immediately. You have no way of knowing and it is not your job to make any assumptions. You are not a judge. Your job is to fill the prescription, answer questions the patient may have about the medicine and take their money. It is not your place to impose your moral judgment on others, such as refusing to provide birth control pills to a woman who might be unmarried. That is a decision she makes, not you.

I think all drug store chains need a clear zero tolerance policy prominently displayed at the pharmacy window. For starters I suggest: “All legal prescriptions are welcome here. We will not employ any pharmacist who refuses to fill any prescription.” But apparently we now need laws to require that prescriptions be filled. It used to be you never gave a second thought that any pharmacist would go against a doctor’s judgment. It appears those nostalgic days are behind us.

I guess we are fortunate that at least physicians take their Hippocratic Oath seriously. There needs to be something with similar teeth in it for pharmacology profession. A doctor cannot usually provide the necessary patient care without the prompt cooperation of a neighborhood pharmacist. So renegade pharmacists are really undercutting the ability of the doctor to perform timely treatment. Rather than respecting the dignity of the patient, these renegade pharmacists are trampling on the dignity and human rights of patients by denying them their right to medicine. Sadly at least some of these renegade pharmacists will scold and humiliate these customers them in the process.

My thanks of course to the vast majority of professional pharmacists out there who have faithfully, promptly and professionally provided the drugs my family and I have needed. I hope these errant pharmacists are few and far between.

The Game of Generations

The Thinker by Rodin

Most of what happens in any generation is just noise. Events that seem monumental in our time, such as September 11, 2001 will be but a few sentences in our history books in just a couple hundred years. We’ll have moved on. You will be dead. Your children will be dead. Your great great great grandchildren will be grappling with their own problems, small and large. The players will have changed but human drama will continue in its macro and micro levels as long as our species survives.

What endures? What truly survives from generation to generation? After all for the most part we are an impatient race. Tearing down and rebuilding is something we do almost by default. If life doesn’t seem to suit us then we will reconfigure it until it does suit us.

Our myopia on the present makes it difficult to predict what will matter about the past to future generations. But we understand innately that the values we teach the next generation probably has the most enduring effect on future generations. After all, ideas and knowledge will change but guiding principles in life successfully handed down from generation to generation have a sense of true immortality. So for many of us the ultimate meaning in life simply comes down to successfully transmitting our values to the next generation.

As I pointed out elsewhere, it is unlikely that billions of people would choose a particular religion of their own free will. It is comparatively simple to instill our values and faith in our children. As proselytizers discover, it is much harder job of selling beliefs to those outside the faith. That’s a lot trickier, since the supply of people who are open to a change in belief today is pretty small. Given the reality that when the current supply of savages is so low, market share is gained by religions that emphasize the virtue of larger families. Since both Catholics and Mormons have no qualms about large families it is reasonable to expect that they will gain more influence and mind share in the future. Most likely religions like mine (Unitarian Universalism) will continue to be marginal. (I’m not sure I am acquainted with any UU family where there are more than two children in the family.) So beliefs like Christianity and Islam will pick up steam while those with little traction like Zorasterism disappear altogether. The Shakers believe sexual intercourse is sinful. Not surprisingly their religion is almost extinct.

So the game is about faith, but really it’s about faith minus the mysticism: values. In reality faith is irrelevant. This may be news to many of the devout. There may or may not be an afterlife, but the true purpose of a faith is not to prepare people for the hereafter, but to instill guiding principles in the current generation that make life endurable at worse, and inspiring at best. Values are these guiding principles. Values are the energy that does the work of controlling human behavior at macro level.

That is why values discussions permeate our politics. While even the most conservative Christian in Congress would love it if all Americans shared his religious beliefs, what matters more is that they share his values. So he affiliates with people with similar but not identical values. Over time these values are manifest in what we call political parties. And inside each political party are subfactions that agree on the larger goals but are anxious to promote their particular values inside a receptive community. And sometimes it works. Twenty years ago libertarian principles were almost unknown in the Republican Party. Today we have a Republican president promoting libertarian values like private social security accounts.

So in a sense modern politics has become tribalism at the macro level: it’s my sets of beliefs against your sets of beliefs. Every generation in every country fights the battle on many levels. It takes many generations to see who the winner is. At least in America we don’t usually resort to violence to get others to agree with us. The current war in Iraq is, of course, the obvious current and dangerous exception.

What I find interesting is that the process of transmitting the values really says nothing about the correctness of the underlying beliefs and values. Instead the process only demonstrates the efficacy of the process itself: how well it moves a set of values from generation to generation. If a hundred years from now America is the neo-conservative paradise people like Don Rumsfeld and Paul Wolfowitz are promoting, all it really says is that their sales strategy worked better than the others. Their values may not be empirically correct but they are correct in the sense that they have thrived while others have withered. Value Darwinism succeeded. (One way to possibly get values to thrive is to force them on people through law. Not surprisingly that’s why issues like abortion rights become flashpoints.)

The game continues like a game of tennis where each set lasts a generation. Most people don’t even see it happening at all because it generally happens only a glacial generational pace. Occasionally though monumental changes can happen very rapidly. Communism is an example of such a radical change. The old rules of the social order (serf vs. nobility, worker vs. capitalist) broke down rather abruptly and the serfs took command. Social structures that facilitated the old system, like the Russian Greek Orthodox Church, disappeared, or at least seem to disappear. As the Communists learned, religion is a meme that, if it can be erased at all, requires many generations. After all we all have the same sense of foreboding that is inherent in our mortality. Religion provides a natural solace to the angst of death.

Perhaps then it is our mortality and the certainty of death that makes the promotion of values so terribly important for each generation. Knowing that, as the Catholics say at the Sacrament of Confirmation, “You are made of dust and to dust we shall return”, it behooves us to get off the dime and actively push our values. So we tend to respect those who are forceful in pushing their beliefs, even if we don’t always like the beliefs they are promoting. While some of us might like to have had parents that emphasized the value of kicking back and living a life of leisure, it doesn’t feel a natural fit. Because we are mortal we feel life as fleeting and precious. The older we get the more fleeting it feels and the more important values become to us. While I don’t consider myself old at 48, I have heard from many people far my senior that leaving a legacy becomes a driving goal as they age. Otherwise our lives often feel meaningless.

So we are all caught in a whirlwind of values that I believe have their roots in our inherent mortality and the impermanence of all things in general. But perhaps if we were wiser we’d take the time to examine our own values and determine if they truly ennoble our species. Do our values offer a true solution, or are they simply a response to the angst that comes from our mortality? Perhaps instead of growing up as a species, value transmission becomes a form of societal thumb sucking that is passed from generation to generation. If so will we ever grow up?