Tuesday, March 27, 2007

Looking at the Pharmacist Conscience Clause Issue in Context

Many people have bought into the mistaken idea that the dispute over the proposed pharmacist conscience clause and Plan B is a struggle between religion and women’s health care. In reality, it is something else entirely. All impartial observers of the conscience issue need to be aware of larger context in which it is moving: An overall strategy by the abortion industry to increase the number of health care workers performing abortion either voluntarily or through state or economic coercion.

One of the biggest problems facing the abortion industry right now is the lack of “providers.” Most doctors who spend a good deal of time, money and effort to finish medical school and complete a residency don’t want to be involved in a business that kills children. While the money might be there, the prestige, gratitude, and professionalism isn’t. After 35 years the abortion industry hasn’t been able to shake their “back-alley” image. Furthermore, doctors are burnt-out and many suffer from the effects of Post Traumatic Stress Syndrome.

The response of the abortion industry has been to first search for escape hatches and magic bullets, i.e. chemical abortion pills like RU-486, to help distance the physician from the trauma of abortion. In this scenario, the woman, rather than the physician, is the one usually left to confront the bloody parts of the dismembered fetus. Secondly, they’ve made serious efforts to recruit non-physicians to voluntarily participate in abortion while simultaneously working to pass laws and apply pressure that will compel others to participate.

That Seems a Little Extreme
You don’t have to take my word for it. Visit the web site of groups like The Abortion Access Project and you can see that they are already recruiting midwives, nurse practitioners, and physicians assistants for abortion training. Or as AAP explains on their web site:

New Abortion Provider Training Initiative (NAPTI) seeks to address the shortage of abortion providers and to expand the scope of practice of advanced practice and other primary care clinicians to include medical and surgical abortion.

Hospitals aren’t off the hook either. They are slated for a strategy of intimidation and pressure as the abortion industry attempts to shift abortion services away from the current archipelago of abortion dominated mills toward a “community-based” delivery system. In pharmacies, community or hospital health clinics, and small one- and two-nurse practices in strip-malls, the idea is that abortion could mix in seamlessly with flu shots, mid-wifery, and cold medications.

More Abortions over a Larger Group of Providers
This strategy benefits the industry by increasing access to abortion and diffusing abortion services over a larger number of providers, making it harder for pro-life activists to target any particular provider. It also seeks to address some of the isolation that abortion providers feel within the medical community as well as release the pressure that comes with doing abortions as a primary part of one’s practice. If “everybody’s doing it” there’s support and comfort for those who have a nagging conscience. Of course there will be financial incentives along with the honors and awards that generally fall to those who assist those in power.

But I thought only Doctors were Supposed to do Abortions
Tell it to the governor, or the health department or the sheriff. But don’t expect much of a response. Despite the state law only allowing physicians to perform abortions, Christine Gregoire as attorney general, ruled that Advanced Nurse Practitioners can administer RU-486 chemical abortions without physician supervision,

Attorney General Gregoire, in the 2004 ruling, declared that the “physicians-only” part of Initiative Measure No 120 was obsolete by stating,

[T]he state now recognizes a new category of health care professional with a scope of practice that overlaps in certain ways the “practice of medicine” that was once reserved to licensed physicians.

She also ruled that the “right to abortion” is preeminent and that the state is required by the statute to place the “least restrictions on a woman’s right to have an abortion”. Therefore, “freezing” (her word) the scope of practice of health care professions would make it more difficult for a woman to get an abortion and conflicts with the statute. Washington’s abortion law is obviously continually evolving.

Hey, I didn’t Vote for That
Well, maybe you did and maybe you didn’t. It all depends on who is doing the interpreting.
Here’s the language from Gregoire’s ruling:

We note, first of all, the opening language of RCW 9.02.110 itself that the “state may not deny or interfere with a woman’s right to choose to have an abortion prior to viability of the fetus, or to protect her life or health.” The initiative opens with a statement of policy that “[e]very woman has the fundamental right to choose or refuse to have an abortion”. RCW 9.02.100(2). Furthermore, the initiative also contains language requiring that the state impose “the least restrictions on the woman’s right to have an abortion” of the available alternatives. RCW 9.02.140(3). It would be inconsistent with these statements of intent to read RCW 9.02.110 as
“freezing” the scope of practice of health care professionals in such a way as to make it more difficult for a woman to obtain an abortion in those circumstances where she is constitutionally and statutorily entitled to do so.
According to this logic, NOT allowing pharmacists or other health care workers to administer abortifacient drugs or perform abortions in any manner would be contrary to the statute.

Finally, we are told that when new laws conflict with old laws the new law prevails: “If there is an irreconcilable conflict between the new provision and the prior statutes, the new provision will control as it is the later expression of the legislature.”

They Can’t Force Me
Why not? If the “right to abortion” is preeminent and the state is required by the statute to place the “least restrictions on a woman’s right to have an abortion” then what reason could anyone possibly give for resisting participation. Employers who enjoy the revenue certainly won’t stand by such trouble makers. Any fall-back on conscience rights you think you might have is just about to be eviscerated by either the state Board of Pharmacy or legislature – both heavily influenced by the abortion industry.

It Couldn’t Happen Here
Advanced Nurse Practitioners can already administer RU-486 in our state, so it is happening. Here’s how it can continue to happen on a much grander scale.

Are pharmacists, because of Collaborative Practice Agreement legislation currently on the books in Washington and Attorney General Gregoire’s 2004 ruling that a “new category of health care provider with a scope of practice that overlaps in certain ways the ‘practice of medicine’…,” already empowered to administer RU-486? If pharmacists don’t have a right to conscience regarding Plan B how will they have a right to conscience for RU-486 or other abortion drugs?

Will physicians and health care workers be compelled to offer abortion as a matter of course whenever and wherever a woman seeks pregnancy related health care? A friend of mine reported that when she went to Group Health for a pregnancy test not too long ago they did just that. When her pregnancy test came back positive they handed her a list of abortion centers simply because she was pregnant. The medical establishment in the state as long viewed abortion as “health care” so such a move wouldn’t be radical for them in the least.

If hospitals in Washington (including Catholic hospitals) that are already compelled to administer Plan B to “rape” victims, and workers in the health care field do not currently have a right to conscience as has been argued by the state of Washington, then how can they expect an exemption from offering and performing abortions?

Clearly the going forward strategy on the part of the abortion lobby is to find ways within the existing laws (or through new legislation), and with the help of abortion-friendly attorneys general, to allow for all health care workers to practice both chemical and surgical abortion and to force others to do so under fear of losing their employment.

What about the Women?
It’s never been about the women. And it’s never been about health care. All it really takes is the right attorney general, an arrogant and misdirected legislature, and a public uncomfortable with and uninformed about abortion to twist the laws and institutions of Washington to the idea that anything that doesn’t serve the cause of abortion is against the law.

(This is the second in our series on the pharmacist conscience clause leading up to the March 29th Board of Pharmacy meeting.)

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