Again; Should Pharmacists Be Allowed To Refuse To Dispense Drugs They Object To?

But the pharmacist isn’t subscribing to government restrictions except in matters of public safety. Thus he can be consistent in accepting licensing without giving up his right to choice in other matters.

The FDA cite provided earlier says that Plan B is sold in pharmacies and retail outlets with a pharmacy, and this is done so that minors cannot buy the product. IOW, it is not done as a matter of public safety, as it is when only licensed people can dispense penicillin or Schedule II narcotics.

Or, to put it another way, you have a right to Plan B, but you do not have the right to force someone else to provide it to you. I have the right to drive a car, but no one has to make my car payment. I have the right to smoke, but I can’t force the local pharmacy to sell me my cigars. I have the right to drink liquor, but not the right to buy beer at McDonald’s.

“The right to choose” was supposed to be such a private decision that no one could interfere with it. Now we get all these arguments that it should be interfered with. What good is a right to choose if someone else can override it?

Regards,
Shodan

You don’t understand what licensing is, then, Doreen. Even if there is no cap on the numbers of licenses, the existence of a licensing requirement, at the margins, limits the number of participants in a market, if there are any costs involved in obtaining the license, or any requirements needed to get the license. If there aren’t, it is a pretty foolish license.

Does it reduce competition in practice? Hard to say. However, when arguing with libertarians, one is kind of forced onto a theoretical basis, which isn’t necessarily a bad thing. I would say it is likely that licensing requirements favor pharmacies with economies of scale, increasing the pressure towards chain stores over individually run pharmacies. This may either make it more likely Plan B is available everywhere or less likely it is available everywhere, depending on the policies of the chains.

I’ve said repeatedly that I think centralizing supply of this (and many other drugs) would potentially be a good thing. Not requiring central supply, but liberalizing the law to make it possible. You know, removing restrictions.

And I have also said I think removing restrictions on where it can be sold would be a good thing. What you are refusing to see is that we are dealing in a world of second best solutions. The government is restricting supply of this drug. We can argue back and forth on whether it should or not, but the bottom line is that it is. Given that it is, how do we deal with that situation.

Your solution is to shrug your shoulders, and walk away. I think there are certain areas where the government, given that it is already limiting availability, can turn around and say, if you want the benefit of this government licensing scheme, here are a list of rules you have to follow. Rule 1 - all these drugs need a prescription. This seems to be one you accept. Rule 2 - you must make these particular drugs available for sale, whether in stock or on rapid order. This you don’t accept. Rule 3 - you cannot refuse service to people based on the color of their skin, or their sex, or their national origin etc. I don’t know where you stand on this one.

We differ on whether there is a fundamental difference between Rules 1 and Rules 2 & 3. I would maintain that there is no arguable difference between Rule 2 and Rule 3. I do not think you can support a Rule 3, and then claim a Rule 2 is illegitimate, and I hope you would agree - you might think Rule 2 was not a good rule, but I don’t think you could question its legitimacy and maintain a coherent position. Fair?

Now, personally, I can understand, but disagree with a position that supports Rule 1 and dismisses Rules 2 & 3 as illegitimate. My biggest problem with that is you can dress almost anything up as a public safety issue, and thus back door in all manners of regulations. But if that is your position, I think we are at a total impasse.

But it needn’t be a given. I don’t know how else to explain it. The government created the restricted access to the property. To say that this willful act is justification for the governemnt to require someone to create supply–a supply the government restricted–whether that person wants to or not it is, simply, ridiculous. It’s not second best. It’s insane.

You keep referring to this as a given in the sense that it’s unavoidable, so we all have to make the best of it. It is not. It just isn’t.

Sorry, I thought they were OTC, whether or not they could only be sold in pharmacies. Is that wrong?

You can want whatever you want. No one is obliged to create the supply for that want. Sorry, that’s life (or it should be).

As a general rule, I personally have no moral objection allowing a firm to decide who to serve or what to serve for whatever reason they’d like. That doesn’t mean I agree with their decision. Let them deal with the reaction to their policy.

Seriously - we are in a situation where there is a restriction. I might well agree with you that the restriction is wrong, but it is there. I cannot change that. I am arguing about whether, in a world where the government restricts the availability of pharmaceuticals, it is better or worse that the license to sell pharmaceuticals comes with a requirement to make Plan B (or any other drug) available. It isn’t a debate about what a utopian world would be.

I know it isn’t unavoidable. But I didn’t think we were debating all possible starting points. We also aren’t debating a starting point where every person is given a machine to produce Plan B in their own home. I didn’t think that would be a productive addition to the debate.

The Rule 1 to which I referred was a general rule you accept if you take a pharmacy license - that certain drugs (referred to confusingly by me, I admit, as these drugs) require a prescription.

We’re not discussing some hypothetical Utopia though. You say, “I cannot change that,” while simultaneously saying you’d accept a licensing requirement to sell certain things, a regulation you also can’t control. So you seem inconsistent. At its essence, we’re discussing what the government ought to do, and both pieces of this are in play, it seems to me. Don’t know why it wouldn’t be.

This is disingenuous. I’m not debating some magical, impractical possibility. I’m asking why the government can logically restrict sale of Plan B to a single type of place / person and simultaneously force that person to sell something he’d rather not. If you want to frame that as some unachievable pipe dream, uh, okay.

My argument the one being disingenuous? Sheesh. Fine. (As I thought I had made pretty clear multiple times) in a country where there are no restrictions on where Plan B can be obtained, then I would not support a requirement that a licensed pharmacist make it available if their moral conscience dictated that handing a box over a counter would damn them to hell in perpetuity.

However, in a country where Plan B is only available through licensed pharmacies (like the one in which I live, if I have the law correct) then I think it is justifiable to impose said minor restriction on a licensed pharmacist.

My apologies if I did not make it repeatedly obvious that was my position.

I think the disagreement is whether, if the government regulates access for any reason, they can regulate it for any other reason.

I (and I expect Stratocaster) accept the basis for restrictions for public safety. But I don’t see why that automatically justifies any other restrictions, without what I would think of as an equally good reason. And ISTM that the reason you are suggesting for limiting the right to choose No on abortifacients is “because the government did it to protect the public safety”. Forcing pharmacists to dispense Plan B cannot be justified in terms of the public safety. But there doesn’t seem to be any other reason given to justify the imposition.

My default, as mentioned earlier, is that every single time the government interferes with anyone’s rights, they (the government) has to justify the interference anew. It is not enough to say, “well, they got away with it for one reason, so that means they can get away with it now, even if that reason doesn’t apply.”

It would be (to take a different and more extreme example) if the government shut down a newspaper because of some safety issue with the printing presses. I can see and accept that shut-down - it is in the interest of public safety. But then the government could not legitimately turn around and begin dictating what the newspaper could say on its editorial page (about abortion, say), and then argue that they should be allowed to do so because they were allowed to interfere with newspaper operations in the interest of public safety.

Action for one reason does not justify action for a different reason, IMO.

YMMV.

Regards,
Shodan

I fully understand where you are coming from, and that isn’t the argument that is having me bang my head against my desk.

I don’t believe one restriction automatically opens the door for others. What I do believe is that first, the government has artificially restricted the supply of Plan B. I have seen no evidence to suggest that this restriction is a good thing, or the rationale behind it. But it is there. Second, given that restriction, it has been made (to some degree or other) harder for people to obtain Plan B. Third, pharmacists have voluntarily chosen to enter a profession regulated by the government, and have benefited from those regulations in the form of restrictions on their competition. Fourth, this would be a further regulation on pharmacists that they could chose to accept or leave the industry (and I already said I would consider grandfathering).

Yes, it still has to be justified as a restriction, but the bottom line is the third point above. Phil Pharmacist entered a regulated industry, and a pretty heavily regulated industry at that. These regulations require him to take affirmative measures as well as negative ones (no lortabs without prescription; keep a registry of purchasers of certain drugs). So it isn’t an affirmative/negative divide that is the problem here. We come back to the regulation for ‘public safety.’ If we dress up a requirement to carry a particular drug as being ‘for the public safety’ does that make everything OK? Would a finding by Congress that teenage pregnancy was harmful to the public safety and so pharmacists should be required to carry all forms of contraception suffice here?

In the final analysis, the pharmacist has made gains through his government protected licensed status. If the government then asks him to do something, reasonably connected with his profession, within their constitutional power to request, and he choses not to do it, well, benefit over. Which brings me to your newspaper point. I was under the impression that stopping a newspaper publishing because of opinions raised was not within the power of the government under the constitution. And simply calling it public safety, as the government has done regularly to suppress free speech, doesn’t pass muster in my book.

Good. I appreciate the clarifications you have offered when I asked non-rhetorical questions.

Not to put too fine a point on it, but the cite I provided mentions that the restriction is put in place to prevent easy access to minors of Plan B. Which I would characterize as a matter of public safety, as I mentioned. So, AFAICT, that is the rationale behind the restrictions. If it helps, perhaps we can define “public safety” broadly, to include “not interfering with the duty of parents to make important decisions on behalf of their minor children”.

I see your point - but the case we are discussing is where a pharmacist is giving up the benefit of being able to vend Plan B. He obviously derives no benefit from not selling something - just the opposite, he loses business. So it is not a matter of gaining the benefit but refusing to “pay” for it by abandoning rights.

Well, frankly, yes - if there were a convincing reason that forcing pharmacists to dispense Plan B against their principles was in the interest of public safety, then I would accept the restriction of their rights just as I do for other restrictions. I can even see forcing a pharmacist to dispense Plan B to a woman whose life was threatened by an involuntary pregnancy.

But it doesn’t seem you are arguing for a public safety rationale, but a financial one.

But then we bump up against what seems a fundamental divide between us -

It is not (in my view) within their constitutional power to request this, unless they can come up with a public safety or other valid reason to request it. According to Roe v. Wade (bad law, IMO, but let’s accept it as valid for the moment), there is a right for an individual to decide about abortion. No one can interfere with that right without a valid justification. Remember that Plan B is not a prescription drug, merely one that can only be sold in a pharmacy or retail outlet with a pharmacy included. My local grocery store has such a pharmacy. But it is sold like tobacco - kept away from minors, and behind the counter only for that reason.

Your argument now seems to be that the financial benefit involved in working in a pharmacy necessarily implies that the government can revoke one or more of your rights without any other justification but that you work there.

I wasn’t saying that it was a public safety issue. ISTM that by the same logic as for the pharmacist, since the government can shut down a newspaper’s printing press because it is unsafe, they can then revoke the other rights of the newspaper for reasons unrelated to public safety. The precedent is set, just as it was for the pharmacist.

If it makes it any clearer, reconsider my alcohol argument. You have to have a liquor license to run a liquor store. Thus, the government is restricting access to alcohol, and the liquor store owner benefits financially from the lack of competition. But the owner wants to run a family-friendly business, and so he refuses to sell, say, adult magazines and tobacco (or Mein Kampf, for that matter). Would it be licit for the government to require the owner to sell these things if there were no bookstores or tobacconists nearby? If you can restrict liquor sales for reasons of public safety, can you then argue that the liquor store owner has forfeited other of his rights at the same time?

Regards,
Shodan

I must have missed the cite - apologies. I didn’t mean to deny that was one of the government’s purposes behind the restriction, just that I hadn’t seen what it was. I think likely there is also a moral policeman purpose as well, but I can accept that “public safety” however defined is their stated aim. However, my point was that this aim can and very often is twisted and manipulated to include almost anything. It’s like the Commerce Clause. Now we can argue all day about whether that is a good or a bad thing (and I think we would probably agree bad) but it doesn’t alter my basic point that the government calling something “for the public good” doesn’t actually mean a whole hill of beans.

If he got no benefit from not selling, he wouldn’t not sell. His benefit isn’t always measured in financial terms. And what he is “abandoning rights” for is the continuance of his license, a beneficial gift from the government.

OK. What degree of harm has to come to someone before a pharmacist’s rights can be ignored?

Pretty much yes - I don’t think ‘public safety’ is the only grounds upon which a government can place restrictions upon the issuance of a license.

I think you are constitutionally wrong here. There are many examples of people having to surrender constitutional rights to receive benefits from the government. The closest I think you could come on this one is with some of the more bizarre interpretations of the religion clauses, butthen you would get to the crazy situation of your ‘right’ not to sell Plan B because you are a Catholic being protected, and your ‘right’ not to sell Plan B because you think contraception is bad for the community not protected.

Actually, I am not talking about the pharmacy workers, but the licensee. If an owner wants to allow a worker not to sell it, fine, as long as there is adequate coverage.

I just think using the press is a bad example, because the government is specifically prevented from interfering with a free press. Would those restrictions on a liquor store be licit? On the surface (and I reserve the right to think more deeply about this) yes, under my analysis. That doesn’t mean they are good, or should be in place, and I would certainly oppose them. Kind of like blue laws really. I think they are wrong, but I am pretty certain states are allowed to impose them (except not, because in my mind they are an Establishment of religion, and so violate the first, but let’s not go down that path right now…)

Your position wasn’t unclear, though I think it’s illogical. My point about it being disingenuous (I should have said it seemed disingenuous) was your comparing my suggesting (a) the government ought not to restrict the places Plan B can be sold if they want people to have access to it to (b) a government program that gives people machines in their home so they can manufacture their own Plan B. If you don’t find that a tortured comparison, well, YMMV.

I do. The only clarification I’d provide is that I believe the government can restrict someone from creating an unsafe circumstance. The government shouldn’t be able to force me to create a safe environment for you. I can be restricted from actively creating harm. I shouldn’t be compelled to create “good,” however that’s defined. In this thread, that’s an important distinction.

Then I think our disagreement may be mostly semantic. You see in my state (and probably most others) individual pharmacists are licensed, and if they lose their license they may not work in any pharmacy. Not a one pharmacist pharmacy, not a CVS, not a nursing home pharmacy. Pharmacy establishments are registered. I’ve got much less of a problem with the government requiring the establishment to carry the drug than I have with the government requiring an individual to dispense it.

Agreed. The distinction between allowing someone to act, and forcing them to act, is an important one. In my view, the government should nearly always do the first, and hardly ever do the second. And if they do the second, they better have a darn good reason ready.

I don’t think I agree with this. Not that I disagree that the “public safety” idea cannot be abused, but ISTM that if it can be disproved that some restriction is in the interest of public safety, the restriction becomes illicit and cannot be sustained. It is the same reasoning that says that, although the government can restrict for reasons of public safety, they have to justify other restrictions with valid reasons. No precedent is ever set, IYSWIM.

True, but I thought you were arguing that the financial benefit from imposed scarcity was the reason the pharmacist’s right could be abrogated. Certainly there are other, non-financial benefits, but aren’t those included in the transaction, one way or the other?

And again, licensing is not a gift of the government. It is a measure taken in the public interest, justifiable only for the public interest, and not otherwise acceptable in a free society. All restrictions by the government have to be justified, and in every case. The default is never that “whatever is not prohibited is mandatory.”

What degree? I’m not sure. What I am arguing is that some degree has to be proven, as in my example of Plan B to save the life of the mother. If the argument is made, not that “the public safety is threatened by the pharmacist’s refusal and here’s how”, but “you were OK with restrictions for the public safety, so now you can’t object to restrictions for other, non-specified reasons”, that is a different matter.

Nor do I. But those other grounds you mention have to be made clear - it never changes to the point where the pharmacist has to justify not having his rights restricted.

I completely agree. Perhaps the only differences are that I don’t believe a worker can be forced to sell even if the Plan B is not otherwise conveniently available. Even if this is the only pharmacy or retail outlet in town, a citizen has the right to refuse to consent to participation.

Same for owners. If the owners of the pharmacy outlet decide that their store won’t sell Plan B, then the customers have no right to compel them to do so. Everyone gets to choose, in other words, and no one can overrrule that decision.

I think we are bumping up against basic assumptions here. You post -

My belief is that the government may not act even if the Constitution doesn’t expressly forbid it to. Freedom of speech and religion and so forth is guaranteed by the First Amendment, gun ownership by the Second, and other rights by other clauses. Under the Tenth Amendment, any powers not specifically delegated to the federal government belong exclusively to the states, or the people. That is to say, the federal government may not do anything at all that the Constitution does not explicitly say they can do.

So you are certainly correct that the feds cannot interfere with a free press, because the First Amendment forbids them to do so. But the feds cannot interfere with a citizen’s right to refuse to sell Plan B, because the Constitution does not specifically say that they can so interfere. Since the Constitution does not specifically say they can, they can’t - unless they can justify it on some licit ground, like public safety.

I think our assumptions are different. I assume, based on the Tenth Amendment, that the government should usually do nothing. Even if it is already involved by licensing or whatever, they cannot do anything more, based (again) on the Tenth Amendment. It sounds libertarian, and in a way it is, but it is based more on my belief in limited government.

The feds have to come up with a damn good reason to do anything at all. And the default for citizens should be (IMO) to tell the feds to go pound sand.

Regards,
Shodan

I have never said anything different to this. What I have said is that I don’t think (necessarily) that someone should be allowed to refuse to sell this and maintain a license. Different things.

And I would reiterate that I don’t see any difference between an ordinary citizen and a licensed one. Both have rights, and the government needs to come up with a specific justification for removing any of those rights, even if a licensed or unlicensed worker has consented to the removal of other rights for some useful purpose.

For all the reasons mentioned above.

Methinks we have reached the point of repetition. Thanks, I enjoyed the discussion.

Regards,
Shodan