To Be Titled

On my drive back from work today, I listened to parts of the discussion on Talk of the Nation on NPR about Obama’s pending rescission of the Bush-issued regulation protecting provider conscience. The discussion revolved around some pharmacists refusing to fill prescriptions for the morning-after pill based on their personal convictions and whether/how their personal views should be protected.

They should not in any modern society. The US is predominantly a modern society, in which professionals should not be protected for their personal beliefs in practicing their professions.

By modern, I do not mean in the temporal sense but in the sociological sense of how societies are organized and how they function. In modern societies, their economies function based on impersonal relationships rather than personal ones. Trust and exchanges are based on impersonal institutions and roles individuals play rather than on personal ties and deep knowledge of one another’s idiosyncrasies.

In the context of the morning-after pill and pharmacies, the following is the expected scenario in modern societies. A patient receives a prescription from her doctor. The patient expects to be able to fill the prescription when she walks into a pharmacy—any pharmacy—in the country as long as there is a licensed pharmacist on staff. The expectation is not based on any personal relationship with the pharmacist but on the institution of pharmacies and staff who work there.

This is in contrast to “traditional” societies in which relationships are in fact based on personal ties. An example would be a small close-knit town or a village where everyone intimately knows one another. In such a context, the hypothetical patient above would have different expectations about the single drugstore in town and the sole pharmacist that works there. The patient might know that the pharmacist is deeply religious and has strong convictions against abortions and the morning-after pills. Based on that knowledge and the expectation that the pharmacist would be unwilling to fill the prescription, the patient may need to seek alternative options.

In modern societies, impersonal relationships based on institutions and roles allow smooth functioning of the economy within a large scale, allowing people who do not personally know one another to successfully carry out exchanges. This implies that personal convictions and beliefs cannot interfere with individuals’ fulfillment of professional responsibilities (e.g. filling prescriptions of whatever medicine, as long as a valid prescription from a medical doctor is presented). Should an individual wish to professionally pursue and implement their personal convictions and beliefs, they should choose a career in which the professional responsibilities and personal convictions coincide (e.g. family-planning counselor that explicitly provides advice against abortions and provides alternatives).

Update: Two additions to the very quickly written thoughts above.

1) The main imperatives of a modern society requiring impersonal relationship-based exchanges are a) the heterogeneity of individuals’ preferences and beliefs and b) the scale—number of individuals—in a society. This is why traditional societies—both old and existing ones—tend to be homogenous and small.

2) A more extreme example but a corresponding one to moralistic pharmacists is a homophobic police officer. If a modern society allowed personal beliefs to intervene in professional responsibilities, a homophobic police officer may, contrary to a victim’s expectations, choose to allow a hate crime against a known gay person to proceed, because the police officer believes  homosexuality to be an abomination that needs to be punished.