Essay: The Limits of Conscience: Moral Clashes over Deeply Divisive Healthcare Procedures
![handle is hein.journals/amlmed34 and id is 41 raw text is: American Journal ofLaw 0 Medicine, 34 (2008): 41-63
© 2008 American Society of Law, Medicine & Ethics
Boston University School of Law
Essay: The Limits of Conscience:
Moral Clashes over Deeply Divisive
Healthcare Procedures
Robin Fretwell Wilsont
INTRODUCTION
Refusals by individual pharmacies and pharmacists to fill prescriptions
for emergency contraceptives (EC) have dominated news headlines, from the
Washington Post to the Miami Herald.' In the act that sparked a firestorm of
controversy, an Eckerd pharmacist refused to fill a rape victim's prescription
for Plan B.2 A few months later, 11 Alabama nurses resigned positions at state
clinics rather than provide EC against their moral convictions.' These refusals
do not seem to be driven by moral concerns about promiscuity, since
pharmacists have refused to dispense Plan B to married couples as well.'
Instead, the refusals reflect moral and religious concerns about facilitating an
act that would cut-off a potential human life.'
t Professor of Law, Washington & Lee University School of Law. I am grateful to the
University of Virginia Center for Biomedical Ethics and Humanities, the University of
Maryland School of Law, the Maryland Healthcare Ethics Committee Network, Northwestern
University School of Law's Searle Center, and Northeastern University School of Law for the
opportunity to present an early version of this Essay. I also would like to thank Pamela
Melton and John Lopatka for their careful reading and valuable comments.
A Lexis Nexis search in News-All found more than 3000 articles with the terms
emergency contracept[ion] or Plan B in the headline since 2004.
2 Liz Austin, Denial of Emergency Contraception for Texas Woman Raises Moral,
Legal Questions, THE ASSOCIATED PRESS, Feb. 24, 2004.
3 Debbie Elliot, Alabama Nurses Quit over Morning-After Pill, ALL THINGS
CONSIDERED (National Public Radio broadcast July 28, 2004), available at
http://www.npr.org/templates/story/story.php?storylD=3627209.
4 Rob Stein, Pharmacists Rights at Front of New Debate; Because of beliefs, some refuse
to fill birth control prescriptions, WASH. POST, Mar. 28, 2005, at Al, available at
http://www.washingtonpost.com/wp-dyn/articles/A5490-2005Mar27.html.
5 Emergency contraceptives-like Plan B and the morning after pill-contain
progestins that inhibit or delay ovulation and disrupt embryo transplant and implantation,
although the precise mechanism by which post-coital oral contraception works is not well
understood. David A. Grimes, et al., Emergency Contraception Review, 137 ANNALS INTERN.
MED. 180, 181 (2002), available at http://www.annals.org/cgi/reprint/137/3/180.pdf. Some
see this as tantamount to abortion. Charisse Jones, Druggists Refuse to Give Out Pill, USA
TODAY, Nov. 8, 2004, at 3A, available at http://www.usatoday.com/news/nation/2004-11-08-
druggists-pill x.htm (noting that some pharmacists believe that preventing the implantation
of a fertilized egg is a form of abortion); Susan B. Apel, Access to Assisted Reproductive](ViewImageLocal?handle=hein.journals/amlmed34&div=6&collection=journals&method=preview&ext=.png&size=3)
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Essay: The Limits of Conscience: Moral Clashes over Deeply Divisive Healthcare Procedures
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