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I love this show - it’s my sunday show lol

This gentleman has crafted a logical and rational dissection of ethics without recourse to “deities”. Sounds like my kind of book. One question though, are any of the people who insist that ethics come from <religious book of your choice> going to read it?

I finally got around to listening to this ep enroute to work today. A several points I found myself shouting at my iPod,
“DJ, ask him X!” and “Aw c’mon, DJ, you can’t let that stand, follow up on Y!” Which behavior generally means I enjoyed
the ep but felt DJ gave the guest too many softballs and free passes. A couple of areas where I felt DJ should have drilled
down:

1. early in the interview, Lindsey mentions that one very important input into his ideas for constructing ethics was “what most
people believe is moral and ethical” (don’t have the exact words in front of me, but that was the sense of it). This idea of
basing ethics on “majoritarianism” is not only silly, it is dangerous. Ethics are not politics, and the idea that “majority rules”
can be used to ground a valid ethical system (as opposed to a popular ethical system) is completely discredited.

2. I think Lindsey’s discussion on the whole idea of who/what is a “moral agent” was muddy and badly-conceived. It had a
strong taint of that whole Habermasian “open discourse among rational moral agents” naivete about it. I felt that when he
tried to defend his position that a first-trimester fetus was not a “moral agent” but a severely retarded or brain-damaged
adult was on the basis that the latter “have family ties and relationships”, I felt he did that important topic of
discussion no justice.

All told, not one of the better episodes (though I had enormous fun shouting at my iPod, which always wakes me up in the
morning ...

I am glad that my interview allowed steveg144 the opportunity to become alert without excessive consumption of caffeine, but I am afraid he has misstated my views (perhaps I was not sufficiently precise in the interview—it is difficult to discuss moral theory in the space of a few minutes). Anyway, I do not subscribe to the view that what the majority thinks is morally right is morally right. That would be absurd. However, I do subscribe to common morality theory (other proponents of this theory include philosophers Bernard Gert and Tom Beauchamp), which holds that there are a few abstract norms that are shared across cultures. These include norms such as those prohibiting killing, stealing, deceit and the like. These norms are widely, if not universally, shared, because most people must follow these norms most of the time if we are to live together successfully—which to me seems the principal point of morality.
My understanding of morality as a practical enterprise, i.e., something that has objectives, is the crux of my moral theory. Viewing morality as something with a purpose is important if we are to achieve any measure of consensus about disputed ethical matters. Clearly, from the norms of common morality, which, as indicated, are both abstract and few in number, we cannot leap to normative conclusions about assisted dying, the regulation of human enhancement technology, and other issues in bioethics. To limit the range of morally acceptable policies on these matters (and I believe that is all we can realistically expect of a moral theory; the notion that some moral theory—yet to be discovered—will deliver the one right answer to our doorstep is just a fantasy), we need to explore the rationale for our proposed norms. For example, why do we prohibit killing and are our reasons for prohibiting killing inconsistent with allowing physicians to hasten the deaths of terminally ill patients?
The foregoing is just a sketch of my views, of course. As they say, for more detail and explanation, one will have to read the book. (Chapter 2 explains my method.)
Let me close by briefly commenting on the question of moral status, which relates to steveg 144’s second point. I do not recall using the term “moral agent” in the interview. It would be stange if I did because, in my view, moral agency is not the key to moral status, nor is rationality, sentience, or any of the other intrinsic properties that have been advanced as being sufficient conditions for moral status. These properties are not irrelevant to moral status, because they are important for how we interact with the beings that possess these properties, but moral status is also dependent on relational properties, including emotional bonds. With respect to the distinction between a fetus and a cognitively impaired adult, these relational properties are very important for moral status, if we accept, as I do, that morality is a practical enterprise. What is the point of forcing a woman to carry to term a child she does not want? How is the moral community benefited by that? On the other hand, there is some point to providing appropriate care to a cognitively impaired adult who has established relations with the community (especially when we consider that all of us have the potential to become cognitively impaired). The issue of moral status is discussed at some length in my concluding chapter.

I am glad that my interview allowed steveg144 the opportunity to become alert without excessive consumption of caffeine

Ah, there’s your first mistake. My shouting behaviors are usually the direct result of excessive consumption of caffeine.

I do not subscribe to the view that what the majority thinks is morally right is morally right. That would be absurd. However, I do subscribe to common morality theory (other proponents of this theory include philosophers Bernard Gert and Tom Beauchamp), which holds that there are a few abstract norms that are shared across cultures. These include norms such as those prohibiting killing, stealing, deceit and the like. These norms are widely, if not universally, shared, because most people must follow these norms most of the time if we are to live together successfully—which to me seems the principal point of morality.

I may very well have heard (and then had my aging brain mangle) the “common morality theory” that you describe as a form of majoritarianism. If so, that’s my bad, my brain-fart. It was mentioned in passing
along with other inputs into moral decision-making, so it wasn’t something you strongly emphasized, as I recall. I wish DJ had slapped on the brakes and drilled down into that; it would have been a fascinating discussion.
I’d have a whole other set of issues with “common morality theory”; for one, it really just abstracts that whole “majority rules” concept from the level of the individual to the level of societies as a whole: “most societies have a prohibition against killing, therefore it is valid to use that” as opposed to “most people in a given society agree that killing is bad, therefore it is valid to use that.”  And “most societies” until very very recently (mostly thanks to the European Enlightenment, which to a large extent defined itself as going against the grain of what most societies believed was correct) have had prohibitions against suffering a witch to live, and that’s hardly an argument in favor of including witch-killing in one’s ethical outlook. Or do we just say “common modern, Western moral theory”, which creates a hierarchy in which one puts forward claims that a certain subset of all the societies in history and a subset of all the societies in the world today are the only ones whose common moral theories we should incorporate. I suspect that these sort of questions have the potential to force the “common moral theory” into such a high level of abstraction containing such a small number of common moral edicts, as to become almost useless for nuanced, day-to-day decision making. “Don’t kill people” doesn’t help with ethical decision-making when the larger ethical question at hand is “how does one define a ‘person’?” You can see where this can go (and I’m sure you’ve had the pleasure of going there more times than you want to count), but that’s maybe a discussion for a follow-on interview with DJ. I’d love to hear that conversation happen.

Let me close by briefly commenting on the question of moral status, which relates to steveg 144’s second point. I do not recall using the term “moral agent” in the interview. It would be stange if I did because, in my view, moral agency is not the key to moral status, nor is rationality, sentience, or any of the other intrinsic properties that have been advanced as being sufficient conditions for moral status. These properties are not irrelevant to moral status, because they are important for how we interact with the beings that possess these properties, but moral status is also dependent on relational properties, including emotional bonds. With respect to the distinction between a fetus and a cognitively impaired adult, these relational properties are very important for moral status, if we accept, as I do, that morality is a practical enterprise. What is the point of forcing a woman to carry to term a child she does not want? How is the moral community benefited by that? On the other hand, there is some point to providing appropriate care to a cognitively impaired adult who has established relations with the community (especially when we consider that all of us have the potential to become cognitively impaired). The issue of moral status is discussed at some length in my concluding chapter.

One could argue that either way. One could argue that if a woman should not be forced to carry to term a child she does not want, then why should a society be forced to “carry” a member of the society who will be a net drain on the resources of the society? As the father of a mentally-disabled adult, it’s not an argument I’d make, and I’d fight tooth and nail anyone who tried to advance it. But again I think we have that matter of just bumping something from one level of abstraction to another. On the personal level, what the woman “wants” trumps the fetus; but one would then be forced to consider that what the larger society “wants” trumps the cognitively-impaired adult. Like I said, it’s a repugnant argument to me, but there doesn’t seem to be anything in your methodology that would prevent one from drawing precisely this conclusion.

PS: sorry for putting the words “moral agent” in your mouth. I swear to dog I heard those exact words, late in the interview, but it was pretty noisy in the cab of my pickup, what with all the caffeine-fueled shouting and all.   I shall have to replay it at lunchtime today, see where the misunderstanding came from/.

All that being said, I still plan to buy your book; sounds like it will give me plenty to shout and rant about. :-D

All I had to read was that you were going to buy the book.  I hereby adopt everything you say. 

No, seriously, you raise many interesting issues which are difficult to address via this post, especially in light of my keyboarding skills (if that is the correct word).  Perhaps DJ should have another show that focuses exclusively on the moral theory I advance in my book.  In any event, although it is certainly true that there has been disagreement among cultures about moral norms, I think if one surveys different cultures, both historically and in the present, one would be hard-pressed to find cultures that do not subscribe to the following norms as they affect recognized members of the moral community: Do not kill, do not cause pain or suffering, do not steal, keep your commitments, do not deceive, assist others in distress, and perhaps a few others.  If you know of such a culture, please let me know.  (Do not use Colin Turnbull’s example of the Ik, which has been discredited.)  If you think about it, widespread acceptance of these few core norms is to be expected once we recognize that, given certain perennial aspects of the human condition, such as vulnerability to disease, the elements, and predators (including other humans), and the inability of isolated humans to acquire or produce sufficient goods to satisfy their needs, cooperation for mutual advantage within a community is important for the functioning and the continued viability of that community.  Morality plays an important role in ensuring the continuation of this cooperation by praising or rewarding those who engage in cooperative activity and censoring or punishing those who do not.  Now, of course, the fact that all societies share these core norms does not, by itself, justify adherence to these norms.  But if we assume that the point of morality is to enable us to live together and to facillitate cooperative activity (and what is the point of morality otherwise?), then these norms are justified to the extent they promote those objectives.  And to me, these norms that I have mentioned do seem to promote these objectives.  Naturally, as you point out, these shared norms are so abstract that in many situations they may not provide the specific guidance that we seek.  Nonetheless, they provide a bedrock of agreement.  How we can arrive at the necessary level of specification is something I describe in the book.  Similarly, you are correct to point out that common morality theory cannot specify who is included within the scope of our moral norms, that is, who is a member of the moral community.  That has been a subject of intense disagreement across cultures. 

I may have more to say about these issues later in the week, but I am going to have to sign off now. 

Thank you for your contributions.  I have found this discussion interesting and worthwhile.

All I had to read was that you were going to buy the book.  I hereby adopt everything you say. 

OK, now that was funny. 

No, seriously, you raise many interesting issues which are difficult to address via this post, especially in light of my keyboarding skills (if that is the correct word).  Perhaps DJ should have another show that focuses exclusively on the moral theory I advance in my book. 

I enthusiastically agree. This whole question of how we derive a viable ethical system without resort to supernaturalism is a subject that I can’t
get enough of. I often think that it is the question that humanism has to confront and resolve. When Dostoevsky said “If God is dead then
everything is permitted,” and Nietzsche said “God is dead!” the ethical “stuff” hit the fan. We humanists have to figure out ways to say “Yes,
God is dead, but no, everything is not permitted, and here’s why.” Otherwise we risk having the 21st century be a fast-forward replay of the
20th.

I’m really hoping DJ will tee up a follow-on episode to give you the breathing room to drill down on some of the issues we’ve poked at here.
DJ?

I found something said by Mr. Lindsay to be somewhat troubling. One of his ethical claims near the end of the podcast is quite questionable, perhaps his own personal bias is showing through. The claim that a doctor or pharmacist who chooses to not perform a service or sell a product is somehow “forcing” their beliefs on others is insupportable. Patients are free to choose to go to other doctors or pharmacists, no force of any kind is being applied to them.

Is Wild Oats forcing their beliefs on me by not selling me Frosted Flakes? What about McDonalds not selling me a wheat germ shake? Should all stores end their “no shirt, no shoes, no service” policies because they force their beliefs on nudists? Or is it just that doctors are special, and once they decide to become doctors they must give up their own ethics and adopt Mr. Lindsay’s?

The relationship between the patient and the doctor is completely voluntary and either side has the right to end a transaction if they so choose, for whatever reason. Interfering with these voluntary transactions cannot be supported ethically. No one has a right to force another person to perform labour for them, we gave that up about 150 years ago.

There is no doubt that invoking “conscientious objector” status is a misguided attempt at an emotional appeal, it certainly doesn’t apply in this case. But I find it ironic that Mr. Lindsay says the label doesn’t apply because it only applies to those who are being forced to do something, yet that is exactly what he proposes.

The problem with what the pharmacist was doing in forcing his morals upon those he is supposed to serve, is that not only was he refusing their prescriptions, but he would not tell them where they can go to get the prescription filled. Imagine if you substitute chemotherapy, and this particular pharmacist did not believe in chemotherapy as a treatment for cancer, endorsing latrile instead. Would you feel the same? To your (anticipated) reply that the examples are not comparable, how many lives do you think are destroyed by unwanted pregnancy, and you can start by counting the child. As an ICU nurse, I do not always believe in what I am doing, but I cannot, and refuse to, impose my values on my patients and their families as long as what they are doing is legal—i.e. I am obligated both legally and morally to report abuse of any kind. The morning after pill and birth control are still legal in this country. I have NEVER heard of a doctor or pharmacist refusing to supply a man with VIAGRA! Insurance companies that will not cover the morning after pill or birth control COVER VIAGRA! It appears to me to be a bit misogynistic.

John Stewart of ‘The Daily Show’ made a great remark about this on his show tonight. Speaking with Newt Gingrich, he said, “so what Sarah Palin is saying is ‘Respect my rights to make decisions regarding my family’ and elect me so I will take away your abilities to make decisions regarding your family”. (It’s not exact, but that is the gist)

Imagine if you substitute chemotherapy, and this particular pharmacist did not believe in chemotherapy as a treatment for cancer, endorsing latrile instead. Would you feel the same? To your (anticipated) reply that the examples are not comparable, how many lives do you think are destroyed by unwanted pregnancy, and you can start by counting the child.

If you had said, “Imagine if you substitute chemotherapy, and this particular pharmacist did not believe in chemotherapy as a treatment for cancer and refused to sell chemotherapy drugs,” then, yes, I would feel exactly the same. But you added “endorsing latrile [sic] instead” which does indeed change the argument. In that case the pharmacist is taking an action that is fraudulent. We’re not talking about the pharmacists lying about the efficacy of any drugs, only refusing to sell them; a world of difference. Not only does the pharmacist have a right to not sell a drug, but they have a right to not provide any information about it either, as long as they’re honest about it.

I’m not defending their actions in any way, only defending their rights to make them (or not make them, as the case may be). Certainly doctors or pharmacists who do this should be exposed to public scrutiny and ostracised. But that wasn’t the suggestion, it was instead that they should be forced to sell the drugs.

I cannot, and refuse to, impose my values on my patients and their families as long as what they are doing is legal.

But do you have a problem imposing your values on your pharmacist?

I have a problem with the fact that MY DOCTOR can prescribe a LEGAL DRUG, for a condition that HE IS TREATING, and the Pharmacist will want to make a judgement to deny it to me based on his religious views. HE SHOULD NOT HAVE BECOME A PHARMACIST IF HIS RELIGION WAS GOING TO AFFECT HIS ABILITY TO DO HIS JOB EFFECTIVELY, or he should work in a capacity where he would have no patient contact.

Another example: You’re child is in a horrible accident and is bleeding to death. (S)he is brought to the emergency room on death’s door desperatly needing a blood transfusion for survival. The doctor immediately signs the paper work for untyped O- blood, 4 units to be delivered to the ED to try to save this child’s life. the nurse assigned to care for your child on this very busy Fri night is a Jehovah’s witness and stalls then refuses. Your child dies. You did not make the choice to withhold care, the nurse did. Even if you did decide to withhold the blood, the doctor would be on the phone with a judge to get an emergency order, because the law has determined that while the parent is a Jehovah’s witness, the child has not declared his beliefs. That being said, we do everything in our powers to respect the wishes of those with beliefs that are not the same as ours, to the extent it will not cause harm to the child(and I have seen some ‘wacky beliefs).

In the 1980s I worked with doctors that refused to order blood no matter how dire the situation because of their religion. The hospital went through the staff and fired them. They decided that it was not the doctor’s place to withhold proven treatment to patients. Nurses that I have worked with since recognize the difference between their beliefs and the rights and belief of their patients, and transfuse the blood.

Why is this pharmacist any different from the parents withholding medical treatment from their daughter while she died a miserable death from diabetic ketoacidosis? And I can guarantee you that it WAS miserable.

I have a problem with the fact that MY DOCTOR can prescribe a LEGAL DRUG, for a condition that HE IS TREATING, and the Pharmacist will want to make a judgement to deny it to me based on his religious views. HE SHOULD NOT HAVE BECOME A PHARMACIST IF HIS RELIGION WAS GOING TO AFFECT HIS ABILITY TO DO HIS JOB EFFECTIVELY, or he should work in a capacity where he would have no patient contact.

There’s a simple solution:  Get a different pharmacist.

The hospital went through the staff and fired them.

Another simple solution.

Why is this pharmacist any different from the parents withholding medical treatment from their daughter while she died a miserable death from diabetic ketoacidosis?

Are you accusing these pharmacists of kidnapping people and preventing their treatment? If not, then that’s the difference.

Bottom line:

You do not have a right to force another human being to perform labour for your benefit. What ethical framework do you have which allows you to think that you do?

Are you accusing these pharmacists of kidnapping people and preventing their treatment? If not, then that’s the difference.
Bottom line:
You do not have a right to force another human being to perform labour for your benefit. What ethical framework do you have which allows you to think that you do?

If I remember correctly, and I’m sure I do, the pharmacist WOULD NOT RETURN THE SCRIPT SO THE PATIENT COULD GO ELSEWHERE. What ‘ethical’ frame work would this be????

If I remember correctly, and I’m sure I do, the pharmacist WOULD NOT RETURN THE SCRIPT SO THE PATIENT COULD GO ELSEWHERE. What ‘ethical’ frame work would this be????

Now that’s a valid complaint, because that’s theft. But that’s also a shift in argument.

The argument was that the pharmacist does not have the right to not fill the prescription. Do you agree that the pharmacist has no such right?

If I remember correctly, and I’m sure I do, the pharmacist WOULD NOT RETURN THE SCRIPT SO THE PATIENT COULD GO ELSEWHERE. What ‘ethical’ frame work would this be????

Now that’s a valid complaint, because that’s theft. But that’s also a shift in argument.

The argument was that the pharmacist does not have the right to not fill the prescription. Do you agree that the pharmacist has no such right?

Sorry, you are correct. it was a shift in argument. If the pharmacist could not/ would not fill the prescription, he should refer the person to another pharmacist who will. Including a coworker in the pharmacy. If you have a limited amount of time for the medication to be effective, if you are not given the information, you could spend hours and hours searching for a pharmacist willing to fill your prescription. Imagine that the young lady may have been raped. Why should she go through the trauma of going from pharmacy to pharmacy to beg some one to help her. It’s like adding more assaults upon the original violation.

If the pharmacist could not/ would not fill the prescription, he should refer the person to another pharmacist who will.

We absolutely agree on this, the pharmacist should do it, and any pharmacist who doesn’t is a bad pharmacist. Indeed, any pharmacist refusing to fill a prescription is already a bad pharmacist.

My question is, what should the consequence be for the pharmacist?

Personally, I think they should be fired. If the pharmacy won’t do that, then it should be boycotted and protested. But even with all that, I still acknowledge the right of the pharmacist to do it, since they didn’t use force on anyone. In other words, the consequences for voluntary actions should themselves be voluntary. The podcast, however, took the tack that the pharmacist has no right to refuse service. That can only mean that potential customers have a right to force the pharmacist to perform work for their benefit; that is what I cannot agree with.

Personally, I think they should be fired. If the pharmacy won’t do that, then it should be boycotted and protested. But even with all that, I still acknowledge the right of the pharmacist to do it, since they didn’t use force on anyone. In other words, the consequences for voluntary actions should themselves be voluntary. The podcast, however, took the tack that the pharmacist has no right to refuse service. That can only mean that potential customers have a right to force the pharmacist to perform work for their benefit; that is what I cannot agree with.

I agree. A person who owns a pharmacy should be able to run it however they like, within reason. As abhorrent as the example is… I find it a lesser evil the poor moral choice made freely by an American as compared to forced morality from the government.
I have had discussions with feminist groups on this subject. I am astounded just how fiercely feminists have often fought for their own freedom and self determination only to turn around and cheer when someone else’s freedom and self determination is taken away.

Much happens.. but we learn nothing from it.

Personally, I think they should be fired. If the pharmacy won’t do that, then it should be boycotted and protested. But even with all that, I still acknowledge the right of the pharmacist to do it, since they didn’t use force on anyone. In other words, the consequences for voluntary actions should themselves be voluntary. The podcast, however, took the tack that the pharmacist has no right to refuse service. That can only mean that potential customers have a right to force the pharmacist to perform work for their benefit; that is what I cannot agree with.

Agree wholeheartedly. AND the pharmacist should have been charged with the theft, which would have impacted his license, just as if he’d stolen some pills from his pharmacy.

Agree wholeheartedly. AND the pharmacist should have been charged with the theft, which would have impacted his license, just as if he’d stolen some pills from his pharmacy.

Even worse, it’s the same as stealing pills from a patient. I think it’s worse, anyway, at least the pharmacy can replace the pills without anyone being harmed.

Agree wholeheartedly. AND the pharmacist should have been charged with the theft, which would have impacted his license, just as if he’d stolen some pills from his pharmacy.

Even worse, it’s the same as stealing pills from a patient. I think it’s worse, anyway, at least the pharmacy can replace the pills without anyone being harmed.

Stealing prescription meds would get MY license yanked very quickly!

Sounds like my kind of book.

I thought it was a good interview—I think the book would be interesting and thought-provoking….

(1) the term “bioethics” is relatively uncommon and this might get in the way of book sales
http://ecx.images-amazon.com/images/I/51tuy-BssxL._SL500_AA240_.jpg
(2) I thought I understood the interview to say that in the original Hippocratic Oath the doctor would not charge for services. I didn’t find this in the Wikipedia version http://en.wikipedia.org/wiki/Hippocratic_Oath and will do more digging.  So far it seems to me that it says not to charge for the teaching of medicine, nothing about charging the patient.  Would appreciate any info here….
(2a) I wasn’t aware of this either—but there are a some interpretations of the original Hippocratic Oath [ SUCH AS THIS ONE] which call attention to its apparent proscription of both abortion and euthansia.  Maybe Ronald Lindsay could comment.
(3) in the podcast Lindsay makes an argument in favor of stem cell research which suggests the point that in concept an embryo is no different than a stem cell (or something like that) and that our body is made up of millions of cells which could in principle become individual living entities.  I’m not sure I understood this argument, but it seems to me that embryos formed by the fertilization of egg & sperm represent a new and unique individual with DNA different from either parent, and that this is fundamentally different from a"clone” which one could in principle get from one’s own stem cells.  I am in favor of stem cell research and am only questioning whether this particular argument as stated isn’t sufficiently strong.  I think the related argument that our medical technology will eventually be up to the task of generating trillions of truly independent human beings and the earth just doesn’t have the resources to sustain them all—we don’t have an obligation to generate these trillions of distinct people etc etc.
(3b) I was wondering if Lindsay’s book or Lindsay himself considers the ethics of aborting embryos which do not have desired characteristics—to pick an extreme example, a Henry VIII wants a son and his wives keep aborting embryos until the doctor says he’s got a boy.  Or—will the baby have the blue eyes of his/her siblings.  And if this is okay, does the book or Lindsay himself consider whether “fetus-cide” or “infantcide” is also ethical for such selfish reasons.  Although I fully support abortion rights, I’m sort of assuming/hoping that the mother would never do choose it for such reasons—except medical progress may make this a minor choice {one can access the info from the mother & father's DNA and actually make choices -- whose decision should it be whether the child has blue eyes or a musical prodigy like Aunt Maizie}

Anyway, these are my thoughts on listening to it once—I recommend the podcast….

Let me comment first on the discussions between adamruth and asanta. Adamruth in particular seemed troubled by what he thought was my contention that health care professionals, in particular pharmacists and physicians, do not have a right to refuse service. Sense slavery has been abolished, it is obviously true that no one in this country can be forced to perform any work that she or he chooses not to perform. However, with respect to pharmacists and nurses who refuse to perform certain services, in almost every instance what they want to do is to be able to keep their employment while selecting which tasks are to their liking. I do not see why they should be able to refuse to perform certain services without any penalty and while retaining their job, especially as this has often interfered with the health care decisions of patients. Unlike their selection of a physician, patients do not typically choose their pharmacist or nurse. They have dealings with whichever pharmacist or nurse the drugstore or hospital happens to assign to them. Accordingly, they typically will not know before their dealings with the pharmacist or nurse which services these health care workers may refuse to provide. No one is forced to become a pharmacist or nurse. (This, among other factors, distinguishes their situation form the draftee who conscientiously objects to military service.) If one chooses to become a professional in these occupations, then one should expect to be required to perform all legal duties that their employer asks them to perform. And, typically these days, both nurses and pharmacists are employees. (There is a not insignificant number of pharmacists who run their own businesses, but overall they are a small minority.) In any case, as the book points out, persons who run their own business are in a different position than employees, and provided they do not mislead the public about the scope of their services, they can justifiably decline to provide certain services. However with respect to employees, why should we treat pharmacists and nurses, and other health care workers, any differently than other employees. Other employees cannot refuse to do certain tasks based on their religious or moral views if that refusal materially interferes in some way with their employer’s services to customers or patrons. There was a controversy not long ago involving Muslim taxicab drivers at the Minneapolis airport who refused to convey passengers who were transporting alcohol. Would asanta claim that these cab drivers had the right to refuse to convey customers based on their objection to alcohol? Can a librarian refuse to stock certain books because of her objections to their content? Can a male truck driver refuse to be partnered with a female truck driver because he finds this objectionable to his religious beliefs? Can a server in a restaurant refuse to wait on tables that order meat products because the server is a vegetarian? Once we start allowing all employees to refuse to provide services in a job that they have freely chosen, and to do so without penalty, we will have chaos. Regarding physicians, as my book points out, they are in a somewhat different position, because in our health care system they are the ones who decide, in consultation with the patient, what health care will be provided. Moreover, although this is increasingly not the case, patients still have more choice over their physician than they do over the choice of their nurse or pharmacist. Provided the physician makes clear to the patient at the beginning of their relationship what services he or she will not provide, then I am not especially concerned about the physician’s refusal to perform an abortion, carry out a sterilization, etc. But the patient should be informed about the limitations on the physician’s services upfront.

Let me turn now to some comments made by Jackson, beginning with comments on the Hippocratic Oath. Jackson is right that I misspoke about not charging for services to patients. That was too broad a statement. The oath required those who took it to provide free services (especially teaching services) to fellow physicians and to their children. But the key point I was making was that the Hippocratic oath contains provisions that have not been followed by physicians for some time. Among other things physicians nowadays typically do not swear by “Apollo.” In addition, one thing that many do not realize is that the Hippocratic oath did not even reflect accepted medical practice in most of the ancient Greek city-states, where many physicians would provide a lethal drug for a suffering patient that could not be cured. In other words, the Hippocratic oath represented a minority view even in ancient times. Finally, and perhaps most importantly, the Hippocratic oath has not been administered in most United States medical schools for decades. Currently, only 6 of the 122 medical schools in the US administer an oath that would prohibit physician assistance in hastening death. Regarding the argument on stem cell research, my point here was to undercut the claim that because the embryo supposedly has the potential to be an adult human individual, we cannot do anything that might harm the embryo. Based on recent developments in biomedical technology, it appears that each of the cells in our body could in principle become an embryo and therefore, might develop into an adult human individual. If the underlying moral claim of opponents of embryonic stem cell research is that we should not do anything to harm cells that have the potential to become adult human individuals, then logically this implies we cannot do anything to harm any of the cells in our body, which of course is an absurd conclusion. Unlike Jackson, I do not see any fundamental difference between an individual created through cloning and an individual created through the fertilization of an ovum by sperm. (Identical twins have the same DNA.)

Regarding the argument on stem cell research, my point here was to undercut the claim that because the embryo supposedly has the potential to be an adult human individual, we cannot do anything that might harm the embryo. Based on recent developments in biomedical technology, it appears that each of the cells in our body could in principle become an embryo and therefore, might develop into an adult human individual. If the underlying moral claim of opponents of embryonic stem cell research is that we should not do anything to harm cells that have the potential to become adult human individuals, then logically this implies we cannot do anything to harm any of the cells in our body, which of course is an absurd conclusion. Unlike Jackson, I do not see any fundamental difference between an individual created through cloning and an individual created through the fertilization of an ovum by sperm. (Identical twins have the same DNA.)

Yes, I raised this same point in a thread awhile back in a thread HERE, re. a new procedure which apparently allows scientists to turn ordinary skin cells into embryonic stem cells. Doing this sort of manipulation will only become easier as time goes on.

Mr. Lindsay, thank you for clarifying your viewpoint. I think, perhaps, it can get a bit confusing when the concept of “rights” comes up, particularly when discussing rights and private arrangements. So, it seems then that this “conscientious objector” status is intended to be between a pharmacist and their employer, not between a pharmacist and a customer. That’s a world of difference, and the idea that a pharmacy would be forced to retain a disobedient pharmacist is just as antithetical to freedom as the idea of a pharmacist being forced to fill a prescription they do not want to.

Would [adamruth] claim that these cab drivers had the right to refuse to convey customers based on their objection to alcohol? Can a librarian refuse to stock certain books because of her objections to their content? Can a male truck driver refuse to be partnered with a female truck driver because he finds this objectionable to his religious beliefs? Can a server in a restaurant refuse to wait on tables that order meat products because the server is a vegetarian?

Absolutely they have the right to, but I’m using a more narrow definition of “right” than I believe you are. You seem to be saying that they don’t have the right to refuse service *and* retain their job if their employer objects. Since no one has a right to a job, then obviously their own rights don’t override the rights of their employer to fire them. If, in any of these cases, the employer didn’t have an objection then they could do these things without consequence (the consequence of losing their job anyway).

What would your opinion be if the pharmacy owner agreed with the pharmacist in not filling the prescription? What should the consequences to the pharmacy be?

Once we start allowing all employees to refuse to provide services in a job that they have freely chosen, and to do so without penalty, we will have chaos.

You’re right because *we* don’t have any say in the matter. That’s strictly an issue between the employer and employee. We don’t have the right to interfere and tell the employer they must either fire or retain their employee, it’s a private contractual matter.

To respond to your question re the consequences to the pharmacy, if the pharmacy is entirely privately owned, receives no tax breaks/subsidies from the federal, state or local government, and the pharamacy makes its policy known to customers, then there should not be any consquences to the pharamacy. There are actually some pharmacies that have been established that style themselves as pro-life pharmacies and refuse to carry many contraceptives.
I think alerting customers is important, becase the reasonable default assumption is that a pharamacy will not refuse to carry a range of legal medications for religious reasons.

Mr. Lindsay, thanks again for your response. It looks like we’re on the same page. I take back all of the mean things I considered saying about you but was too lazy to

To respond to your question re the consequences to the pharmacy, if the pharmacy is entirely privately owned, receives no tax breaks/subsidies from the federal, state or local government, and the pharamacy makes its policy known to customers, then there should not be any consquences to the pharamacy. There are actually some pharmacies that have been established that style themselves as pro-life pharmacies and refuse to carry many contraceptives.
I think alerting customers is important, becase the reasonable default assumption is that a pharamacy will not refuse to carry a range of legal medications for religious reasons.

Thank you for clarifying your position, I see nothing I do not agree with. I had not thought about the fact that people do not usually pick their nurses. I have had people refuse a nurses services on the basis of personality conflict, but I can’t see that a patient would be allowed to refuse a nurse on the bases of the nurse’s race or religion these days. While I have seen it happen and enforced in the 1990s, I believe it is now considered illegal discrimination. I have had patients refuse a nurse based on their own religion (a male is not allowed to care of a female muslim patient for example) and we usually try to respect this, but I find that even muslims apply this inconsistently, and the ones who try to enforce it across the board are compromising the care of their loved one so thoroughly, we can’t morally, legally or ethically follow their wishes.

If the underlying moral claim of opponents of embryonic stem cell research is that we should not do anything to harm cells that have the potential to become adult human individuals, then logically this implies we cannot do anything to harm any of the cells in our body, which of course is an absurd conclusion. Unlike Jackson, I do not see any fundamental difference between an individual created through cloning and an individual created through the fertilization of an ovum by sperm. (Identical twins have the same DNA.)

Thanks for responding to the comments—it does sound like an interesting book.

As I noted, I’m in favor of stem cell research, but I personally don’t get this “all cells are equal” argument.  The podcast emphasized other contradictions which I found compelling, such are requiring the extra stem cells or embryoes (after an infertile couple successfully has a child)  to be destroyed rather than used for medical research.  The general population now supports contraception as well as the treatment of infertility, and I’m hopeful the use of stem cells will be part of normal medicine in time.

Thanks again for bringing up many thoughtful points in the interview.

One of the things I really like about this forum is that so often we are able to hear from authors who will participate in discussions here.
Thanks again

if the pharmacy is entirely privately owned, receives no tax breaks/subsidies from the federal, state or local government, and the pharamacy makes its policy known to customers, then there should not be any consquences to the pharamacy

I have to disagree with this, since it overlooks the fact that pharmacies and pharmacists are licensed by the state. This is because they are acknowledged to offer services and products which can potentially be harmful if improperly provided, so government oversight and establishment of standards that ensure public safety is justified. If a pharmacy can pick and choose which services and medications to offer, or allow its employees to do the same, then it becomes nearly impossible for the consumer to trust that whatever pharmacy they go to will meet consistent, appropriate standards for their services.

As an example in a different context, the British public health service sent investigators to a number of homeopathic pharmacies posing as travellers to areas where malaria is endemic and asking for anti-malrial prophylactics. In all cases, they were discouraged by the pharmacists from using these proven drugs and encouraged to use homeopathic preparations with no real efficacy. Following this advice from a licensed, and so supposedly trustworthy, professional would expose the customer to unecessary medical risk based solely on the pharmacists idiosyncratic beliefs about medicine.

The case seems much the same to me if someone goes to a pharmacy requesting emergency contraception, regular contraception, AIDS medications, or any other legitimate medical product the pharmacist may have personal objections to. Being denied the service, and perhaps being given inappropriate or inaccurate information about the condition or the medications, potentially exposes the customer to harm based on the individual preferences of the pharmacist. I don’t believe this is acceptable, especially for a profession licensed by the government for the purpose of ensuring accurate and trustworthy information and service for the customer. The only reason the issue comes up at all is because the views in question are more widespread and generally based on religious belief, unlike the homeopathy example. This is a pragmatic political reason for exempting pharmacists from the general standards of licensed medical professionals, but it is not I think a strong reason based on principle.

Allowing pharmaicsts and pharmacies to choose their own exemptions from the standard services they are licensed to provide creates what I believe is an unacceptable burden on the pateint. Should a rape victim be expected to survey local phramacies to determine which will or will not humiliate her by denying her a prescription contraceptive? I hardly think that’s reasonable. Part of the burden of being granted a state license to practice, and profit from, pharmacy is to serve patients according to pre-established and uniform standards set for the sake of public welfare, and if that is unacceptable then there are other careers available. You’ve made this same point regarding individual pharmacists, so I don’t see why it should not apply to the institutions they work for.

Excellent post.

if the pharmacy is entirely privately owned, receives no tax breaks/subsidies from the federal, state or local government, and the pharamacy makes its policy known to customers, then there should not be any consquences to the pharamacy

I have to disagree with this, since it overlooks the fact that pharmacies and pharmacists are licensed by the state. This is because they are acknowledged to offer services and products which can potentially be harmful if improperly provided, so government oversight and establishment of standards that ensure public safety is justified. If a pharmacy can pick and choose which services and medications to offer, or allow its employees to do the same, then it becomes nearly impossible for the consumer to trust that whatever pharmacy they go to will meet consistent, appropriate standards for their services.

mckenzie, so basically what you’re hedging at is that healthcare should be fully socialised/nationalised. This seems like a fine idea until you get a fully conservative government as we so recently had. Maybe the gov’t in its wisdom would decide RU486 and the like don’t need to be legal. In this case there is nothing for the goodly pharmacist or victim to do other than vote. My government has actively worked to rollback EPA standards, to halt science and medical funding, to hand millions in free money to churches and these people are going to say what pills the pharmacy is allowed/forced to sell? You argue the gov’t already has the power but you’d be handing them a whole lot more. The HPV vaccine comes to mind…strongly opposed by American conservatives supposedly for “health” reasons.

The problem in your homeopathic remedy hypothetical is that “homeopathic” would be permitted the status of “medicine” which of course it is not and thus should not be sold in anything resembling a pharmacy nor marketed as or claimed to be medicinal.

In practice, lots of pharmacies will carry just about anything that makes them money. If anything, the issue with any sort of drugs and medicine in a market economy is that it will be made too readily available. Add to the mix the rise of the internet-based (legit) pharmacy and the whole issue seems a bit irrelevant. There are some examples that are potentially problematic however, as in the case of the rape victim but then shouldn’t ERs and state clinics have those suppies on hand as they are “emergency care” type items? Or at least they ought to be. Concievably, a person in a small town with only WalMart for a pharmacy could find themselves in a pickle and I find this a weakness of my position.