Will Wilkinson has a post investigating Chris Hayes’s comment that most Republicans are racist and the various pushback. This part caught my attention:
When I was a Rand-toting libertarian lad, I believed, as I believe now, that racism of any stripe is a disgusting form of collectivism. Where my opinion has changed is that I used to think that if negative rights to non-interference were strictly observed, liberty was guaranteed, but I don’t now. Here’s how I had thought about the matter. One racist acting in a private capacity on his or her racist beliefs can’t violate anyone’s legitimate, negative rights. (No one is entitled to another’s good opinion!) Two racists acting as private citizens on their racist beliefs can’t violate anyone’s rights. Therefore, I inferred, thousands or millions of racists acting non-coercively on their racist beliefs can’t coercively violate anyone’s rights. I now think this is quite wrongheaded.
Eventually I realised that actions that are individually non-coercive can add up to stable patterns of behaviour that are systematically or structurally coercive, depriving some individuals of their rightful liberty. In fact, rights-violating structures or patterns of behaviour are excellent examples of Hayekian spontaneous orders—of phenomena that are the product of human action, but not of human design. This shift has led me to see racism and sexism themselves as threats to liberty. Racism and sexism have come to matter more to me in that I have come to see them in terms of the political value that matters most to me: liberty. And so I have become much more sympathetic to policies that would limit individual liberty in order to suppress patterns or norms of behaviour that might pose an even greater threat to freedom. So I’ve become fairly friendly toward federal anti-discrimination law, affirmative action, Title 9, the works. I have found that this sympathy, together with my belief in the theoretical possibility and historical reality of structural coercion, releases me almost entirely from the liberal suspicion that I’m soft on racism (even if I do wish to voucherise Medicare). Phew!
This jumped out at me because I went through the same line of thinking*. I was never a Randian, though I dabbled in strong libertarianism for a time. This was one of the more perplexing problems that I had to deal with. Contrary to my libertarianism being a good excuse for racism, I was actually deeply troubled by not being able to do anything about overt employment discrimination (for instance). Eventually, though, I sort of came to the conclusion that WW did. Individual acts of freedom, repeated enough, become more a threat to freedom than the government stepping in.
I turned in my libertarian card a long time ago, but my thinking on this has actually persevered to a degree. When confronted with an issue where the government has to step in and make someone do something they don’t want to do, one of the questions is whether that freedom will be repeated enough to constitute a problem.
For example, I am all about vaccinations for youngsters. I think it should be required, I think it should be free. However, I am nonetheless uncomfortable telling people who have a real religious objection to it (for instance) that they absolutely must. My ultimate inclination is to grant waivers for religious/conscience reasons and then see what happens. If too many people are taking advantage of it, then you have to start cracking down.
Similarly, I would never go to a pharmacyt that didn’t fill birth control prescriptions. I don’t mean that I wouldn’t get birth control for my wife there, as that is self-evident. I wouldn’t get my own prescriptions there. Partly to make a point, but mostly because I don’t want to have to deal with more than pharmacy. The same applies to a pharmacy where I would have to show up at a particular time when a particular pharmacist is on duty. Despite all of this, I do cringe at the prospect of forcing them to fill prescriptions that they consider to be immoral. I remain confident that the number of pharmacies that would refuse to do so is small enough we would have other options. If this confidence is misplaced, and access becomes a real problem, then you start looking at either other ways of distributing the medication or doing that thing I would rather not do.
One of the reasons that I was on the fence on PPACA’s contraception requirement for religiously-affiliated employers was the lack of a clear idea of how many actual employees would be affected. Hypotheticals about Christian Scientist employers were quite uninteresting to me without some indication that it would become widespread that finding an employer that covers contraception becomes a problem. I eventually came around on the issue in large part because the “penalties” for declining to offer contraception were comparatively minor.
I think there is often too much of a jump straight to “They shouldn’t be able to do that” (or “they shouldn’t be able to not do that”) because, well, we don’t think they should be able to do that. The sense of injustice that somebody is getting away with doing something we believe they shouldn’t be (or the other way around) and inconveniencing the rest of us in the process. Generally, though, I’d prefer to meet halfway if at all possible. That’s not always possible, though. Given our national history with race, and with humanity, well, being what it is, lack of anti-discrimination law has repercussions that simply aren’t justified by giving employers complete discretion over who to hire and who not to.
* – Not always to the same conclusion. I remain softly opposed to affirmative action, but even there I recognize that need to be conscientious of disparities and support many policies that would seek to remediate. I support restructuring Title IX, but believe it or something like it to have been necessary to address a real problem. In other words, I may have some skepticism of the means involved, but have no problem with the rationale of involvement.
I come at it from the other side, so
[,,,] actions that are individually non-coercive can add up to stable patterns of behaviour that are systematically or structurally coercive, depriving some individuals of their rightful liberty.
has always seemed bloody obvious. What took me a while to get to (and I’m not completely there) is being able to see criticism of the 1964 CRA as anything other than willful disregard of this truth.
It helps if you were skinny and bullied.
Despite all of this, I do cringe at the prospect of forcing them to fill prescriptions that they consider to be immoral.
Here is how I squared that circle:
So, let’s see. We’ve got a situation where the government has handed out a license to sell Product X.
If I try to sell Product X without a license, I will be arrested and go to jail.
If I try to buy Product X from someone who doesn’t have a license to sell it, I will be arrested and go to jail.
If I try to sell Product X with a license to someone who does not have a prescription for Product X from his doctor, I will be arrested and go to jail.
If I try to buy Product X without a prescription from my doctor, I will be arrested and go to jail.
The licenses to sell Product X at all are kept artificially scarce by the government who is colluding with both the manufacturers and distributors of Product X.
And the complaint is “but what about Liberty?” when it comes to the conscience of the people who actually have a license to distribute Product X to people?
It’s not a hard square to circle. When the government licenses or funds someone, they command a degree of control over them. I have expressed a reticence towards using that as a blank check, but obviously it can be used. The question is the degree to which we should use it if we don’t have to.
For me, you are each over-thinking it. To my mind it comes down to the small town scenario:
It’s one thing to live in Manhattan and have a pharmacy decide it doesn’t want to fill prescriptions of legal medications that a physician has prescribed. There’s probably another pharmacy across the street that will be happy to fill it for you.
It’s another thing to live in, say, Emery, UT where there may be one pharmacy – or Amarillo, TX, where there may be several, but the larger community might pressure all of them to refuse to fill certain prescriptions.
For those that still think it’s acceptable, I ask that you take it one step further: What if in a small town, the only pharmacies have issues with homosexuality, and because of this refuse to fill various “cocktail” prescriptions for a town member that is HIV positive? Is there a point where the health and well being of the town member, as determined by that person and their physician, outweighs the desire of the people charged with dispensing drugs not to do so?
If the role of a pharmacy in a community is to dispense prescribed medications, I have a problem with them second-guessing your physician.
Tod, that’s more-or-less my position (though not necessarily with the same emphases).
My main thing is that before telling pharmacists what their job is, I want it to be (a) demonstrated that their individual behavior is causing a collective disruption and (b) there isn’t another way of going about it (mail-in prescriptions, video conferencing consultation, whatever). If those are the case, then we have to do what we have to do.
My main issue with this is that some states are diving into forcing the pharmacists to fill BC prescriptions even if there are other pharmacies available. Now, as a federalist, I don’t mind it nearly as much on the state level, but I’d still it rather not be done if it can be avoided.
Despite all of this, I do cringe at the prospect of forcing them to fill prescriptions that they consider to be immoral.
Then maybe those people ought to get different jobs. I mean, no one is holding a gun to their head, right?
{{{Now I feel like I didn’t address the central themes of the post}}}
I’m with Mike S above – and you – in that “actions that are individually non-coercive can add up to stable patterns of behaviour that are systematically or structurally coercive, depriving some individuals of their rightful liberty.” That’s a big problem for libertarians, but also for governance generally.
One man’s freedom is another man’s tyranny. How to balance those things between what’s morally right and what’s politically possible and what’s socially stable is the trick, no?
I’m not a fan of “If you don’t want to do Thing X, you shouldn’t take Job Y” when Job Y consists of a whooooole lot of things beyond Thing X.
A similar argument can be made that obstetricians that don’t want to perform abortions could have chosen another career. The main reason not to do this is the same conscience-based objection that the pharmacists are pointing to. Which makes me at least somewhat sympathetic.
The question, to me, is the extent to which we can accommodate them. Not whether we should blow them off because they could have chosen another vocation. Of course we can and of course they could. But I’d really rather not.
A similar argument can be made that obstetricians that don’t want to perform abortions could have chosen another career.
Yes. Exactly. They could have become podiatrists. Or ear/nose/and throat guys. Or GPs. Or…
We all make these types of decisions all the time, Will. If abortion is the law of the land, and providing abortions is part of the job description of being an obstetrician, then that person chose unwisely.
Now, I get that at some point a general, society wide moral disinclination to perform certain tasks presents a real challenge to the policy and practices of certain job-descriptions and institutional arrangements. That’s one way change occurs. But not on the outer edges of things. If a person loves to weld but is morally opposed to the oil industry, then they should find a job where they don’t have to in the oil fields.
We all make these types of decisions all the time, Will. If abortion is the law of the land, and providing abortions is part of the job description of being an obstetrician, then that person chose unwisely.
The problem, for me, is deciding for others what is a part of their job description. Sometimes you gotta, but forcing them into that kind of decision is simply not something we should shrug off on the basis that they could have been a haberdasher.
Saying that you can’t get a job delivering babies of filling our prescriptions at a particular place if you’re not willing to do these other things is a pretty natural choice to force. Saying that you can’t deliver babies anywhere or fill out prescriptions anywhere is much more problematic, in my view.
If a person loves to weld but is morally opposed to the oil industry, then they should find a job where they don’t have to in the oil fields.
But we’re basically saying here is that if you’re not willing to lend your services to the oil industry, you can’t weld at all. (Unless you’re simply saying that a pharmacy should be able to fire someone for refusing to fill out birth control prescriptions, then we don’t disagree.)
Well, if you’re arguing this at the level of individual behavior, then we’re back to the claim you cited in the OP:that “actions that are individually non-coercive can add up to stable patterns of behaviour that are systematically or structurally coercive, depriving some individuals of their rightful liberty.”
I guess I’m not as convinced as you are that this is a real conundrum.
The salient factors, to me, are the extent to which the behavior is or would be widespread enough to be coercive and the degree of sacrifice being made being made by the person whose behavior we seek to alter.
I consider “change careers” to be a big sacrifice. I consider “change employers” to be less so. I conside “Go to this pharmacy and not that one” to be relatively monor, though “the nearest pharmacy is now 200 miles away” to be bigger.
So, if enough pharmacists refuse to fill birth control prescriptions, we have a problem that may require pharmacists to make tough choices, but absent a demonstration of individual choices being made with enough frequency to qualify as coercion, I am inclined to let the pharmacist be wrong.
There are other potential solutions to this delimma, such as mailed prescriptions or pharmacists having to put up discouraging signs about being “partial service pharmacies”, but you get the idea of the tradeoffs I am looking at.
If you don’t want to let people read books with bad words in them you shouldn’t be a librarian. (You can come back and check that book out tomorrow? Not really good enough.) If you don’t want to let people buy meat, you shouldn’t be a grocery clerk. If you consider blood transfusions immoral, don’t be an EMT.
You’re not saying that it should be illegal to open a private library (or bookstore) that doesn’t stock certain books, are you? Or that it should be illegal to open up a vegetarian grocery store?
Actually, we can turn this into a pretty good analogy: Should grocery stores be required to carry Kosher and Halaal versions of foods which are not generally Kosher or Halaal? Vegan versions of foods which are normally made with animal products? I mean, if we allow grocers to make those choices on their own, then that could add up to a pattern of coercion.
No, I’m slaying you can’t go to work at a general-purpose library, grocery store, or emergency room, plead conscience about not doing an important part of the job, and expect not to be fired.
Yeah, just don’t buy the book in the first place, talk about the budget, and you’re golden.
Mike,
I don’t think anyone here is talking about conscience job protection on this front. I know some conservatives support that, but we’re talking about the ability to open your own pharmacy and offer some things but not other things.
(There are some cases where I can be convinced of a conscience job protection, but birth control for a pharmacist isn’t really one of them since birth control is one of the most common prescriptions available.)
How common is it to go to a pharmacy, Rx in hand? I can’t recall the last time I did that. My doctor phones in the prescription, then I wait a reasonable amount of time and go pick it up. Since Dr. X should know which pharmacies stock what he prescribed, the only problems would come if none of the nearby ones do, or if an individual pharmacist refuses to fill the prescription. I agree with you that the former is currently rarely if ever the case.
Actually, I think it’s pretty simple: What is the core duty of Job X.
For a pharmacist? It is, basically, to take a prescription from my doctor for a controlled subtance, collect the allowed amount of that substance, and hand it to me.
Sure, he’s got other requirements — he’s supposed to eyeball drug interactions (ideally my pharmacist fills all my drugs, even ones from other doctors I might have forgotten to mention to the guy that wrote me my latest) and help me with questions like “Is analgesic another name for suppository?” (joke!).
But in the end, his core job is “Guy who hands out controlled substance to people authorized to purchase it”.
If he’s not willing to hand out each and every one of those controlled substances a pharmacy is allowed to have to a customer, he needs a new job.
It gets fuzzier when it comes to games like “We simply don’t stock X” — it gets more clear with games like “I won’t fill X and I won’t transfer your prescription to another pharmacist either”.
But in general: If he’s got Drug X behind the counter, I have a valid prescription for it, his JOB is to measure it out and hand it to me in return for cash. If he’s morally opposed to it, he needs another line of work.
If it’s Catholic Bob’s Pharmacy, then there wouldn’t be any birth control behind the counter. If it’s Catholic Bob’s and Episcopalian Annie’s Pharmacy, to me that’s between Bob and Annie. If Catholic Bob works for Safeway, that’s between Bob and Safeway. At least, up until the point that the individual consciences represent a systemic problem.
Requiring that Partial-Service Pharmacies keep cards with a 1-800 number that would help people find Full-Service Pharmacies strikes me as very reasonable.
figure this is bullshit. plenty of things that are birth control behind any pharmacist’s counter.
of course plenty of them are poisons…
As I said, it becomes fuzzier with the “we don’t keep it in stock”. I would argue against hard-and-fast rules (sadly, that’s the only way to really make law!), because in the end it’s going to come down to intent:
Were you not stocking a drug because you didn’t want to fill legal prescriptions or had a moral objection to the drug? If so, your intent is contrary to the core nature of your job.
Were you not stocking a drug because it’s rarely called for? (space is limited) That seems entirely reasonable and bang alongside the core nature of your job.
So, fuzzy. Especially when you get into (effective) one pharmacy towns.
OTOH, trying to fill your BC prescription at Catholic Bob’s and having him take and say “We don’t fill prescriptions for BC here” and refuse to give it back or transfer it to another pharmacy? Horse of a different color, one might say.
Interestingly enough, given the rural/urban split between conservatives and liberals, the whole pharmacy thing is liberals sticking up for conservatives. Cindy in New York City might find having to get her prescription filled elsewhere a hassle, but a minor one to change pharmacies.
Cindy in Nowhere, Texas? The nearest other pharmacy might be 30 miles away.
Nowhere Texas is a lot more likely to be voting for conservatives than liberals, but liberals are a heck of a lot more likely to try to ensure Cindy from Texas’ pharmacist isn’t making moral judgements for her.
If driving 30 miles to get medication is to be considered a hardship, that is something that needs to be addressed separately because there are a lot of people that have to do that anyway. Figure out what to do with the good people of Wisdom, Montana, and you’ve figured out what to do with someone in Afton, Wyoming, if none of the three pharmacies there (in a town of 2,000) will fill birth control prescriptions.
There may be some examples of single-pharmacy towns, but I’ve honestly never seen one. Either there is no pharmacy and you simply have to drive, or there are multiple pharmacies. I’ve not really heard of a case of a single-pharmacy town where that pharmacy refuses to fill BC prescriptions. I am skeptical of a case where none of the three pharmacies in Afton or somewhere else will fill BC prescriptions.
I’m not sure what the rules for mail-in prescriptions are right now. My wife had to go a couple hours away for one of her prescriptions (not for the reasons discussed here). She had to go out there for the original consult or whatever (where they explain what needs to be explained) but after that they just mailed it to us. Throw in video-conferencing or phone conferencing or something, and we may have bypassed the problem not just for Cindy but for the folks of Wisdom.
By and large, though, the cases of any real hardship due to pharmacist actions seem to mostly occupy “what if” territory despite the ability of pharmacists to do what we’re talking about. If there is a genuine problem with access, and if the problem can’t be mitigated by a Wisdom Solution, then I am open to telling at least some pharmacists that they’re going to have to bite the bullet. It’s not something I like doing, even if I don’t like what the pharmacists are doing.
Here’s a question that may clarify some things (while it muddies others):
What are the limits to our jurisdiction when it comes to setting things right?
If any, of course.