Friday, June 29, 2018

How not to handle conscientious objection

On the evening of June 21, Nicole Mone Arteaga went to Walgreen's Pharmacy in Peoria, Arizona (a suburb of Phoenix) to fill a prescription for misoprostol. The 9 week fetus in her longed-for pregnancy had no heartbeat, and the pregnancy would end in a miscarriage. She chose a medical rather than surgical removal of the non-viable fetal tissue.

When she arrived at the pharmacy, staff pharmacist Brian Hreniuc asked if she was pregnant. On hearing the answer he told her his "ethical beliefs" forbade him from filling the prescription. According to Ms. Arteaga's Facebook post her 7 year old and five customers could hear the exchange. The result: "I left Walgreens in tears, ashamed and feeling humiliated by a man who knows nothing of my struggles but feels it is his right to deny medication prescribed to me by my doctor."

Next day Ms. Arteaga was able to fill the prescription at another branch of Walgreen's. 

Arizona law allows pharmacists to exercise conscience as Mr. Hreniuc did. And while reflective individuals differ on whether professional responsibility to serve one's patients or individual conscience should rule in situations like this, my Catholic friends have helped me understand how for Mr. Hreniuc, filling the prescription could make him feel complicit in what he might see as a mortal sin. But as experienced by Ms. Arteaga, he did not communicate in the right way.

Here's what needed to be done. (1) "I'm so sorry for what you are going through." (2) "I have to refer you to another pharmacy/pharmacist." (3) "I want to wish you the best for the future." The conversation should have been private, not audible to others. The tone should be warm, caring and apologetic, not self-righteous. Ideally, Walgreen’s would have systems in place so that patients would not encounter pharmacists who were not willing to fill their prescriptions. And for those like Mr. Hreniuc, there should be rigorous training in how to communicate in a manner that respects the needs of patients as well as the conscience claims of the staff.

It's not impossible that Mr. Hreniuc conducted himself this way. The pain of the situation could have prevented Ms. Arteaga from experiencing an effort at compassion. I know from experience that this can happen. Many years ago I came upon a distraught couple at the health center where I worked. They had just received bad news. The husband had cancer. I had recently taken a course on dealing with bad news. I sat down with the couple and spoke with them. I'm reasonably confident that a videotape would have shown that I applied what I had learned.

A week or two later a letter of complaint came to the administrator of the health center (me) from the couple. The letter described the cold, cruel person they had encountered (me). For me it was a chastening lesson in the potential difference between what is intended and said by the clinician and heard by the patient.

Arizona state Sen. John Kavanagh, co-sponsor of the 2009 law that allows pharmacists to refuse to fill abortion or emergency-contraceptive prescriptions based on moral or religious beliefs, showed a shameful defensiveness and lack of empathy in his comments on Ms. Arteaga's experience:

He said he was surprised that Arteaga wasn't more sympathetic with the pharmacist, given that she eventually was able to get the medicine from another Walgreen's location. "What's the problem?" he said. "She got what she wanted. The pharmacist complied with the law. I don't see why she doesn't respect the pharmacist's right to not do this," he said.
In her Facebook post Ms. Arteaga shows an admirable understanding of the situation: "I get it, we all have our beliefs." She appears to accept the issue of conscience but rightfully does not accept the way the conscience exception was carried out. In her response - a public post and a complaint to Walgreen's management - she is being an ideal advocate. Her complaint gives Walgreen's, and  professionals who might invoke conscience in not offering a medically indicated legal service, guidance in how to conduct themselves in a more ethically admirable manner.

No comments: