Pharmacists and Conscience: Individual Right or Associational Interest?

I appreciate Tom's tough questions about my thoughts on the freedom of conscience movement as it pertains to pharmacists.  Our exchange boils down to the question, Is the moral agency of pharmacists best pursued as an individual right or as an associational interest?  Tom lays out a perfectly reasonable case for the former understanding, so let me make a few points in favor of the latter.

First, waging the "culture wars" in the language of individual rights is, in my view, dangerous (but sometimes unavoidable, I admit), and should be undertaken only as needed.  To the extent that we frame significant contests over values in terms that presume that the only relevant bulwarks against oppression are rights-bearing, atomistic individuals, we relegate intermediate bodies to the sidelines.

Second, Tom's concern about the potential for meaningful identity-shaping behavior in a rapidly concentrating market is a valid one, but an individualist approach to conscience only exacerbates the problem.  If pharmacies are faced with a legal system in which they are 1) forced to allow pharmacists to exercise moral agency; or 2) forced to forbid pharmacists from exercising moral agency, there is no capacity to stake out any unique institutional identity on the issue, much less a countercultural one.  If, by contrast, the power is given to pharmacies themselves, wouldn't there at least be the potential for the cultivation of a mediating role?  If one pharmacy required its pharmacists to dispense the morning-after pill and one did not, consumers (and pharmacists themselves) might start utilizing those distinctions in forming their preferences.

Third, Pharmacists for Life is, as Tom suggests, a group that mediates between an individual and the surrounding society.  But its mediating function is of the thinnest sort.  Rights-based advocacy produces an array of member-funded organizations, but generally the only involvement required is financial.  If civil society consisted only of groups modeled after AARP, for example, rather than the local senior citizens center, we'd all be worse off.  Instead of concentrating on one-shot lobbying pushes in state legislatures (as I assume they do, though I'm not very familiar with the group), Pharmacists for Life's mediating function would be much more robust if they operated as a support group to equip members to thrive as conscientious professionals in a vibrant, but occasionally unwelcoming, marketplace.  A conversation premised on individual rights is geared toward legislative or judicial action; a healthy civil society (subsidiarity in particular) demands that our conversations also be geared toward winning the hearts and minds of our neighbors.

Fourth, in response to Tom's point about Medicare/Medicaid "conscience" provisions, when government funding is involved, I believe that the government has a role in shaping marketplace norms.  So if the government wants to condition funding on institutions' acceptance of health care professionals' moral agency, I'm not as worried about that as I am about a blanket enshrinement of moral agency as individual right.  The key is for the government to participate as a market actor, communicating its own norms and ideals, not as a trump on the market through the top-down imposition of a fixed set of norms and ideals.  In the health care context, I realize that this is a very difficult distinction to maintain given that government funding is an inescapable and market-defining reality.  I'm still wrestling with that one.

To be clear, if my only two choices are a world in which all pharmacists are legally required to provide all legal pharmaceutical products and one in which individual pharmacists are shielded from state and employer interference with their morality-driven decisions on which pharmaceutical products to provide, I'll choose the latter without hesitation.  But those two choices are not the only viable alternatives.  (And if they are, then civil society is in more trouble than we thought.)

Rob