Where I am spending some time visiting my mother, there is a controversy about a nearby drug store which is refusing to fill prescriptions having to do with birth control. The store in question is the nearest store to where my mother lives, and the only pharmacy in the neighborhood. It has recently been purchased by a couple who are Catholic and who announced that they would use this policy in their store. The local newspaper picked up the announcement and the story has generated a fair amount of debate.
The debate concerns a conflict between the rights of a store owner to sell what they please, versus the rights of individuals to obtain whatever legal medical care is available without being required to pass a religious test.
On the side of store owners being able to sell what they please, we must consider the case of a grocery store that makes a choice not to sell meat. Most people would not get too upset about the option. We do not require a grocery store to sell every type of legal food available. Indeed, we permit some grocery stores to sell only a limited set of foods. We do not call this an act of discrimination or bigotry against customers who do not like the food that the store serves. We simply say something like, “This is a vegetarian grocery store,” and we move on.
Similarly, we do not hold that a Catholic church is guilty of discrimination for holding only Catholic religious ceremonies. They are not engaging in discrimination against Jews and Muslims because they do not host religious ceremonies outside of their own tradition.
An example that is more directly relevant to this is the case of medical care. A hospital is not required to make all possible forms of medical care available to its patients. It can decide not to purchase particularly expensive equipment or to have particular types of skills represented among its doctors. This is its right.
Yet, there is an important difference in the case of people seeking birth control and other forms of medication when compared to people seeking a good steak or a place to pray. In the case of buying meat and prayer, the inconveniences are small, and we have less reason to condemn private beliefs for these costs. In the case of birth control and similar medical options, the price is significantly larger. In other words, this is a case in which the world would have been a better place if people did not have attitudes such as these, so people have much stronger reason to condemn those who have these attitudes.
Religion, Harm, and Causation
I would like to use this opportunity to briefly discuss the relationship between religion and harm. A few days ago I criticized Christopher Hitchens for making claims about similar situations that the only reason these wrongs get done is because of religion. In spite of my protests to the contrary, I worry about some people taking my argument to mean that I think that religion is impotent, and that we can ignore religion as a cause of harm.
I would like to use a quick analogy to explain my position.
Imagine that somebody in Colorado hops into a 1967 pickup and heads off to San Francisco. In a case like this, we would have to acknowledge that the 1967 pickup is not impotent – it has the ability to take a person from Colorado to San Francisco. However, the fact that it is not impotent does not imply that it is uniquely potent.
If we rid the world of 1967 pickups, we can rest assured that nobody will ever go from Colorado to San Francisco in a 1967 pickup. However, it is still the case that there are substitutes – that people in Colorado can still travel to San Francisco in something other than a 1967 Pickup.
My view on the relationship between religion and harm follows this model. Clearly, religion is not impotent – it can and is used to get people to adopt attitudes that adversely affect the well-being of others, as in the case of the couple that purchased the nearby pharmacy.
However, acknowledging that religion has the power to cause people to adopt attitudes that diminish the well-being of others does not imply that religion is the only entity with this power. Acknowledging that a 1967 pickup can get a person from Colorado to San Francisco is not the same as acknowledging that it is the only vehicle one can use to get to San Francisco from Colorado.
Consequently, I can condemn a particular set of religious beliefs, in this case, for creating a situation that will make the lives of some of my wife’s neighbors worse off than they otherwise would have been. I can say that they are being made worse off for no good reason. In saying this, I am not saying that non-religious options cannot generate the same (or worse) results. This can still be true, even if this time religion, and not some other entity, fills this role.
Condemnation
When people act so as to make the lives of others worse off than they would have otherwise been, and uses poor reasoning to defend their action, it is perfectly legitimate to condemn them for it. Condemning a person for saying or doing something contemptible is not the same as violating their rights.
This couple can quite honestly say that they have the right to choose what to sell in their store. However, I have argued that a ‘right’ to do something only means that a person should be free to do that thing without somebody responding directly with violence and harm. The right of the American Nazi Party to hold a march through some Jewish neighborhood means that they have a right against violent interference with their actions. It is not a right to be free from condemnation. Nor is it a right to be free from whatever private actions (e.g., boycotts) in response to their adopting this policy.
It is a matter of empirical fact that these people will be making the lives of many of those in the neighborhood worse than those lives would otherwise have been. I also assert that they have no good reason to do so. The desire on the part of others that this attitude is thwarting gives them reason to inhibit this attitude through condemnation and private actions. An interest in preserving the peace denies others the right to inhibit this attitude through formal sanctions or violence.
In fact, I would argue that it is a bit counter-productive to focus on the question of whether the state should require these owners to sell a product they do not wish to sell. Instead, I would propose using this as an example of people who are acting in ways that lower the quality of life of others. Claiming that people have a right to practice their religion seems quite benign, until one points out that what their religion commands them to act in ways that are harmful to others.
Summary
This is also a case in which people are using religious arguments to defend actions that make the quality of life worse for others. Those arguments are highly questionable. Those who are to be made worse off by the actions of others have a right to condemn others who use such poor reasons for doing harm.
All of this is quite consistent with the claim that religion is not the only medium one can use to ‘justify’ doing harm to others, and that where no religion exists we can still expect people to form ‘tribes’ that treat outsiders unjustly an even brutally. Animals – particularly primates – form groups like this without any belief in a God to guide them.
It is the medium being used in this case, and those who do so are deserving of some measure of condemnation for it.
Alonzo,
ReplyDeleteInteresting piece. I think there's another way to frame the problem, though, which gives a quicker judgement against the conduct of the pharmacy. A pharmacist who owns his store fills two roles, not just one. That is, he's not only a store-owner, who can sell whatever he wants, but also a pharmacist, who is granted a particular special power -- dispensing medications -- with concordant responsibility -- to dispense medications as they are prescribed by a physician. If the pharmacist doesn't want to live up to the responsibility, then I see no reason to allow him to retain the special power. Consider, by analogy, the psychiatrist who refuses to prescribe psychotropics, not because he believes they don't work, but because he just chooses not to. There's a case to be made there, I think, that the psychiatrist has given up the responsibility associated with his role as physician, and should thus be restricted in that role.
If that's right, then of the comparisons you draw, only the hospital remains apt, and I would suggest that, if the hospital has certain special powers associated with its role, and if these powers come with the responsibility to provide all levels of care required by patients, then it would follow that the hospital had also done wrong. (For what it's worth, in my experience if a particular hospital can't provide a needed treatment, they will arrange treatment at the nearest centre that can, at least in acute cases.)
I also have a worry about your condemnation test:
When people act so as to make the lives of others worse off than they would have otherwise been, and uses poor reasoning to defend their action, it is perfectly legitimate to condemn them for it.
It seems vulnerable to counterexamples. Suppose A and B are both starving, such that each will die if they do not eat immediately. Suppose also that there is food available, but only enough to preserve either A's life or B's life, but not both. If A eats the food, then he will make B worse-off, by killing him; similarly, if B eats the food, then he will make A worse-off, by killing him. If both A and B eat the food, then they will make each other worse-off (and, indeed, themselves worse-off) because, ex hypothesi, there is not enough food to keep them both alive. I don't see what reasoning could justify any of the options available to either A or B, i.e., eat the food and let the other die, share the food and both die, or let the other have the food and die oneself. So, it seems that A and B, although trapped in a horrible situation not of their own making, will automatically be condemnable no matter what they do. This strikes me as wrong: the situation is sufficiently tragic that neither A nor B should be condemned, no matter what they do.
The above suggests the test is not sufficient; I believe I can also show that the test is not necessary. Suppose that A and B are, once again, starving. However, there's two portions of food, and each portion would be enough to keep A and B alive. A, being greedy, takes both portions of food and gorges himself. In short order, he dies (say the food was extremely fatty and he had a massive heart attack). B, being a lucky sort of person, miraculously finds another portion of food, which he eats and thus lives. By your test, though, it seems that A should not be condemned: B is not actually worse-off than he would have been (if he had eaten one of the two original portions, he would have lived; instead, he ate the third, miraculous portion of food, and lived; the outcomes are the same on either possibility), even though A's reasoning (if there was any) could not be considered good. However, that A took more than he needed, when B's need was as acute as his, suggests that A should be condemned. So, the test is not a necessary condition, either.
...if the hostpital has certain special powers associated with its role, and if these powers come with the responsibility to provide all levels of care required of patients, then it woul follow that the hospital had also done wrong.
ReplyDeleteThere are several reasons not to require a hospital to provide all levels of care.
(1) Liberty. The presumption should be in favor of allowing people to do as they wish unless a compelling interest can be shown in the alternative. The burden of proof is on those who will seek to limit freedom.
(2) Affordability. If we were to require that a hospital in Miles City, MT provide the same level of care as the Mayo Clinic, there would be no hospital in Miles City, MT.
(3) Specialization. A dentist's office should not be required to offer brain surgery as another medical procedure.
(4) Availability. Restrictions and requirements will simply reduce the number of options available. One might think that a law that requires all individuals to provide services A and B will make both more widely available. Yet, in many cases, the requirement that individuals provide services A and B will simply close the doors to those who provide only A or only B.
If a particular pharmacy is the only pharmacy for a significant distance, then there may be a compelling interest in forcing it to make all pharmaceutical options available. However, if this legislation proves to have the effect of simply closing down this sole pharmacy, then this is not helping.
As for your first counter-example, the standard moral solution in this type of case would be to simply draw straws for the food - leaving the decision as to who lives or dies up to chance. I do not see how this provides a counter-example.
Your second counter-example does require more specificity in my statements than the space of a blog allowed.
In desire utilitarianism, a person deserves condemnation if he performs an action that a person with good desires would not do. Good desires are maleable desires that tend to fulfill the desires of others.
In your second case, A, being greedy, performs an action that people generally have reason to condemn. It may be, in this case, that B gets lucky. However, in general (an in real-world situations where morality must function) he acts on maleable desires that would tend to thwart the desires of others.
The owners of this pharmacy exhibits attitudes that will tend to thwart the desires of others. If this harm was due to an oversite that anyboy could make, then condemnation would be appropriate. However, in this case, a person with good desires would not adopt this attitude unless forced into it - would give the benefit of the doubt to options that benefit others and accept options that harm others only under a burden of proof beyond reasonable doubt.
These standards are not met in this circumstance, making condemnation appropriate.
The relevance of negative liberty is unclear to me. We're talking about hospitals, which aren't moral agents, and so can't have liberty. Specialization, affordability, and availability are fair enough complaints, but they don't eliminate the responsibility of the hospital to do something in terms of service provision: such as ship the patient in question to the nearest institution that can provide the necessary care (in time-limited cases) or refer the patient to same (in cases with no pressing need). The parallel in the case of a pharmacy, then, would be to actually transport the customer to the nearest pharmacy in cases of pressing need, and refer the customer to the nearest pharmacy in all other cases.
ReplyDeleteOf course, this all operates at the institutional level; it does nothing to the claim that the pharmacist, by virtue of being a pharmacist, is obligated to fill prescriptions. If there were some division within pharmacy parallel to the specializations within medicine, then pharmacists could legitimately claim to limit themselves to only the role that they have assumed; since, AFAIK, there aren't such divisions, pharmacists don't have a justification for accepting the power associated with their role (dispensing medications) and denying the responsibility (to dispense prescribed medications). (FWIW, dentistry is not considered part of medicine. I'm not sure why; there's probably historical reasons.)
The purpose of the first counter-example was to show that the conditions of the condemnation test can be fulfilled and yet condemnation not be appropriate. Drawing straws is a (possibly) legitimate decision mechanism, but it doesn't solve the condemnation question, as the two issues are separate. It's possible, after all, that following the best decision mechanism available will still leave one vulnerable to condemnation, and that following the worst will still leave one above condemnation.
As far as the second case, the analysis of desire looks incomplete to me. If a good desire is defined in terms of fulfilling the desires of others, what is it that defines the desires others have? The way you use "tends" suggest to me that you may be thinking dispositionally -- so, a desire is a disposition to perform certain actions in certain circumstances. That would mean the definition of "good desire" applies to those dispositions to perform certain actions in certain circumstances such that the actions in those circumstances fulfill the desires of others. A "bad desire", then, would have to be a disposition to perform certain actions in certain circumstances such that the actions in those circumstances prevent the fulfillment of the desires of others.
You may also be thinking in terms of probabilistic causality -- so, a desire causes certain actions in certain circumstances with a particular probability. That would mean the definition of "good desire" applies to the cause of actions in certain circumstances such that the actions in those circumstances generally fulfill the desires of others. A "bad desire" would be the cause of actions in certain circumstances such that the actions in those circumstances generally prevent the fulfillment of the desires of others.
If either of these is right, though, the second case still stands as a counter-example. Looking at the dispositional analysis, A doesn't necessarily have a disposition to perform actions that deprive B of fulfilling his desire for food. All that's revealed is that he did perform an action that deprived B of fulfilling his desire for food; it doesn't follow from A's taking all the food that he is disposed to take all the food.
The causal analysis has a similar problem. Since the bad desire only causes actions that generally prevent the fulfillment of the desires of others, and the good desire only causes actions that generally fulfill the desires of others, it follows that the good desire can cause an action that, in a particular case, prevents the fulfillment of the desires of others (and vice versa for a bad desire causing a beneficial action).
If you eliminate the probabilistic terminology, and read the causal claims deterministically, that would save the result: A had a bad desire which did indeed cause him to do something that prevented B's fulfilling his desire for food. It's not plausible as a model of human action, though, as (for one) it's hard to see why A is blamed for doing what he did if his desire deterministically caused him to do it. We could blame A for having the desire (assuming desire-formation is not deterministically caused), but not for the action the desire caused; once the desire was in place, it was inevitable that the action would result.
adhr said: Suppose that A and B are, once again, starving. However, there's two portions of food, and each portion would be enough to keep A and B alive. A, being greedy, takes both portions of food and gorges himself. In short order, he dies (say the food was extremely fatty and he had a massive heart attack). B, being a lucky sort of person, miraculously finds another portion of food, which he eats and thus lives. By your test, though, it seems that A should not be condemned
ReplyDeleteWe act to fulfill the more and greater of our desires given our beliefs. A and B both believed that there were exactly 2 servings of food. Believing this, A took B's food anyway, expecting this to result in B dying and A living; thus he is to be condemned. Unexpected miracles and heart attacks do not retroactively make an evil act good.
Unexpected miracles and heart attacks do not retroactively make an evil act good.
ReplyDeleteAgreed, but not relevant. The point was that, given the definition of condemnation in play, A couldn't be condemned. Since that's the wrong result, there must be something wrong with the definition.
We act to fulfill the more and greater of our desires given our beliefs.
From this, we still couldn't conclude A did anything wrong. If he just wanted to eat two helpings of food more than he wanted to help B, or if he didn't actually believe that B would die without the food, then A acted correctly.