Thursday, July 9, 2009

Contraception: reversal of the direction of repugnance?

What is viewed as a repugnant transaction can change over time, and even reverse direction entirely. An example is that laws in the US have gone from prohibiting contraception to prohibiting pharmacists from declining to provide contraception.

Repugnance to contraception is far older than effective contraception, with roots sometimes attributed to the Bible*. In the United States, the Comstock Law of 1873 made it a Federal crime to sell or distribute contraceptives or information about them, and many states followed with bans of their own. These were not finally overturned until the Supreme Court, in Griswold v. Connecticut (1965), overturned Connecticut's ban on contraception, and found that the Connecticut law violated a fundamental right of privacy. (Here's a summary of the case.)

More recently, a number of states have passed laws requiring hospitals and health care providers to inform rape victims of the availability of "morning after" contraception, and sometimes requiring pharmacies to stock it and dispense it: 50 State Summary of Emergency Contraception Laws.

This in turn has raised the question of whether health care providers and pharmacists who find contraception repugnant can or should be compelled to provide information about it. One of the final acts of the Bush administration was to issue regulations allowing pharmacists and doctors to decline to provide contraception or information about it if they found it morally repugnant:

Bush's Last-Minute 'Conscience' Rules Cause Furor
"Health care workers, hospitals and even entire insurance companies could decline to perform, refer or pay for abortion or any other health care practice that violates a "religious belief or moral conviction" under new rules issued by the outgoing Bush administration.
"This rule protects the right of medical providers to care for their patients in accord with their conscience," said Health and Human Services Secretary Michael Leavitt.
But opponents of the rule, now set to take effect Jan. 19, say it could threaten patients' health. "This is a very wide, broadly written regulation that upsets what has been a carefully established balance between respecting the religious views of providers, while also making sure that we're guaranteeing patients access to health care," said Cecile Richards, president of the Planned Parenthood Federation of America. "
(See the rule here, called (confusingly) Ensuring That Department of Health and Human Services Funds Do Not Support Coercive or Discriminatory Policies or Practices in Violation of Federal Law)

Subsequently, these conscience clauses have come under attack:
Obama administration may rescind 'conscience rule'

"February 27, 2009
WASHINGTON — Taking another step into the abortion debate, the Obama administration Friday will move to rescind a controversial rule that allows health-care workers to deny abortion counseling or other family-planning services if doing so would violate their moral beliefs, according to administration officials.The rollback of the "conscience rule" comes just two months after the Bush administration announced it last year in one of its final policy initiatives.The new administration's action seems certain to stoke ideological battles between supporters and opponents of abortion rights over the responsibilities of doctors, nurses and other medical workers to their patients.Seven states, including California, Illinois and Connecticut, as well as two family planning groups, have filed suits challenging the Bush rule, arguing it sacrifices the health of patients to religious beliefs of medical providers."

(See the proposed rule here: Rescission of the Regulation Entitled ``Ensuring That Department of Health and Human Services Funds Do Not Support Coercive or Discriminatory Policies or Practices in Violation of Federal Law''; Proposal)

So it appears that we have come full circle in a certain sense, and now have laws that prohibit the withholding of information about contraception (and contraception itself), where once we had laws forbidding the dissemination of contraception and information about it.

(No wonder the study of repugnant transactions doesn't lend itself to simple theories about what is and is not repugnant...)

*The biblical story that is sometimes interpreted as indicating repugnance to contraception is the story of Onan in Genesis 38. However that story is complex, and it is far from clear to me that contraception is the issue.

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