In March 1916, the author Lytton Strachey entered Hampstead Town Hall at the behest of a military tribunal to explain his refusal to fight in the Great War. Asked if he had a conscientious objection to all wars, Strachey, according to his biographer Holroyd (1971, p.628), replied, ‘Oh no, not at all. Only this one.’ His interrogator retorted, ‘Then tell me, Mr Strachey, what would you do if you saw a German soldier attempting to rape your sister?’ Strachey answered, ‘I should try and come between them.’
An obscure episode from over a century ago has no connection to modern medicine … or has it? With rape a commonly used weapon of war, a modern-day Strachey might reply that were his sister raped by a soldier, he would advise her to take emergency hormonal contraception (EHC), a safe and effective means of preventing pregnancy following sexual assault, unprotected sexual intercourse, or a failure of contraception. Taken in tablet form, it has been available without prescription in the UK and Ireland from 2001 and 2011, respectively (Gallagher et al, 2013)
To what extent do the religious and moral judgments of EHC providers obstruct the delivery of appropriate treatment to women who ask for help? Harrison (2005) telephoned hundreds of both Catholic and non-Catholic hospitals in the United States, asking about EHC availability. She found that almost half of hospital emergency departments (42% of non-Catholic and 55% of Catholic hospitals) refused to provide EHC, regardless of circumstance. Further, of those hospitals that refused EHC ‘only about half gave callers a valid referral, and most referrals were ineffective’ (Harrison, 2005).
Strachey's conscientious objection to military service in the Great War has relevance to those contemporary hospitals/pharmacists who decline to provide EHC to patients, and award themselves the status of conscientious objectors (COs). As COs to military service are against killing through combat, COs to EHC provision are against what they see as killing through medical intervention.
Does the principle behind conscientious objection to military service transfer easily to non-provision of EHC? Take a CO who objects to killing in combat, is against all wars, and accepts the consequences, such as imprisonment. Similarly, a pharmacist, who is a CO to EHC because it kills a zygote opposes all medicines that might kill a zygote and accepts the sanction(s) of their regulating authority.
However, if such an individual opposes both EHC provision and any other medicine that might kill a zygote, they must oppose the provision of, for example, those medicines that influence lactation in a particular way. This theme is explored by Card (2011) who notes that some women who breastfeed experience lactational amenhorrhoea (LA), and LA's post-fertilisation effect could prevent implantation, and thus kill a potential zygote. As it is ludicrous to conscientiously object to breastfeeding, no matter the threat it might pose to a zygote, it must follow that it is the principle of selective conscientious objection specifically to EHC provision that is invoked by a dissenting pharmacist or other healthcare professional… just as Strachey claimed that his objection was only to the Great War.
‘Harrison (2005) telephoned hundreds of both Catholic and non-Catholic hospitals in the United States, asking about EHC availability. She found that almost half of hospital emergency departments (42% of non-Catholic and 55% of Catholic hospitals) refused to provide EHC, regardless of circumstance’
It seems to me that a selective CO is on even shakier moral ground than a ‘conventional’ CO. This is because if a CO is going to assert the principle of selective conscientious objection, they are bound to assert a strongly held belief in one case, but a less strongly held belief in another.
Gallagher et al (2013) have tried to cut a path of reason through the present jungle of moral obfuscation by citing Immanuel Kant's first formulation of the categorical imperative, which, when applied to the present argument, means that regulators of a profession ‘… such as pharmacy could not be expected to draft bespoke codes of conduct for each of their members …’ Clearly disinclined to favour the dancing-on-the-head-of-a-pin school of philosophy, Gallagher et al (2013) assert plain common sense by saying that ‘either the regulators must compel all pharmacists to dispense emergency contraception to all patients who request it, or a pharmacist must refuse either to supply EHC or to refer the patient to an alternative supplier and challenge any subsequent sanctions imposed by their regulator.’
It is a conclusion that even Lytton Strachey could not have argued against.