Tuesday, September 30, 2008
Just a quick response to Richard Stith's thoughtful comments on the proposed HHS conscience regulation. First, if local governments (such as New York City's) are getting heavy-handed in negating the moral autonomy of health care providers, I think the proper response is to address those local governments through targeted regulation. The proper response is not to marginalize the entire lawyer of organizations that stand between the state and the individual. In terms of subsidiarity, assume that A is the highest level of social actor and F is the most localized. If C is unnecessarily limiting the freedom of F, A's proper response would be to address C's conduct, not to leap-frog all the intermediate levels by giving F a categorical trump over the identity-forming autonomy of D and E. I see the conscience regulation as unwisely leap-frogging several levels in the chain of prudently devolved authority.
Second, I agree that forcing a pro-choice pharmacy to incur the added financial and message-muddying cost of accommodating pharmacists who defy the organization's moral identity is not as personally intrusive as forcing a pro-life pharmacist to dispense products that conflict with her moral convictions. Nevertheless, it does pose a significant burden on those organizations. Further, it entrenches the notion that the battle over conscience is really a battle for the reins of state power in service of the individual. Politically, I don't think there is much perceived difference in forcing all organizations to accommodate every individual employee and forcing all organizations to accommodate every individual consumer.