9th Circuit: pharmacists must dispense morning-after pill

posted at 10:15 am on July 11, 2009 by Ed Morrissey

The most overturned appellate court has teed up another case for the Supreme Court to consider — and likely soon. The 9th Circuit overturned an injunction in a district court case, allowing the state of Washington to force a pharmacy to stock and dispense morning-after pills, which causes the abortion of an embryo in the early days of a pregnancy. The pharmacy owners had objected, claiming that the law violated their religious practice:

Pharmacists are obliged to dispense the Plan B pill, even if they are personally opposed to the “morning after” contraceptive on religious grounds, a federal appeals court ruled Wednesday.

In a case that could affect policy across the western U.S., a supermarket pharmacy owner in Olympia, Wash., failed in a bid to block 2007 regulations that required all Washington pharmacies to stock and dispense the pills.

Family-owned Ralph’s Thriftway and two pharmacists employed elsewhere sued Washington state officials over the requirement. The plaintiffs asserted that their Christian beliefs prevented them from dispensing the pills, which can prevent implantation of a recently fertilized egg. They said that the new regulations would force them to choose between keeping their jobs and heeding their religious objections to a medication they regard as a form of abortion.

Ralph’s owners, Stormans Inc., and pharmacists Rhonda Mesler and Margo Thelen sought protection under the 1st Amendment right to free exercise of religion and won a temporary injunction from the U.S. District Court in Seattle pending trial on the constitutionality of the regulations. That order prevented state officials from penalizing pharmacists who refused to dispense Plan B as long as they referred consumers to a nearby pharmacy where it was available.

On Wednesday, a three-judge panel of the U.S. 9th Circuit Court of Appeals lifted the injunction, saying the district court was wrong in issuing it based on an erroneous finding that the rules violated the free exercise of religion clause of the U.S. Constitution.

There have been two different issues in the legal fight over Plan B.  In one group, pharmacists not working for themselves — for instance, at chain pharmacies — objected to dispensing the pill and wanted job protection despite their refusal.  Those cases hardly stand up to scrutiny.  The owner of the pharmacy has the right to decide on his own inventory and what to sell, and the employees of that pharmacy either should follow that policy or find a job somewhere else if it offends them.  It falls into the same category as a cashier who refuses to handle meat at the checkout counter because he’s a vegetarian.

However, this is something else.  The owners of the pharmacy do not want to stock the pills for their own reasons.  Even apart from religious grounds, that still seems to be their decision in the marketplace.  If they don’t want to sell aspirin, or Ginsu knives, or inflatable life vests for swimming pools, that should be their decision, too.  If their customers object to their policies, they will find other pharmacies to patronize.  The government has a public interest in telling retailers what they cannot sell for safety reasons (like dynamite, as an example), but should not force business owners to sell something they do not want to sell.

I’ll be interested in the appeal to this decision.  I suspect we’ll get another 5-4 decision.  I just hope that the decision will support the rights of business owners to determine for themselves the products and services they will offer.

Update: Gabriel Malor wants to emphasize that this ruling overturned the temporary injunction sought by the pharmacy, and is not a ruling on the case itself, which proceeds in district court.  I believe the ruling can be appealed to attempt to reinstate the injunction, and I hope it is.


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Responding to Chekote who said:

… So when the egg is fertilized in a petrie dish, the woman is pregnant? Do you know anything about IVF? The woman is not pregnant until the embryo implants in the uterus.

Chekote on July 12, 2009 at 12:06 AM

Chekote,

This thread is talking about the 9th District Court legislating from the bench and forcing pharmacists to provide abortifacient pharmaceuticals which kill a new human being.

Under that thread and context we are talking about women who become pregnant normally through sexual reproduction, meaning the meeting of the father’s sperm and the mother’s oocyte, in vivo – inside the woman’s body. We are NOT talking about women who become mothers ex vivo (outside of the woman’s body) via In Vitro Fertilization (IVF). The IVF produced baby situation does not require the “morning after pill,” or a pharmaceutical abortifacient to “fix the problem” and kill the new human being. Only the reproduction which takes place in vivo, sexually – with sperm and oocyte, or asexually reproduced new human being – as in monozygotic twinning, is the focus of abortifacients.

What you have done is tried to change the topic, skipping the actual subject, women who become pregnant under normal in vivo reproduction, not those whose baby begins his or her life ex vivo, outside the womb, as in IVF, artificial reproductive technologies, etc. Furthermore, you are avoiding the more important part of this topic, that the abortificient kills a new human being, which the new human embryo is, a human being who started his or her life in the fallopian tube and who travelled from there to the uterus where the abortifacient makes the womb a hostile environment where the baby cannot survive.

In the case of IVF (In Vitro Fertilization) the father and mother become parents upon the fertilization by the sperm of the father of the oocyte of the mother. They become parents at that moment, the beginning of the life of their new baby BEFORE the baby is introduced into the mother’s body. In those cases, of course the mother is not pregnant until baby is inside her. It is illogical to think otherwise.

Nevertheless, as I stated above, the new human being has already started his or her life before the new human being, as a human embryo, the first stage of development in a human being’s life engages in implantation, and the father and mother are already parents before implantation.

In normal in vivo reproduction (inside the mother’s body) the new human being’s life begins at first contact, the penetration by the father’s sperm of the zona pellucida of the woman’s oocyte, and at that same time the woman, or mother, becomes pregnant.

In the case of in vivo reproduction (which includes both sexual and asexual reproduction in vivo) there is no delay before the mother is pregnant. She is pregnant immediately. After several days of travel from the fallopian tube to the inner wall of the uterus the new human embryo, the new human being, penetrates the wall of the uterus, the beginning of implantation. That is NOT the beginning of pregnancy in in vivo reproduction, which is what we are talking about in the original thread presented here, for the pregnancy in that case has already occured before implantation.

Quoting Chekote:

… I have never heard of a IVF patient announcing they were pregnant as soon as the sperm was delivered into the egg in the petrie dish. …

No, in IVF (reproduction ex vivo – outside the mother’s body) the woman is not pregnant until the new human being, the new human embryo is introduced into the mother’s body.

However, she, and the father of the baby, are parents at the time of first contact of sperm and oocyte when the life of their new child begins. In in vivo reproduction (as stated above) the mother IS pregnant upon penetration by the father’s sperm of the zona pellucida of the woman’s oocye, not later upon implantation.

Again, in cases of in vivo reproduction in which the new human being’s life begins inside mother’s body, which is the time she becomes pregnant, not at implantation, the abortifacients that the 9th District Court rules that the pharmacist must distribute against his or her will kills the new human being.

William2006 on July 12, 2009 at 10:57 PM

If He got so fed up with his chosen people that He finally let barbarians overrun them entirely, you can bet your boots our court date is set!
Dark-Star on July 12, 2009 at 10:17 PM

The only difference between the Ammonites (and for a time the Israelites) and Americans is the name of the god each nation worships: Molech for the former and each one’s own self the latter. If ever this country needed a Josiah. This country has absolutely no shame left, no concept of God’s Law. Or as Paul writes, “Furthermore, since they did not think it worthwhile to retain the knowledge of God, he gave them over to a depraved mind, to do what ought not to be done. They have become filled with every kind of wickedness, evil, greed and depravity. They are full of envy, murder, strife, deceit and malice. They are gossips, slanderers, God-haters, insolent, arrogant and boastful; they invent ways of doing evil; they disobey their parents; they are senseless, faithless, heartless, ruthless. Although they know God’s righteous decree that those who do such things deserve death, they not only continue to do these very things but also approve of those who practice them.” This country “drinks iniquity like water” and asks for more. God help us.

Send_Me on July 12, 2009 at 11:29 PM

Ed, I haven’t read all the comments, but I presume you already must have several correcting an assertion in your post about how plan B works.

It works by delaying ovulation. It is not an “abortion pill”. It will not abort an established pregnancy.

SarahW on July 12, 2009 at 10:52 PM

Sarah,

The “Plan B” (levonorgestrel) pill, often referred to as the “Morning After Pill” (MAP) can act to retard ovulation, but it can also act as an abortifacient which makes the womb a hostile environment and prevents the implantation of the new human being, the new human embryo, ending his or her life, aborting her.

One type of MAP includes a combination of estrogen and a progestogen, another includes a progestogen only. The estrogen progestogen combination can act as a contraceptive (prevents conception) by preventing ovulation, and it can also act as an abortifacient by preventing implantation. The other type, progestogen only, causes less nausea and vomitting and is an abortifacient only, meaning it aborts the new human being.

In the science of Human Embryology, the science which actually studies, researches, and lays out the terminology related to the most recent, up-to-date findings of early human development the new human being’s life begins at fertilization, upon the penetration by the sperm of the father of the zona pellucida of the oocyte of the mother. At that time the mother has become pregnant, not several days later upon implantation. In this case I am referring to reproduction in vivo, inside mother’s body, not reproduction ex vivo, outside of mother’s body. In reproduction ex vivo (begins outside the mother’s body) cases the father and mother have already become parents once fertilization has begun, but the woman is not pregnant in reproduction ex vivo until the new baby is introduced into her body.

Back to reproduction in vivo, and abortifafient pharmaceuticals, in preventing implantation of an already alive, already existing new human being the pharmaceutical acts to abort the new person, hence it is an abortifacient. So pharmaceuticals, e.g., RU 486, the “Morning After Pill” (levonorgestrel) (MAP), etc., do act as abortifacients and do kill the new human being.

On those grounds it is right and just for pharmacists to refuse to fill such prescriptions.

I also support the pharmacist’s right to refuse to refer the client to another pharmacy which will fill the prescription for the abortifacient. It is counter productive to do so. It is as if the pharmacist refuses to take part in the killing of a third party but refers the person requesting the killing to a hit man who will do the job for them.

William2006 on July 12, 2009 at 11:31 PM

I also support the pharmacist’s right to refuse to refer the client to another pharmacy which will fill the prescription for the abortifacient. It is counter productive to do so. It is as if the pharmacist refuses to take part in the killing of a third party but refers the person requesting the killing to a hit man who will do the job for them.

William2006 on July 12, 2009 at 11:31 PM

This crap all got started because pharmacists were not handing back money and prescriptions handed over in anticipation of the services the pharmacy would not perform. As long as the prescription and any money paid to the pharmacist for the prescription are handed back to the patient IMMEDIATELY, there should be no problem.

Sekhmet on July 12, 2009 at 11:57 PM

This crap all got started because pharmacists were not handing back money and prescriptions handed over in anticipation of the services the pharmacy would not perform. As long as the prescription and any money paid to the pharmacist for the prescription are handed back to the patient IMMEDIATELY, there should be no problem.

Sekhmet on July 12, 2009 at 11:57 PM

Boo-Hoo! So now an innocent pharmacist is forced to make the hit-man reference per William2006′s metaphor?? That’s some real leftie type convoluted reasoning ala finding the right to an abortion in the federal constitution…… The pharmacists that kept prescriptions or money need to be dealt with according to existing law

cjk on July 13, 2009 at 12:26 AM

Maybe anti-Plan B Christians shouldn’t own pharmacies.

RightOFLeft on July 12, 2009 at 9:16 PM
>>>>

Be careful what you wish for. When only people who don’t value human life are the ones handing out your pills, you never know what you might get.

justincase on July 13, 2009 at 12:47 AM

justincase,

You believe that a fertilized egg is a child. Others don’t. You believe that a blueprint is the same as a building. Others don’t. Current law allows both sides to practice their beliefs. I think that’s the best solution given the diversity of thought and religion in this country.

Chekote on July 12, 2009 at 1:17 AM

Checkote,

Where under this thread re: 9th Circuit: Pharmacists must dispense morning-after pill, did Justincase say anything about blue prints being the same as a building?

Isn’t that really just YOUR argument, not justincase’s?

You create an argument based on something YOU said, not on something that justincase said, then you attack HIM on your false argument!

That is both dishonest AND disingenuous, as well as malicious.

A new human being is NOT a blue print, but a living human organism, developing, growing, etc. A blue print does NOT do that. A blue print does not grow and develop. A blue print is not alive, or a living organism.

Regarding your statement to justincase “You believe that a fertilized egg is a child. Others don’t.” What has this to do with anything?

First, where did justincase use those words? It appears that YOU put those words together, not him.

1) A new human being is NOT a fertilized egg. During the first eight weeks of life inside the womb the new human being is a living human organism, a new member of the human race, a new human embryo. She or he is NOT a “fertilized egg.” Human beings do not come from eggs, do not incubate in eggs, do not “hatch” from eggs.

New human beings inside their mother’s body normally grow and develop inside the womb of their mother till term/birth. Human beings are born alive, not hatched from eggs.

The development of human beings does not end in the embryonic stage, or in the fetal stage, or at birth, or in the neonatal stage. The development of human beings is a continuum of overlapping stages of development which continue into adulthood.

In the case of sexual reproduction, in vivo, it is more accurate to say “A new human embryo, resulting from the union of the father’s sperm and the mother’s oocyte, is a new human being.” The same holds true for asexual human reproduction (reproduction which does not require sperm and oocyte, e.g. monozygotic twinning, triplets, etc., blastomere separation, blastocyst splitting, etc., as in artificial reproduction technologies, etc.), and reproduction which takes place ex vivo.

That is factual.

If someone does not believe it, or chooses to deny it, does not make that fact inaccurate. It merely shows that the person denying that fact is ignorant of the facts or chooses to deny them, and they who deny that fact are scientifically inaccurate.

So, it matters not that justincase “believes” that a new human embryo is a new human being but that someone else might not believe it. Justincase is correct in this matter and the other person is incorrect.

William2006 on July 13, 2009 at 12:49 AM

Maybe anti-Plan B Christians shouldn’t own pharmacies.

RightOFLeft on July 12, 2009 at 9:16 PM

>>>>

Be careful what you wish for. When only people who don’t value human life are the ones handing out your pills, you never know what you might get.

justincase on July 13, 2009 at 12:47 AM

justincase,

I am enjoying reading your comments under this thread.

Thank you for taking the time to post them!

“RightOFLeft”

Of course you can refer to them as “anti-Plan B Christians” but that assumes that all pharmacists who oppose abortion are Christians, whereas many abortion opponents are NOT religious, and are NOT Christians.

Also, I think that the term “antiabortion” pharmacists, or even “Pro-life Pharmacists,” and “Right to Life Pharmacists” apply.

William2006 on July 13, 2009 at 12:54 AM

cjk on July 13, 2009 at 12:26 AM

The less intrusive answer is to make sure it is illegal for the pharmacist not to hand back money and prescriptions if they do not intend to fill the prescription. Not to force pharmacies that don’t want to carry a drug to carry it. Read what I have been saying on this thread.

Sekhmet on July 13, 2009 at 1:13 AM

Be careful what you wish for. When only people who don’t value human life are the ones handing out your pills, you never know what you might get.

justincase on July 13, 2009 at 12:47 AM

I’ll get my prescription filled. Also, I don’t presume that somebody doesn’t value human life based on their acceptance of Plan B.

RightOFLeft on July 13, 2009 at 1:27 AM

Of course you can refer to them as “anti-Plan B Christians” but that assumes that all pharmacists who oppose abortion are Christians, whereas many abortion opponents are NOT religious, and are NOT Christians.

Also, I think that the term “antiabortion” pharmacists, or even “Pro-life Pharmacists,” and “Right to Life Pharmacists” apply.

William2006 on July 13, 2009 at 12:54 AM

Not really. It assumes that there are some Christians who oppose Plan B. You can extrapolate the statement to other faiths if you’d like.

RightOFLeft on July 13, 2009 at 1:32 AM

If the law says a retailer HAS to stock and sell something he doesn’t want to sell, can’t he just follow the letter of the law, then charge $1,000 per pill and not sell any that way? (/sarc?)

In any case, FWIW – Plan B IS abortion on demand, and it ends a human life. It’s pure nonsense to tell me that a live sperm and a live egg getting together forms anything other than a live human being, albeit one who hasn’t attained full growth yet. It’s irrelevant where it occurs – petri dish, test tube or wherever it was that conceptions used to take place. Abortion is murder, plain and simple, and it also doesn’t matter when or where it happens. Only THAT it happens.

Fishoutofwater on July 13, 2009 at 2:29 AM

As a business man it makes my blood boil that Government would force me to carry any product. What the F^&5k is that? I take the risk. I don’t want products that will put my investment to sleep and not make any returns. This country has gone so far out of left you people are talking about

Maybe anti-Plan B Christians shouldn’t own pharmacies.
RightOFLeft on July 12, 2009 at 9:16 PM

Who the fuck are you or the government to tell me as a business owner that I should carry any particular product? DO YOU PAY FOR ME TO STOCK IT? This make my head spin with the micromangment of the business in this country. I also have right to fire any employee who doesn’t sell my products. At least I thought I did. GOD HELP US!!

Ed Laskie on July 13, 2009 at 4:14 AM

Figures.

SuperManGreenLantern on July 13, 2009 at 6:29 AM

First, licensing of those who provide such things that are as potentially dangerous as drugs is important for public safety, and improves lives overall.

Second, such a license should in no way be a slave collar. It should prevent you from acting in certain proscribed ways (selling medication without all due verifications), but should never require you to act (selling a medication you don’t want to sell). Which is not to say that your boss can’t fire you for it, though.

Count to 10 on July 12, 2009 at 10:42 AM

Public safety? People have a right to decide what to put in their own bodies. If they’re morons that want to od on painkillers, then so be it. Who am I to stop them?

Libertarian Joseph on July 13, 2009 at 8:10 AM

and it isn’t like they couldn’t get their hands on it anyway

Libertarian Joseph on July 13, 2009 at 8:11 AM

In the case of sexual reproduction, in vivo, it is more accurate to say “A new human embryo, resulting from the union of the father’s sperm and the mother’s oocyte, is a new human being.” The same holds true for asexual human reproduction (reproduction which does not require sperm and oocyte, e.g. monozygotic twinning, triplets, etc., blastomere separation, blastocyst splitting, etc., as in artificial reproduction technologies, etc.), and reproduction which takes place ex vivo.

That is factual.

William2006 on July 13, 2009 at 12:49 AM

It is the “being” part that people disagree on. As you point out a blastocyst my split. How can it be an individual being if it may soon become two?

dedalus on July 13, 2009 at 8:23 AM

I haven’t had a chance to read all 500+ comments, so someone has probably already made this point.

No pharmacy stocks every drug out there. When I needed Lovenox six years ago, my doctor had to give me several days worth so I’d have some until a pharmacy could order it in – it was a new enough (and *expensive* enough) drug that no one actually kept it on the shelf, since they couldn’t be sure that they would be able to dispense it before it’s expiration date. At $25 or more per injectable, as businesses, they weren’t going to risk it. And noone expected them too. Now that it’s becoming a more common prescription, they do keep some in stock, but still often not enough to fill an entire 2 week script, just enough for the patient until they can get more in.

So why do we expect every pharmacy out there to stock Plan B? What if they are in an area where 95% of their clients are practicing Catholics (or others who don’t believe in abortion and/or contraception)? Even if the pharmacist had no objections to dispensing Plan B, without gov’t regulation, the store would be unlikely to stock it, because they wouldn’t fill enough prescriptions to make it economically sound.

LibraryGryffon on July 13, 2009 at 8:51 AM

If it’s your job to dispense prescriptions, and you don’t like the prescriptions your job will require you to dispense, then you should probably go find another job at another pharmacy that shares your worldview or open your own. The end.

Dave Rywall on July 13, 2009 at 8:53 AM

Dave Rywall on July 13, 2009 at 8:53 AM

Your petulant response is laughable. RTFA and make a more informed comment. How aweful it must be to go thru life with your cheeks so chapped all the time…

daesleeper on July 13, 2009 at 9:12 AM

Your petulant response is laughable. RTFA and make a more informed comment. How aweful it must be to go thru life with your cheeks so chapped all the time…

daesleeper on July 13, 2009 at 9:12 AM
—-

Common sense eludes you. Not my fault.

Dave Rywall on July 13, 2009 at 9:18 AM

If it’s your job to dispense prescriptions, and you don’t like the prescriptions your job will require you to dispense, then you should probably go find another job at another pharmacy that shares your worldview or open your own. The end.

This suit involves proprietors.

Chris_Balsz on July 13, 2009 at 9:50 AM

Look, this really needs to get cleared up. Although it is theorized as POSSIBLE that Plan B may have some affect on implantation of a fertilized ovum, there is actually zero direct evidence that it does so. Seriously. Plan B has not been shown to have any material affect on implantation.

The natural wastage rate of fertiliza ova is high, and whatever neglible effects Plan B has on implantation would be difficult to distinguish between that which occurs in nature. Similarly, abortifacient effects of regular dose birth control pills or medical devices as an IUD would have to be considered.

The chief, and only proven, mechanism of Plan B is delay of ovulation.

Whatever philosophical differences one might have against contraception occurring after intercourse, I hope it is at least clearly understood that conception itself is being prevented, and that no implanted pregnancy can be destroyed.

Should pharmacists who refuse to dispense medication stocked by a pharmacy when it is prescribed according to FDA guidelines in an appropriate patient with no conflicts or contraindications applicable to that patient known to the pharmacist, have their jobs or licenses protected? I really think that is up to the discretion of the employer, and personally, that if you can’t bear to do your job you really ought to find another.

SarahW on July 13, 2009 at 10:41 AM

It is the “being” part that people disagree on. As you point out a blastocyst my split. How can it be an individual being if it may soon become two?

dedalus on July 13, 2009 at 8:23 AM
>>>>

Through cloning, any one of us could become two. Does that make us any less an individual until that happens?

justincase on July 13, 2009 at 11:07 AM

SarahW, if making the uterus hostile to implantation is not being attempted, why is progestin used?

And yes, some oral contraceptives have the same effect as Plan B – though you’ll be hard pressed to find a public health nurse who will admit it. It would be a service to women everywhere to make that fact known.

justincase on July 13, 2009 at 11:13 AM

Justincase, again, there is zero direct evidence that Plan B has any effect on implantation.

But assume some minor and secondary effects of interference with implantation – an inhospitable uterine lining is not the same thing as physically removing an implanted fertilized egg.

Many eggs are not able to implant because of their own issues,( and there is no proof it can until it does, and Plan B does not affect established pregnancy) or naturally inhospitable uteruses. There is a high wastage rate in nature. Personally, I can’t see that a woman has any obligation to maximize the fluffy accepting nature of her uterine lining; otherwise you are arguing that a woman might be committing murder if she has uterine ablation to treat her bleeding, instead of a more conservative treatment, or fibroids she chooses not to treat, and still engages in coitus when the potential for egg to meet sperm still exists but successful implantation is unlikely.

The fact remains that delay of ovulation is the only proven mechanism of Plan B.

SarahW on July 13, 2009 at 11:34 AM

Through cloning, any one of us could become two. Does that make us any less an individual until that happens?

justincase on July 13, 2009 at 11:07 AM

With artificial cloning you’d be able to identify individual “A” and individual “B”, since “A” existed as an individual for some time before “B”.

If adults spontaneously twinned into genetically identical bodies, how would you tell “A” from “B”? It might be difficult, though if one branch of the individual contained all the memories and knowledge while one was a blank slate we’d agree on who was the “orignal” and who was the copy.

With a blastocyst we don’t have similar clarity on which individual existed before the cloning.

dedalus on July 13, 2009 at 11:46 AM

SarahW, why do they include progestin?

justincase on July 13, 2009 at 12:21 PM

Dedalus, what about siamese twins? Do we know which existed before the other? Does it matter?

justincase on July 13, 2009 at 12:22 PM

Also, SarahW, we’re talking about specifically making it so that the child can’t latch on. Let’s say a mother has a child on a deserted island and the only way the child can survive is if she allows the child to latch on and breastfeed. So she cuts off her breast because she doesn’t want her child to accidentally latch on. Is that cool with you? Is that parental neglect? All she had to do was what comes naturally but she specifically made sure it didn’t happen in order to ensure that her child died.

justincase on July 13, 2009 at 12:25 PM

If it’s your job to dispense prescriptions, and you don’t like the prescriptions your job will require you to dispense, then you should probably go find another job at another pharmacy that shares your worldview or open your own. The end.

Dave Rywall on July 13, 2009 at 8:53 AM

Sir,

We have already been through this. Not you and I but this thread as a whole. Someone else shared similar sentiments (of which there would be no argument against) borne out of the same ignorance. This case is about a business owner(s) being coerced by judicial mandate to carry, sell, and dispense a product they do not want. The second sentence at the top even covers that very point.

anuts on July 13, 2009 at 12:33 PM

And SarahW, that’s not saying that she can’t have breast removal if she has cancer. It’s also not saying that a woman who has a breast removed for cancer and later can’t feed her child on a deserted island would be charged with neglecting that child.

Specifically removing your child’s ability to be fed, for no other reason than that you want the child dead. That’s what we’re talking about. Is that cool with you?

justincase on July 13, 2009 at 12:36 PM

Dedalus, what about siamese twins? Do we know which existed before the other? Does it matter?

justincase on July 13, 2009 at 12:22 PM

Siamese twins are two individuals, as are identical twins. They can be identified by their separate brains and thoughts. The question is which of the twins exists as a zygote before there is a second? If the zygote is a person which one is it? If we can’t say “who” it seems to be something different (a proto-individual) than an infant or even an 24-week old fetus (both of which are individuals).

dedalus on July 13, 2009 at 1:18 PM

If it’s your job to dispense prescriptions, and you don’t like the prescriptions your job will require you to dispense, then you should probably go find another job at another pharmacy that shares your worldview or open your own. The end.

Dave Rywall on July 13, 2009 at 8:53 AM

We’re talking about exactly that. The 9th found against the owners of the pharmacy, who were refusing to stock or allow dispensing of Plan B. So your solution to go find another job at another pharmacy that shares your worldview or open your own just won’t fly, will it, in our brave new world?

unclesmrgol on July 13, 2009 at 1:29 PM

Consider a plant which is divided. Before it was divided it was one plant. After it was divided it is 2 plants. That doesn’t mean it was never a plant. It doesn’t matter which part of the plant was original and which the break-off. Before the break-off it was still a plant.

My mom sort of had the same question as you have, regarding her identical twin daughters. She wondered if at conception one soul was formed, and then it split into two when the zygote became two – thus resulting in the two girls each having half of the same soul.

I don’t know how these things happen. I can’t imagine it ever being documented. But to deny the individuality of a zygote because of the possibility that it can be split to form another individual zygote doesn’t make sense to me.

justincase on July 13, 2009 at 1:33 PM

I don’t know how these things happen. I can’t imagine it ever being documented. But to deny the individuality of a zygote because of the possibility that it can be split to form another individual zygote doesn’t make sense to me.

justincase on July 13, 2009 at 1:33 PM

Yeah, it is a bit of esoterica. There are a lot of people who are opposed to surgical abortions performed at around 10 weeks who are much less concerned with a blastocyst that fails to implant (maybe 30% of them naturally fail to anyway).

As you point out many plants reproduce asexually, but there is no soul or self-awareness. No there there to assign individual rights to. Unlike, identical twins identical plants are interchangeable.

I don’t make a case that all zygotes deserve legal protection equivalent to children. For those that do though, it seems like the twinning process raises a tough question if the belief is that the zygote is “a person” rather than just a human organism that is potentially a person.

dedalus on July 13, 2009 at 2:18 PM

I’d say maybe the zygote is a person that is capable of being divided to form another person.

Totally off-topic, but sort of like Adam’s rib.

justincase on July 13, 2009 at 2:30 PM

I don’t make a case that all zygotes deserve legal protection equivalent to children. For those that do though, it seems like the twinning process raises a tough question if the belief is that the zygote is “a person” rather than just a human organism that is potentially a person.

dedalus on July 13, 2009 at 2:18 PM

If you can be cloned, does that make you a potential person?

unclesmrgol on July 13, 2009 at 3:00 PM

As a pharmacist and business owner, I appreciate the debate this subject is getting. I live and work in Oregon. The liberal organization that pushed this law in Washington went after Oregon as well. Our state board saw it coming and heads it up though. As a pharmacist in charge of my pharmacy I am required to have a policy in place to address how staff should handle a situation when a pharmacist has “moral or ethical” objections to filling a prescription. This is to address not only selling Plan B but also the “death cocktail” for Oregon’s assisted suicide law.

State law regulates professional practices in the medical field with the objective of keeping the general public safe. That is suppose to be the reason for their existance. The dispensing of Plan B or the “death cocktail” are not emergencies and failing to dispense them would not put a patient at risk or unsafe. In either case the patient can find alternative means to geting their prescription filled within a reasonable amount of time.

1.The government should not regulate what a business sells. The market should regulate that.
2.The government has no business telling a health care worker that he or she must perform any function that they find morally or ethically objectionable.

As for “finding another job” instead of keeping my own and dispensing Plan B. My job is highly specialized. I am trained to a very specific field. Shouldn’t the government be forced to re-train me to a job that is just as secure and makes me the same compensation? Given the time, energy and money it takes to become a pharmacist these days it’s the least they should do.

DStevens on July 13, 2009 at 3:05 PM

If you can be cloned, does that make you a potential person?

unclesmrgol on July 13, 2009 at 3:00 PM

If people spontaneously split into two identical copies of themselves, sharing identical memories it would upend our notions of individuality and with it our legal system.

dedalus on July 13, 2009 at 3:13 PM

If having identical memories and genetics would negate individuality, then identical twins at the point of divergence would not be individuals either. From that point on they would acquire their own one-of-a-kind memories but then so would clones so I don’t understand what difference it makes.

I don’t understand why what can potentially happen (either naturally or in a lab) makes any difference to the reality of what exists now. I’m going to die someday. That doesn’t mean that someone can call me dead already, or to say that we can only tentatively say that I’m alive now because I might not be alive tomorrow.

The zygote is one person today. Whatever happens tomorrow doesn’t change the fact of what is real today. At every moment of my life I could have become a different person (having different memories than I have now) if something different had happened to me. That doesn’t negate the fact that who I am is a person. I could have been a different person, or two persons – as could have you. That POTENTIAL didn’t change the fact of my existence at any step along the way.

justincase on July 13, 2009 at 3:55 PM

IMO, being forced to provide a product or service basically evokes the word “tyranny.” What else could you call it?

PersonalLiberty on July 13, 2009 at 4:05 PM

If people spontaneously split into two identical copies of themselves, sharing identical memories it would upend our notions of individuality and with it our legal system.

dedalus on July 13, 2009 at 3:13 PM

But twinning isn’t splitting into two identical copies, sharing identical memories. Nor is cloning, of which twinning is an example, albeit a natural one.

Even identical (monozygotic) twins have some dissimilarities; the clone of an adult, even more so.

I expect that human clones from adults will become normal, especially if they are legally made nonhuman, so that their organs and tissues can be harvested. In our brave new world, we will build doppelgangers so we can kill them and allow ourselves a longer, happier life. Kick back and sip away on them there mint juleps…

unclesmrgol on July 13, 2009 at 4:09 PM

As for “finding another job” instead of keeping my own and dispensing Plan B. My job is highly specialized. I am trained to a very specific field. Shouldn’t the government be forced to re-train me to a job that is just as secure and makes me the same compensation? Given the time, energy and money it takes to become a pharmacist these days it’s the least they should do.

DStevens on July 13, 2009 at 3:05 PM

Yup. +1000

unclesmrgol on July 13, 2009 at 4:11 PM

The zygote is one person today. Whatever happens tomorrow doesn’t change the fact of what is real today. At every moment of my life I could have become a different person (having different memories than I have now) if something different had happened to me. That doesn’t negate the fact that who I am is a person. I could have been a different person, or two persons – as could have you. That POTENTIAL didn’t change the fact of my existence at any step along the way.

justincase on July 13, 2009 at 3:55 PM

You can’t legally become a different person–even with amnesia or senility. You may reproduce, but your children are different people.

Clearly the zygote is human organism that might become one or more human beings. However, what qualities does it possess that make it an individual person? If it is a person, which of the twins is it? It seems like we should be able to make that identification if we are going to equate its individuality to that of a child.

dedalus on July 13, 2009 at 4:36 PM

unclesmrgol on July 13, 2009 at 4:09 PM

Yeah, those bio-ethical questions will arise. Perhaps, by saving the genetic material from umbilical chords we’ll be able to manufacture perfect-match organs one day.

Creating entire clones for that purpose seems a non-starter ethically and financially.

dedalus on July 13, 2009 at 4:42 PM

Justincase, you keep asking about the active ingredient in plan B (there’s only one) levonogestrel. Its mechanisms of action are delay/prevention of ovulation, and prevention of sperm meeting egg by affecting tubal transport. It MAY also make the uterine lining less hospitable but there is no direct evidence that it has this effect.

An unfounded or magical belief about a drug’s effects would not protect a pharmacist from firing if the drug were any other, and there is no way to legally distinguish its effects from regular birth control pills.

You said “but it’s deliberate interference with implantation” – assume that this is possible in some cases, though it will usually work by preventing conception. This is different from uterine ablation how? A woman isn’t obligated to maintain maximum accepting fluffiness of her uterus.

SarahW on July 13, 2009 at 5:45 PM

As I understand it, 99.75% of the times a zygote doesn’t split to form 2 embryos.

I also understand that in the splitting there are often (don’t know the percentage) differences in the DNA, as unclesmrgol referred to above. I would think that the embryo which doesn’t exactly match the DNA of the original zygote would be the person newly created by the split.

Aside from that, I don’t know if there would be any way to identify which was which. What is the lifeforce that makes the zygote create the placenta separate from the embryo? We don’t know that mystery either. Maybe our knowing doesn’t matter much.

You’ve given me something to think about, and I’ll ponder it. Probably won’t ever come up with an understanding, sort of like the wave vs particle theories of light, extra dimensions, etc. lol. In .75% of the cases, there may be a question about the personal identity of the zygote, pre-separation of identical twins.

By the time implantation is prevented by Plan B, IUD, etc, there are definitely two distinct persons if there are going to be. I don’t know of any method of birth control which claims to kill the child/children in the days between conception and implantation, which is the timeframe you’re talking about here with a zygote. Once the sperm and egg unite, there’s no stopping what will be, until the time that implantation is either allowed or disabled. By that time any questions regarding how many persons are actually there are already resolved.

justincase on July 13, 2009 at 5:54 PM

A woman deliberately making her uterine wall “unfluffy” so that her child won’t accidentally latch on and be fed is not the same thing as refusing to fluff it up. Nobody is saying she has to fluff up her uterine wall. But a mom who deliberately cuts off her nipples precisely so that her child will starve to death has a problem, I would say.

You never answered that though. Is that okay with you?

justincase on July 13, 2009 at 5:58 PM

http://www.rxlist.com/plan-b-drug.htm

Levonogestrel is a synthetic progestogen (progestin).

Why use progestin?

justincase on July 13, 2009 at 6:06 PM

DStevens on July 13, 2009 at 3:05 PM

Well said.

This 9th circuit case is laying the ground work for what we can expect if the Progressives are successful in the government takeover of healthcare.

If this stands the next case will be to force the Catholic Charities hospitals to offer the panorama of “reproductive rights”. And to disallow those in the medical field to switch assignments (as is done now) if they find themselves in a care giving situation which is in conflict with their ethics/morality/religion.

2.The government has no business telling a health care worker that he or she must perform any function that they find morally or ethically objectionable.

Ironically the same posters who vigorously object to the government pouring water up the nose of terrorists – well they have no problem with the government telling it’s citizens in the medical profession to STFU with their medical/moral/ethical objections or go get a new job.

batterup on July 13, 2009 at 6:07 PM

Creating entire clones for that purpose seems a non-starter ethically and financially.

dedalus on July 13, 2009 at 4:42 PM

Financially maybe. But ethically? Ethics are so passe’.

Besides, exactly what kind of ethics does an “abortion doctor” have? The one who was murdered is said to have “performed” over 60,000 abortions (many if not most of them “late-term”).

Squiggy on July 13, 2009 at 7:26 PM

In the case of sexual reproduction, in vivo, it is more accurate to say “A new human embryo, resulting from the union of the father’s sperm and the mother’s oocyte, is a new human being.” The same holds true for asexual human reproduction (reproduction which does not require sperm and oocyte, e.g. monozygotic twinning, triplets, etc., blastomere separation, blastocyst splitting, etc., as in artificial reproduction technologies, etc.), and reproduction which takes place ex vivo.

That is factual.

William2006 on July 13, 2009 at 12:49 AM

It is the “being” part that people disagree on. As you point out a blastocyst my split. How can it be an individual being if it may soon become two?

dedalus on July 13, 2009 at 8:23 AM

That is a common confusion, misconception, and misunderstanding that many people share with you, dedalus.

Let us look at and see what is happening, “dedalus.”

The first new human embryo IS a new individual human being.

The second, new human embryo, the twin, is also a new human being.

It is referred to as “asexual reproduction.”

It takes place in vivo – inside the mother’s body, as in monozygotic twinning which produces identical twins, triplets, etc., and other ways that twinning takes place in vivo, and it takes place outside the mother’s body, as in artificial reproductive technologies.

An example of how monozygotic twinning occurs in vivo is that, during cell division in the new human embryo, some of the cells can separate from the embryo. If these separated cells still have the ability, are totipotent, can become any cell for any tissue for any organ for any system in the body, they can also become another new human embryo, resulting in identical twinning, triplets, etc.

In asexual reproduction, as in monozygotic twinning, etc., there is no sperm or oocyte involved as their is in sexual reproduction, normal reproduction, in which the sperm and oocyte meet resulting in a new human being.

In asexual reproduction like monozyogotic twinning, blastomere separation, blastocyst splitting, etc., the first new human being, the first, original embryo is, in a sense, the “parent” of the subsequent siblings.

In other words, there is no question, scientifically speaking, that when we have a new human embryo there is an individual human being. If twins, triplets, etc., eventually also come into being it merely means that the first new human embryo has “parented” (in a sense) his or her siblings.

dedalus,

I hope this clears up your confusion or misunderstanding.

Take care.

William

William2006 on July 13, 2009 at 8:32 PM

So, William, it’s kind of like the embryo casts off cells like we cast off dead skin cells, except that the cast-off cells have the same potency as the “parent” embryo?

justincase on July 13, 2009 at 8:54 PM

William2006 on July 13, 2009 at 8:32 PM

Well stated. You a developmental biologist?

daesleeper on July 13, 2009 at 10:15 PM

I also understand that in the splitting there are often (don’t know the percentage) differences in the DNA, as unclesmrgol referred to above. I would think that the embryo which doesn’t exactly match the DNA of the original zygote would be the person newly created by the split.

justincase on July 13, 2009 at 5:54 PM

The differences are more due to relative differences in the (nutrient) environment than to any change in DNA. Rarely is there a mutation after twinning, but the differing environments (even before birth) contribute to different genes being switched on or off in each of the twins, even though the DNA is identical. Gene activation/deactivation occurs throughout life, and hence identical twins become less identical as time goes on.

unclesmrgol on July 14, 2009 at 1:26 AM

A woman deliberately making her uterine wall “unfluffy” so that her child won’t accidentally latch on and be fed is not the same thing as refusing to fluff it up. Nobody is saying she has to fluff up her uterine wall. But a mom who deliberately cuts off her nipples precisely so that her child will starve to death has a problem, I would say.

You never answered that though. Is that okay with you?

justincase on July 13, 2009 at 5:58 PM

Are you sure? Both acts you describe intend starvation of the child. You are right — they are not the same thing, but the intent is identical, and equally horrendous and stupid.

unclesmrgol on July 14, 2009 at 1:30 AM

http://www.rxlist.com/plan-b-drug.htm

Levonogestrel is a synthetic progestogen (progestin).

Why use progestin?

justincase on July 13, 2009 at 6:06 PM

Interestingly, Plan B is a FDA Pregnancy Category X drug, a fact not mentioned in the rxlist.com article. I wonder why?

unclesmrgol on July 14, 2009 at 1:34 AM

Category X. Meaning, that if the child survives the implantation process it will have a much greater risk of birth defects. Every oral contraceptive has progestin in it, doesn’t it? I wonder if they’re all Category X.

I read yesterday that they all use 3 methods of “birth control”: altering the cervical mucus to slow down the sperm, tricking the body into thinking it’s already pregnant so it doesn’t ovulate, and altering the uterine wall so a baby can’t implant.

Unless a woman takes Plan B within 10 minutes of healthy sperm being present, the cervical mucus effect won’t matter. If the woman has already ovulated the ovulation suppression won’t work. The only thing that would actually be effective if the woman has already ovulated is the abortifacient effect.

There are normally only about 5 days in her cycle when a woman can get pregnant so most of the times Plan B makes no difference whatsoever. Two or three of the fertile days are before ovulation and two or three are after ovulation. So the only time when Plan B actually PREVENTS conception would be if it is taken in the 2-3 days before ovulation. The other 2-3 fertile days it would be an abortion pill. An abortion pill which – if it fails – may cause birth defects.

I’ve never understood how they determine “effectiveness”. If only 5/28 days are fertile, any one-time pill would have more than 80% success rate at preventing conception simply because the woman isn’t fertile. Or are the success rates only considering the fertile days and comparing them to the rate of conception where no pill is taken?

justincase on July 14, 2009 at 8:36 AM

Justincase, your question about the progestin was answered. It delays ovulation, and impairs tubal transport of gametes so that they do not successfully meet.

There is, again, no direct evidence that implantation is affected, though it may have some effect it is not proven to have this effect. It is not the primary mechanism of effectiveness at preventing pregnancy.

Again, deliberately ablating the uterine wall? you don’t answer.

SarahW on July 14, 2009 at 11:39 AM

Justincase, I can see by some of your comments that you have a limited understanding and no desire to have it improved. You have your axe to grind.

The law is not appropriate, as employers should be able to fire employees that will not perform the essential functions according to appropriate standards of care.

SarahW on July 14, 2009 at 11:44 AM

SarahW, as I’ve explained in other posts, it can’t delay ovulation if ovulation has already occurred. Healthy sperm can make it through the cervix in 10 minutes – long before most women would ever take Plan B. That means that in those cases where ovulation has already occurred, the only means to get rid of the child is by preventing implantation – which is one of the three mechanisms mentioned for all oral contraceptives. I gave you the link for that information.

Your continued denial of the third mechanism (which I found on EVERY pharmaceutical site which described the mechanisms) tells me that you are not only unwilling to learn, you are willing to lie about what’s in the site I already gave you. Typical leftist.

Furthermore, your last comment to me shows you didn’t even read Ed’s post. This isn’t about being able to fire employees. It’s about the government forcing a pharmacist to carry Plan B. I don’t know what law you’re talking about, but it’s obviously not this judgment by the Ninth Circuit.

I don’t know what “ablating the uterine wall” means, but I’ve already said that what I (like these pharmacists who are now FORCED to carry and dispense Plan B) have a problem with is a deliberate action of a mother to make sure that her child cannot survive. If there is a health reason for doing something that may have the unintended consequence of hindering the woman’s parenting ability, that’s different. That’s like having a breast removed for cancer.

A woman is also not required to maximize every possibility of being able to care for her child – although I would say that a good mother would do the best she can.

But a deliberate action for no other reason than to ensure a dead child…. I have a problem with that. Apparently you don’t, although you would never answer my question about that.

justincase on July 14, 2009 at 1:05 PM

Okay. “Ablating the uterine wall” is a D&C, commonly done for endometriosis.

That’s like having a breast removed for cancer. There’s a medical reason for it; any effect on implantation is a side effect. And by the way, untreated endometriosis affects fertility also so having a D&C to treat endometriosis may actually HELP a woman’s chance of having a child.

To have a D&C just for the hell of it, to make sure your womb is barren? Why not just go the whole way and have a hysterectomy? Or if you don’t want a permanent barrenness, have your tubes tied – a reversible procedure. I have no objections to any of those because they prevent a child from being conceived in the first place, which is fine.

To deliberately create a “scorched-earth” womb to kill any child you conceive…. is wrong and unnecessary.

justincase on July 14, 2009 at 1:32 PM

The law is not appropriate, as employers should be able to fire employees that will not perform the essential functions according to appropriate standards of care.

SarahW on July 14, 2009 at 11:44 AM

In this case, it was the employers who were sued for not wanting to carry Plan B or to dispense it. Certainly an employer should be able to have employees who follow the employer’s legal wishes, and should be able to terminate those who do not. That wasn’t the issue in this case — it was the morals/ethics of the employers — their freedom of conscience — which is being negated here.

This finding by the 9th negates state freedom of conscience statutes, since the court’s decision has a citizen’s right to Plan B abortifacient trumping state freedom of conscience statutes. It’s looking like it’s time for a federal law (or regulation) guaranteeing pharmacy owners a freedom of conscience exemption from having to fill such prescriptions, even as doctors were given a freedom of conscience exemption from having to write such prescriptions.

unclesmrgol on July 14, 2009 at 10:04 PM

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