"Controversies over Women's Access to Birth Control" by Marcia Clemmitt. Opposing Viewpoints Resource Center.
1. Introduce the author, the title of the essay you are analyzing, and the author's thesis in 1-3 sentences. You don't have to discuss the second essay until later in the paper.
2. Summarize the essay in your own worlds in 1-3 sentences. Do not simply copy.
3. State YOUR thesis. Your thesis is about the effectiveness of the author's argument, not whether you agree or disagree with the author's thesis. So you will ask questions such as, "Does the author clearly explain the problem?" "Are the author's solutions adequate?"
In your analyzing, you must use each of the following words: purpose, title, example, cause, solution, evidence or proof, appeal to emotions, define or definition, opposing point of view.
Use the following prompts to construct your analysis. You must include a discussion of an opposing point of view.
A. Does the author clearly state the purpose of the essay?
B. Does the article of the essay tell the reader anything?
C. Is the problem that the essay discusses clearly stated? Does the author use examples to illustrate the problem?
D. What is the cause of the problem? Are there other cause? Are some causes primary while other causes are secondary? How do you know?
E. What solutions does the author propose? Is there evidence that the solution works?
F. Are other examples used in essay? What purpose does each example serve?
G. Does the author quote any authorities? Why?
H. Does the author offer adequate evidence to support the claims of the essay? Quote some evidence. If there is no evidence, why not? Is lack of evidence a flaw?
I. Is the meaning of keywords clear? Do any important words need a definition?-Human life.
Evaluate the article. Does it make a solid argument? Do you see any problems with the argument? If you have an argument you want to make, do it here in the conclusion. Have you learned anything from reading about the topic?
this is the article we have to analyze:
Marcia Clemmitt, ?Birth Control Debate,? CQ Researcher, vol. 15, June 24, 2005. Copyright ? 2005 by the CQ Press, published by CQ Press, a division of Congressional Quarterly, Inc. All rights reserved. Reproduced by permission.
While arguments for and against the use of birth control pills have been around since before "the pill" first became available in the early 1960s, the controversy has recently gained new attention as reports about pharmacists refusing to fill birth control prescriptions make national headlines. Most of the controversy has focused on whether pharmacists have the right to morally object to filling these prescriptions. Another major issue of this debate focuses on emergency contraception
, or the so-called "morning-after pill," which, if taken within seventy-two hours of sexual intercourse, may prevent conception. Marcia Clemmitt, a social-policy researcher and writer, attempts to sort out the current debate, which she refers to as "a new front in America's culture wars." She takes up several sides of the dispute, including religious and moral viewpoints, medical professionals' viewpoints, and women's viewpoints. In the end, she speculates, the disputes will be decided by the court system. Clemmitt is a former editor in chief of Health and Medicine and is currently a staff writer for CQ Researcher in which this selection first appeared.
Neil Noesen was filling in as a back-up pharmacist at the Menomonie, Wis., Kmart when college student Amanda Phiede came in to refill her prescription for birth-control pills.
Noesen is a devout Catholic who believes that birth-control pills can cause what he regards as early-stage abortions. Noesen?the lone pharmacist on duty that day?refused to fill Phiede's prescription.
"I explained to her that I couldn't give it to her with a good conscience," Noesen said. "I did not direct her to another pharmacy."
Phiede went to a nearby Wal-Mart, but when the pharmacist there asked Noesen to transfer her prescription, he refused. Two days later, the Kmart pharmacy manager?who had been out of town?finally filled Phiede's prescription. By then, she had missed a pill and had to take two pills to catch up, increasing her risk of unintended pregnancy. The incident occurred in 2002.
A state administrative board eventually charged Noesen with unprofessional conduct for refusing to transfer the prescription, which is considered the patient's property. In April 2005 the state pharmacy board ordered Noesen to attend ethics classes and pay about $20,000 to cover costs of the disciplinary proceedings. He was allowed to retain his pharmacy license as long as he informs all future employers in writing that he won't dispense birth-control pills and describes steps he will take to ensure that patients get their prescriptions some other way....
Noesen has remained firm in refusing to have any part in dispensing birth control pills. Using the pills is "evil," under God's moral code, he told the disciplinary hearing last October. He would not transfer a contraceptive prescription because "it would be a sin to induce another to sin" and would make him "part of a bucket brigade, just another step in facilitating the end result."
Refusing to Dispense Contraception
Over the past several years, only a handful of pharmacists have refused to dispense contraception
, and even fewer have tried to prevent a patient from obtaining pills elsewhere. Nevertheless, the incidents demonstrate that birth control has become a new front in America's culture wars. While recent battles have focused on abortion, debate over birth control has intensified?pitting the religious beliefs of a minority of Americans against the desire of the overwhelming majority to retain easy access to contraception
According to a December 2004 report by the federal Centers for Disease Control and Prevention (CDC), contraceptive use in the United States "is virtually universal," with more than 98 percent of sexually active women of reproductive age having used "at least one contraceptive method" at some point.
Moreover, most doctors?including 87.5 percent of Catholic physicians?dispense birth control. Likewise, most health-care providers and pharmacists generally support greater access, says Don Downing, a University of Washington professor of pharmacy. But many hospitals?especially those affiliated with the Roman Catholic Church, which make up a growing percentage of the hospitals in America?refuse to dispense contraceptives or emergency birth control, even to women who have been raped. The church opposes both birth control and abortion.
Emergency birth control consists of a large dose of regular birth-control pills that, when taken within five days after unprotected sex can prevent a pregnancy. Some religious conservatives and pro-life advocates object to it?as well as to regular birth-control pills and intrauterine devices?because they may interfere with a fertilized egg's implantation in the uterine wall. Opponents of such birth-control methods believe life begins when the egg is fertilized and that such pills and devices, in essence, cause the fertilized egg to be aborted.
But emergency contraception
is not the only birth-control method stirring controversy. Some doctors, pharmacists and hospitals will not dispense or prescribe any birth control on the grounds that artificial contraception
itself is wrong. Others object only to giving birth-control pills to single women who plan to use them for contraceptive purposes rather than for health reasons, such as regulating menstrual periods.
Health-care workers and hospitals that refuse on moral grounds to provide certain contraception
services argue strongly that their constitutional right to religious freedom should protect them from employer sanctions, even if they refuse to refer patients elsewhere for birth control. "It [is] unethical to force practitioners to participate in specific actions involving what they believe would be a cooperation with abortions," Noesen told the Wisconsin legislature in 2003, when it was considering a conscience clause.
Opponents Face Off
Opponents of certain types of birth control and advocates for easy access to contraception
are facing off in state legislatures across the country, as lawmakers debate a variety of bills governing contraceptives. Some states are considering mandating that hospitals and pharmacies dispense contraception?including emergency contraception?while other states are allowing health-care workers and hospitals to exercise their "conscience rights" not to dispense medications they see as facilitating abortions. Some states are trying to do both.
At least seven states?Alaska, California, Hawaii, New Hampshire, New Mexico, Washington and Maine?have allowed pharmacists to dispense emergency contraception
(without having received a prescription from a doctor), as long as they collaborate with a local physician and follow a predetermined protocol. "Growing numbers of people are interested in dispensing [emergency contraception
]," says Downing, who developed programs to enable pharmacists to dispense emergency birth control.
Meanwhile, the U.S. Food and Drug Administration (FDA) has been asked to allow over-the-counter sales of emergency contraceptives, called Plan B. In May 2004, the agency overruled its own scientific advisory panel, which had voted 23-4 in favor of Plan B. The agency said it agreed with the minority on the panel who argued there was not enough evidence that girls under 15 could safely take the product. The decision, which shocked birth-control advocates, was a significant victory for those opposed to emergency birth control on religious grounds.
Birth-control advocates point out that when pharmacists or hospitals refuse to dispense contraception?emergency or otherwise?it typically disadvantages those lacking easy transportation to another pharmacy or facility, most often the poor and women living in rural areas without alternative pharmacists or hospitals nearby.
Moreover, repeated federal cutbacks in family planning funds since 1998 also have disproportionately affected the poor, potentially leading to a jump in unintended pregnancies, says Carol Hogue, professor of maternal and child health at Emory University's Rollins School of Public Health. The cuts may already be reducing the use of birth control, she says, citing the CDC study, which showed that the number of adult women having unprotected sex during the previous three months rose from 5.2 percent in 1995 to 7.4 percent in 2002?the same level as in 1982. Low-income women rely heavily on subsidized birth control, and with government support waning, "it shouldn't be surprising that people aren't availing themselves of it as much," Hogue says.
According to James Trussell, director of the Princeton University Office of Population Research, nearly half of unintended pregnancies (47 percent) occur among the small group of women who have unprotected sex. A 43 percent increase in that population recently reported by the CDC could create up to an 18 percent increase in unintended pregnancies, he says.
And more unintended pregnancies could lead to an increase in the number of abortions as well as "marital discord, domestic violence and children at high risk for developmental problems," Hogue points out.
advocates argue that the same kinds of problems are triggered when birth control fails, as it often does. The result frequently is "abortion ... single motherhood?often attended by poverty ... or an unsuitable marriage that ends in divorce," says Janet Smith, chair of life ethics at Detroit's Sacred Heart Major Seminary and a well-known speaker on Catholic sexual ethics.
Religious Views, Not Science
Critics of the administration's birth-control policies say the FDA's refusal to allow Plan B?only the second time in 50 years the agency rejected an advisory panel's advice?was influenced more by the religious views of minority panel members than by science.
David Hager, an obstetrician-gynecologist and one of three panel members appointed by President [George W.] Bush, led the opposition to Plan B on the grounds that it may sometimes prevent implantation of a fertilized egg. He told FDA officials there was not enough evidence to show that non-prescription sales of Plan B would be safe for girls under 15....
But the advisory panel's majority and many other analysts say Hager's assertion there is insufficient data on the safety of Plan B for young girls is not based on science at all. Trussell, a panelist who voted for over-the-counter sales, says the panel reviewed numerous studies showing that adolescents can understand Plan B's package instructions "as well as anybody else."
However, aside from questions about Plan B's appropriateness for young teens, the FDA also has dragged its heels in making Plan B available without a prescription for women over 16. A year ago, Barr Laboratories applied to sell Plan B over-the-counter to women 16 and older while requiring a prescription for girls under age 16. But the FDA let a January 2005 deadline to act on that application pass without taking action. Soon after that, Democratic Sens. Hillary Rodham Clinton (N.Y.) and Patty Murray (Wash.) announced they would hold up the confirmation of FDA Acting Commissioner Lester Crawford as commissioner until the FDA acts on Barr's new application.
In March Crawford told the Senate Health, Education, Labor and Pensions Committee that the decision has been slowed because "it's a very complex kind of application never received before by the agency."
Pharmacists Must Fill Prescriptions
Meanwhile, the American Medical Association [AMA] voted on June 20 to support legislative initiatives around the country requiring pharmacies to fill legally valid prescriptions.
If a pharmacist or pharmacy has objections, they should provide an "immediate referral to an appropriate alternative dispensing pharmacy without interference," said a resolution by the AMA's policymaking House of Delegates.
"Our position is on behalf of the patient," said Peter Carmel, an AMA board member and neurosurgeon from New Jersey. "The AMA strongly believes patients have to have access to their medications. It's the obligation on behalf of the pharmacist ... to tell them where to go."
The AMA's policy would be similar to that of the nation's largest pharmacy chain, Walgreen Co....
Should Religion Count?
The question is especially complicated in the case of emergency contraception
, because it is only effective if taken within about five days of the unprotected intercourse.
Thus, refusing to fill a prescription "may place a disproportionately heavy burden on those with few options, such as a poor teenager living in a rural area that has a lone pharmacy," lawyer Julie Cantor and physician Ken Baum wrote last year in The New England Journal of Medicine. "A refusal to fill a prescription for a less advantaged patient may completely bar her access to medication."
It's also unclear where conscientious objection would end, once permitted. The consequences could amount to "invasive" behavior, according to Cantor and Baum. "If pharmacists can reject prescriptions that conflict with their morals, someone who believes that HIV-positive people must have engaged in immoral behavior could refuse to fill those prescriptions," they point out.
Many analysts agree that pharmacists' right to follow their consciences must be balanced against patients' right to have legal medications. But when it comes to achieving that balance, different people use different scales.
The issue is almost always framed as one of honoring?or not honoring?the pharmacist's conscience. But, says Rosemarie Tong, distinguished professor in health-care ethics at the University of North Carolina at Charlotte, there are always at least two consciences involved?the pharmacist's and the patient's. "Whose moral decision should be captive to the other person's in this situation?" she asks.
According to Tong, the person who risks less potential harm should yield right of conscience. In the case of emergency contraception
, "the person who's going to bear the brunt of the pregnancy" risks harm that's "much greater" than the potential damage to a pharmacist who reluctantly violates his or her conscience.
Proponents of strong conscience clauses disagree. A woman seeking emergency contraception
generally has plenty of other options, says physician David Stevens, executive director of the 17,000-member Christian Medical and Dental Associations. "Sign up for mail order, get a referral to another pharmacy," he suggests. But the pharmacist has only one conscience, and "conscience is the most sacred of all property."
Others argue that, given today's nationwide pharmacist shortage, druggists have more options. "What happens to the patient if a pharmacist has the right to refuse?" asks Todd Brown, an associate clinical specialist at the Northeastern University School of Pharmacy in Boston.
For pharmacists seeking so-called conscience clauses to protect them from employer retaliation if they refuse to dispense a drug, the issue hinges on whether they are going to be treated like professionals, says Noesen. Enacting a conscience clause "would simply be giving legal recognition to the professional autonomy that we already hold as pharmacists."
Limits of Professional Autonomy
But critics counter that professional autonomy is limited by the requirement that a pharmacist put the clients' needs first. "Professional autonomy has its limits," write Cantor and Baum. Pharmacy professionals "are expected to exercise special skill and care to place the interests of their clients above their own interest."
"I don't think pharmacists should have conscience clauses," Brown says. "They're not being asked to be the patient's religious leader."
Besides, he says, student pharmacists learn early on about the various kinds of medications provided by the health system. They should decide right away whether they object to dispensing them, says Brown, and those who have moral objections should work at pharmaceutical companies, health plans, nursing homes, hospitals and elsewhere, he says, rather than working in a pharmacy serving the general public.
But those calling for broad conscience clauses say it's very difficult to predict future medical treatments. As biomedical science advances, emergency contraception
represents only the "tip of the iceberg" when it comes to technologies that may be morally objectionable, Stevens says. Other morally questionable therapies include stem cells and euthanasia drugs.
Supporting Conscience Clauses
The American Pharmacists Association (APhA) supports conscience clauses but thinks refusing pharmacists should refer customers to another pharmacist who will fill the prescription. When a pharmacist conscientiously objects, it is "appropriate to step away but not to step in the way," says Anne Burns, APhA's group director of pharmacy practice and research.
Individual employees' conscience objections should be discussed up front so a drug store?or an entire community?may put systems in place to protect pharmacists' conscience objections as well as patients' rights to get legal medications, Burns says. For example, "in rural areas, physicians could dispense" controversial drugs, she says.
But some health-care providers would consider that "moral complicity," Stevens says....
States Conflicted over "Morning After" Pills
The introduction of emergency contraception
pills into the U.S. market in 1998 injected new urgency into birth-control debates. Some providers have refused to dispense the pills, even to rape victims, claiming they cause early-stage abortions. The availability of a convenient pill that could protect rape victims from pregnancy and reverse birth-control mishaps like condom failure galvanized advocates to fight for wide availability.
State legislatures, where most of the current battles over emergency birth control are taking place, are pulled in two directions on the issue?as recent debates in Illinois and Colorado show.
Early this year, the Colorado legislature approved a bill allowing health-care professionals to refuse to offer emergency contraception
due to religious or moral beliefs but requiring hospital emergency departments to offer rape victims information and referrals for obtaining emergency contraception
. Gov. Owens vetoed the measure in April, however, complaining that it did not offer protections to hospitals and other health-care institutions. "That is wrong," he said. "And it is unconstitutional."
As a testament to lawmakers' ambivalence, when sponsors led a failed attempt to override Owens' veto, several who had voted originally for the legislation later switched sides to vote against it.
Illinois, on the other hand, has the nation's most sweeping conscience law for health-care providers as well as the most liberal law in the nation regarding emergency contraception?a law requiring all pharmacies to dispense emergency contraception
. Several Illinois pharmacists are suing Democratic Gov. Rod Blagojevich over the rule, arguing that it conflicts with the state's broad conscience exemption.
If sheer numbers of supporters determined policy outcomes, laws broadening contraceptive access would be the easy winner. In a May 2005 poll, 73 percent of Americans said they believe pharmacists should be required to fill prescriptions for emergency contraception
, even if they are personally opposed to it.
Nevertheless, arguments based on America's constitutional tradition of religious freedom, combined with conservative Christians' new political clout, have won a hearing for expanded conscience clauses?both in Congress and in statehouses around the country....
Despite all the rhetoric over limiting access to birth control, states generally have considered more pro-birth control measures recently than efforts to limit access to contraception
Courts to Decide?
The strong public desire for contraceptive access, coupled with the growing strength of Christian conservatives in American life, promises to fuel birth-control debates into the foreseeable future, says Allan Rosenfield, an obstetrician-gynecologist and dean of Columbia University's Mailman School of Public Health. High-level political opposition to birth control "is not something that's going to go away without changing not only the administration but Congress as well, and I don't see that happening," he says.
Ultimately, the disputes will be decided by the courts, says ethicist Tong at the University of North Carolina. For instance, pharmacists in Illinois are suing the governor over the rule requiring pharmacies to dispense emergency contraception
, arguing that it conflicts with Illinois' broad conscience clause.
Judicial settlements deal in the "limited language of rights" and don't necessarily deal with the full scope of these delicate issues, since they "opt out of the emotional tangles" involved, Tong says. Nevertheless, "only the courts can untangle whose conscience trumps whose," a provider's or a patient's.
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