Can Economics Make Sense of the "Medical Crisis of Conscience"?
16 Jul 2006 in Regulatory Economics, Litigation
Today the Washington Post's Rob Stein published a Page One article describing how some providers of medical services are refusing to sell their services on moral grounds. Almost all of the article focuses on conservative medical service providers declining to perform or assist in medical procedures they find morally offensive. A small section of the article compares this phenomenon to liberal medical service providers for whom it is morally offensive to participate in legally sanctioned executions.
A great deal of the article is highly charged with polarizing rhetoric. Can an understanding of economics help clarify the issues and thereby lower the temperature?
Stein quotes conservative physicians who refuse to perform abortions, assist suicides, or provide erectile dysfunction medication to single men. He tells the stories of an emergency medical technician who was fired after refusing to help transport a woman to an abortion clinic and a pharmacist who refused to dispense a "morning after pill." The stories of these "sellers" of medical services are balanced with the stories of the "buyers" who were refused. It appears that these particular cases became known because they were followed by lawsuits alleging illegal or tortious conduct of one form or another.
All these cases have an important economic attribute in common: They were not voluntary exchanges between willing sellers and buyers. Each case involved a willing buyer and an unwilling seller. In each case, the buyer believed that the seller had an obligation to provide the service -- that is, the buyer had a right to acquire the service from the seller even if the seller did not want to sell. (Some of these cases are complicated by nested labor market transactions. In the case of the fired EMT, for example, a prior contractual relationship existed between the buyer of the labor service [the ambulance company] and the seller [the EMT]. There may or may not have been a prior contractual obligation of the seller to provide the service. Stein's article doesn't say.)
The essence of a well-functioning market is voluntary exchange, because voluntary exchanges make both buyers and sellers better off. But if a buyer can compel a seller to sell, or a seller can compel a buyer to buy, the outcome is not a market transaction. It is a coerced exchange. Transactions that are driven by coercion do not make both buyer and seller better off. Whoever has the power to coerce another is made better off at the expense of whomever he was able to coerce.
No one likes being coerced, so it's not surprising that coerced exchanges create controversy. The print version of Stein's article includes maps showing which states have enacted or are considering laws that either endorse coercion exchange or prohibit it. Stein quotes philosophers and lawyers on both sides of the issue, but left the final word to one who apparently declined to take sides:
"The bottom line is, this is a vexed question," said John A. Robertson of the University of Texas School of Law. "There's not some clear way through this thicket yet."
It's hard to argue with that, but it misses the economic crux of the problem. If a "clear way through the thicket" means the resolution of conflict, as opposed to the victory of one side over the other, coerced exchange will not be part of the solution. Coerced exchange always causes conflkict.
