Category: The Conversation

Source: The Conversation – USA (3) – By Elizabeth Chiarello, Associate Professor of Sociology, Washington University in St. Louis

Imagine walking into your pharmacy, handing over your prescription and having it denied. Now imagine that the reason is not insufficient insurance coverage or the wrong dose, but a pharmacist who personally objects to your medication. What right does a pharmacist have to make moral decisions for their patients?

Lawmakers have wrestled with this question for decades. It reemerged in August 2025 when two pharmacists sued Walgreens and the Minnesota Board of Pharmacy, saying they had been punished after refusing to dispense gender-affirming care medications that go against their religious beliefs.

According to the pharmacists, Walgreens refused their requests for a formal religious accommodation, citing state law. One pharmacist had her hours reduced; the other was let go. If Minnesota law does not allow such an accommodation, their lawsuit argues, it violates religious freedom rights.

As a sociologist of law and medicine, I’ve spent the past 20 years studying how pharmacists grapple with tensions between their personal beliefs and employers’ demands. Framing the problem as a tension between religious freedom and patients’ rights is only one approach. Debates about pharmacists’ discretion over what they dispense also raise bigger questions about professional rights – and responsibilities.

Duty to dispense?

The most famous controversy, perhaps, dealt with contraception. In the early 2000s, some pharmacists refused to dispense Plan B, also known as “emergency contraception” or the “morning-after pill.” Their refusal stemmed from a belief that it caused an abortion.

That is inaccurate, according to medical authorities. When Plan B first became available in 1999, the label said the medication might work by expelling an egg that had already been fertilized. In 2022, the Food and Drug Administration relabeled Plan B to say that it acts before fertilization. From a medical perspective, both mechanisms are contraception, not abortion.

States responded to pharmacists’ refusals by adopting “responsibility laws.” Some states adopted “conscience clauses” that permitted pharmacists not to fill the prescription. Others opted for “duty to dispense” laws that required pharmacists or pharmacies to provide the medication, or “refuse and refer” laws obligating objecting pharmacists to hand the prescription off to a colleague.

This fight largely broke down across political lines. Groups that oppose abortion rights argued that pharmacists should have the right to opt out, while groups in favor of abortion rights argued that pharmacists should be required to dispense.

As this fight escalated, the conflict became about more than contraception or abortion. It revealed Americans’ views about what kinds of professionals pharmacists should be, and whether they are professionals at all – that is, members of occupational groups that have specialized knowledge and skills, and exclusive rights to do particular kinds of work.

In 2015, for example, the advocacy group NARAL Pro-Choice American – now called Reproductive Freedom for All – released an ad with a man and a woman in bed, their feet hanging out of the sheets. Stuck between them was someone else wearing heavy black shoes. “Who invited the pharmacist?” the ad asked.

Pro-choice organizations insisted that pharmacists had no right to question a doctor’s prescription. “A pharmacist’s job is to dispense medication, not moral judgment,” said the president of Planned Parenthood Chicago.

Some pharmacists felt that such messages did not just criticize “moral gatekeeping” but also undermined their claims to professional authority. Pharmacists undergo six years of training to earn a doctorate and are health care’s medication specialists. The idea that pharmacists were simply technicians, hired to fill whatever a prescription said, made them seem like physicians’ underlings.

Keeping patients safe

A short time later, when the opioid overdose crisis began to escalate, pharmacists again found themselves pulled in two directions. This time, the question was whether they should be both medical and legal gatekeepers.

When the U.S. first tried to crack down on unauthorized opioid use, many pharmacists felt ambivalent about tasks like identifying people who were misusing or selling medications. One pharmacist told me, “Although I’m in the business of patient safety, I’m not in the police business.”

Later, pharmacists began to see policing tasks as health care tasks. They reasoned that policing patients helped keep patients safe, and they embraced enforcement as a key component of their work.

Fast-forward to 2021. America was in the throes of the COVID-19 pandemic, and some doctors were prescribing hydroxychloroquine and ivermectin to treat sick patients, though the FDA had not approved the medications for that purpose. Many pharmacists refused to fill those prescriptions, citing lack of scientific evidence and potential harm.

Legislators in Missouri, where I teach, responded by passing a bill that required pharmacists to dispense the two medications, no questions asked – though that rule was later struck down by a federal judge. Similar conflicts played out in Iowa and Ohio, among other states.

Again, the fight broke down along political lines, but in the opposite direction. Liberals tended to oppose the bills, portraying pharmacists as skilled professionals whose expertise is essential to prevent harm. Conservative supporters claimed that pharmacists should dispense whatever the doctor writes.

Professional power

Each of these controversies has focused on a specific legal, ethical or medical issue. By extension, though, they are also about what kinds of professional discretion pharmacists should be able to exercise.

When it comes to medication, doctors prescribe, nurses administer and pharmacists dispense. Before the 20th century, pharmacists diagnosed disease and also compounded drugs. That changed when physicians placed themselves at the top of the medical hierarchy.

When it comes to professional autonomy, states regulate health care, but they permit health care professions to regulate themselves: to educate, license and discipline their own workers through professional boards. In exchange, these boards must do so “in the public interest” – prioritizing public health, safety and welfare over professionals’ own interests.

Health care professionals, including pharmacists, must also follow ethical codes. The day they receive their iconic white coats, pharmacists vow to “consider the welfare of humanity and relief of suffering [their] primary concerns.” Pharmacists also commit to “respecting the autonomy and dignity of each patient,” which means that pharmacists partner with patients to make choices about their health.

Self-regulation has legally given pharmacists the right to act as “medical gatekeepers” – to use their professional expertise to keep patients safe. This role is critical, as patients whose lives have been saved by pharmacists catching errors can attest.

It has not, however, given them the right to be “moral gatekeepers” who put their personal beliefs above the patient’s. Pharmacists control medications because of professional commitments, not personal beliefs. The code of ethics describes the pharmacist-patient relationship as a “covenant” that creates moral obligations for the pharmacist – including helping “individuals achieve optimum benefit from their medications,” being “committed to their welfare” and maintaining their trust.

If pharmacists wish to regulate themselves, history makes clear they need to define what it means to act in the public interest and ensure that other pharmacists comply. If not, the state has proved more than willing to step in and do the job for them. They may not like the results.

Elizabeth Chiarello has received funding from the National Science Foundation.

– ref. Conflict at the drugstore: When pharmacists’ and patients’ values collide – https://theconversation.com/conflict-at-the-drugstore-when-pharmacists-and-patients-values-collide-264844

Source: The Conversation – USA (2) – By Vanessa Delgado, Professor of Sociology, Washington State University

The Trump administration is upending norms and policies across the American educational system. One of the many groups facing uncertainty are prospective and current students living in the country without legal authorization.

For those students, applying to and attending college has long been a complicated, patchwork process that varies greatly across states.

In August 2025, the Department of Justice sued Oklahoma for a state law that allowed Oklahoma students living in the country without legal permission to pay a lower tuition rate that is guaranteed to in-state residents.

The Department of Justice also sued Kentucky, Texas and Minnesota over the summer on the same grounds.

Texas, Kentucky and Oklahoma have all announced they will no longer offer in-state tuition to students who are living in the U.S. illegally. Minnesota is currently challenging the Justice Department’s lawsuit.

Amy Lieberman, the education editor at The Conversation U.S., spoke with Vanessa Delgado, a scholar of Latino families and their educational experiences, to understand the higher education pathways for students living in the U.S. without legal authorization – and how the Trump administration is affecting their options.

How large is the population of students who are living in the U.S. without legal authorization?

There are 408,000 undocumented students enrolled in U.S. colleges and universities – that’s about 2% of the entire U.S. college population.

California and Texas have the greatest number, with about 21% of all undocumented college students living in California and 14% in Texas. Those numbers are likely to be an underestimate, as there are no official surveys that track this information.

We don’t have strong data on the high school graduation rates of college students who are not living in the U.S. legally. The best estimates suggest that about 5% to 10% of all undocumented high schoolers go off to college.

Research shows that legal battles over Deferred Action for Childhood Arrivals, or DACA, have contributed to a drop in college enrollment. DACA is a federal immigration policy that allows some immigrants who came to the U.S. as young children to receive temporary protection from deportation and to get work permits.

College graduation rates are shaped by a number of factors, including the state an immigrant student lives in and whether they can receive in-state tuition and state-based financial aid. Other important factors are whether there are undocumented student resource centers and supportive mentors on campus.

How is attending college different for students without legal authorization?

Undocumented high school students thinking about college may be unaware of their legal and financial options. Undocumented students frequently receive incorrect information about college options – and sometimes they do not want to disclose their immigration status to a school counselor.

Where an undocumented student lives determines whether they can afford to pay for college, or in some cases whether they can attend at all. Undocumented students cannot receive any federal student aid, regardless of where they live, because you need to be an American citizen to receive this aid. Financial help is critical for many students, including immigrants, as most students receive some financial aid to pay for college.

There are 22 states, as well as Washington, that allow undocumented students to pay in-state tuition. In addition, undocumented high schoolers are eligible for state-based financial aid in 14 states.

Conversely, 10 states, like Wisconsin and Oklahoma, have enacted laws to block undocumented students from receiving in-state tuition.

Can these students receive merit-based scholarships?

That depends. Some scholarship programs require a lawful immigration status. Some scholarships might require students to be eligible for Pell Grants, meaning they also need lawful immigration status. Other programs, like public colleges in California and Washington state, have merit-based scholarships that undocumented students can apply for. Several national private scholarships are also available for undocumented students.

Are there some cases where these students simply cannot legally attend college?

There are three states – Georgia, Alabama and South Carolina – where undocumented students cannot apply to most public universities. For these states, the board of regents prohibits admission for undocumented students.

In Washington state, undocumented students who are residents can apply for state-based financial aid. Other states, like California, provide similar forms of aid.

What are other practical questions prospective students need to consider?

First, there’s the cost of going to college. Undocumented students are much more likely than citizens to be living in poverty. And in general, college tuition is rising. If you do not have access to resources, such as in-state tuition and state-based financial aid, the cost will likely be a prohibitive factor.

Then there is the question of what comes after college. Generally, without a lawful immigration status, undocumented students struggle to find work. Some states, like California and Washington, have enacted policies to remove barriers for professional licenses, letting undocumented immigrants still pursue different career paths.

How is Trump changing the education landscape for immigrant families?

The Trump administration’s aggressive enforcement of immigration policy is prompting more undocumented students to consider whether they need to stay close to home, as many fear that they or their family members will be deported.

Many undocumented students face significant family obligations at home, as I find in my research. This can dissuade them from going far from home, or even from going to school at all.

I know students who are now contemplating taking a year of absence, or dropping out altogether. I also know students who cannot concentrate on school work, because they are anxious about whether their loved ones will be detained. Many also have younger siblings and feel the pressure of stepping into a guardian role.

Texas is an example of a place where undocumented students are particularly under stress. It was one of the first states to provide in-state tuition for undocumented students. In June 2025, the state rescinded the policy.

Now, undocumented college students in Texas need to pay out-of-state tuition costs, even if they have paid in-state so far. That roughly doubles the cost of annual tuition. Students and staff on the ground are scrambling to figure how to make sense of this abrupt policy shift. Similar rollbacks have happened in Florida and other states, and all of these measures are making it more challenging for undocumented students to consider pursing higher education.

Vanessa Delgado does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. A fragmented legal system and threat of deportation are pushing higher education out of reach for many undocumented students – https://theconversation.com/a-fragmented-legal-system-and-threat-of-deportation-are-pushing-higher-education-out-of-reach-for-many-undocumented-students-266324

Source: The Conversation – USA (2) – By Alex Volonte, Graduate Research and Teaching Assistant in Journalism, University of Florida

In September 2025, podcaster Pablo Torre published an investigation alleging that the NBA’s Los Angeles Clippers may have used a side deal to skirt the league’s strict salary cap rules. His reporting, aired on multiple episodes of “Pablo Torre Finds Out,” focused on star forward Kawhi Leonard.

Leonard, one of the NBA’s most sought-after free agents, signed a four-year, US$176 million contract renewal with the Clippers during the 2021-22 off-season – the maximum allowed under league rules at the time. But Torre reported that in early 2022, Leonard’s LLC, KL2 Aspire, signed a cash and equity deal amounting to roughly $50 million through a brand sponsorship with Aspiration, a now-bankrupt financial technology startup that marketed itself as a climate-friendly bank.

Torre highlighted how the sponsorship coincided with major investments in Aspiration by Clippers owner Steve Ballmer and another team investor. The arrangement, Torre suggested, looked less like a conventional endorsement deal and more like a “no-show” side payment that could have helped the Clippers keep their star without technically violating the salary cap.

Leonard has denied that the partnership was improper, insisting he fulfilled his contractual obligations. The Clippers and Ballmer have also rejected claims of wrongdoing.

Torre’s reporting nevertheless had an immediate impact. Major outlets picked up the story, Aspiration’s bankruptcy filings drew renewed scrutiny, and the NBA announced it was investigating the matter.

At the University of Florida’s College of Journalism & Communications, part of my research involves unpacking the importance of decentralized networks of local outlets that cover stories from underrepresented areas of the country.

I see Torre’s work as a clear example of the growing need for this kind of bottom-up, citizen journalism – particularly given media industry trends.

An eroding fourth estate

Watchdog journalism is supposed to hold power to account.

This is sometimes referred to as the “fourth estate.” A term that dates back to the 17th century, it reflects the idea that an independent press is supposed to act as a fourth pillar of power, alongside the three traditional branches of modern democracies – legislative, executive and judicial.

Proudly independent from political or financial influence, fourth estate news media has traditionally demonstrated a public service commitment to exposing corruption, encouraging debate, highlighting issues that are important and forcing leaders to address those issues.

The need for watchdog journalism appears more urgent than ever.

In the Western world, with authoritarianism on the rise, the fourth estate is experiencing widespread threats. Reporters Without Borders’ latest World Press Freedom Index found that global press freedom reached an all-time low in 2025. For the first time, it classified the situation as “difficult.”

Meanwhile, market forces and profit motives have weakened the media’s role in upholding democratic checks and balances. Fierce competition for clicks, eyeballs and ad revenue impacts the type of content and stories that commercial outlets tend to focus on.

There appears to be less and less of a financial incentive to put in the time, resources and effort required for deep investigative reporting. It’s just not worth the return on that investment for commercial outfits.

A full-court press

In the U.S., the Trump administration and media consolidations have further weakened the press’s ability to serve as a check on those in power.

Over the past year, two major TV networks — ABC and CBS — reached settlements for separate lawsuits brought forward by President Donald Trump tied to editorial choices on their broadcast programming. Needless to say, both decisions create significant precedents that could prove consequential for journalistic integrity and independence.

In July 2025, the GOP-led Congress stripped over $1 billion from the Corporation of Public Broadcasting, dealing a blow to public nonprofit outlets NPR, PBS and their local affiliates.

More recently, Washington Post columnist Karen Attiah lost her job after speaking out against gun violence on social media in the wake of Charlie Kirk’s assassination.

From a structural standpoint, the U.S. media ownership landscape has, for decades, been plagued by consolidation. Media channels have become merely one slice of the massive asset portfolios of the conglomerates that control them.

It’s probably fair to say that producing costly and burdensome watchdog journalism isn’t exactly a priority for busy executives at the top of these holding companies.

What about local media?

Independent local outlets are a dying breed, too.

Studies have shown that news deserts – areas with little or no local coverage – are multiplying across the U.S.

This has dire consequences for democratic governance: News deserts often correlate with lower civic engagement, reduced voter turnout and less accountability for business and political leaders.

What’s more, fewer local journalists means less scrutiny of local governments, which undermines transparency and enables corruption.

For these reasons, more readers seem to be getting their news from social media and podcasts. In fact, according to a new Pew Research Center report, 1 in 5 Americans get their news from TikTok alone. And in its 2025 Digital News Report, the Reuters Institute noted that “engagement with traditional media sources such as TV, print, and news websites continues to fall, while dependence on social media, video platforms, and online aggregators grows.”

With this in mind, the U.S. government’s latest framework for a deal for TikTok’s parent company, ByteDance, to sell the social media platform’s stateside operations to a consortium of American investors takes on even more significance. Many of these investors are allies of Trump. They’ll get to control the algorithm – meaning they’ll be able to influence the content that users see.

Bottom up

At the same time, social media has also allowed independent journalists such as Torre to find an audience.

Granted, with past journalistic stints at both Sports Illustrated and ESPN, Torre is not exactly a pure outsider. Yet he’s far from a household name, with fewer than 200,000 podcast subscribers.

Luckily, he’s by no means the only independent journalist serving as a citizen watchdog.

In January 2025, freelance journalist Liz Pelly published her book “Mood Machine,” which details her investigation into Spotify’s dubious financial practices. Through her research and reporting, she alleges that the music technology company conspired to suppress legitimate royalty payments to artists.

Andrew Callaghan of Channel 5 News fame on YouTube runs one of the largest crowdfunded independent newsrooms in the world. His exclusive interview with Hunter Biden in July 2025 got him a type of access that established mainstream media couldn’t get.

In 2020, Canadian siblings Sukh Singh and Harleen Kaur founded GroundNews, an online platform providing news aggregation, curation and rigorous fact-checking. All Sides and Straight Arrow News are similar bottom-up projects designed to expose media bias and fight misinformation.

Meanwhile, the nonprofit media outlet ProPublica has published award-winning investigative journalism through a distributed network of local reporters. Their “Life of the Mother” series, which explored the deaths of mothers after abortion bans, earned them multiple awards while prompting policy changes at federal and state levels.

All have surfaced meaningful stories worth bringing to light. Historically, these types of stories were the purview of newspapers of record.

Today, underground sleuths might be among the last bulwarks to abuses of power.

The work isn’t easy. It certainly doesn’t pay well. But I think it’s important, and someone has to do it.

Alex Volonte does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Watchdog journalism’s future may lie in the work of independent reporters like Pablo Torre – https://theconversation.com/watchdog-journalisms-future-may-lie-in-the-work-of-independent-reporters-like-pablo-torre-265839

Source: The Conversation – USA (3) – By Elizabeth Chiarello, Associate Professor of Sociology, Washington University in St. Louis

Imagine walking into your pharmacy, handing over your prescription and having it denied. Now imagine that the reason is not insufficient insurance coverage or the wrong dose, but a pharmacist who personally objects to your medication. What right does a pharmacist have to make moral decisions for their patients?

Lawmakers have wrestled with this question for decades. It reemerged in August 2025 when two pharmacists sued Walgreens and the Minnesota Board of Pharmacy, saying they had been punished after refusing to dispense gender-affirming care medications that go against their religious beliefs.

According to the pharmacists, Walgreens refused their requests for a formal religious accommodation, citing state law. One pharmacist had her hours reduced; the other was let go. If Minnesota law does not allow such an accommodation, their lawsuit argues, it violates religious freedom rights.

As a sociologist of law and medicine, I’ve spent the past 20 years studying how pharmacists grapple with tensions between their personal beliefs and employers’ demands. Framing the problem as a tension between religious freedom and patients’ rights is only one approach. Debates about pharmacists’ discretion over what they dispense also raise bigger questions about professional rights – and responsibilities.

Duty to dispense?

The most famous controversy, perhaps, dealt with contraception. In the early 2000s, some pharmacists refused to dispense Plan B, also known as “emergency contraception” or the “morning-after pill.” Their refusal stemmed from a belief that it caused an abortion.

That is inaccurate, according to medical authorities. When Plan B first became available in 1999, the label said the medication might work by expelling an egg that had already been fertilized. In 2022, the Food and Drug Administration relabeled Plan B to say that it acts before fertilization. From a medical perspective, both mechanisms are contraception, not abortion.

States responded to pharmacists’ refusals by adopting “responsibility laws.” Some states adopted “conscience clauses” that permitted pharmacists not to fill the prescription. Others opted for “duty to dispense” laws that required pharmacists or pharmacies to provide the medication, or “refuse and refer” laws obligating objecting pharmacists to hand the prescription off to a colleague.

This fight largely broke down across political lines. Groups that oppose abortion rights argued that pharmacists should have the right to opt out, while groups in favor of abortion rights argued that pharmacists should be required to dispense.

As this fight escalated, the conflict became about more than contraception or abortion. It revealed Americans’ views about what kinds of professionals pharmacists should be, and whether they are professionals at all – that is, members of occupational groups that have specialized knowledge and skills, and exclusive rights to do particular kinds of work.

In 2015, for example, the advocacy group NARAL Pro-Choice American – now called Reproductive Freedom for All – released an ad with a man and a woman in bed, their feet hanging out of the sheets. Stuck between them was someone else wearing heavy black shoes. “Who invited the pharmacist?” the ad asked.

Pro-choice organizations insisted that pharmacists had no right to question a doctor’s prescription. “A pharmacist’s job is to dispense medication, not moral judgment,” said the president of Planned Parenthood Chicago.

Some pharmacists felt that such messages did not just criticize “moral gatekeeping” but also undermined their claims to professional authority. Pharmacists undergo six years of training to earn a doctorate and are health care’s medication specialists. The idea that pharmacists were simply technicians, hired to fill whatever a prescription said, made them seem like physicians’ underlings.

Keeping patients safe

A short time later, when the opioid overdose crisis began to escalate, pharmacists again found themselves pulled in two directions. This time, the question was whether they should be both medical and legal gatekeepers.

When the U.S. first tried to crack down on unauthorized opioid use, many pharmacists felt ambivalent about tasks like identifying people who were misusing or selling medications. One pharmacist told me, “Although I’m in the business of patient safety, I’m not in the police business.”

Later, pharmacists began to see policing tasks as health care tasks. They reasoned that policing patients helped keep patients safe, and they embraced enforcement as a key component of their work.

Fast-forward to 2021. America was in the throes of the COVID-19 pandemic, and some doctors were prescribing hydroxychloroquine and ivermectin to treat sick patients, though the FDA had not approved the medications for that purpose. Many pharmacists refused to fill those prescriptions, citing lack of scientific evidence and potential harm.

Legislators in Missouri, where I teach, responded by passing a bill that required pharmacists to dispense the two medications, no questions asked – though that rule was later struck down by a federal judge. Similar conflicts played out in Iowa and Ohio, among other states.

Again, the fight broke down along political lines, but in the opposite direction. Liberals tended to oppose the bills, portraying pharmacists as skilled professionals whose expertise is essential to prevent harm. Conservative supporters claimed that pharmacists should dispense whatever the doctor writes.

Professional power

Each of these controversies has focused on a specific legal, ethical or medical issue. By extension, though, they are also about what kinds of professional discretion pharmacists should be able to exercise.

When it comes to medication, doctors prescribe, nurses administer and pharmacists dispense. Before the 20th century, pharmacists diagnosed disease and also compounded drugs. That changed when physicians placed themselves at the top of the medical hierarchy.

When it comes to professional autonomy, states regulate health care, but they permit health care professions to regulate themselves: to educate, license and discipline their own workers through professional boards. In exchange, these boards must do so “in the public interest” – prioritizing public health, safety and welfare over professionals’ own interests.

Health care professionals, including pharmacists, must also follow ethical codes. The day they receive their iconic white coats, pharmacists vow to “consider the welfare of humanity and relief of suffering [their] primary concerns.” Pharmacists also commit to “respecting the autonomy and dignity of each patient,” which means that pharmacists partner with patients to make choices about their health.

Self-regulation has legally given pharmacists the right to act as “medical gatekeepers” – to use their professional expertise to keep patients safe. This role is critical, as patients whose lives have been saved by pharmacists catching errors can attest.

It has not, however, given them the right to be “moral gatekeepers” who put their personal beliefs above the patient’s. Pharmacists control medications because of professional commitments, not personal beliefs. The code of ethics describes the pharmacist-patient relationship as a “covenant” that creates moral obligations for the pharmacist – including helping “individuals achieve optimum benefit from their medications,” being “committed to their welfare” and maintaining their trust.

If pharmacists wish to regulate themselves, history makes clear they need to define what it means to act in the public interest and ensure that other pharmacists comply. If not, the state has proved more than willing to step in and do the job for them. They may not like the results.

Elizabeth Chiarello has received funding from the National Science Foundation.

– ref. Conflict at the counter: When pharmacists’ and patients’ values collide – https://theconversation.com/conflict-at-the-counter-when-pharmacists-and-patients-values-collide-264844