(Conscientious Objection and Emergency Contraception)
Howard Brody, Susan S Night
The American Journal of Bioethics
Extract We conclude that, although a “duty to refer” may not describe very well an actual, working policy that effectively balances the duties of personal and professional integrity for the objecting pharmacist, Card’s (2007) mandatory-service policy fails at a basic level to respect the dual dictates of personal and professional integrity. A policy that attempts to maximize the extent to which both duties can be fulfilled might be denounced by Card as a “moderate” policy in the sense that he finds objectionable. Nonetheless, it is ethically the soundest option.
Extract Thus my conclusion is not very far from Card’s, but it rests on very different grounds. A pluralistic framework leads to an expectation that the pharmacist provide EC, even while acknowledging the legitimacy of his view that using it is wrong. The pharmacist should in this kind of case respect and yield to the differing view of the client. Yet in other kinds of situations—such as when what is required is direct action, as distinct from mere assistance—conscientious objection should sometimes be allowed.
Extract Conclusion Medical ethics and the practice of medicine as an act of conscience have become integral to this scientifically unsettled debate. Before medication is prescribed or dispensed, a prudent practitioner weighs carefully the risks of the medication with the potential benefits. 70 Laws that require a medical professional to perform an act against his or her best judgment violate the code of ethics of that profession to do no harm in the professional’s highest and best medical judgment. It ought to be alarming that a patient’s expectations may become the standard for professional action. Ought medical professionals prescribe and dispense what the patient wants even if it harms him or her, just because the patient’s autonomy allows a patient to live a risky life? 71 Family planning deserves a principled approach carried out with integrity that protects the parties, and that approach should be reflected in legal policy and lawmaking.
Should doctors and pharmacists be able to refuse to give out emergency contraceptives based on conscientious objections? Sexual freedom that was protected by the Supreme Court’s emancipation of sexuality from reproduction has allowed emergency contraceptives to be used for any purpose an individual desires, rather than for the best and most responsible medical purposes. Therefore, when a medical professional has concerns that an emergency contraceptive may harm the health of his or her patients or customers or their offspring, a conscientious objection provided by law seems more appropriate than a legal requirement to dispense despite objections, at least until a medical and legal consensus can be reached.
Extract Conclusion Conscience clauses raise many difficult issues in a pluralistic society. Health care providers have special obligations to patients that are not replicated in many other professional endeavors. Duties prescribed by law and professional codes of conduct expect health care providers to act out of respect for the patient’s welfare and dignity. While no one suggests that health professionals should abandon their religious or moral principles, patients should not suffer harm or potential harm because of a belief they do not share. It is often appropriate to accommodate individuals who wish to exercise their principles in the care of patients, but conscience clauses that promote blanket immunity for refusals to provide health care services resolve the tension between patient needs and provider autonomy in a onesided manner.
When health care providers deviate from standards of care, engage in unprofessional conduct, or unduly burden their colleagues and employers through refusals to perform services, exemptions from malpractice, disciplinary, or employment actions are not appropriate. . .Accordingly, legislators should not tie the hands of disciplinary boards in addressing such conduct.
The clamor for absolute immunity from employment actions for health care workers asserting moral refusals to treat demonstrates a myopic view of the burdens imposed by such objections on patients, employers, and coworkers. . . . Although legislators may choose to heighten the de minimis accommodation standard under Title VII, abrogation of the undue hardship test is not warranted from either a policy or legal prospective.
. . . the overriding purpose of our health care system is to protect the health and safety of patients. The expansion of refusal legislation to create immunity for health care providers who refuse any service for almost any reason is cause for alarm. Conscience clauses fail to achieve a reasonable balance when they confer a special benefit on those whose religious, moral, or ethical beliefs compel them to deny health care while absolving them of the potentially harmful consequences of their choices. . .
Extract This Article will demonstrate that a pharmacist’s refusal to fill a valid prescription for emergency contraception constitutes sex discrimination and violates the WLAD. Part I explains the nature and function of emergency contraceptive pills (ECPs) as well as their role in basic health care for women and the importance of their accessibility. Part II addresses federal civil rights protections and the failure of these protections to provide relief for women facing refusals. Focusing on the WLAD, Part II also explains how state public accommodation statutes protect women from discrimination in places of public accommodation. It further sets forth the prima facie case of such a claim where a woman is refused access to emergency contraception. Part III presents arguments likely to be submitted by a pharmacist facing litigation under the WLAD. Finally, Part IV illustrates how Washington public policy supports women and the protection of reproductive freedom. The Article concludes with suggestions for judicial interpretation..
Abstract On the grounds that rape is an act of violence, not a natural act of intercourse, Roman Catholic teaching traditionally has permitted women who have been raped to take steps to prevent pregnancy, while consistently prohibiting abortion even in the case of rape. Recent scientific evidence that emergency contraception (EC) works primarily by preventing ovulation, not by preventing implantation or by aborting implanted embryos, has led Church authorities to permit the use of EC drugs in the setting of rape. Doubts about whether an abortifacient effect of EC drugs has been completely disproven have led to controversy within the Church about whether it is sufficient to determine that a woman is not pregnant before using EC drugs or whether one must establish that she has not recently ovulated. This article presents clinical, epidemiological, and ethical arguments why testing for pregnancy should be morally sufficient for a faith community that is strongly opposed to abortion.
Extract The problem of refusals to dispense prescription contraceptives in pharmacies is real and urgent. State public accommodations statutes offer an excellent vehicle in many states for challenging these discriminatory practices. State public accommodations lawsuits should ideally be brought solely against the pharmacy, not against the individual pharmacist who refuses to dispense a prescription. Pharmacies are best positioned to make institutional adjustments that ensure the filling of prescription contraceptives while accommodating the views and legal rights of their pharmacist employees. Moreover, a state public accommodations lawsuit will likely have a greater remedial and public relations impact if brought against a pharmacy as opposed to against an individual pharmacist and will result in broader systemic change.
Extract pharmacists are autonomous, moral agents who are accountable for their choices and entitled—within limits— to decide in which activities they will participate. Pharmacists’ professionalism is defended, their responsibilities in the provision of drug therapy are set forth in the context of pharmaceutical care, and these lead to the conclusion that pharmacists’ refusals may be ethically justified. There are important limits on how are being asked to participate in actions they find morally objectionable. Notably, they must ensure that these prescriptions are filled by someone else in a timely manner and must refrain from any abusive or demeaning treatment of patients, as summed up in our Principle of Conscientious Refusal to Dispense.
Abstract The pharmacist who wants her integrity and self-conception to be respected must accord respect to the woman whose views about sex, life processes, and parenthood differ from her own by courteously offering her own rationale and a referral.
Abstract This paper examines the obligations of pharmacy licensees and pharmacists in the context of conscience-based objections to filling lawful prescriptions for certain types of medications-e.g., standard and emergency contraceptives. Claims of conscience are analyzed as means to preserve or maintain an individual’s moral integrity. It is argued that pharmacy licensees have an obligation to dispense prescription medications that satisfy the health needs of the populations they serve, and this obligation can override claims of conscience. Although efforts should be made to respect the moral integrity of pharmacists and accommodate their claims of conscience, it is argued that the health needs of patients and the professional obligations of pharmacists limit the extent to which pharmacists may refuse to assist patients who have lawful prescriptions for medically indicated drugs.
