Journal Extract It has been 40 years since the seminal papers on pharmacy’s status as a profession sparked debate about the pharmacist’s role in health care, yet the questions they raised are just as poignant today as they were then. The issue of pharmacy’s status as a profession and its role in health care has again been brought into question, albeit in a roundabout manner, through discussions over the pharmacist’s right to refrain from dispensing emergency contraception. The key to understanding the contemporary pharmacist’s role as part of the health care team, as well as the pharmacist’s alleged right to refrain from dispensing emergency contraception, is to examine a situation that almost every contemporary pharmacist experiences.
Abstract Emergency contraception (EC) provides women with a safe means of preventing pregnancy following unprotected sexual intercourse or potential contraceptive failure, and is accepted as a legitimate method of fertility control. The right of women to access EC, along with other contraceptive methods, needs to be affirmed. The consequences of unintended pregnancy are serious, imposing appreciable burdens on children, women, men, and families. Every child has the right to be a wanted child and not enter this world because its mother was denied access to EC. For maximum effectiveness, barriers to access must be removed. It is essential that EC pills are available over-the-counter with no minimum age for access. There is a tension between the rights of women to access EC without medical or legal intervention and the rights of providers who have a conscientious objection to provision on religious or moral grounds. The principles of autonomy, non-maleficence, and beneficence all weigh in favor of the rights of a woman faced with the possibility of an unintended pregnancy to unrestricted access to EC against providers whose religious views are opposed to this.
Abstract Recent legislation in Wisconsin mandating provision of emergency contraception to victims of sexual assault may create a conflict of conscience for some health care professionals. Although disputes exist over the exact mechanism of action of emergency contraception, those professionals who espouse a particularly strict stance may be reluctant to dispense the medication for fear that it could prevent a fertilized embryo from implanting in the uterus. While no objection of conscience clause was written into the new law, Wisconsin law has a long tradition of recognizing rights of conscience in matters of religious conflict. This legal tradition both at statutory and common law levels is summarized with application to the recent emergency contraception mandate. A case is made for a potential legal defense should a health care professional abstain from dispensing emergency contraception.
Bradley CT. Emergency Contraception and Physicians’ Rights of Conscience: A Review of Current Legal Standards in Wisconsin. Wis Med J. 2009 May; 108(3):156-160
Journal Extract This Educational Bulletin outlines delivery systems and contraceptive formulations, summarizes advances in emergency contraception and reviews the effects of hormonal contraception on cancer risks, cardiovascular disease, and bone.
Abstract BACKGROUND: For over 30 years, pharmacists have exercised the right to dispense medications in accordance with moral convictions based upon a Judeo-Christian ethic. What many of these practitioners see as an apparent shift away from this time-honored ethic has resulted in a challenge to this right.
OBJECTIVE: To review and analyze pharmacy practice standards, legal proceedings, and ethical principles behind conflicts of conscientious objection in dispensing drugs used for emergency contraception.
DATA SOURCES: We first searched the terms conscience and clause and Plan B and contraception and abortion using Google, Yahoo, and Microsoft Networks (2006-September 26, 2008). Second, we used Medscape to search professional pharmacy and other medical journals, restricting our terms to conscience, Plan B, contraceptives, and abortifacients. Finally, we employed Loislaw, an online legal archiving service, and did a global search on the phrase conscience clause to determine the status of the legal discussion.
DATA SYNTHESIS: To date, conflicts in conscientious objection have arisen when a pharmacist believes that dispensing an oral contraceptive violates his or her moral understanding for the promotion of human life. Up to this time, cases in pharmacy have involved only practitioners from orthodox Christian faith communities, primarily devout Roman Catholics. A pharmacist’s right to refuse the dispensing of abortifacients for birth control according to moral conscience over against a woman’s right to reproductive birth control has created a conflict that has yet to be reconciled by licensing agents, professional standards, or courts of law.
CONCLUSIONS: Our analysis of prominent conflicts suggests that the underlying worldviews between factions make compromise improbable. Risks and liabilities are dependent upon compliance with evolving state laws, specific disclosure of a pharmacist’s moral objections, and professionalism in the handling of volatile situations. Objecting pharmacists and their employers should have clear policies and procedures in place to minimize workplace conflicts and maximize patient care.
Abstract Objective: The aim of this study was to focus on barriers, controversy and perceived risk associated with use of emergency contraception (EC) after unprotected sexual intercourse.
Design and method: Data were extracted from the literature of the MEDLINE database service. Original articles, surveys, clinical trials and investigations are considered for this review.
Results: After the introduction of over-the-counter and advance prescription provisions for easy access to EC, the rural–urban disparity in availability of EC poses a barrier to use of EC for rural dwellers. The socio-economically weaker section of the population is unable to purchase EC because of low or no income, although there is mounting pressure by the State for prevention of unintended pregnancy by use of EC. Some healthcare providers have objected to provide EC to the patient on the grounds of their conscience and morality. Some providers and users have also expressed concerns about the possibility of increase in irresponsible sexual behaviour because of easy access to EC. There may be some truth in their apprehension because nearly 3.2 million unintended pregnancies occur annually despite various contraceptive options available in USA and the extensive use of EC is directly proportional to the volume of unprotected sexual intercourse, which is too directly proportional to the quantum of risk for contacting sexually transmitted infections (STIs)/AIDS.
Conclusions: Emergency contraception is a one-off postcoital procedure and not to be opted after every sexual intercourse. Controversy about EC may be resolved if it is used within this limit. Extensive use of EC may increase risk for contacting STIs/AIDS.
Abstract The analysis of a dispute can focus on either interests, rights, or power. Commentators often frame the conflict over conscience in clinical practice as a dispute between a patient’s right to legally available medical treatment and a clinician’s right to refuse to provide interventions the clinician finds morally objectionable. Multiple sources of unresolvable moral disagreement make resolution in these terms unlikely. One should instead focus on the parties’ interests and the different ways in which the health care delivery system can accommodate them. In the specific case of pharmacists refusing to dispense emergency contraception, alternative systems such as advanced prescription, pharmacist provision, and over-the-counter sales may better reconcile the client’s interest in preventing unintended pregnancy and the pharmacist’s interest in not contravening his or her conscience. Within such an analysis, the ethicist’s role becomes identifying and clarifying the parties’ morally relevant interests.
Abstract Physicians sometimes refuse to provide legally permitted medical services on the grounds that they cannot do so in good conscience. Such conscientious refusals are at least as old as the Hippocratic movement. Yet new events, such as the refusal by health care professionals to prescribe or dispense post-coital (‘‘emergency’’) contraception, have kindled new debates about what physicians are obligated to do when patients request legal medical interventions to which their physicians have moral objections. In a recent national survey, we found that a large majority of physicians believe they are obligated in such circumstances to present all possible options to the patient, including information about obtaining the requested intervention, and to refer the patient to a clinician who does not object to the requested intervention. Yet a substantial minority of physicians—particularly those who are more religious and/or who themselves object to common controversial practices—disagree with these majority opinions.
Extract In posing the question of whether it is morally right for the only pharmacist in town to refuse healthcare services based on his or the community’s religious convictions, I could not help but think of “the conscience clause.” While many states across the United States support the conscience clause, which protects healthcare professionals from discrimination when refusing to dispense birth control pills or performing abortions and sterilizations, such clauses have different implications in the rural setting.When a physician or pharmacist refuses to prescribe or dispense birth control pills, the urban patient is able to acquire birth control from another healthcare provider with less difficulty than the rural patient. The rural patient may have to drive a great distance to acquire birth control even if it is needed for a medical condition rather than to prevent pregnancy.
Extract Conclusion Pharmacists are already involved in litigation over conscience clauses; it is probably only a matter of time before a woman sues a pharmacist for wrongful conception. Changes in the pharmacy profession and correlative tort duties mean a common law or statutory duty to dispense or sell emergency or daily oral contraceptives is not outside the realm of possibility. Many religious pharmacists have compelling reasons to refuse to sell, but federal Free Exercise protections are currently uncertain. State statutory conscience clauses offer some protection and do not violate the Establishment Clause. Therefore, more states should not hesitate to provide this protection to all healthcare providers.
