Morning after pill Archives - Page 9 of 10 - Protection of Conscience Project Library

Conflicts of Conscience

Katherine A James

Extract
There is concern that conscience clauses for pharmacists will lead to pharmacists refusing to fill prescriptions outside the area of contraception. For example, pharmacists who believe AIDS is a punishment from God may not fill a patient’s prescription for AIDS medication. Doctors who think children should only be born to heterosexual, married couples may not provide adequate fertility treatment or may not encourage their patients to explore their options fully. The current trend of pharmacists refusing to fill prescriptions because of personal beliefs violates a woman’s constitutional rights, a pharmacist’s duty of care, and a woman’s right to confidentiality. Forcing pharmacists to fill prescriptions that conflict with their religious beliefs also violates their constitutional right to free exercise of religion. Allowing individual pharmacists to decline to fill prescriptions while mandating that pharmacies have a policy to ensure that customers’ needs are met will help alleviate the concerns of both parties to the conflict. Thus, any legislation that is enacted should balance the needs of both pharmacists and patients.

James KA. Conflicts of Conscience. Washburn Law J. 2006 Jan;45(415-435).

Patient expectations and access to prescription medication are threatened by pharmacist conscience clauses

Kelsey C Brodsho

Extract
The medical community agrees that while health professionals may be given statutory rights to refuse health services for moral reasons, refusal cannot prevent patients from receiving “the information, services, and dignity to which they are entitled.” In theory, laws and institutional policies that allow pharmacists to transfer prescriptions to another pharmacist do not interfere with established treatment plans. However, in practice these laws may delay health care services and harm patients. . . . In many foreseeable situations, a pharmacist’s moral objection may delay or prevent the receipt of prescription mediation. Pharmacists who refuse to provide services or transfer prescriptions to colleagues act contrary to professional objectives. Unnecessary delays or obstructions by pharmacists jeopardize treatment plans established by physicians and patients. . . . Conscience clause legislation that does not assure patient access to contraceptive services likely conflicts with reproductive liberty interests. . . states may require pharmacists to fill all prescriptions. Alternately, states may pass conscience clause legislation that assures patient access to health care services by prescription transfer or other similar procedure. . . . Conscience clause debate should not be clothed in abortion politics. Rather, its focus should be on whether a pharmacist has a right to interfere with a treatment plan established by a patient and his or her primary health care provider.

Brodsho KC. Patient expectations and access to prescription medication are threatened by pharmacist conscience clauses. Minnesota Journal of Law, Science & Technology. 2005;7(1):327-336.

(Editorial) Pharmacists’ Rights of Conscience: Whose Autonomy Is It, Anyway?

Stephen Joel Coons

Extract
Patient autonomy is the foundation of the ethical principles that guide a health professional’s actions. It can be defined as “the right of individuals to make decisions about what will happen to their bodies; what choice will be made among competing options; and what they choose to take or not take into their bodies. ” By being a barrier to the patient’s receipt of a legally available prescription product, the pharmacist is not only denying the patient her autonomy but potentially causing her emotional and/or physical harm.

Coons SJ. (Editorial) Pharmacists’ Rights of Conscience: Whose Autonomy Is It, Anyway?. Clin Ther. 2005 Jun;27(6):924-925

Service or Servitude: Reflections on Freedom of Conscience for Health Care Workers

Sean Murphy

Abstract
The authors suggestion that patients should be able to access morally controversial services without compromising health care workers’ freedom of conscience is most welcome, as is their acknowledgment that “other options exist” when pharmacists decline to fill prescriptions.

However, the conflicting interests of patients and health care providers may be accommodated but cannot be balanced because they concern fundamentally different goods. Neither the concept of autonomy nor an appeal to the “needs” of the patient help to resolve conflicts in these situations, while fiduciary obligations cannot necessarily be invoked because they are not governed by fixed rules, and there can be no obligation to participate in wrongdoing.

The fact that post-coital interceptives can cause the death of an early embryo is at the heart of the controversy over the drugs. The authors’ advocacy of mandatory referral follows from their belief this is not wrong. Those with different beliefs do not share their conclusions. Conscientious objection does not prevent patients from obtaining post-coital interceptives from other sources. As the exercise of freedom of speech does not force others to agree with the speaker, the exercise of freedom of conscience does not force others to agree with an objector. Concerns about access to legal services or products can be addressed by dialogue, prudent planning, and the exercise of tolerance, imagination and political will. A proportionate investment in freedom of conscience for health care workers is surely not an unreasonable expectation.

Murphy S. Service or Servitude: Reflections on Freedom of Conscience for Health Care Workers (2004 Dec 20) Protection of Conscience Project (website).

The Limits of Conscientious Objection-May Pharmacists Refuse to Fill Prescriptions for Emergency Contraception?

Julie Cantor, K Baum

New England Journal of Medicine, NEJM — New England Journal of Medicine

Abstract
Several reports have detailed cases in which pharmacists have refused to fill prescriptions for emergency contraception. Should pharmacists have the right to refuse access to these medications? This Sounding Board article discusses arguments for and against the right to refuse and proposes a balanced solution to the problem.

Cantor JD, Baum K. The Limits of Conscientious Objection-May Pharmacists Refuse to Fill Prescriptions for Emergency Contraception?. N Engl J Med. 2004 Nov 04;351(19):2008-212.

(Correspondence) In Response

Bernard M. Dickens, Rebecca J. Cook

Journal of Obstetrics and Gynaecology Canada

Extract

As neither our original Commentary on access to emergency contraception nor our letter response was suitable for fully referenced legal or ethical reasoning, we appreciate this opportunity to expand a little on the substance of both, addressing the points Mr Murphy raises.

Dickens BM, Cook RJ. (Correspondence) In Response. 2004 Aug; 26(8): 706-707.

(Correspondence) Access to Emergency Contraception

Sean Murphy

Extract

In a letter in the February issue of JOGC, Rebecca J. Cook and Bernard M. Dickens state, “Physicians who feel entitled to subordinate their patient’s desire for well-being to the service of their own personal morality or conscience should not practise clinical medicine” (emphasis added).
The statement is unsupported by their own legal references, and it has little to recommend it as an ordering principle in the practice of medicine.

Murphy S. (Correspondence) Access to Emergency Contraception. JOGC. 2004 Aug; 26(8): 705-706.

(News) Emergency contraception could lower abortion rate

Barbara Sibbald

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Extract
Anti-abortion groups should welcome proposed new regulation allowing patients to access emergency contraception without a prescription, says the Society of Obstetricians and Gynaecologists of Canada. . . . Emergency contraception, or the “morning after pill,” is sold in Canada as levonorgestrel (Plan B). If taken within 72 hours of unprotected intercourse, it can prevent ovulation, or interfere with fertilization, or implantation. . .The Catholic Organization for Life and Family and other anti-abortion groups believe pregnancy begins with conception, not implantation. In a letter to Health Canada, the organization called levonorgestrel an “abortifacient.”.

Sibbald B. Emergency contraception could lower abortion rate. Can Med Assoc J. 2004 Jun 22;170(13):1903.

Access to emergency contraception

Rebecca J Cook, Bernard M Dickens

Abstract
The merits of non-prescription distribution of levonorgestrel as emergency contraception (EC), which is effective within 72 hours of unprotected intercourse, are contentious. The advantage of promptness and convenience of access may be offset by the absence of medical counselling. Opposition to EC based on the possibility of the drug acting after fertilization but before implantation departs from standard medical criteria of pregnancy. Physicians who propose to apply non-medical criteria, and use religious objections to abortion to deny prescription of EC, must publicize their opposition in advance, so that women may seek assistance elsewhere. When objecting practitioners, or facilities, become responsible for women for whom EC is indicated, such as rape victims, they are bound ethically and legally to refer them to reasonably accessible non-objecting sources of care.

Cook RJ, Dickens BM. Access to emergency contraception. J Ob Gyn Canada. 2003 Nov;25(11):914-916.

Human Rights Dynamics of Abortion Law Reform

Rebecca J Cook, Bernard M Dickens

Abstract
The legal approach to abortion is evolving from criminal prohibition towards accommodation as a life-preserving and health-preserving option, particularly in light of data on maternal mortality and morbidity. Modern momentum for liberalization comes from international adoption of the concept of reproductive health, and wider recognition that the resort to safe and digniﬁed healthcare is a major human right. Respect for women’s reproductive self-determination legitimizes abortion as a choice when family planning services have failed, been inaccessible, or been denied by rape. Recognition of women’s rights of equal citizenship with men requires that their choices for self-determination be legally respected, not criminalized.

Cook RJ, Dickens BM. Human Rights Dynamics of Abortion Law Reform. Hum Rights Quart. 2003 Feb;25(1):1-59. Available from: