Pharmacy Archives - Protection of Conscience Project Library

(News) Woman suing two pharmacies after being denied emergency contraception

The US case brings to light concerns around conscientious objection at a time when a federal religious discrimination bill is being debated in Australia

Sheshtyn Paola

Exract
A woman has filed a lawsuit against a Thrifty White Pharmacy and a CVS Pharmacy in Minnesota in the US, alleging the two pharmacies illegally kept her from accessing emergency contraception.

Andrea Anderson, a 39-year-old mother of five, says she asked the pharmacist at her drugstore in Minnesota more than once why he couldn’t fill her prescription for emergency contraception, according to the Star Tribune.

“I then realised what was happening: he was refusing to fill my prescription for emergency contraception because he did not believe in it,” Ms Anderson said on Tuesday.

Paola S. Woman suing two pharmacies after being denied emergency contraception. Australian Pharm J [Internet]. 2019 Dec 12.

What the Doctor Ordered: Balancing Religion and Patient Rights in U.S. Pharmacies

Rachel T Caudel

Extract
Conclusion
. . . A statute that requires pharmacies to select their own policies regarding contraceptives and sexual health medication, to publish that policy, and to be required to adhere to the stated policy, however, is a near perfect solution to the delicate balance of protected rights. With cooperation from physicians and compliance within the pharmacies, women will be able to access the pharmaceuticals prescribed to them without delay, hassle, misinformation, or shame. Women will be able to find a pharmacist who will allow them to exercise their choice to use or not to use contraceptives. Pharmacists, on the other hand, will more easily schedule their careers to line up with their moral and religious convictions. A pharmacist will easily be able to determine a pharmacy’s policy on sexual health medications and contraceptives and therefore more easily find employment with a pharmacy that shares his value system. An individualized sexual health medication policy, when accompanied by a directory program, policy publication and compliance supervision, is the best, and possibly only method of insuring all rights at stake are protected.

Caudel RT. What the Doctor Ordered: Balancing Religion and Patient Rights in U.S. Pharmacies. Ky Law J. 2018 Aug;97(3):521-539.

Community pharmacists’ attitudes on suicide: A preliminary analysis with implications for medical assistance in dying

Andrea L. Murphy, Claire O’Reilly, Ruth Martin-Misener, Randa Ataya, David Gardner

Extract
Conclusion
Pharmacists are likely underestimating their frequency of interactions with people with thoughts of dying or with intentions to die either by suicide or through medical assistance in dying procedures. Pharmacists report empathetic responses for those with severe and incurable diseases wishing to end their life, but most do not support death by suicide or through medical assistance. From the preliminary analysis, a personal connection to mental illness or suicide does not appear to influence the permissiveness of pharmacists’ attitudes towards suicide. Framing effects in survey research for pharmacists have not been adequately considered, and more work is needed to determine how this influences the responses of pharmacists.

Murphy AL, O’Reilly C, Martin-Misener R, Ataya R,Gardner D. Community pharmacists’ attitudes on suicide: A preliminary analysis with implications for medical assistance in dying. Can Pharm J (Ott). 2017 Dec 1;151(1):17-23. doi: 10.1177/1715163517744225.

The Conscience of the Pharmacist

John J Conley

Proceedings of the Sixteenth University Faculty for Life Conference — Proceedings of the University Faculty for Life

Abstract
Recent legal efforts to force pharmacists to distribute potentially abortifacient drugs constitute a violation of conscience. This campaign of coercion violates religious freedom, professional deontology, and the right to refuse even material cooperation in acts of grave evil.

Conley JJ. The Conscience of the Pharmacist. In: Koterski JW editors. Proceedings of the UFL Life and Learning Conference XVII. 2007;431-437.

Striking a Balance Between Faith and Freedom: Military Conscientious Objection as a Model for Pharmacist Refusal

Maria Teresa Weidner

Lexis Nexis Summary
Pharmacists who have subscribed to this movement assert that they have a “right” to refuse to fill valid patient prescriptions whenever doing so might violate their own religious or moral beliefs. … The governments of Arkansas, Florida, and South Dakota sought to both endorse and shield from liability instances of religiously motivated pharmacist refusal to dispense family planning products. … Such expectations, as demonstrated in the policy positions set forth by organizations like the American Pharmacists Association (APhA) and Pharmacists for Life, harm the profession by undermining its credibility while underscoring the need to preserve the regulating power of liability as a tool to protect patient interests. … These factors, compounded with the profession’s own struggle for professional legitimacy and insistence on recognition of the practitioners’ “clinical role” in the provision of medication to patients indicate that a defense against alleged malpractice based on a free exercise theory would not succeed both based on the secular nature of the profession and as a matter of existing free exercise jurisprudence. … South Dakota’s legislature has already demonstrated as much by including a provision in its pharmacist refusal clause permitting pharmacists to refuse to dispense palliative drugs that might be used to hasten death, clearly a measure that can affect women and men alike

Weidner MT. Striking a Balance Between Faith and Freedom: Military Conscientious Objection as a Model for Pharmacist Refusal. J Gender, Race & Just. 2008 Jan;11(2):369-408

Emergency Contraception, Institutional Conscience, and Pharmacy Practice

Robert F CarD, Carl G Williams

Abstract
“Emergency contraception” case law from the state of Washington is reviewed and analyzed. Important legal, social policy, and professional ethical questions are considered with focus on professional and institutional conscientious objection to participating in this therapy.

Card RF, Williams CG. Emergency Contraception, Institutional Conscience, and Pharmacy Practice. J Pharm Pract 2014 Apr;27(2):174-7. doi: 10.1177/0897190013515710

Whose Self-Determination? Barriers to Access to Emergency Hormonal Contraception in Italy

Emanuela Ceva, Sofia Moratti

Abstract
In Italy, Emergency Hormonal Contraception (EHC) is a prescription drug, available only in pharmacies. Evidence suggests that a number of doctors and pharmacists refuse to provide EHC, on grounds of conscience, although the exact frequency of this phenomenon is unknown. This creates a barrier to access to EHC for women, thus risking undermining their right to reproductive self-determination. In this article, we aim to offer a clearer empirical and theoretical understanding of the situation and to assess the force of doctors’ and pharmacists’ claims against providing EHC. Unlike standard discussions of the issue, we argue that the category of conscientious objection is not the most appropriate one for making sense of these claims, because they are not grounded in a conflict between two contrasting moral duties. The seemingly forced choice between protecting doctors’ and pharmacists’ professional self-determination and women’s reproductive self-determination could be prevented by distributing EHC without medical prescription and in a number of outlets (including supermarkets), thus relieving doctors and pharmacists from the legal duty to provide it.

Ceva E, Morati S. Whose Self-Determination? Barriers to Access to Emergency Hormonal Contraception in Italy. Kennedy Inst Ethics J. 2013 Jun;23(2):139-167. Available from:

Conscientious objections in pharmacy practice in Great Britain

Zuzana Deans

Abstract
Pharmacists who refuse to provide certain services or treatment for reasons of conscience have been criticized for failing to fulfil their professional obligations. Currently, individual pharmacists in Great Britain can withhold services or treatment for moral or religious reasons, provided they refer the patient to an alternative source. The most high-profile cases have concerned the refusal to supply emergency hormonal contraception, which will serve as an example in this article.

I propose that the pharmacy profession’s policy on conscientious objections should be altered slightly. Building on the work of Brock and Wicclair, I argue that conscientious refusals should be acceptable provided that the patient is informed of the service, the patient is redirected to an alternative source, the refusal does not cause an unreasonable burden to the patient, and the reasons for the refusal are based on the core values of the profession. Finally, I argue that a principled categorical refusal by an individual pharmacist is not morally permissible. I claim that, contrary to current practice, a pharmacist cannot legitimately claim universal exemption from providing a standard service, even if that service is available elsewhere.

Deans Z. Conscientious objections in pharmacy practice in Great Britain. Bioethics. 2013 Jan;27(1):48-57. doi: 10.1111/j.1467-8519.2011.01918.x. Epub
2011 Jul 29. PubMed PMID: 21797914.

Conscientious objection, health care and Article 9 of the European Convention on Human Rights

Mark Campbell

Abstract
Article 9 of the European Convention on Human Rights provides protection for freedom of thought, conscience and religion. From one perspective, it may be said that Article 9 guarantees a right to conscientious objection in health care, whereas from another perspective, a Strasbourg case, such as Pichon and Sajous v France, effectively means that Article 9 provides little or no protection in that context. In this article it is argued that the matter is more complex than either of these two positions would suggest. Moreover, given the nature of the subject matter, national authorities should be afforded a significant margin of appreciation in the way that they protect and regulate conscientious objection. By way of illustration, there is a discussion of the ways in which Article 9 might affect conscientious objection in health care under English law. The final part of the article considers the conceptual limitations of Article 9 in thinking about conscientious objection in health care; in particular, the claim that the extent to which Article 9 of the Convention provides protection for a conscientious objection in the health care context is a different question from whether conscientious objection by doctors and other health care practitioners is justified in principle.

Campbell M. Conscientious objection, health care and Article 9 of the European Convention on Human Rights. Medical Law International. 2011 Dec 06;11(4):284-304.

Alternative Burdens on Freedom of Conscience

Adam J. Kolber

Abstract
Suppose a pharmacist refuses to dispense pills that induce abortion claiming that dispensing such pills runs counter to principles he holds dear. Indeed, the pharmacist claims that forcing him to dispense the pills would violate his freedom of conscience. He even claims that he would not have become a pharmacist had he foreseen an obligation to dispense such pills at the time he entered his profession. Should the pharmacist’s job be protected if he is making a bona fide claim of conscience? And does it matter whether the pharmacist’s objection to dispensing the pills is rooted in religious or nonreligious reasons?

Kolber AJ. Alternative Burdens on Freedom of Conscience, 47 San Diego L. Rev. 919 (2010).