Pharmacy Archives - Page 6 of 8 - Protection of Conscience Project Library

Pharmacies, pharmacists, and conscientious objection

Mark R Wicclair

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.

Wicclair MR. Pharmacies, pharmacists, and conscientious objection. Kennedy Inst Ethics J. 2006;16(3):225-250.

“Conscience Clauses” or “Unconscionable Clauses”: Personal Beliefs Versus Professional Responsibilities

Martha S Swartz

Yale Journal of Health Policy, Law and Ethics

Abstract
Conclusion
Ultimately, this Article proposes a new model for such “conscientious objections,” one that presumes the general obligation ‘of health care professionals, who hold monopolistic state licenses, to participate in requested medical care that is not contraindicated or illegal, notwithstanding their personal moral objections. This model is based on “the· premise that it “is the patient’s best interest (as determined by -the patient, but mediated by the health care professional’s medical judgment), not the health care professional’s personal interests, that should govern the professional relationship. This should be the standard taught in professional schools and promoted by professional associations. “Conscientious objections” should be permissible based on prevailing medical ethics; however, to the extent that they are based on the personal morals of the· health care professional, they should be actively discouraged.

Swartz MS. “Conscience Clauses” or “Unconscionable Clauses”: Personal Beliefs Versus Professional Responsibilities. Yale J Health Pol Law Ethics. 2006;6(2):269-359.

(Correspondence) Royal Pharmaceutical Society and conscientious objectors

Lynsey Balmer

Extract
If a pharmacist’s beliefs or personal convictions prevent him or her from providing a particular service, the pharmacist must disclose this fact before accepting employment to allow procedures to be put in place to enable patients to access the services they require. In such circumstances the Code of Ethics and Standards requires that a pharmacist must not condemn or criticise the patient and that either the pharmacist or a member of staff must advise the patient of an alternative source for the service requested.

Balmer L. (Correspondence) Royal Pharmaceutical Society and conscientious objectors. The Lancet. 2006;367(9527):1980.

When pharmacists refuse to dispense prescriptions

Katrina A Bramstedt

Journal Extract
The dilemma of conscientious objection by US pharmacists has yet to be resolved. The issue was thrust into the mass-media spotlight when a pharmacist in Texas rejected a rape victim’s prescription for emergency contraception (the morning-after pill). The pharmacist argued that dispensing the drug was a “violation of morals”.

Further cases have since been reported and include such acts as intimidation and confiscation of the prescription by the pharmacist. Pharmacists argue that they are a health-care provider and, like doctors, should have the right to refuse to participate in services they morally object to. Pharmacists argue that they are a health-care provider and, like doctors, should have the right to refuse to participate in services they morally object to. In fact, the policy of the American Pharmacists Association permits pharmacists to object to dispensing drugs but requires them to ensure another pharmacist is available to dispense or transfer the prescription to another pharmacy. Further, the Association argues that this approach is “seamless” and the patient is “not aware that the pharmacist is stepping away from the situation”.

Bramstedt KA. When pharmacists refuse to dispense prescriptions. The Lancet. 2006;367(1219-1220.

(Correspondence) Personal conviction: what role should it play

Sandra E Brickell

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Extract
I have, however, a question about the implication that the pharmacy assistant was being unprofessional because he let his personal conviction affect the provision of care. I would like to assume for the sake of argument that his personal conviction was that Plan B is unethical because it induces abortion and he is of the opinion that abortion ends a person’s life. By providing Plan B he would be doing something that he genuinely believes is in the best interest of neither his adult client nor her embryo. Wouldn’t it be unprofessional to ignore this conviction and provide the drug anyway? What should a professional do when he is asked to do something by a client that he genuinely believes is not in the client’s best interest? What would a lawyer do?

Brickell SE. (Correspondence) Personal conviction: what role should it play. Can Med Assoc J. 2006;174(8):1134.

Pharmacist Refusals: Dispensing (With) Religious Accommodation Under Title VII

Amy Berquist

Abstract
Conclusion
. . . The pharmaceutical industry will continue to create drugs to which some pharmacists object on religious grounds. Employers must anticipate that some pharmacists will object not only to birth control, but also to Ritalin, 226 Viagra for unmarried men, or drugs to treat AIDS; some pharmacists may even object on religious grounds to serving particular customers. The religious discrimination provisions of the Civil Rights Act allow most employers to dispense with the majority of possible religious accommodations for pharmacists who refuse to fill prescriptions on religious grounds. Those provisions are meaningless, however, if employers are reluctant to assert Title VII’s protections against accommodations imposing an undue hardship on the pharmacy’s business operations. As pharmacies negotiate the tensions between consumers demanding prompt access to prescription drugs, a tight labor market for pharmacists, pressure from certain religious groups to discourage the use of birth control, vocal national groups advocating expanded access to contraception, and their own economic bottom line, Title VII can serve either as an answer or as an excuse. Employers may use Title VII as a pretense to justify unnecessary accommodations for objecting pharmacists; pharmacies may attempt to use federal law to shield themselves from customer and activist criticism by asserting that they have no choice but to accommodate. On the other hand, pharmacies can utilize Title VII as a tool to define the outer limits of their pharmacist accommodation policies. A clear understanding of the parameters of Title VII’s religious accommodation requirements will help guide and monitor the behavior and legal justifications presented by employers, employees, and customers when pharmacists refuse to dispense certain drugs on religious grounds.

Berquist A. Pharmacist Refusals: Dispensing (With) Religious Accommodation Under Title VII. Minn Law Rev. 2006;90(4):1073-1106.

An Essential Prescription: Why Pharmacist-Inclusive Conscience Clauses are Necessary

Brian P Knestout

Journal of Contemporary Health Law and Policy

Extract
Conclusion
. . . The only solution to this dilemma may be the solution that the APhA suggested, namely, to endorse a conscience clause, but simultaneously require pharmacists to refer a valid prescription to another service provider. Those members of the profession who bear the burden of this course of action are those who believe that a referral is equivalent to the act itself. However, such a view safeguards most of the ethical goals of pharmacists while simultaneously serving the public need for effective provision of legally prescribed drugs.

Knestout BP. An Essential Prescription: Why Pharmacist-Inclusive Conscience Clauses are Necessary. J Contemp Health Law Pol. 2006 Spring;22(2):349-382.

(Op/Ed) Counter attack

Barbara W

Extract
The assignment: to buy the drug in a small, remote town where I was sojourning on business. If I could not get the pill in this straight-talking, hard- working place, who could? . . . approached a smiling pharmacy worker and asked for Plan B. . . . Kevin refused to hand it over. Only a pharmacist could give me the drug. He was a pharmacist’s assistant; the real pharmacist was on her break. . . . When I returned at 5:30, Kevin, the man of steely resolve, informed me that the pharmacist had left for the day. No pharmacist, no Plan B. [Pharmacist assistant seems to have answered questions evasively] . . . Was this not a nonprescription drug. Yes. Why could I not purchase the drug if no prescription was necessary? And then he said it: “Because, ethically, I don’t believe in it and I would not give it to you anyway. It is against my principles, and I don’t have to do anything I am uncomfortable with,” he said loudly and proudly. . . According to Kevin, there is nothing unprofessional about placing personal conviction ahead of a woman’s health care needs. . . a reasonably articulate curmudgeon like myself cannot obtain emergency contraception, what chance does a worried, upset teenage girl have?

Barbara W. Counter attack. Can Med Assoc. J. 2006;174(2):211-212.

Conscientious Objection and Collaborative Practice: Conflicting or Complementary Initiatives?

Susan C Winkler, John A Gans

Journal of the American Pharmacists Association

Extract
Expanding collaborative practice navigates the issue well, providing a seamless way for women to access emergency contraception without compromising the pharmacist’s ability to opt out. Such legislative initiatives are far more effective in expanding access to emergency contraception than misguided regulations that require pharmacists or pharmacies to assure dispensing of contraceptives “without delay.” In addition to blatantly insulting the professionals who are required to check their beliefs at the door, duty-to-dispense laws can have the opposite effect by limiting access to contraceptives when pharmacy practices simply choose not to carry the products rather than face sanctions if workable solutions for accommodating the patient and the pharmacist are disrupted by misguided regulations. Conscience and collaborative practice can complement each other, but only if both are available.

Winkler SC, Gans JA. Conscientious Objection and Collaborative Practice: Conflicting or Complementary Initiatives? J Am Pharm Assoc. 2006 Jan;46(1):12-13.

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).