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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.

Foreword: The Role of Religion in Health Law and Policy

William J Winslade, Ronald A Carson

Extract
This symposium issue explores several continuing controversies at the intersection of Law, Ethics, Healthcare, Politics, Health Policy and Religion: abortion, contraception, the status of embryos, stem cell research, IVF, personal and professional autonomy, end- of-life decisions, and religiously based health care systems. The multiple values associated with each of these topics strain and threaten to usurp the effectiveness of our legal system to regulate them.

Winslade WJ, Carson RA. Foreword: The Role of Religion in Health Law and Policy. Houston Journal of Health Law & Policy. 2006 Sep;6(2):245-248.

(Correspondence) Infertility Treatments for Gay Patients?

Anthony Charuvastra

Extract
We are entering an era where medicine is becoming more like engineering. The distinction between “treatment” and “enhancement” blurs as we are ever better at tinkering with the body. . .

Medical scientists will be able to modify and control an ever-expanding range of human bodily functions, from drugs that slow down aging to drugs that alter basic aspects of mood, anxiety, and cognition. Someday soon, the conflict between a physician’s idea of how people ought to live and how those people want to live will occur in fields far removed from reproductive technology. . .

Charuvastra A. (Correspondence) Infertility Treatments for Gay Patients?. Hastings Cent Rep. 2006 Sep;36(5):6-7.

“Who Should Survive?: One of the Choices on Our Conscience”: Mental Retardation and the History of Contemporary Bioethics

Armand H Matheny Antommaria

Abstract
The film “Who Should Survive?: One of the Choices on Our Conscience” contains a dramatization of the death of an infant with Down syndrome as the result of the parents’ decision not to have a congenital intestinal obstruction surgically corrected. The dramatization was based on two similar cases at The Johns Hopkins Hospital and was financed by the Joseph P. Kennedy, Jr., Foundation. When “Who Should Survive?” was exhibited in 1971, the public reaction was generally critical of the parents’ decision and the physicians’ inaction. Although technological developments in medicine were a necessary condition for the production of this film and its unanticipated reception, they were not a sufficient condition. The proximate cause was a changed understanding of the capabilities of individuals with Down syndrome. Part of the impetus for this change was data showing the adverse effects of institutionalization on normal children.

Antommaria AHM. “Who Should Survive?: One of the Choices on Our Conscience”: Mental Retardation and the History of Contemporary Bioethics. Kennedy Inst Ethics J. 2006;16(3):205-224.

(Correspondence) Infertility Treatments for Gay Patients?

Jeffrey Blustein

Extract
an egalitarian justice argument, he mentions only briefly as more promising than the former: refusing to provide reproductive assistance to homosexual parents while making it available to heterosexual parents constitutes unjust discrimination against the former. Appel does not develop this suggestion at all, but I want to say a word about an issue on which it hinges, namely, the moral standing that reproductive assistance has in a just health care system.

Blustein J. (Correspondence) Infertility Treatments for Gay Patients? Hastings Cent Rep. 2006;36(5):6.

Emotional and Psychological Effects of Physician-Assisted Suicide and Euthanasia On Participating Physicians

Kenneth R Stevens

Extract
Conclusion
Physician participation in assisted suicide or euthanasia can have a profound harmful effect on the involved physicians. Doctors must take responsibility for causing the patient’s death. There is a huge burden on conscience, tangled emotions and a large psychological toll on the participating physicians. Many physicians describe feelings of isolation. Published evidence indicates that some patients and others are pressuring and intimidating doctors to assist in suicides. Some doctors feel they have no choice but to be involved in assisted suicides. Oregon physicians are decreasingly present at the time of the assisted suicide. There is also great potential for physicians to be affected by countertransference issues in dealing with end-of-Iife care, and assisted suicide and euthanasia..

Stevens KR. Emotional and Psychological Effects of Physician-Assisted Suicide and Euthanasia On Participating Physicians. The Linacre Quarterly. 2006;73(3).

“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.

Conscientious objection and emergency contraception

Robert F Card

Abstract
This article argues that practitioners have a professional ethical obligation to dispense emergency contraception, even given conscientious objection to this treatment. This recent controversy affects all medical professionals, including physicians as well as pharmacists. This article begins by analyzing the option of referring the patient to another willing provider. Objecting professionals may conscientiously refuse because they consider emergency contraception to be equivalent to abortion or because they believe contraception itself is immoral. This article critically evaluates these reasons and concludes that they do not successfully support conscientious objection in this context. Contrary to the views of other thinkers, it is not possible to easily strike a respectful balance between the interests of objecting providers and patients in this case. As medical professionals, providers have an ethical duty to inform women of this option and provide emergency contraception when this treatment is requested.

Card RF. Conscientious objection and emergency contraception. Am. J. Bioeth. 2007;7(6):8-14.

(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.

What is the relevance of women’s sexual and reproductive rights to the practising obstetrician/gynaecologist?

Dorothy Shaw, Anibal Faúndes

Best Practice and Research Clinical Obstetrics & Gynaecology

Abstract
Women’s sexual and reproductive rights are an integral part of daily practice for obstetricians/gynaecologists and the key to the survival and health of women around the world. Women’s sexual and reproductive health is often compromised because of infringements of their basic human rights, not the lack of medical knowledge. Understanding the relevance of respecting and promoting sexual and reproductive rights is critical for providing current standards of care, and includes access to information and care, confidentiality, informed consent and evidence-based practice. The violation of women’s rights in their daily lives through common problems such as gender-based violence and discrimination results in serious consequences for their health. Obstetricians/gynaecologists are natural advocates for women’s health, yet may be lacking in their understanding of relevant laws or the limits of conscientious objection. This chapter outlines the framework for sexual and reproductive rights, and explores its relevance to the practising clinician.

Shaw D, Faúndes A. What is the relevance of women’s sexual and reproductive rights to the practising obstetrician/gynaecologist? Best Practice and Research Clinical Obstetrics and Gynaecology. 2006 Jun;20(3):299-309.