Pharmacy Archives - Page 3 of 7 - Protection of Conscience Project Library

Adjudicating rights or analyzing interests: ethicists’ role in the debate over conscience in clinical practice

Armand H Matheny Antommaria

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.

Antommaria AHM. Adjudicating rights or analyzing interests: ethicists’ role in the debate over conscience in clinical practice. Theor Med Bioeth. 2008;29(3):201-212.

The Conscience Clause in American Pharmacy: An Historical Overview

Robert A Buerki

Extract
Conscience is a tricky business. Some interpret its personal beacon as the guide to universal truth. But the assumption that one’s own conscience is the conscience of the world is fraught with dangers. As C. S. Lewis wrote, “Those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.” As nations become more ethnically and religiously diverse, and science and medicine develop new and more complex health interventions, new forms of conscientious objections are likely to emerge. Conscientious objection is not simply a matter for individual pharmacists; it is a matter that must engage the entire profession of pharmacy and society as a whole. Professional associations, boards of pharmacy, and state legislatures must work together to prevent patients from bearing the burdens of excusing pharmacists from delivering the full measure of pharmaceutical care.

Buerki RA. The Conscience Clause in American Pharmacy: An Historical Overview. Pharmacy in History. 2008;50(3):107-118.

Conscientious refusal by physicians and pharmacists: Who is obligated to do what, and why?

Dan W Brock

Abstract
Some medical services have long generated deep moral controversy within the medical profession as well as in broader society and have led to conscientious refusals by some physicians to provide those services to their patients. More recently, pharmacists in a number of states have refused on grounds of conscience to fill legal prescriptions for their customers. This paper assesses these controversies. First, I offer a brief account of the basis and limits of the claim to be free to act on one’s conscience. Second, I sketch an account of the basis of the medical and pharmacy professions’ responsibilities and the process by which they are specified and change over time. Third, I then set out and defend what I call the “conventional compromise” as a reasonable accommodation to conflicts between these professions’ responsibilities and the moral integrity of their individual members. Finally, I take up and reject the complicity objection to the conventional compromise. Put together, this provides my answer to the question posed in the title of my paper: “Conscientious refusal by physicians and pharmacists: who is obligated to do what, and why?”.

Brock DW. Conscientious refusal by physicians and pharmacists: Who is obligated to do what, and why? Theor Med Bioeth. 2008;29(3):187-200.

Moral Courage Through a Collective Voice

(Ethics and Rural Healthcare)

Julie Aultman

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.

Aultman J. Moral Courage Through a Collective Voice (Ethics and Rural Healthcare). Am J Bioeth. 2008;8(4):67-69.

Conscientious Objectors Behind the Counter: Statutory Defenses to Tort Liability for Failure to Dispense Contraceptives

Jennifer E. Spreng

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.

Spreng JE. Conscientious Objectors Behind the Counter: Statutory Defenses to Tort Liability for Failure to Dispense Contraceptives. 1 St. Louis U. J. Health L. & Pol’y 337, 337-40 (2008)

Pharmacists and the “Duty” To Dispense Emergency Contraceptives

Jennifer E Spreng

Abstract
Stories abound of both women with prescriptions turned away at the pharmacy door and members of the most trusted health care profession losing jobs and running afoul of ethics rules. Scholars have spilt much intellectual ink divining whether a pharmacist must dispense Plan B, the primary emergency contraceptive. Now, many are calling for a common law “duty to dispense” that could serve as a foundation for a wrongful pregnancy action against a dissenting pharmacist. Such a duty simply does not arise from established tort principles or pharmacist-specific precedents. Only in rare circumstances will a pharmacist and customer have the type and quality of relationship giving rise to a duty to dispense. Nevertheless, law changes over time and makes allowances for unique circumstances. Pharmacists are taking on more responsibility for drug therapy. They have an awkward role in the distribution of Plan B. Moreover, while the law may protect pharmacists’ consciences, it may not be so receptive to pharmacists-as-activists. Dissenting pharmacists can take practical steps to protect themselves today, but tomorrow is another day.

Spreng JE. Pharmacists and the “Duty” To Dispense Emergency Contraceptives. Issues Law Med. 2008 Spring;23(3):215-277.

The Limits of Conscience: Moral Clashes Over Deeply Divisive Healthcare Procedures

Robin Fretwell Wilson

Extract
Refusals by individual pharmacies and pharmacists to fill prescriptions for emergency contraceptives (“EC”) have dominated news headlines. . .These refusals. . .reflect moral and religious concerns about facilitating an act that would cut-off a potential human life.

Recently, conscience-based refusals have ballooned far beyond EC. Pharmacists are refusing to fill prescriptions for birth control, and other ancillary care professionals are asserting their own conscience concerns.

Conclusion
Ultimately we must decide as a community whether we prize access more highly than religious freedom. The older healthcare conscience clauses offer us a range of methods to manage the clash between competing moral interests. If urgency for the service cannot be achieved through better information, state legislatures could make a number of choices. They could choose not to burden the professional’s choice at all—prizing religious liberty more highly than access. They could force providers to provide every service legally requested—prizing patient access more highly than moral or religious freedom. Or they could choose to allow individuals of conscience to exempt themselves up to the point that it creates a hardship for the patient or employer. In a pluralistic society, a live-and-let-live regime like this may be the most we can hope for.

Wilson RF. The Limits of Conscience: Moral Clashes Over Deeply Divisive Healthcare Procedures. Am J Law Med. 2008 Mar 01;34(1):41-63.

Ethical, religious and factual beliefs about the supply of emergency hormonal contraception by UK community pharmacists

Richard J Cooper, Joy Wingfield, Paul Bissell

Journal of Family Planning and Reproductive Health Care

Abstract
Background and methodology
Community pharmacists’ role in the sale and supply of emergency hormonal contraception (EHC) represents an opportunity to increase EHC availability and utilise pharmacists’ expertise but little is known about pharmacists’ attendant ethical concerns. Semi-structured qualitative interviews were undertaken with 23 UK pharmacists to explore their views and ethical concerns about EHC.

Results
Dispensing EHC was ethically acceptable for almost all pharmacists but beliefs about selling EHC revealed three categories: pharmacists who sold EHC, respected women’s autonomy and peers’ conscientious objection but feared the consequences of limited EHC availability; contingently selling pharmacists who believed doctors should be first choice for EHC supply but who occasionally supplied and were influenced by women’s ages, affluence and genuineness; non-selling pharmacists who believed EHC was abortion and who found selling EHC distressing and ethically problematic. Terminological/factual misunderstandings about EHC were common and discussing ethical issues was difficult for most pharmacists. Religion informed non-selling pharmacists’ ethical decisions but other pharmacists prioritised professional responsibilities over their religion.

Discussion and conclusions
Pharmacists’ ethical views on EHC and the influence of religion varied and, together with some pharmacists’ reliance upon non-clinical factors, led to a potentially variable supply, which may threaten the prompt availability of EHC. Misunderstandings about EHC perpetuated lay beliefs and potentially threatened correct advice. The influence of subordination and non-selling pharmacists’ dispensing EHC may also lead to variable supply and confusion amongst women. Training is needed to address both factual/terminological misunderstandings about EHC and to develop pharmacists’ ethical understanding and responsibility.

Cooper RJ, Wingfield J, Bissell P. Ethical, religious and factual beliefs about the supply of emergency hormonal contraception by UK community pharmacists. J Fam Plan & Repro Health Care. 2008 Jan 01;34(1):47-50.

Pharmacists’ Right of Conscience: Strategies for Showing Respect for Pharmacists’ Beliefs While Maintaining Adequate Care for Patients

Jessica D Yoder

Extract
Conclusion
In conclusion, states may provide pharmacists and pharmacies with rights of conscience without infringing upon the constitutional rights of patients. Pharmacists’ beliefs should be respected and accommodated, especially when there are ways to do so without depriving patients of validly prescribed medications. Specific conscience clause legislation is the best method for protecting pharmacists’ consciences, and such legislation also provides the most clarity and certainty when well- drafted. Conscience clause legislation should address who is covered, whether a religious objection is required, the medications involved, the scope of the protection, any requirements for compliance, and whether a private cause of action is created. Such legislation provides adequate protection to pharmacists and clarifies the rights of both pharmacists and patients. If such legislation operates in tandem with policies such as pharmacist prescribing, doctor dispensing, and doctor referrals to pharmacies known to handle the prescription, which have shown promise in some states, then patients should have adequate access to medications without forcing pharmacists to compromise their beliefs.

Yoder JD. Pharmacists’ Right of Conscience: Strategies for Showing Respect for Pharmacists’ Beliefs While Maintaining Adequate Care for Patients. Valparaiso U Law Rev. 2007 Winter;41(2):975-1025.

Harm reduction or women’s rights? Debating access to emergency contraceptive pills in Canada and the United States

LL Wynn, Joanna N Erdman, Angel M Foster, James Trussell

Abstract
This article compares the ethical pivot points in debates over nonprescription access to emergency contraceptive pills in Canada and the United States. These include women’s right to be informed about the contraceptive method and its mechanism of action, pharmacists’ conscientious objection concerning the dispensing of emergency contraceptive pills, and rights and equality of access to the method, especially for poor women and minorities. In both countries, arguments in support of expanding access to the pills were shaped by two competing orientations toward health and sexuality. The first, “harm reduction,” promotes emergency contraception as attenuating the public health risks entailed in sex. The second orientation regards access to pills as a question of women’s right to engage in nonprocreative sex and to choose from among all reproductive health-care options. The authors contend that arguments for expanding access to emergency contraceptive pills that frame issues in terms of health and science are insufficient bases for drug regulation; ultimately, women’s health is also a matter of women’s rights.

Wynn LL, Erdman JN, Foster AM, Trussell J. Harm reduction or women’s rights? Debating access to emergency contraceptive pills in Canada and the United States. Stud Fam Plann. 2007 Dec 07;38(4):253-257.