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

Prescription Ethics: Can States Protect Pharmacists Who Refuse to Dispense Contraceptive Prescriptions?

Maryam T Afif

Extract
Conclusion
Offering legal protection to pharmacists comes at too great a cost to women’s health and legal rights. The pill is a viable and effective method of birth control for many women and, as Congress has noted, it can be used to prevent other social, economic, and medical problems. The Supreme Court has clearly established that a state cannot interfere with a woman’s right to access contraceptives, including the pill. While pharmacists should be free to practice their religion, that practice cannot interfere with their professional duty to dispense valid prescriptions free of moral judgment. Furthermore, the vague wording in most conscience clause statutes does not restrict objections to those of a religious nature. A pharmacist can use any personal moral objection as an excuse not to dispense a prescription. The result of a pharmacist’s objection can be quite severe for the patient (an unintended pregnancy or health problems), and the duties imposed under tort law should apply. A pharmacist should not be able to escape the legal consequences of his or her actions. States that allow pharmacists to do so are clearly protecting the rights of a small segment of their citizens at the expense of others. If these statutes are challenged in court, it is likely that the statutes will be found to be unconstitutional. While this is a serious consequence, it is appropriate given the rights at stake.

Afif MT. Prescription Ethics: Can States Protect Pharmacists Who Refuse to Dispense Contraceptive Prescriptions? Pace Law Review. 2005;26(1):243-272.

Conscientious Objection and the Pharmacist

Henri R Manasse Jr

Abstract
What has been lost in the media coverage of and political dialogue about this issue are the nuances and implications of conscientious objection. Like their physician and nurse colleagues, pharmacists routinely operate within both professional and personal ethical frameworks (3). On a personal level, pharmacists have the same rights as their fellow health-care colleagues. Like a surgeon who refuses to perform abortions because of a personal moral objection or a nurse who believes that turning off a patient’s respirator would contradict her beliefs on the sanctity of life, pharmacists must be allowed to be true to their own belief systems as they practice their profession. This does not mean that pharmacists should be allowed to impose their personal morals on patients under their care. As with physicians and nurses, it simply means that pharmacists must maintain the right to “step away” from the offending activity and should refer the patient in question to another pharmacist who can dispense the prescription.

Manasse Jr HR. Conscientious Objection and the Pharmacist. Science. 2005 Jul 10;308(5728):1558-1559.

Conscience Clauses for Pharmacists: The Struggle to Balance Conscience Rights with the Rights of Patients and Institutions

Matthew White

Abstract
Conclusion
. . .The patchwork of current conscience protection for pharmacists indisputably fails its purpose-in almost all cases the current legislation is severely one-sided and out of date. Although such conscience protection admirably attempts to embody the purposes of the First Amendment, most of the actual and proposed legislation suffers from severe partisan myopia. Statutes purporting to offer absolute protection to patients, to employers, or to health care providers rather than striking a balance tend to prolong and enlarge conflict rather than resolve it. . .

Patients, pharmacists, and employers all have civil rights implicated in the delicate interactions that surround the use of oral contraception, and decisive action should be taken to enact statutes that protect the rights of each, rather than statutes that protect one group exclusively. Legislators should make a painstaking effort to craft new conscience legislation that protects the conscience rights of pharmacists without inserting the pharmacist between the patient and her doctor. Such legislation should also make some provision for employers that would be substantially burdened by an inability to conduct their business in the event of a bona fide conscience claim.

White M. Conscience Clauses for Pharmacists: The Struggle to Balance Conscience Rights with the Rights of Patients and Institutions. Wisc Law Rev. 2005;6(1611-1648.

(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

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.

Reproductive Health Services and the Law and Ethics of Conscientious Objection

Bernard M Dickens

Abstract
Reproductive health services address contraception, sterilization and abortion, and new technologies such as gamete selection and manipulation,in vitro fertilization and surrogate motherhood. Artificial fertility control and medically assisted reproduction are opposed by conservative religions and philosophies, whose adherents may object to participation. Physicians’ conscientious objection to non-lifesaving interventions in pregnancy have long been accepted. Nurses’ claims are less recognized, allowing nonparticipation in abortions but not refusal of patient preparation and aftercare. Objections of others in health- related activities, such as serving meals to abortion patients and typing abortion referral letters, have been disallowed. Pharmacists may claim refusal rights over fulfilling prescriptions for emergency (post-coital) contraceptives and drugs for medical (i.e. non-surgical) abortion. This paper addresses limits to conscientious objection to participation in reproductive health services, and conditions to which rights of objection may be subject. Individuals have human rights to freedom of religious conscience, but institutions, as artificial legal persons, may not claim this right.

Dickens BM. Reproductive Health Services and the Law and Ethics of Conscientious Objection. Med Law. 2001;20(2)283-293.

Conscience clause: moral compromise

Chris Thatcher

Extract
Ask your pharmacist: It’s the ubiquitous slogan of the past decade, underscoring the campaigns of most national and provincial pharmacy organizations as they promote the value of pharmacy services. But what if the question is about RU-486, the abortion drug, or Preven, the morning-after-pill? What if the question is from a physician seeking information on terminal sedation or assisted suicide?

Such questions push, and often breach, an ethical boundary for some pharmacists, who find their desire to help the patient in conflict with their moral convictions. And the ethical quagmire is likely to get deeper as advocacy groups press the federal government to allow physician-assisted suicide and various health organizations promote greater access to emergency postcoital contraception.

If these practices compromise your moral convictions, could you be fired by your employer for refusing to fill a prescription? More specifically, is there a point at which your personal beliefs supersede your obligation to the patient? That’s the difficult question posed by an Alberta-based group called Concerned Pharmacists for Conscience, which has suggested a conscience clause to protect pharmacists in such situations.

Thatcher C. Conscience clause: moral compromise. Can Pharm J. 1999;132(7):10-11

Pharmaceutically assisted death and the pharmacist’s right of conscience

William L Allen, David B Brushwood

Extract
In this article, we describe the pharmacist’s potential involvement in what has been referred to as “physician assisted suicide”. We suggest that when a physician prescribes a medication for the purpose of terminating a patient’s life, and when that prescription is presented to a pharmacist for filling, a moral dilemma may exist. The basis of the dilemma is the choice a pharmacist may be required to make between the duty to fill a legal prescription for a medication that is deemed appropriate by both the prescriber and the patient, and the duty to adhere to one’s own belief that medication should not be used to end life. We contend that in filling a prescription, especially given the recent advances in pharmacy practice, a pharmacist is no mere bystander in drug therapy. Rather, the pharmacist is an active participant whose values, attitudes, and beliefs should be given consideration.

Allen WL, Brushwood DB. Pharmaceutically assisted death and the pharmacist’s right of conscience. J Pharm Law. 1996;5(1):1-18

Conscientious objection and abortifacient drugs

D B Brushwood

Abstract
The legal right to assert a conscientious objection is reviewed, using as an example the dispensing of abortifacient drugs by pharmacists. The three areas of law that most significantly concern the right to assert a conscientious refusal are employment law, conscience clauses, and religious discrimination law. Each of these is reviewed, with descriptions of recent cases. It is concluded that employment law protects refusals that are consistent with public policy, but does not permit an employee’s personal policy to determine how a business will be run; that conscience clauses appear to provide protection for pharmacists who object to dispensing abortifacients, but that the precise meanings of critical words and phrases in some clauses need to be defined; and that even though laws of religious discrimination require that employers accommodate religious beliefs, they may not protect a pharmacist who objects to dispensing abortifacients if the accommodation becomes unreasonably burdensome.

Brushwood DB. Conscientious objection and abortifacient drugs. Clin Therapeutics. 1993 Jan-Feb;15(1):204-212.