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Academics argue against "conscience clause" for pharmacists

By News team

All pharmacists in the UK and Ireland should be required to dispense emergency hormonal contraception (EHC) regardless of their moral or religious objections, according to a perspective paper published in the Journal of Medical Ethics (online, 30 January 2013).

Alternatively, those who object to dispensing EHC should also refuse to refer patients to other suppliers, and face up to whatever regulatory consequences might follow, the paper says.

It argues against the General Pharmaceutical Council and Pharmaceutical Society of Ireland’s use of a “conscience clause”, which allows pharmacists to refuse to dispense EHC on religious or moral grounds as long as they help patients to access the service elsewhere.

Any rules governing the supply of EHC should be universally applicable, say the authors, who hail from the University of Hertfordshire pharmacy department and the School of Pharmacy at the Royal College of Surgeons in Ireland. They warn of the “inevitable incidence” of a pharmacist refusing to supply EHC to a patient who cannot be referred elsewhere — for example, in a rural area where the nearest alternative supplier might not be accessible within the 72-hour time window.

They also argue that pharmacists who conscientiously object to dispensing EHC and yet refer patients to another provider are convincing themselves of an ethical distinction that does not exist. “The situation is morally no different from refusing to supply 200 paracetamol tablets to a depressed customer for the purpose of committing suicide but explaining to him that he can purchase 16 tablets in each of the dozen newsagents in the surrounding area. If they do not believe that paracetamol should be put to this purpose, then they must remove themselves entirely from the chain of supply.”

The GPhC and PSI have created an unsatisfactory “pass the buck” system, whereby conscientious objectors to EHC still facilitate the use of the drug and patients are subjected to “the indignity of being morally judged by those whose duty it is to see to their healthcare needs”, say the authors.

Responding to the criticisms, the GPhC highlighted its guidance on the provision of pharmacy services affected by religious and moral beliefs. The guidance specifically says that if pharmacists’ beliefs prevent them from providing a service then, before accepting employment, they should think about where they are going to work and whether the services they will object to providing are accessible elsewhere in the vicinity.

Duncan Rudkin, chief executive of the GPhC, said: “Putting patients’ interests first is the overriding principle in the professional standards that all pharmacists must follow… . Individual pharmacists have a professional responsibility to ensure that their own beliefs do not impact adversely on patients.” The standards also remind pharmacists that they must not discriminate against patients on the grounds of religion, belief, lifestyle or for any other reason, he told PJ Online.

The GPhC is planning to review its standards of conduct, ethics and performance in 2013–14, including standard 3.4, or the “conscience clause”.

In a meeting last April the council noted the interim findings of a review of standard 3.4, including the rights and responsibilities set out in human rights legislation and the position of other health professional regulators. Both the General Medical Council and the Nursing and Midwifery Council have conscience clauses akin to the GPhC’s — however, the NMC’s clause does not allow registrants to refuse to supply EHC.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2013.11116408

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