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"Forced from the profession" by emergency contraception?

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As a well taught pharmacy student I cite the care of patients as my first concern. Although personally against abortion and possibly the use of emergency contraception, I think patients should have the choice. In light of this, I was drawn to a couple of media articles a few weeks ago. Journalists and lawyers were keen to question the wisdom of the GPhC guidance (September 2010) provided to pharmacists on providing services affected by religious and moral beliefs.

It's clear that pharmacists' personal advocacy (or not) of EHC depends, broadly speaking, on the extent to which they believe they have the authority to make decisions about life and death, based on core beliefs and secondary opinions in greyer areas. I could be a pharmacist opposed my own personal use of EHC on the grounds that it is designed work after possible conception. I could even be a pharmacist unwilling to sell or supply EHC.

Having resolved to put patients first, to what extent can pharmacists with these beliefs legitimately opt out of providing EHC as a service on the grounds of personal beliefs? For many, there’s no debate at all. For others it’s an epic task deciphering where the line should be drawn when deeming conscientious objection (religious or otherwise) justifiable. For some Muslim, Jewish and Christian pharmacists, this debate might well bring to life the reality of religious discrimination. 

Although many seem to disagree, I concur with the practical GPhC guidelines given to pharmacists unwilling to provide the service themselves. I don’t think it unreasonable to ask those declining the provision of EHC to signpost an alternative supplier for patients.

Understandably, however, pointing someone towards something can be perceived equal to supplying it. Lawyer Neil Addison, who comments on religious discrimination law, expressed concerns that the guidance misses the point of conscientious objection.

“What many people do not seem to grasp is the fact that if you are refusing to do something because it is morally objectionable you cannot be obliged to recommend someone else. If they (the GPhC), accept that a person has a right to conscientious objection they cannot take it further than that.”

However, when the law allows the public to obtain EHC from community pharmacies it seems outrageous to encourage a system curtailing access by allowing the impact of conscientious objection to spread beyond personal beliefs.

In my opinion, people should have the choice to refuse the sale of certain medicines on the grounds of personal beliefs as long as to do so does not affect the provision of the service overall. Questions remain, however, since in the smallest sense the refusal of one individual sale still affects the provision of the service. Not all patients are willing or physically able to source the medication elsewhere. It could easily be said that those refusing the sale and supply of EHC consciously desire (or at least consent to) compromising public access to EHC.

This is not to say that the concerns raised against the guidance are not valid. Most worrying to some who object to the supply of EHC is the increased likelihood of experiencing religious discrimination, which may arise as a result of pharmacists being required to declare their unwillingness to sell or supply EHC prior to appointment in a community pharmacy job. It’s another grey area. It does seem logical to flag up necessary practicalities for employers who must ensure that services are uncompromised. On the other hand, job applicants may well feel disadvantaged and discriminated against by having to declare their religious views on an application form.

“Anybody who values the sanctity of life from the moment of conception will be forced from the profession.”

Perhaps this is a bit dramatic, but it is a concern of some pharmacists, which shouldn’t be dismissed. My personal views on providing EHC to the public are not such that I’m concerned about being ‘driven from the profession’, but I know there are many from more than one minority group (in terms of religious beliefs) who might feel this way.

Having said this, in terms of potential discrimination, I wonder how far removed choosing to refuse the sale of EHC is from stating on an form that as a Christian I might choose not to work on Sundays. Or indeed, that I am a woman of child bearing age? While confident that the profession recognises the importance of equal opportunities, I feel it surely wise to make sure we’re still alert to and safeguarding against areas where our integrity is at risk of compromise in this area. I'm not sure how this will work out in the reviewed guidance, or what any new rules should consist of, but it will be interesting to find out.

The guidance referred to is non mandatory at present but subject to review in the near future. The guidance in full alongside details about its review can be found on the GPhC website.

NB. my personal view on EHC provision is a secondary to the centre point of the Christian faith, and is therefore likely to differ from that of the person in the next pew. In the same way, the importance I attach to the issue and any specific beliefs may differ from others. I'm sure the same principle applies to beliefs which associate with other faith groups!


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From: Tomorrow's pharmacist blog

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