Friday, 30 April 2010

General Pharmaceutical council & conscientious objection

Though the first of the seven principles of pharmacist professionalism published by the GPhC is "To make patients your first concern", the GPhC's draft standards allow pharmacists to refuse to hand over items that they find distasteful to their beliefs such as emergency contraception. This 'conscience clause' sounds to me as though the first concern is the pharmacist, not the patient.

As this article from the BBC details, a pharmacist refused to hand over the contraceptive pill to a woman, who was told to come back the next day when a member of staff who did not have such objections would be available.

Similar goings on in the US; in 2004 a rape victim was refused emergency contraception in Denton, Texas by 3 pharmacists, who refused to dispense the prescription due to their religious beliefs. In 2005 a Milwaukee pharmacist berated a woman with a prescription for EC shouting “You’re a murderer! I will not help you kill this baby. I will not have the blood on my hands.” In the US, the legislative situation is complicated; conscience clauses are endorsed or forbidden by local state law or alternatively by pharmacy boards, and these laws/codes may apply either to the pharmacy or indvidual pharmacists. Three states have passed laws mandating pharmacies to fill valid prescriptions (with a further state - Illinois - legislating that pharmacies must dispense birth control pills if stocked); a further three have pharmacy board statements requiring pharmacists to dispense valid prescriptions (source: Guttmacher Institute and National Women’s Law Center, 2008).

Back in the UK, the GPhC's draft standards state "3.4 Make sure that if your religious or moral beliefs prevent you from providing a service, you tell the relevant people or authorities and refer patients and the public to other providers".

The draft standards are available at

A consultation exercise is running on the draft standards until 28th May 2010 at

The council should be urged to remove the 'conscience clause' which essentially gives pharmacists the arbitrary right not to dispense medication that has been legally prescribed by a doctor. Whilst conscience clauses may be acceptable in certain situations e.g. a pacifist stance upon conscription to the army, pharmacists are not conscripted. As LaFollette and LaFollette state in an excellent article in The Journal of Medical Ethics (J Med Ethics 2007 33: 249-254):
Some medical professionals want to follow their private consciences without having to sacrifice their livelihood. We understand that. However, since their actions standardly affect others, often profoundly, we should not straightforwardly let them act on that conscience, especially since in their roles they uniquely satisfy some public needs. We should not recognise—nor should medical professionals claim—an unqualified right of conscience.
(Thanks to Epsilon Clue for this one: The Washington Post reports on a 'pro-life' pharmacy which recently closed down due to a lack of customers).

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