Conscience Project Report 2000-01

An instruction from the Ethics Advisory Committee of the College of Pharmacists of British Columbia was published in the March/April, 2000 issue of the College newsletter, the Bulletin. This instruction included statements that impugned the integrity of conscientious objectors within the profession. The Registrar of the College later acknowledged that she had no evidence to support the statements made in the bulletin, but refused to retract them and apologize.

Similar statements were made in an article by one of the Ethics Advisory Committee members that appeared in the Canadian Pharmaceutical Journal. The author of the article has ignored requests that evidence be provided to support the statements.

Publication of unsubstantiated imputations of dishonesty contradicts ethical principles that ought to govern the conduct of an Ethics Advisory Committee, and appears inconsistent with Value VII of the Code of Ethics of the College of Pharmacists of B.C. The subsequent refusal to retract and apologize is troubling for the same reasons. However, Committee members appear to have acted as a result of ignorance rather than malice. This may be related to the nature of the Committee.

The Ethics Advisory Committee is an ad hoc group. There is no policy governing selection of its members or appointments to the Committee, and its members lack formal qualifications in ethics, philosophy, or related disciplines. There is no policy governing its operation. This policy vacuum lends itself to ethical nepotism and the exclusion of people whose views differ from those of the College establishment. It has an adverse impact on those who seek to live and work in conformity to transcendent ethical principles, particularly religious believers.

INTRODUCTION

The last decade saw increasing interest in drug-induced abortion and growing pressure - occasionally successful - to legalize euthanasia and assisted suicide. Execution by lethal injection is practised in some jurisdictions, and developing reproductive technologies may require pharmaceutical products.

Pharmacists who have moral or ethical objections to some or all of these procedures have been forced to re-examine their drug distribution practices. Some have concluded that they will not dispense drugs for these purposes, because to do so would constitute participation in an immoral act. For the same reason, others have decided that they will neither dispense the drugs, nor refer patients for them.

The growing concern among some in the profession is illustrated by an increasing number of protection of conscience laws or policies. These provide safeguards against discrimination or retaliation, though the degree of protection depends upon the wording of the ‘conscience clause’.

The provision of health care in Canada is within the jurisdiction of provincial governments. Each province has a pharmacy association or college that is legally responsible for the regulation of the profession. These bodies establish and enforce guidelines for competent and ethical pharmacy practice, including conscientious objection.

The Code of Ethics of the College of Pharmacists of British Columbia subordinates freedom of conscience to the delivery of pharmacy products and services. It does so by demanding that conscientious objectors refer patients to another pharmacist to obtain morally controversial products, and supply the product themselves if another pharmacist is unavailable.¹ This problem is beyond the scope of this report. [Contents]

THE ISSUES

This report is concerned with only two points:

a) Prejudicial statements made by the Ethics Advisory Committee

b) Ethics Advisory Committee structure and policy

a) Prejudicial statements made by the Ethics Advisory Committee
The Ethics Advisory Committee published an instruction to secure compliance to its rule on conscientious objection. [Appendix "B"]. Referring to pharmacists who have moral objections to some pharmacy services, the instruction, purporting to present their argument, included the following passage:

They should be able to dissuade patients requesting these services by denying their availability, or providing information under the guise of patient counselling . . .

Confirming the imputation of dishonesty, the Bulletin continued:

. . . the profession cannot allow pharmacists to lie about the existence of these services or promote their moral viewpoint in an attempt to persuade patients not to seek recognized pharmacy services they find objectionable.

No evidence was provided to support these statements, which portrayed conscientious objectors as liars or dishonest manipulators. The statements were repeated and amplified - again, without evidence - in an article in a national pharmacy journal in May, 2000:

A third concern is that pharmacists should be able to deny certain legitimate pharmacy services exist . . . or at least to be able to attempt to dissuade such patients, under the guise of patient counselling, by stating religious or moral beliefs as if they were scientific facts. This establishes that lying is justified if pharmacists object to providing contentious services. Denying such services exist is an outright lie, and attempting to dissuade patients by arguments based on personal religious or moral beliefs offered as scientific fact is a dishonest attempt to obtain informed consent . . .

The professional [sic - should read public?]cannot consider it just bad luck if patients are denied recognized pharmacy services, or receive misleading or incorrect information from pharmacists who object to the services.²

The publication of the Bulletin and the article in the Canadian Pharmaceutical Journal impugned the integrity of conscientious objectors, exposing them to the contempt of their colleagues and the public. This was reflected at the convention of the Canadian Pharmacy Association in June, 2000, where the Journal article was cited; two objectors were told during lunch that they should leave the profession.³

b) Ethics Advisory Committee structure and policy
The publication of unsubstantiated imputations of dishonesty is inconsistent with the raison d’être of an ethics committee. When such an anomaly is observed, it is appropriate to determine if it may be the result of attitudes, structures and policies influencing the committee. [Contents]

ADDRESSING THE ISSUES

a) Prejudicial statements made by the Ethics Advisory Committee
A spokesperson for Concerned Pharmacists for Conscience protested the College Bulletin:

. . . I wish to make several points absolutely clear. CPC’s objective is for pharmacists to have the right to refuse to participate in procedures they find morally repugnant, without repercussions. CPC equally respects the freedom of conscience of pharmacists who wish to participate, and those who do not wish to participate, in morally controversial procedures. CPC does not promote blocking access or availability, or prevent other pharmacists from participating.

. . . Can you provide proof that conscientious objectors are guilty of judging, preaching or dissuading patients? [emphasis in original]. . . your College has made such accusations . . . by implying conscientious objectors dissuade patients under the "guise of patient counselling", "lie about the existence of services to patients" and attempt to "promote their moral viewpoint."⁴

Since the Registrar did not acknowledge receipt of this letter, the spokesperson wrote again, repeating her request that the College provide proof of the statements made in the bulletin. She also referred to the Canadian Pharmaceutical Journal article:

Frank Archer’s prejudicial and religiously discriminatory article . . . is an erroneous legal analysis of human rights law. . . Am I correct in understanding that the College of Pharmacists of B.C. supports the opinions of Frank Archer?⁵

The letter was not answered, and the College did not modify the statements made in the Bulletin in light of the information provided by Concerned Pharmacists for Conscience.

Beginning in April, 2000, the Administrator attempted a dialogue with the College of Pharmacists of British Columbia, focussed on its March/April 2000 Bulletin. The Registrar of the College broke off correspondence in July, having written two letters that she believed "provided all the necessary information."[Appendix "C"]

The Administrator acknowledged her position, but pointed out that her letters had not addressed the prejudicial statements made in the Bulletin. He requested that the Registrar provide evidence to support them, or retract them and apologize. This request, repeated in two subsequent letters, was ignored. [Appendix "C"]

In October, 2000 the Administrator filed a request under the Freedom of Information and Protection of Privacy Act to obtain access to all documents held by the College on subjects related to protection of conscience issues, dating from 1 January, 1995. The last of over 240 pages was received by the Administrator at the end of January, 2001. None of the documents contained anything to substantiate the offending passages in the Bulletin or the Canadian Pharmaceutical Journal article.

The Administrator wrote to the Registrar to point this out, and asked her to confirm that the College had no evidence to support the statements made in the Bulletin. When the Registrar failed to respond clearly, the Administrator challenged her with the assertion that the College could not justify the statements in the Bulletin and that their publication was unethical. He asked if the College would retract them and apologize. The Registrar refused to do so. [Appendix "C"]

The author of the Canadian Pharmaceutical Journal article did not respond to four letters from the Administrator, who, as a matter of courtesy, had sent him a copy of a critique of his Journal article. [Appendix "D"] The editor of the Journal did not respond to letters directing his attention to the problem, but has recently agreed to review the matter. [Appendix "E"] [A response has now appeared in an editorial in the CPJ April, 2001 issue - Administrator -]

b) Ethics Advisory Committee structure and policy
The response to the Administrator’s access to information request disclosed that the creation of the Ethics Advisory Committee was mooted during the discussion of a five person task force revising the College’s Code of Ethics.⁶ The Council approved the formation of the Committee with the terms of reference suggested by the Registrar, later revised. [Appendix "A"]

The College has not established the structure of the Ethics Advisory Committee, qualifications for membership, nor set a term of office for its members. There is no policy or process to identify or select members of the Committee, nor a policy requiring that the reasons for rejection of applicants be recorded. There are no bylaws governing its operation. [Appendix "C"]

It appears that members of the task force revising the College Code of Ethics simply continued as members of the Ethics Advisory Committee, augmented by additional appointments.⁷There were seven members of the Committee as of November, 2000.

The members of the Ethics Advisory Committee are all registered pharmacists or former pharmacists. They all hold a Bachelor of Science in Pharmacy degree and have extensive experience as pharmacy practitioners .⁸

The Registrar of the College has been unwilling make enquiries about their formal qualifications in ethics, philosophy or related disciplines. When pressed - repeatedly - to provide this information , she would say only that all of them "have encountered and responded to a variety of ethical dilemmas in the course of their practice as pharmacists". [Appendix "C"]. One concludes that none of them have formal qualifications specific to their role as ethics advisors. [Contents]

COMMENT

This report has a narrow focus: the publication of unsubstantiated imputations of dishonesty. These are liable to encourage bias against conscientious objectors, impose a strain on collegial relations, and adversely impact the workplace environment. The statements offend against ethical notions of justice, non-maleficence and beneficence, and appear contrary to Value VII of the Code of Ethics of the College of Pharmacists of British Columbia.⁹

The injustice visited upon conscientious objectors by the Ethics Advisory Committee becomes more evident if one re-reads the offending passages as if they had been directed at an identifiable group. For example, similar accusations against Asians in the profession would have generated widespread criticism of the College, even if it had some evidence that this or that Asian pharmacist had been found to be dishonest. Negative stereotyping of groups on the basis of isolated incidents is no more acceptable than blind prejudice.

While the misrepresentations of the Committee were unjust, offensive and harmful, it would go beyond the evidence to suggest that they were deliberate. Committee members appear to have acted from ignorance rather than malice. This is indicated by two reviews of the Journal article, one by a constitutional lawyer, that found serious errors in explanations of human rights and labour law, as well as unfamiliarity with basic philosophical concepts that impact ethical reasoning.¹⁰

Moreover, one laments the emphasis in the Bulletin and Journal article on the paradigm of the law of contract, to the exclusion of ethical reflection on freedom of conscience. The authors seem completely unaware of ethical traditions that see freedom of conscience - always understood as a properly formed conscience - as constituent of the nature and dignity of the human person. Nor do they seem to grasp that a pharmacist has only one conscience, by which he must be guided in both private and professional affairs.

Thus, the misrepresentations of the Committee, while damaging, are just a symptom of the underlying problem: the hegemony of 'establishment ethics', and the resulting tendency to suppress all other ethical traditions.¹¹

The absence of College policy governing the Ethics Advisory Committee encourages the development of this ethical nepotism - ‘old boys’ networking that ensures the de facto exclusion from the Committee of anyone who would seriously challenge its understanding of ethics. Among the excluded classes of people are those who adhere to transcendent ethical or moral principles and apply them in daily life and work- precisely those people, in other words, for whom freedom of conscience is a most fundamental good. This is likely to have a disproportionate impact on religious believers. [Contents]

SUMMARY

1. The Ethics Advisory Committee of the College of Pharmacists of British Columbia impugned the integrity of conscientious objectors within the profession in statements made in an instruction published in the March/April, 2000 issue of the College newsletter, the Bulletin.

2. In an article published in the Canadian Pharmaceutical Journal, a member of the Committee expanded upon and amplified these statements.

3. The College has not produced evidence to support the statements made in the Bulletin.. The Registrar of the College of Pharmacists of British Columbia has refused to retract the offending statements or apologize for their publication.

4. The author of the Canadian Pharmaceutical Journal article has not substantiated the statements made in that publication, and has ignored repeated requests that he provide evidence to support the statements made.

5. The statements made in the Bulletin are likely to encourage bias against conscientious objectors, impose a strain on collegial relations, and adversely impact the workplace environment. There is evidence that this has occurred.

6. Publication of unsubstantiated imputations of dishonesty contradicts ethical principles that ought to govern the conduct of an Ethics Advisory Committee, and appears contrary to Value VII of the Code of Ethics of the College of Pharmacists of British Columbia. The subsequent refusal to retract and apologize is troubling for the same reasons. Nonetheless, the objectionable statements appear to have resulted from ignorance rather than malice.

7. The Ethics Advisory Committee is an ad hoc group. There is no policy governing selection of its members or appointments to the Committee, and its members lack formal qualifications in ethics, philosophy, or related disciplines. There is no policy governing its operation.

8. The policy vacuum in which the Ethics Advisory Committee operates is conducive to ethical nepotism and exclusion of diverse ethical viewpoints, with a disproportionate and adverse impact on religious believers. [Contents]

RECOMMENDATIONS

1. The Council of the College of Pharmacists should require the Registrar to retract the offending passages in the Bulletin of March/April, 2000, and apologize for their publication.

2. The Council of the College of Pharmacists should require the author of the article "Emergency Contraceptives and Professional Ethics A Critical Review", Canadian Pharmaceutical Journal, Vol. 133, No. 4, May, 2000 , to retract the offending passages in the article and apologize for their publication.

3. The Council of the College of Pharmacists should enact policies governing the operation of the Ethics Advisory Committee. These policies should include reference to:

a) Qualifications for membership

b) Reflection of true ethical diversity in the appointment of Committee members, so that religious believers and others adhering to transcendent ethical or moral norms are not excluded from membership

c) Procedures for selection and rejection of applicants

d) Keeping record of formal qualifications of sitting members in ethics, philosophy or related disciplines, or the absence thereof

e) Terms of office

f) Formal consultation with religious and other ethical authorities

g) Accommodation of diverse ethical viewpoints within the profession, so that religious believers are not excluded from the profession

4. The Council of the College of Pharmacists should review procedures governing admission to faculties or schools of pharmacy and enact policies to ensure that religious believers and others adhering to transcendent ethical or moral norms are not excluded from teaching or education.

5. The Council of the College of Pharmacists should direct that the Registrar and members of the Ethics Advisory Committee responsible for the publication of the offending passages in the Bulletin and Canadian Pharmaceutical Journal be recused from participation in disciplinary hearings or commentary involving Value IX of the Code of Ethics. [Contents]