APPENDIX "A"
LEGAL FRAMEWORK

Governing statute, regulations and bylaws
The College of Pharmacists of British Columbia regulates the practice of pharmacy in the province under the authority of the Pharmacists, Pharmacy Operations and Drug Scheduling Act (RSBC 1996). Section 2 of the Act imposes upon the College a duty to "serve and protect the public" and exercise its powers "in the public interest"[2(2)a,b]. Section 2 also authorizes the College

(e) to govern registrants according to this Act and the bylaws;

(g) to establish, monitor and enforce standards of practice to enhance the quality of practice and reduce incompetent, impaired or unethical practice among registrants;

(k) to establish, maintain and enforce standards of professional ethics among registrants;

Anyone who practises pharmacy in British Columbia must register with the College [Section 15, 21], and all registered pharmacists are members of the College [Section 3]. The affairs of the College are overseen by a Council comprised of pharmacists elected by their colleagues, and non-pharmacists appointed by the Lieutenant Governor in Council [Section 7]. Bylaws made by the council and approved by the Lieutenant Governor in Council govern the profession [Section 61]. The bylaws may include "standards of practice and conduct to be adhered to by a registrant "[61(2)e] and establish "committees the council determines are necessary or advisable"[61(2)q].

Resolutions passed at annual general meetings of the members of the College are considered to be of an advisory nature, and are not binding on the Council.¹²  [Contents]

Committees required by statute
An inquiry committee established under the Act is responsible for investigating complaints of professional misconduct, and may initiate such investigations [Section 48(1)]. It may refer the matter under investigation to another committee of the College, such as the Ethics Advisory Committee, for a review and report [Section 48(3)]. If the inquiry committee has reasonable and probably grounds to believe that a pharmacist "has been or is negligent or incompetent",[48(8)c] or "has committed professional misconduct or conduct unbecoming a registrant" [48(8)d] it must direct that a disciplinary hearing be held.   [Contents]

Disciplinary hearings are conducted by a panel of three, drawn from a discipline committee of at seven or more persons, at least one of whom must not be a pharmacist [Section 52, 53; Bylaw 4, paragraph 18]. Penalties for conviction range from reprimand through fines and assessment of costs to the cancellation of registration (i.e., dismissal from pharmacy practice) [Section 54]. There is a right of appeal to the Supreme Court by the College council or any person aggrieved or adversely affected by the decision of the disciplinary committee [Section 59].   [Contents]

Committees established by the council
The Council may approve the formation of committees in addition to those required by statute. One of these, the Ethics Advisory Committee, was approved on 14 June, 1997, after the Registrar of the College advised the council of the need for "a group to assist College members and staff, as well as the members of the public, in the interpretation and application of the revised Code of Ethics", with the responsibility "of reviewing the Code on an ongoing basis to ensure its continuing applicability and timeliness."¹³   [Contents]

Ethics Advisory Committee: structure and policy
The original terms of reference for the Committee consisted only of these brief statements by the Registrar. The following year, the original terms of reference were rescinded by the council and replaced with the following:

1. Provide advice and guidance to members of the College (either individually or as a group) regarding ethical questions and dilemmas.

2. Review and recommend updates to the Code of Ethics as necessary.

3. Consult on education program proposals relating to ethics issues.

4. Serve a liaison function with the Faculty of Pharmaceutical Sciences on matters concerning the ethics education of students.¹⁴  [Contents]

Unprofessional conduct
Bylaw 9 of the council defines ‘unprofessional conduct’, including within the term "failing to comply with the Code of Ethics of the College of Pharmacists of British Columbia."¹⁵ It is reasonable to suppose that the Ethics Advisory Committee would have a role to play in disciplinary matters involving Value IX of the Code of Ethics, which concerns conscientious objection. [Contents]

APPENDIX "B"
COLLEGE OF PHARMACISTS OF BRITISH COLUMBIA
BULLETIN MARCH/APRIL 2000 Vol. 25, No. 2

Note: This bulletin was prepared by the Ethics Advisory Committee.¹⁶ No minutes were kept of the drafting of the document; the final (published) version is the only record that exists.¹⁷ The sections relevant to this report are underlined.

The Code of Ethics adopted by the College of Pharmacists of British Columbia acknowledges that some pharmacists have moral objections to providing certain recognized pharmacy services. As a compromise, the Code recognizes conscientious objection as long as patients are not denied legitimate services. These pharmacists must refer patients to colleagues who will provide such services, and in the end deliver these services themselves if it is impractical or impossible for patients to otherwise received them.

Pharmacy, like all professions, has been granted a monopoly right to provide services to the public. And professions have an obligation to provide recognized services to the public, because the public has no alternative. For this, professions receive prestige and financial reward. In the case of pharmacy some might argue we received one without the other, but this is another subject.

Individual pharmacists may experience conscience problems when requested to provide services to which they have a moral objection. At present these services might include provision of contraceptives, syringes and needles for drug addicts, emergency contraceptives, high doses of narcotics to control intractable pain that might hasten death in the terminally ill, and medications for terminal sedation. In future these services might expand to include preparation of drugs to assist voluntary or involuntary suicide, cloning, genetic manipulation, or even execution.

Some pharmacists have argued that if they have a moral objection to providing certain pharmacy services, neither they nor the profession has an obligation to see that patients are provided with these services, and patients should not receive them. They should be able to dissuade patients requesting these services by denying their availability, or providing information under the guise of patient counselling. In some jurisdictions so-called "conscience clauses" have recognized these arguments.

The moral position of an individual pharmacist, if it differs from the ethics of the profession, cannot take precedence over that of the profession as a whole. The public cannot be expected to consider it to be just bad luck if patients are refused recognized pharmacy services because their pharmacists have moral objections to providing them. And 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. [Contents]

APPENDIX "C"
CORRESPONDENCE with COLLEGE OF PHARMACISTS

Note: Project correspondence with the College of Pharmacists dealt with several issues raised by the "Ethics in Practice" column in the College’s March/April Bulletin (reproduced in Appendix "B"). The following extracts concern only the subject of this report.

To: College of Pharmacists of British Columbia
From: Administrator, Protection of Conscience Project

. . . your bulletin seriously misrepresents the position of most conscientious objectors when it claims that their primary concern is to deny patients "recognized pharmacy services". It also misrepresents the purpose of protection of conscience legislation.

I invite you to visit the Project website to become more familiar with some of the issues involved. More important, I look forward to an early retraction of some of the statements made in this bulletin, and a significant clarification of others.

To: College of Pharmacists of British Columbia
From: Administrator, Protection of Conscience Project

Enclosed is a copy of an article that has been submitted for publication to the Canadian Pharmaceutical Journal. I would appreciate it if you would pass it on to Frank Archer.

I believe that you have been busy over the past few weeks, as have I, and I look forward to continuing our dialogue after receiving your response to my letter of 24 May.

To: Administrator, Protection of Conscience Project
From: Registrar, College of Pharmacists of B.C.

I have forwarded the proposed Canadian Pharmaceutical Journal article to Frank Archer, as you requested.

I will not be responding to your 24 May 2000 correspondence because I believe that I have provided all the necessary information in my previous two letters to you.

 27 July, 2000

To: College of Pharmacists of British Columbia
From: Administrator, Protection of Conscience Project

Thank you for passing on the article to Frank Archer.

While I understand that you do not see a reason to continue our correspondence, there is an important issue that has not been resolved by your letters.

In my first letter I referred to the College Bulletin (March/April 2000, Vol. 25, No. 2: "Ethics in Practice"), stating that it seriously misrepresents the position of most conscientious objectors. Referring to pharmacists who have moral objections to some pharmacy services, the Bulletin, purporting to present their argument, includes 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 continues:

"...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."

You will appreciate that unsubstantiated imputations of dishonesty made by persons in authority are likely to encourage bias against conscientious objectors, impose a strain on collegial relations, and adversely impact the workplace environment.

Accordingly, I request that you provide evidence to show that conscientious objectors claim a right to lie to patients, to supply misinformation or promote their moral viewpoint "under the guise of patient counselling", or that their primary goal is to dissuade patients from seeking pharmacy services.

In the absence of such evidence, the College should retract the offending passages in the Bulletin and apologize for having made prejudicial statements.

17 August, 2000

To: College of Pharmacists of British Columbia
From: Administrator, Protection of Conscience Project

I have not yet had a reply to my letter of 27 July referring to the College Bulletin for March/April 2000, Vol. 25, No. 2: "Ethics in Practice".

I noted then that unsubstantiated imputations of dishonesty made by persons in authority are likely to encourage bias against conscientious objectors, impose a strain on collegial relations, and adversely impact the workplace environment.

You have not provided evidence to show that conscientious objectors claim a right to lie to patients, to supply misinformation or promote their moral viewpoint "under the guise of patient counselling", or that their primary goal is to dissuade patients from seeking pharmacy services.

Will the College now retract the offending passages in the Bulletin and apologize for having made prejudicial statements?

8 September, 2000

To: College of Pharmacists of British Columbia
From: Administrator, Protection of Conscience Project

I have not yet had a reply to my letters of 27 July and 17 August referring to the College Bulletin for March/April 2000, Vol. 25, No. 2: "Ethics in Practice".

I noted then that unsubstantiated imputations of dishonesty made by persons in authority are likely to encourage bias against conscientious objectors, impose a strain on collegial relations, and adversely impact the workplace environment.

You have not provided evidence to show that conscientious objectors claim a right to lie to patients, to supply misinformation or promote their moral viewpoint "under the guise of patient counselling", or that their primary goal is to dissuade patients from seeking pharmacy services.

Please retract the offending passages in the Bulletin and apologize for having made prejudicial statements.

11 October, 2000

To: College of Pharmacists of British Columbia
From: Administrator, Protection of Conscience Project

Enclosed is an Access to Information Request made under the Freedom of Information and Protection of Privacy Act . . .

I look forward to hearing from you within the time specified by the statute.

[Among other things, the access request sought all documents pertaining to the following.]

a) policy on qualifications for appointment to the ethics committee of the College of Pharmacists of British Columbia;

b) policy on the process to be followed in applying for membership in the ethics committee of the College of Pharmacists of British Columbia;

c) policy on the process to be followed in appointing members of the ethics committee of the College of Pharmacists of British Columbia;

d) the number of current members of the ethics committee of the College of Pharmacists of British Columbia, and their academic and professional qualifications and experience relevant to their role as ethics committee members;

e) the number of rejected applications for membership on the ethics committee of the College of Pharmacists of British Columbia received by the College since 1 January, 1995, and the reasons for rejection.

14 November, 2000 (date received by courier)

To: Administrator, Protection of Conscience Project
From: Registrar, College of Pharmacists of British Columbia

. . . There are no formal policy statements relating to the qualifications or application process for appointment to the Ethics Advisory Committee.

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.

There are no records relating to the rejection of applications of Ethics Advisory Committee membership. . .

To: College of Pharmacists of British Columbia
From: Administrator, Protection of Conscience Project

. . . It appears that some documents and information that were covered by the request were overlooked. Attached to this letter is a list of the documents that appear to be missing. . .

Academic and professional qualifications and experience of current members of the Ethics Advisory Committee, relevant to their role as ethics committee members.

The following information, provided by the Registrar, includes no information about professional qualifications and experience in ethics or related disciplines (such as philosophy, theology, or law).

"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."

To: Administrator, Protection of Conscience Project
From: Registrar, College of Pharmacists of British Columbia

. . . Academic and professional qualifications and experience of current members of the Ethics Advisory Committee: There are no written or other records relating to this topic in our records system.

To: College of Pharmacists of British Columbia
From: Administrator, Protection of Conscience Project

. .. It appears from the material supplied and from your letters that the College has no evidence to support statements made in its Bulletin for March/April 2000, Vol. 25, No. 2: "Ethics in Practice" (i.e, that conscientious objectors claim a right to lie to patients, to supply misinformation or promote their moral viewpoint "under the guise of patient counselling", or that their primary goal is to dissuade patients from seeking pharmacy services). Please confirm that this is the case.

It also appears that none of the members of the Ethics Advisory Committee have academic or professional qualifications in ethics, philosophy or related disciplines. I would appreciate it if you would confirm whether or not this is the case by making the appropriate enquiries, and provide the details of any such qualifications held by Ethics Advisory Committee members.

To: Administrator, Protection of Conscience Project
From: Registrar, College of Pharmacists of British Columbia

. . . I wish to confirm that I have provided you with all existing records in my custody pertaining to the "Ethics in Practice" column in the March/April issue of the Bulletin.

I also wish to confirm that I have no records in my custody pertaining to the Ethics Advisory Committee members’ academic or professional qualifications in ethics, philosophy or related disciplines. Under the provisions of the Freedom of Information and Protection of Privacy Act,

I am not obligated to create records in order to respond to your request under the Act . . .

14 February, 2001

To: College of Pharmacists of British Columbia
From: Administrator, Protection of Conscience Project

. . . It is now clear that the College cannot justify the statements made by its Ethics Advisory Committee in the College Bulletin for March/April 2000, Vol. 25, No. 2: "Ethics in Practice" (quoted in my letter of 31 January and in earlier correspondence.) These unsubstantiated imputations of dishonesty offend against justice, beneficence, and non-maleficence, and appear to contradict Value VII of the College’s Code of Ethics, the very Code that the authors of the bulletin are, by their terms of reference, supposed to interpret and apply.

Will you now retract the statements made in the bulletin and apologize for having published them?

Quite apart from my Access to Information requests, and in view of the foregoing, I ask that you explain what academic or professional qualifications Ethics Advisory Committee members have in ethics, philosophy or related disciplines. Their qualifications are of interest not only to your members, but members of the public.

To: Administrator, Protection of Conscience Project
From: College of Pharmacists of British Columbia

I have your letter . . . in which you request a retraction and apology for statements made in the "Ethics in Practice" column in the March/April 2000 issue of our newsletter, the Bulletin. I will not be retracting the comments, nor offering an apology.

As I have indicated in previous correspondence, the members of the College’s Ethics Advisory Committee are experienced pharmacists and former pharmacists, all of whom have encountered and responded to a variety of ethical dilemmas in the course of their practice as pharmacists. [Contents]

 APPENDIX "D"
CORRESPONDENCE with FRANK ARCHER

17 August, 2000

To: Mr. Frank Archer
From: Administrator, Protection of Conscience Project

I understand that Ms. Lytle has given you my response to your column in the May issue of the Canadian Pharmaceutical Journal. Enclosed is a copy of a self-explanatory letter to the CPJ.

I am making the same request of you that I have made to the editor of the CPJ: that you provide evidence to support the allegations you have made, or issue a retraction and apology.

8 September, 2000

To: Mr. Frank Archer
From: Administrator, Protection of Conscience Project

I await your reply to my letter of 17 August, 2000.

Unsubstantiated imputations of dishonesty made by persons in authority are likely to encourage bias against conscientious objectors, impose a strain on collegial relations, and adversely impact the workplace environment.

Accordingly, I request that you retract the offending passages in the your article in the Canadian Pharmaceutical Journal and apologize for having made prejudicial statements.

15 November, 2000

To: Mr. Frank Archer
From: Administrator, Protection of Conscience Project

I await a reply to my letters of 17 August and 8 September, and reiterate my request that you retract the offending passages in the your article in the Canadian Pharmaceutical Journal, and apologize for having made prejudicial statements.

20 February, 2001

To: Mr. Frank Archer
From: Administrator, Protection of Conscience Project

As a result of an access to information request, I am now aware that the College of Pharmacists of British Columbia has no evidence to support imputations of dishonesty directed at conscientious objectors. Almost identical statements appeared later in an article you wrote for the Canadian Pharmaceutical Journal.

You have ignored my letters of 17 August, 8 September and 15 November, in which I asked you to provide evidence to support your allegations, or retract them and apologize. I do not anticipate the courtesy of a reply to this letter.

However, if your conduct in this matter exemplifies what you consider to be "the ethics of the profession", I question your continued involvement with the Ethics Advisory Committee of the College. [Contents]

 APPENDIX "E"
CORRESPONDENCE with CANADIAN PHARMACEUTICAL JOURNAL

17 July, 2000

To: The Editor, Canadian Pharmaceutical Journal
From: Administrator, Protection of Conscience Project

Enclosed is an article written in response to a column by Frank Archer that appeared in the May issue of the Journal . . 

To: The Editor, Canadian Pharmaceutical Journal
From: Administrator, Protection of Conscience Project

On 17 July, 2000, I forwarded a manuscript and computer disk with the submission In Defence of the New Heretics: A Response to Frank Archer . . .

I have enclosed a stamped, self-addressed envelope for the return of the manuscript if it is not your intention to publish it.

However, I draw your attention to Mr. Archer’s accusations, published in the CPJ in his May column, that conscientious objectors believe that they are entitled to lie to and mislead patients, and that they wish to obtain patient consent by dishonest means. No evidence was provided to support these statements.

Publication of unsubstantiated and prejudicial generalizations is known in some forums as "poisoning the workplace environment." I request that the Canadian Pharmaceutical Journal provide evidence to substantiate the accusations, or print a retraction and apology for having published them.

To: The Editor, Canadian Pharmaceutical Journal
From: Administrator, Protection of Conscience Project

. . . On 17 August I forwarded a stamped, self-addressed envelope for the return of the manuscript. An e-mail response to this letter stated that the article was "currently under review for an upcoming issue of the CPJ."

In my letter of 17 August, I also drew your attention to Mr. Archer’s accusations, published in the CPJ in his May column, that conscientious objectors believe that they are entitled to lie to and mislead patients, and that they wish to obtain patient consent by dishonest means. No evidence was provided to support these statements, and I asked that the Journal provide evidence to substantiate the accusations, or print a retraction and apology for having published them.

Please advise what you intend to do with the article, and when you will provide evidence to support the accusations, or publish a retraction and apology.

To: The Editor, Canadian Pharmaceutical Journal
From: Administrator, Protection of Conscience Project

. . . In my letter of 17 August, I also drew your attention to Mr. Archer’s accusations, published in the CPJ in his May column, that conscientious objectors believe that they are entitled to lie to and mislead patients, and that they wish to obtain patient consent by dishonest means. I asked that the Journal provide evidence to substantiate the accusations, or print a retraction and apology for having published them.

As a result of an access to information request, I am now aware that the College of Pharmacists of BC has no evidence to support almost identical statements that appeared in one of its bulletins last year. The publication of unsubstantiated imputations of dishonesty by a regulatory authority is reprehensible. I am concerned that their re-publication by a professional journal has further prejudiced the profession against conscientious objectors. Please advise whether or not you intend to publish a retraction and apology for having published them. [Contents]

[The editor of the CPJ responded by way of an editorial in the April, 2001 issue of the Journal. - Administrator -]

 NOTES

1. Code of Ethics, College of Pharmacists of British Columbia, Value IX: A pharmacist ensures continuity of care in the event of job action, pharmacy closure or conflict with moral beliefs. Obligations: . . . A pharmacist is not ethically obliged to provide requested pharmacy care when compliance would involve a violation of his or her moral beliefs. When that request falls within recognized forms of pharmacy care, however, there is a professional obligation to refer the patient to a pharmacist who is willing to provide the service. The pharmacist shall provide the requested pharmacy care if there is no other pharmacist within a reasonable distance or available within a reasonable time willing to provide the service.[Back]

2. Archer, Frank M., "Emergency Contraceptives and Professional Ethics A Critical Review", Canadian Pharmaceutical Journal, Vol. 133, No. 4, May, 2000 [Back]

3. E-mail from Maria Bizecki (Concerned Pharmacists for Conscience) to the Administrator, 3 July, 2000 [Back]

4. Letter from Maria Bizecki to the Registrar, 2 August, 2000.[Back]

5. Letter from Maria Bizecki to the Registrar, 7 September, 2000 [Back]

6. Minutes of the Code of Ethics Task Force, 22 October, 1996 1 April, 1997 [Back]

7. Minutes of the Code of Ethics Task Force, 1 April, 1997 [Back]

8. Letter from the Registrar to the Administrator (undated), received 14 November, 2000[Back]

9. Code of Ethics, College of Pharmacists of British Columbia, Value VII: A pharmacist respects the values and abilities of colleagues and other health professionals.[ Back]

10. Murphy, Sean, In Defence of the New Heretics: A Response to Frank Archer; Benson, Iain,  "Autonomy", "Justice" and the Legal Requirement to Accommodate the Conscience and Religious Beliefs of Professionals in Health Care   [Back]

11. Murphy, Sean, Establishment Ethics; Shalit, Ruth, "When we Were Philosopher Kings". The New Republic April 28, 1997  [Back]

12. College of Pharmacists of British Columbia Bulletin, Vol. 35, No. 6, November/December, 2000 [Back]

13. Minutes of the Meeting of the Council of the College of Pharmacists of British Columbia, 14 June, 1997, Page 2 [Back]

14. Minutes of the Meeting of the Council of the College of Pharmacists of British Columbia, 27 March,1998, Page 15, Appendix 3 [Back]

15. Bylaws of the Council of the College of Pharmacists of British Columbia, December, 1999: Bylaw 9, paragraph 90(1) [Back]

16. College of Pharmacists of British Columbia Bulletin, May/June 2000, Vol. 25, No. 3, P. 4 [Back]

17. Letter from the Registrar to the Administrator, 30 November, 2000 [Back]