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Protection of Conscience Project

www.consciencelaws.org

Service, not Servitude
Background

Pharmacists with a Conscience Need Not Apply

Citizenship and the Common Good: Secularism or the Inclusive Society?

Panel: The accommodation of Religion in Canadian Society: A Principle Under Threat or Doing Fine?

19-20 May, 2005: Simon Fraser University Harbour Centre Vancouver B.C.
Co-sponsored by the Centre for Cultural Renewal & Simon Fraser University
Reproduced with permission

Cristina Alarcon*

Freedom of conscience and religion is a basic human right and is a necessary attribute of what it means to be truly human. Yet pharmacists are increasingly being pressured to leave their spirituality at the door, to live incoherent double lives, all for the sake of so-called patient autonomy, an autonomy which in my view is not under threat when the patient is free to walk down the street to the next provider.

I don't think that anyone would deny that we live in a world that is permeated by a clash of worldviews.1 In the field of Healthcare, there are healthcare professionals who desire to care for the sick without violating their own deeply held religious, moral, and ethical principles. For the most part, they are not seeking to impose their morality on others, but simply need to be able to live and work without compromising their deeply held beliefs.

Sadly, there are those who seek to impose their views on others. On certain issues of the day there are strongly contested viewpoints that are perfectly legal to hold. In a free and democratic society it is not the case that we are required to believe the same things.

But what of the duty to serve? Ah, as Shakespeare said: "there's the rub". Some who hold to one side of a contested viewpoint seek not only to promote these views, but they also believe that they are the only valid views, and that everyone else should abide by them. In particular, healthcare workers should lay aside all other norms of conduct, especially if these have any religious foundation, in order to accept the utilitarian worldview that others may hold as the only valid code of conduct. Thus, some healthcare workers are being coerced to participate in procedures they find morally abhorrent.2

For example, in April 2000, an article entitled Ethics in Practice appeared in the official bulletin of the BC College of Pharmacists.3 It states that the College acknowledges that some pharmacists may have moral objections to providing recognized pharmacy services. Further on, it lists some of these future services as preparation of drugs to assist in voluntary or involuntary suicide, cloning, genetic manipulation, or even execution. As a compromise, the bulletin goes on, 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 receive them.

I find the implications of such statements to be quite outrageous. The author of the article in the Bulletin then goes on to accuse conscientious objectors of lying to the public about existing services and of wanting to promote their own moral viewpoint. The moral position of an individual pharmacist, he writes, if it differs from the ethics of the profession, cannot take precedence over that of the profession as a whole. Who in this case, is imposing a morality on whom?

These statements are a perfect recipe for the promotion of intolerance within the profession. The College not only refused to retract the derogatory statements, but also refused to publish any other viewpoint, citing that the purpose of the Bulletin is to reflect official College policy. Attempts to get articles published with alternative viewpoints in Professional journals have also been stonewalled. Religiously informed conduct is increasingly viewed by pharmacy licensing bodies and pharmacy associations across the country as inferior to their own proposed codes of ethics. And so they are denying their organizations any wealth of input from their members if these views conflict with the organization's own worldview.

It so happens that the Catholic Church, for example, has a long tradition of theological and philosophical teachings on the right conduct of medical professionals. Although the Church's teachings on the defense of human life are based on the Christian tradition, they can also be grasped by anyone because they express the consequences of our nature:who we are as persons, what our boundaries or limitations are as human beings. Professional healthcare licensing bodies all across the country are setting themselves up as supreme moral authorities, without any regard for an individual professional's freedom of philosophical understandingof life,and freedom of conscience and religion.4

To date the only provincial pharmacy licensing bodies who do not explicitly require provision of objectionable services or referral for these by the objecting pharmacist, are Manitoba and Alberta. In Alberta, this came about only at the expense of a pharmacist suffering job suspension, and a lengthy investigation which left her with many legal bills to pay.5 These two provinces do require that management prearranges it so that the customers get what they want in an alternate fashion. But what if the manager is the one who is the conscientious objector, as is my case? Clearly, we need conscience protection laws for pharmacists in Canada.

In October 2004, the editor of a national Canadian Pharmacy journal6, went so far as to say that pharmacists who cannot accept the dispensing of the Morning after Pill should practice other careers "that do not put them in conflict with patients' rights and the public trust". This editorial elicited a response from numerous pharmacists across the country and at least one lawyer.7

The editor began by stating that tolerance is a bedrock value of our democracy and that it goes both ways; yet in the next paragraph she contradicts herself by stating that the onus is on the healthcare professional to respect the religious beliefs of the patient, and not the other way around. There is often a complete failure to consider the duty of accommodation that all employers have in all settings. Many articles are written as if the only beliefs and autonomy that exist are those of patients or clients which is obviously erroneous. At least the Canadian Medical Association does not make the same error, merely requiring the physician to inform the patient when his own morality would influence his recommendations. This Code should be the model for all health care settings.

One Calgary pharmacist wrote:The editorial written in October's issue was an excellent demonstration of the discriminatory harassment to which conscientious objectors are subjected. It is clear that Ms.Thompson and people like her feel their morality is superior and are prepared to impose it on anyone disagreeing with them.

In May of 2000, the same journal published an article by an ethical advisor to the BC College of Pharmacists entitled: "Emergency Contraception and Professional Ethics".8 In this article, directed to disputes about the Morning after Pill, the author implies that there is no right to conscientious objection, and he insists that pharmacists must provide or refer patients for "recognized pharmacy services" despite moral objections. He not only claims that conscientious objection is not a right, but also that it is usually punished. Of course, this stems from his premise that because there are murderers, rapists, and thieves who do wrong by following an obviously erroneous conscience, then no one should have a right to freedom of conscience.9

Several people have written in response to Mr. Archer's piece- one of them is the co-chair of this conference, lawyer Iain Benson, to point out the shortcomings in the legal and ethical analysis employed by Mr. Archer.10 The journal refused to print the rebuttal, and so to correct the errors, so that it appears as though the ethical advisor's biased statements, which are based on his own personal beliefs, are in fact based on solid legal and ethical principles.

Whereas past pharmacy Codes of Ethics emphasized excellence in the performance of ones daily duties, today's Codes are increasingly concerned with patient autonomy, as though this were the highest good to strive for. Thus, irrespective of nationality, culture or beliefs, a pharmacist is told to conform to the new Codes of Ethics to ensure that the patient's interests are protected, or else to leave the profession. That which is disregarded is the fact that a pharmacist does act in his patient's best interests when he refuses to provide a woman with a drug he deems harmful to herself and to her offspring in the case of refusal to dispense the Morning after Pill, and that the client has all the freedom in the world to deal with the professional of her choice, much as she would choose a physician.

As I said above, a physicianis not obliged to refer for abortions, but merely required to inform the patient when his own personal morality would influence his recommendations.11 He is neither forced to perform abortions, nor to refer for this procedure. On the contrary, the BC Pharmacy Code allows us to object to the provision of pharmacy services that violate our conscience only so long as we refer, or are prepared to provide the service ourselves if no one else is available or willing to do so.12 What most people do not realize is that referral for a service that I cannot myself provide, would be morally equivalent to providing it myself. In my particular case, I believe that giving a woman a Morning After Pill makes me a direct accomplice in the destruction of a human life should fertilization have taken place. Referral would also make me an accomplice. Contrary to popular belief, I am not seeking to block access to a product, I simply cannot be involved in its provision and the client is free to consult the professional of her choice.

Oftentimes it is suggested that patient autonomy should trump the moral conscience of the professional. One would be hard pressed to name another profession, other than the pharmacy profession, where this principle holds true. If a house owner tells the builder that he must construct the roof in such and such a way, and the builder in his opinion deems it unsafe, the principle of placing house owner autonomy above everything else could result in a disaster.

I would like you to consider these thoughts: Our country was not built upon the principle of unbridled autonomy of the individual, but on that of solidarity and a sense of community that upheld the freedom of conscience and religion of each citizen. Autonomy is necessarily limited. A baby is less autonomous than an adult, but no less human, a paraplegic less so than a fully healthy person, but is not any less human because of his limitations.

Freedom of conscience and religion is a basic human right and is a necessary attribute of what it means to be truly human. Yet pharmacists are increasingly being pressured to leave their spirituality at the door, to live incoherent double lives, all for the sake of so-called patient autonomy, an autonomy which in my view is not under threat when the patient is free to walk down the street to the next provider. My own view is that as a Catholic Christian in the pharmacy profession in Canada my beliefs are not being respected and I am being forced to function according to the dogmatic beliefs of others who do not exercise their roles with proper respect for diversity, tolerance, equality, belief, conscience or religion----all supposedly protected rights in Canada today. And if my employer has had no problem accommodating my spiritual values in the workplace, why, I wonder, do licensing bodies and pharmacy associations have a problem with it?

In conclusion, the accommodation of religion in Canada is "spotty", and as the different approaches between the physicians and the pharmacists show, where one profession (medicine) protects conscience better than the other (pharmacy), there is still work to be done. It cannot be said that accommodation is doing just fine in Canada. Finally, I leave you to ponder these words of the Great John Paul II: " There cannot be two parallel lives in our existence: on the one hand, the so-called spiritual life, with its values and demands; and on the other, the so-called secular life, that is life in a family, at work, in social relationships, in the responsibilities of public life, and in culture. The branch, engrafted to the vine that is Christ, bears fruit in every sphere of existence and activity. In fact, every area of our lives, as different as they are, enters into the plan of God, who desires that these very areas be the places in time where the love of Christ is revealed and realized for both the glory of the Father and service of others."13


Notes
1. And there is an excellent article by lawyer Nikolas T.Nikas, entitled "Law and Public Policy to Protect Health-Care Rights of Conscience" that explains this very well. For those who are interested, it was published in the Spring 2004 issue of the National Catholic Bioethics Quarterly.

2. Please see www.consciencelaws.org

3. Bulletin of BC College of Pharmacists. Ethics in Practice. March/April 2000.

4. See NAPRA's model statement.

5. The investigation by the College was eventually dropped. For conditions under which pharmacist Maria B. could return to work see http://www.consciencelaws.org\Conscience-Policies-Papers\PPPSettlements03.htm

6. CPJ/RPJ Oct.2004, Vol 137, No.8. Can be viewed at or by going to [Link] and clicking of CPJ and then on CPJ issues.

7. These letters can be accessed at www.pharmacists.ca.

8. CPJ, May 2000, Vol.133, No.4, p.22-26. cannot be viewed online.

9. Letters to the editor of CPJ/RPJ . Feb 2000."Standards of Practice" by Frank Archer.

10. See www.consciencelaws.org for these articles: In Defense of the New Heretics: A Response to Frank Archer by Sean Murphy. "Autonomy", "Justice" and the Legal Requirement to Accommodate the Conscience and Religious Beliefs of Professionals in Health Care. By Iain Benson.

11. College of Physicians and Surgeons of British Columbia current Code of Ethics in refusal to treat: Policy manual, no.8. Inform your patient when your personal morality would influence the recommendation or practice of any medical procedure that the patient needs or wants.

12. See Value VIII of Code of Ethics of Pharmacists of British Columbia.

13. From Go in Peace: a Gift of Enduring Love. By John Paul II; edited by Joseph Durepos. P.190 on Christian vocation. 2003 Loyola Press

 

 

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