Pharmacist freedom of conscience in Alberta
Code of Ethics (2009)
A protection of conscience provision is found in the Alberta College of Pharmacy Code of Ethics (2009).1 Objecting pharmacists are directed
- to help patients "obtain appropriate pharmacy services from another pharmacist or health professional within a time frame fitting the patient's needs" (clause 3);
- to arrange their practices so that "the care of [their] patients will not be jeopardized" when they refuse to provide services for reasons of conscience (clause 4);
- to continue "to provide professional services" until another pharmacist or health professional has assumed responsibility (clause 1).
The text seems to presume that the objecting pharmacist need not provide the morally contested service. The requirement to continue to provide "professional services" until someone else assumes responsiblity does not impose an obligation to provide it if another professional is not available within the relevant time frame.
The Code does not require an objecting pharmacist to connect the patient directly with someone willing to provide the contested service by referral or by arranging a transfer of care. Objecting pharmacists would be unwilling to do so if they understood that to involve unacceptable moral complicity, but could comply with the Code by providing the patient with contact information for other nearby pharmacies or professionals authorized to dispense the product.
The nature of pharmacy practice is such that it is often possible to arrange conditions of practice to avoid conflicts between patients and objecting pharmacists. This has been done seamlessly and successfully in Alberta.2
Exercising conscientious objection (2017)
More specific direction (Exercising conscientious objection) has been issued to address the exercise of freedom of conscience in relation to dispensing euthanasia, assisted suicide and abortifacient drugs.3 The document recommends that the issue should be addressed "proactively and respectfully so as to not disrupt access to care, nor to disrupt pharmacy team behaviours and relationships." Objecting pharmacists are advised to give advance written notice to supervisors, something that will facilitate arrangements to accommodate both objecting pharmacists and concerned patients. While this is sound advice, other aspects of the guidance require qualification and warrant criticism.
Exercising conscientious objection asserts that patients have a right to "unbiased information, including where to access legally permissible and available health services," and objecting pharmacists must not "impede" this.
However, the issue of "bias" cuts both ways. The characterization of abortion, euthanasia and assisted suicide as "health services" is usually rejected by those who are morally opposed to the procedures, just as it is supported by those who support them, including the Canadian medico-legal establishment. Thus, the instruction demonstrates bias by adopting the terminology favoured by the establishment.
Nonetheless, it is reasonable to assert that patients have a right to accurate information about where to access legal services. Objecting pharmacists typically do not dispute this. They are usually willing to give patients accurate information about how to contact other pharmacists or health care professionals, and to provide them with contact information for services like Alberta Health Link.4 Similarly, they are normally willing to cooperate with colleagues and supervisors arranging practice environments that can accommodate them and patients seeking services.
Had College authorities insisted upon this, the guidance would have been unexceptionable. However, Exercising conscientious objection goes further. It directs objecting pharmacists to identify "pharmacists or pharmacy technicians . . . to whom they may guide an individual or other health professional seeking the specific service that they object to."
This can be understood to require objecting pharmacists to connect patients directly with someone who will provide the morally contested service. Objectors who consider this kind of facilitation to entail moral complicity in homicide, suicide, abortion, etc. would find this unacceptable.
1. Alberta College of Pharmacy, Code of Ethics, Edmonton: ACPh, 2009, Principle 5.
2. Calgary Co-operative Association accommodates pharmacist freedom of conscience [Internet]. Powell River (BC): Protection of Conscience Project; 2020 Aug 15.
3. Alberta College of Pharmacy, Exercising conscientious objection [Internet]. Edmonton (Alta): ACPh, 2017-Aug 30.
4. Alberta Health Services, 811 Health Link: Health Advice 24/7 (2020).