The Chamber of Pharmacists (Kamra tal-Ispizjara) has sent an email to
its members stating that there is a standard question protocol that
pharmacists must follow when dispensing the Morning After Pill without a
These guidelines, the email said, are professional tools and should be kept confidential.
The Chamber also noted that pharmacists should avoid engaging in public discussions on social media. “The Chamber reprimands pharmacists who do not uphold such standards bringing the profession to disrepute.” [Full text]
Donna Harrison, Cara Buskmiller, Monique Chireau, Lester A. Ruppersberger, Patrick P. Peung Jr.
The purpose of this review was to determine whether there is evidence that ovulation can occur in women using hormonal contraceptives and whether these drugs might inhibit implantation. We performed a systematic review of the published English-language literature from 1990 to the present which included studies on the hormonal milieu following egg release in women using any hormonal contraceptive method. High circulating estrogens and progestins in the follicular phase appear to induce dysfunctional ovulation, where follicular rupture occurs but is followed by low or absent corpus luteum production of progesterone. Hoogland scoring of ovulatory activity may inadvertently obscure the reality of ovum release by limiting the term “ovulation” to those instances where follicular rupture is followed by production of a threshold level of luteal progesterone, sufficient to sustain fertilization, implantation, and the end point of a positive β-human chorionic gonadotropin. However, follicular ruptures and egg release with subsequent low progesterone output have been documented in women using hormonal contraception. In the absence of specific ovulation and fertilization markers, follicular rupture should be considered the best marker for egg release and potential fertilization. Women using hormonal contraceptives may produce more eggs than previously described by established criteria; moreover, suboptimal luteal progesterone production may be more likely than previously acknowledged, which may contribute to embryo loss. This information should be included in informed consent for women who are considering the use of hormonal contraception.
Harrison D, Buskmiller C, Chireau M, Ruppersberger LA,Peung PP. Systematic Review of Ovarian Activity and Potential for Embryo Formation and Loss during the Use of Hormonal Contraception. Linacre Quarterly. 2019 Jan 03; 85(4):453–469.
International Law Office
Lise Gran, Ole Kristian Olseby
The Supreme Court recently deemed that a municipality’s termination of its agreement with a general practitioner (GP) after she refused to insert an intrauterine device (IUD) for a patient for reasons of conscience relating to her religion was invalid.
The criterion for terminating an agreement with a GP is the same as that for terminating an employment agreement under Norwegian law (ie, it must be objectively justified). . . [Full text]
New Hampshire Union Leader
CONCORD — A bill that would allow medical professionals to exercise their “rights of conscience” failed in a 218-109 vote in the House of Representatives on Thursday.
The bill, HB 1787, would allow medical professionals to refuse any procedure that goes against their personal beliefs, including abortion, providing contraceptives or contraceptive counseling.
“In our state right now, there are no rights of conscience protections for medical people,” said Rep. Kurt Wuelper, R-Strafford. “Doctors are required in many areas to participate in and perform procedures that violate their consciences. That’s not right.” . . .[Full Text]
New Hampshire Union Leader
CONCORD – The national debate over the rights of health care workers to refuse to perform procedures like abortion or assisted suicide is working its way through the New Hampshire State House as lawmakers consider “an act relative to the rights of conscience for medical professionals.”
The medical community is divided over the bill, which would allow medical professionals to refuse any procedure that goes against their personal beliefs, including abortion, providing contraceptives or contraceptive counseling.
Doctors at a public hearing last week testified for and against the bill (HB 1787), which would also cover physician’s assistants, nurses, pharmacists, medical students … basically anyone and everyone who works in the health care profession. The lengthy definition of “health care provider” in the bill includes “hospital or clinic employees.” . . . [Full Text]
It’s a telemedicine app that seems rather innocuous — enter your info, have it reviewed by a physician, and get a prescription. The California-based company behind it has raised millions to support its mission of expanding access to the pill, ring, or morning-after pill with minimal hurdles.
But that last option is now starting to attract pushback from anti-abortion activists, who consider the morning-after pill equivalent to abortion — and who say lax telemedicine laws are enabling access to this drug with insufficient oversight.
Nurx, an app that’s been called the “Uber for birth control,” lets patients obtain a variety of contraceptives from the touch of a smartphone; it also gives women access to Plan B and Ella, two forms of the morning-after pill, which is effective in preventing a pregnancy after sex. Women can order these drugs in a few easy steps: answer a series of health questions; provide basic demographic information; and choose a preferred drug. A doctor then reviews the patient’s information, writes a prescription, and the drug is delivered to either the patient’s home or her local pharmacy. . . [Full text]
Ronit Y. Stahl,PhD; Holly Fernandez Lynch, JD, MBE
When the Obama administration included contraception in the essential benefits package to be covered by employer-sponsored health insurance plans under the Affordable Care Act, it sought to preserve access for women while addressing the concerns of employers with religious objections. Although the accommodations and exemptions were not enough for some employers, balance was the ultimate goal. This also was reflected in Zubik v Burwell, the Supreme Court’s most recent decision on the matter; on May 16, 2016, the justices remanded the litigants to the lower court so they could be afforded the opportunity to reach a compromise between religious exercise and seamless contraceptive coverage. No further compromise was forthcoming.
Now the Trump administration has rejected balance as a worthwhile goal.1 Its new contraceptive coverage rules, released on October 6, 2017, prioritize conscientious objection over access.2,3 The rules take effect immediately, and new legal challenges, this time on behalf of patients rather than objecting employers, have already begun.4 The new rules preserve the default requirement that employers must include free access to contraceptives as part of their insurance plans. However, the rules now exempt employers with religious or moral objections to contraceptives, without requiring any alternative approaches to ensure that beneficiaries can obtain contraceptives at no cost.2,3
Stahl RY, Lynch HF. Contraceptive Coverage and the Balance Between Conscience and Access. JAMA. Published online October 19, 2017. doi:10.1001/jama.2017.17086
Hannah C. Smith
Last Friday, the Trump administration revised rules implementing the Affordable Care Act in a way that expands protections for religious and moral objectors to the contraception mandate — achieving the common-sense balance that religious organizations have sought for the past six years. These revisions allow religious nonprofits — like the Little Sisters of the Poor — to avoid millions of dollars in fines because their employee health insurance plans exclude coverage for contraception, a practice contrary to Catholic doctrine on respecting human life.
Judging by some media hyperbole, however, you would think that the federal government had just abolished the ACA’s birth control mandate altogether. Headlines that claim the federal government’s move “reverses” or “scraps” or “ends” the mandate are all wrong.. . .The vast majority of women in America will continue to receive free birth control, and religious objectors will not be forced into providing services that violate their conscience. . . [Full text]
Not so long ago, President Trump’s new guidelines for the Department of Health and Human Services for protecting freedom of religious faith would have been superfluous and unnecessary. A casual observer might have read them in puzzlement, as if the government had reaffirmed its opposition to robbery or murder.
But all that was before the Obama administration sought to bring those of religious faith to heel, ordering employers to pay for contraception devices and abortion-inducing drugs, even if it violated the conscience of employers. Under pressure, the Obama administration grudgingly exempted churches from its mandate, but employers affiliated with religious groups still were required to pay through third-party administrators.
The new guidelines, drawn up by the U.S. Justice Department, change that. The order does not prohibit employers paying such benefits, and many employers will continue to do so. Nor will anyone be deprived by the government of their condoms, diaphragms and other birth-control devices. But “going forward,” as the cliche goes, an employer will not be required by the U.S. Government to violate his conscience for the convenience of those hostile to religious faith. . .[Full text]
WASHINGTON, Oct. 6, 2017 — Today the nation’s largest association of Christian health professionals, the 18,000-member Christian Medical Association (CMA, Christian Medical Association www.cmda.org) applauded the administration’s actions to restore conscience freedoms in healthcare. The administration took action concerning the Obamacare contraceptives mandate, insurance premiums used to pay for abortions, and regarding government respect for religious freedom.
“We are thankful to see these vital conscience freedoms restored in healthcare,” noted CMA Senior Vice President Gene Rudd, MD, and Ob-Gyn physician. “For millennia, medical ethics have provided for conscientious opposition to abortion by physicians who took up the practice of medicine as a healing art never to be used for the destruction of human life. And until recently, our government reinforced those ethical principles with conscience protections. We are heartened to see our government heading back in the direction of these vital freedoms that protect patients, medicine and freedom in our country.”
Jonathan Imbody, director of Freedom2Care (www.Freedom2Care.org), which is affiliated with CMA said, “As Americans who have inherited a nation founded upon freedom of faith, conscience and speech, we can agree that the government must never force individuals to violate their deepest held beliefs on vital and extremely controversial issues such as abortion. When our leaders forget these principles, and take to forcing nuns to participate in matters they consider wholly immoral, the American people realize that our fundamental freedoms are in jeopardy. If the government can take away the rights of one group, then no one is safe from government coercion.
“These actions today by the administration are an important step back in the direction of freedom and respect for one another, and we look forward to more actions in the future, including restoration of the conscience rule for health professionals that President Obama gutted.”
Contact: Margie Shealy, Christian Medical Association, 423-341-4254