Submission to the Alberta College of Pharmacists
Re: Draft Code of Ethics
Appendix "C"
The Exercise of Freedom
of Conscience in Pharmacy
Professional and
Regulatory Responses
Details - February, 2009
Only the URL of a
document is provided when -
- the issue of
conscientious objection
is not addressed by an
entity; or
- the issue of
conscientious objection
is not addressed, but a
policy concerning it can
be drawn from another
source that is
identified as an
authority by the entity.
Legend
Full Text
- (NA) -
Not Addressed
- The issue of
conscientious
objection is not
addressed.
- (P) -
Provide
- Conscientious
objection is
prohibited. The
objecting pharmacist
is required to
provide the
controversial drug
or service.
- (PPA) -
Provide or
Personally Act
- The objecting
pharmacist is
required to
facilitate or
arrange access to
the controversial
drug or service by
referral to a
specific person or
entity, or by some
other act, and to
provide the
controversial drug
or service if this
is not possible.
- (PA)
- Personal Action
- The objecting
pharmacist is
required to
facilitate or
arrange access to
the controversial
drug or service by
referral to a
specific person or
entity, or by some
other act.
- (SC) -
Systemic
Cooperation
- The objecting
pharmacist is not
required to directly
assist in the
delivery of a drug
or service, but is
to work
cooperatively within
a system that allows
patients to access
controversial drugs
and services through
other sources.
- (PA/SC) -
Personal Action
or Systemic Cooperation
- An objecting
pharmacist may
directly assist in
the delivery of a
drug or service by
referral to a
specific person or
entity, or by some
other act, OR work
cooperatively within
a system that allows
patients to access
controversial drugs
and services through
other sources.
- (ND) -
No Duty
- No duty is
imposed upon an
objecting
pharmacist.
- (EAS) -
Includes
consideration of
pharmacist involvement
in execution
- (EX) -
Includes
consideration of
pharmacist involvement
in euthanasia or
assisted suicide
- * - Required by statute
AUSTRALIA
Pharmaceutical Society
of Australia
(Adapted
from the Royal
Pharmaceutical Society of
Great Britain Code of Ethics)
Principle Nine
A
pharmacist shall ensure
continuity of care for the
patient in the event of
labour disputes, pharmacy
closure or conflict with
personal moral beliefs.al
beliefs.
Obligations
9.1 A
pharmacist shall when
required, assist and refer
clients to another
pharmacist in order to
maintain service and care.
(Accessed
2009-02-19)
This
document represents the
current, official position
of the Pharmaceutical
Society of Australia (PSA)
relating to ethical issues
that may arise when a
pharmacist declines to
supply a therapeutic product
or pharmacy service
Background
The
Pharmaceutical Society of
Australia (PSA) acknowledges
that the profession carries
a responsibility to provide
a timely, accurate and high
quality pharmacy service as
needed by the Australian
community.
Pharmacists approved to
supply medicines under the
Pharmaceutical Benefits
Scheme (PBS) must maintain
adequate stock (at their own
expense) for the supply of
pharmaceutical benefits and
may be called upon to
provide the Health Insurance
Commission with details of
the stock held. In addition,
they must publicly display a
notice of their normal hours
of business and are obliged
to supply pharmaceutical
benefits at other times if
the prescription is marked
"urgent" and initialled by
the prescriber. 1
There is
no law that requires a
pharmacist owner or employee
to dispense any or all
non-PBS prescription
medicines. However, if a
failure to supply is
construed as discriminatory
or as leading to foreseeable
harm to the individual, then
there is a risk of liability
for the pharmacist (see
below).
At common
law, a trader may refuse to
sell any product to any
person. However, this right
may be affected by other
laws.
Pharmacy
owners and their employees
are subject to the Trade
Practices Act 1974 which
deals with issues such as
anticompetitive conduct
(Part IV), unconscionable
conduct (Part IVA) and
unfair practices (Part V
Division 1).
Intervention by pharmacists
which may result in
non-supply
Codes of
conduct have been issued by
the PSA2 and by
the Society of Hospital
Pharmacists of Australia3
to establish the principles
and standards of behaviour
expected by the profession
of its members. A key
principle espoused in these
documents for guiding
professional practice is
that the health and well
being of patients and the
community should be the
primary concern when
providing professional
services. The PSA code
elaborates on this principle
by establishing associated
obligations. These include
obligations to avoid
supplying a medicinal
product whose quality,
safety or efficacy is in
doubt; use professional
judgement to prevent supply
of excessive quantities of
medicinal products or those
likely to constitute an
unacceptable hazard to
patients; and ensure that
all reasonable care is taken
when dispensing medicines.
Though
not widely appreciated by
consumers or other health
professionals, pharmacists
are obligated to dispense
medicines according to the
prescription only to the
extent that it is consistent
with patient safety. In some
jurisdictions this
circumstance is recognised
in legislation.4
In limited situations,
consideration of patient
safety may lead to a
pharmacist declining to
dispense a prescribed
medicine.5
The
Society supports and
encourages pharmacists to
play an active role in
monitoring and reviewing the
medicines taken by patients.
The resulting interventions,
including those where the
pharmacist acts to prevent
supply in the interest of
patient safety, are integral
to achieving safe treatment
and optimal therapeutic
outcomes for patients. They
are a key element to
achieving the quality use of
medicines.
PSA
recognises the right of
pharmacists to decline to
provide products or services
to any individual. However,
pharmacists are also
reminded that as health
service providers they are
responsible for considering
the health and well being of
the individual concerned and
the community above any
commercial or other personal
consideration.
Declining supply on moral
grounds
PSA
recognises and respects the
right of individuals,
including health
professionals, to hold a
moral belief on particular
issues. It further
recognises that at times
these moral beliefs may
impact on the roles
undertaken by those health
professionals.
While not
legally binding, the codes
of conduct may serve as a
point of reference when the
appropriateness of the
professional conduct of a
pharmacist is under
consideration. This point is
of particular relevance to a
further two principles of
the PSA Code of Conduct.
Principle Two obligates
pharmacists to uphold the
reputation of the profession
and adhere to legislative
requirements while Principle
Nine obligates pharmacists
to ensure continuity of
care, including in the event
of a "conflict with personal
moral beliefs".2
Care must
be exercised where the
objection to supply is
essentially based on
personal moral
considerations. In the event
that a moral belief of a
pharmacist leads to the
nonsupply of a product or
service, PSA reminds
pharmacists of the
obligations established
under the PSA code to accept
responsibility for ensuring
continuity of care - that
is, timely access to the
required medicine or
service. This may involve
the use of initiative to
identify another reasonably
available source for the
required medicine or
service, particularly in
rural or remote areas or in
other situations where
access to alternate service
providers may be limited.
In 2002,
the South Australian Branch
of PSA released a statement
to pharmacists practising in
that state.6 The
statement, which was based
on legal advice received by
the Branch, was that the
pharmacist had a right to
decline supply of
prescription medicines where
such supply would be
contrary to a moral stance
held by the dispensing
pharmacist.
PSA
recognises there are
jurisdictional variations in
the regulation of the
pharmacy profession.
Nevertheless, where a
pharmacist's moral belief is
likely to impact on the
pharmacy services available
to patients, pharmacists
should consider the
following.
Employee
pharmacists should reach
agreement with their
employer about what
limitations will apply to
their dispensing and other
pharmacy activities and have
these formally recognised in
their terms of employment.
The
owner/manager should have
processes in place (eg. a
sign or leaflet) to clarify
to patients/consumers
seeking pharmacy services,
any limitations applicable
to the services provided.
The information provided
should clearly inform the
patient of appropriate
alternative sources. The
need for this process may be
more compelling where the
availability of alternate
service providers is
limited.
A
pharmacist might choose a
certain course of action
based on moral beliefs which
may result in the provision
of a particular product or
service being declined
either generally or to
particular persons. In such
circumstances, the
pharmacist should be aware
of the following
possibilities.
An
individual may claim
discrimination (eg.based on
medical, disability,
cultural, religious or other
legal grounds) or
unconscionable conduct by
the pharmacist.
Where
there is foreseeable risk of
harm to the individual, the
pharmacist could be held
liable for any consequences
that may arise from the
decision to not supply.
Therefore
pharmacists are strongly
advised to obtain
independent legal advice
where their personal moral
beliefs are likely to
preclude the provision of a
certain product or service
in the course of their
professional practice either
generally or to particular
persons.
References
1. Commonwealth Department
of Health and Ageing.
Schedule of Pharmaceutical
Benefits. Canberra: CDHA;
2003 May.
2. Pharmaceutical Society of
Australia. Code of
Professional Conduct. In:
Pharmacy Practice Handbook.
Canberra: PSA; 2000.
3. The Society of Hospital
Pharmacists of Australia.
SHPA Code of Ethics. In:
Johnstone JM and Viénet MD,
eds. Practice Standards and
Definitions. Melbourne:
SHPA; 1996.
4. For example the Victorian
Pharmacists Regulations 1992
(made under the Victorian
Pharmacists Act 1974).
5. Pharmaceutical Society of
Australia. Dispensing
Practice Guidelines. In:
Pharmacy Practice Handbook.
Canberra: PSA; 2000.
6. Pharmaceutical Society of
Australia. SA Branch
Newsletter. Refusal to
dispense.
Society of Hospital
Pharmacists of Australia
-
Code of Ethics......................................................................NA
(Accessed
2009-02-24)
New South Wales
-
Pharmacy Board of
New South Wales
Pharmacy Practice Act.........................................................NA
(Accessed
2009-02-23)
Australian Capital
Territory
-
Pharmacy Board of
the ACT
Standards
............................................................................NA
Northern Territory
-
Pharmacy Board of
the Northern Territory
(Accessed
2009-02-23)
Queensland
-
Pharmacy Board of
Queensland
As per PhSA...................................................................PA/SC
(Accessed
2009-02-23).
Tasmania
-
Pharmacy Board of
Tasmania
As per
APhS and SHPhA via
Pharmacy Code
.............. PA/SC
(Accessed 2009-02-24)
Victoria
-
Pharmacy Board of
Victoria
As per
APhS via
Guidelines 2005
...................................PA/SC
(Accessed
2009-02-24)
CANADA
National Association of
Pharmacy Regulatory
Authorities (NAPRA)
Approved
by Council: November 1999
Developed
by: Executive and
Inter-Provincial Pharmacy
Regulatory Committees
The use
of prescribed drugs for
emergency contraception and
euthanasia is an arising
issue that has prompted the
pharmacy regulatory
authorities to address the
balance between the
individual rights of
pharmacists and professional
responsibilities to their
patients.
In
response to the need for
clear and consistent
regulatory policy on this
matter, NAPRA Council
approved a model regulatory
position statement on
November 14, 1999. This
model statement was
developed following
preliminary review by
Council and Pharmacy
Registrars in April of this
year and external
consultation with member
Provincial and Territorial
Regulatory Authorities, the
Canadian Society of Hospital
Pharmacists, the Canadian
Pharmacists' Association and
the Consumers' Association
of Canada, throughout the
summer months. NAPRA's
member Provincial and
Territorial Regulatory
Authorities will now
consider the model statement
for adoption or adaptation
and implementation.
"Pharmacists shall hold the
health and safety of the
public to be their first
consideration in the
practice of their
profession. Pharmacists who
object, as a matter of
conscience, to providing a
particular pharmacy product
or service must be prepared
to explain the basis of
their objections. Objecting
pharmacists have a
responsibility to
participate in a system
designed to respect a
patient's right to receive
pharmacy products and
services.
The
following policy clauses
reflect the need to meet a
patient's requirements for
pharmacy products and
services while respecting a
pharmacist's right of
conscience:
- A pharmacist is
permitted to object to
the provision of a
certain pharmacy product
or service if it appears
to conflict with the
pharmacist's view of
morality or religious
beliefs and if the
pharmacist believes that
his or her conscience
will be harmed by
providing the product or
service. Objections
should be conveyed to
the pharmacy manager,
not to the patient.
- The individual
pharmacist must
pre-arrange access to an
alternate source, to
enable the patient to
obtain the service or
product that they need.
Any alternate means must
minimize inconvenience
or suffering to the
patient or patient's
agent."
(Accessed
2009-02-21)
(Accessed
2009-02-20)
Pharmacists' Professional
Responsibility
. . .
Pharmacists who do not wish
to provide EC treatment for
personal reasons should
maintain objectivity and
remain professional in
manner when dealing with
patients. In this case,
patients should be referred
to an alternate source, as
listed below. More
information is found in the
"Model Statement Regarding
Pharmacists' Refusal to
Provide Products or Services
for Moral or Religious
Reasons", approved by NAPRA
Council in November 1999.
The Model
Statement suggests that
pharmacists not convey their
personal objections to the
patient. If the patient
questions the pharmacist as
to why he or she will not
personally be providing the
product or service, the
pharmacist should answer in
a manner that does not make
the patient feel
uncomfortable. Alternate
sources for EC noted might
include referral to one or
more pre-arranged source
options such as:
• another
pharmacist in the same
pharmacy
• another pharmacy in the
vicinity
• the prescribing physician
• nearby hospital
• family planning clinic
(Accessed
2009-02-21)
Canadian Pharmacists
Association
. . . The
physician, the pharmacist,
the nurse should have a
right to take part or not in
assisting a person once he
or she has reached a
decision to put an end to
his or her life. Should they
elect not to participate,
their duty to their patient
requires that they refer
them to health professionals
who will assist them. . .
(Accessed
2009-02-21)
British Columbia
-
College of
Pharmacists of British
Columbia
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. . . 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. . .
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. . .
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. . .
Code of Ethics
...................................................................PPA
Value 8 - A
pharmacist ensures
continuity of care in the
event of job action,
pharmacy closure or conflict
with moral beliefs.
Obligations
1. A
pharmacist has a duty
through coordination and
communication to ensure the
provision of essential
pharmacy care throughout the
duration of any job action
or pharmacy closure.
Patients who require ongoing
or emergency pharmacy care
are entitled to have those
needs satisfied.
2. 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.
(Accessed
2009-02-20)
Alberta
-
College of
Pharmacists of Alberta
Code of Ethics 2008
.......................................................PA/
SC
Principle V:
A pharmacist endeavours to
ensure that the client's
right to pharmaceutical
service is met.
Guidelines for
interpretation:
1. Pharmacists who are
unable or are unwilling to
provide appropriately
prescribed pharmaceutical
services (e.g. compounding
of sterile products) to
clients, must make
reasonable efforts to ensure
that clients are able to
obtain these services from
another authorized provider.
2.
Pharmacists who are unable
or are unwilling to provide
certain pharmaceutical
services are obligated to
arrange the condition of
their practice so that the
care of the client will not
be jeopardized.
3.
Pharmacists who are unable
or are unwilling to provide
a pharmaceutical service
shall make it known to their
potential employer or
employee, whichever the case
may be, before entering into
a formal relationship. If
their convictions change
over the course of their
career, pharmacists must
make it known in their place
of work.
(Accessed
2008-02-18)
Draft Code 2009
...................................................................NA
Saskatchewan
-
Saskatchewan College
of Pharmacists
Pharmacists shall hold the
health and safety of the
public to be their first
consideration in the
practice of their
profession. Pharmacists who
object, as a matter of
conscience, to providing a
particular pharmacy product
or service must be prepared
to explain the basis of
their objection. Objecting
pharmacists cannot abandon
their ethical duty of care
to the patient, and respect
of the patient's right of
autonomy to make informed
decisions to receive
pharmacy products and
services based on objective
and accurate information.
The following policy clauses
reflect the need to meet a
patient's requirements for
pharmacy products and
services while respecting a
pharmacist's right of
conscience:
1. A pharmacist is
permitted to object to the
provision of a certain
pharmacy product or service
if it appears to conflict
with the pharmacist's view
of morality or religious
beliefs, and if the
pharmacist believes that his
or her conscience will be
harmed by providing the
product or service. The
reasons for the objection
should be conveyed to the
pharmacy manager, and to the
patient. It would be
improper and unethical
conduct if the pharmacist
used the opportunity to
promote his/her moral or
religious convictions, or
engage in any actions, which
demean the patient.
2. Duty of care
includes ensuring that the
decisions of the pharmacist
do no harm or promote the
wellbeing of the patient.
This might mean that the
individual pharmacist refers
the patient to, or
pre-arranges access to an
alternate source, to enable
the patient to obtain the
service or product that they
need. Any alternate means
must minimize inconvenience
or suffering to the patient
or patient's agent and must
maintain patient
confidentiality.
(Accessed
2009-02-21)
Nova Scotia
-
Nova Scotia
Pharmaceutical Society
(Nova Scotia College of
Pharmacists)
Code of Ethics 2002
.............................................................SC
(Accessed
2009-02-21)
Code of Ethics 2003
.............................................................SC
(Accessed
2009-02-24)
Code of Ethics 2007
.............................................................SC
Value V
Pharmacists respect
the rights of patients to
receive pharmacy services
and ensure these rights are
met.Pharmacists who are
unable to provide prescribed
medicines or services to
their patients shall take
reasonable steps to ensure
these medicines/services are
provided and the patients'
care is not jeopardized.
Pharmacists who are
unwilling to provide
prescribed medicines or
services to patients because
of moral or religious
reasons shall inform
pharmacy management of their
objections at the onset of
employment. Pharmacy
management shall provide
reasonable accommodation of
the pharmacist's right of
conscience and develop an
alternate means of providing
the medicines or services.
The alternate means shall be
timely and convenient for
the patient.
Pharmacists have a duty,
through communication and
co-ordination, to ensure the
continuity of care of
patients during pharmacy
relocation/closure, job
action, natural disasters or
situations where continuity
of care may be problematic.
Manitoba
-
Manitoba
Pharmaceutical
Association
Over the
past couple weeks, there
have been many media reports
regarding Emergency
Contraception medication and
the role of the pharmacist.
. . .
While the MPhA has not
received any reports of
misconduct by pharmacists in
the provision of Emergency
Contraception care, the
following information serves
as an important reminder . .
.
A
pharmacist or pharmacy that
refuses to sell emergency
contraception as a matter of
conscience needs to plan a
process to enable patients
to access the medication. .
.
(Accessed
2009-02-21)
4)
Pharmacists, who object to
providing Emergency
Contraception Care as a
matter of conscience, must
participate in a system that
respects a patient's right
to receive that care (MPhA
SOP #1 & #5)*. Ensuring the
patient's right to receive
care could mean referral to
a colleague, an emergency
room, a clinic, or other
health practitioner offering
the care. If EC Care is not
available in the pharmacy, a
sign must be posted in the
pharmacy advising patients
that EC Care is not
available and where the
patient care can be obtained
(e.g. a sign located in the
pharmacy front window and/or
at the dispensary). An
obligation to provide care
is not the same as refusal
to supply a product for an
individual patient based on
professional judgement. When
providing care with Schedule
2 or 3 medications, the
pharmacist is accountable
for that care. At times, a
pharmacist may be requested
to supply EC Care to a
patient's agent. The
pharmacist is undertaking a
professional decision, and
must still keep records
including the reasons for
the decision to supply care
in the absence of the
patient.
(Accessed
2009-02-21)
Standards of Practice:
Community
June, 2006
............................................................................SC
D.
Pharmacist's
Responsibilities in the
Refusal to provide Products
or Services for Moral or
Religious Reasons
1.9.
Pharmacists shall hold the
health and safety of the
public to be their first
consideration in the
practice of their
profession. Pharmacist who
object, as a matter of
conscience, to providing a
particular pharmacy product
or service must be prepared
to explain the basis of
their objections. Objecting
pharmacists have a
responsibility to
participate in a system
designed to respect a
patient's right to receive
pharmacy products and
services.
1.10. The
following policy reflects
the need to meet a patient's
requirement for pharmacy
products and services while
respecting a pharmacist's
right of conscience:
1.10.1. A
pharmacist is permitted to
object to the provision of a
certain pharmacy product or
service if it appears to
conflict with the
pharmacist's view of
morality or religious
beliefs and if the
pharmacist believes that his
or her conscience will be
harmed by providing the
product or service.
Objections should be
conveyed to the pharmacy
manager, not the patient.
(Accessed
2009-02-21)
Ontario
Ontario College of
Pharmacists
-
Code of Ethics 1996
.............................................................PA
Principle Two
The pharmacist actively
promotes the well-being of
every patient in a caring,
compassionate manner. The
patient's well-being is at
the centre of the
pharmacist's professional
and business practices. This
principle ensures that no
patient shall be deprived of
pharmaceutical services
because of the personal
convictions or religious
beliefs of a pharmacist.
Where such circumstances
occur, the pharmacist refers
the patient to another
pharmacist who can meet the
patient's needs. The
pharmacist exercises his or
her professional judgement
to ensure that patients'
needs are met in situations
where emergency services or
care may be required.
Following
is the position statement
approved at the March 2001
Council meeting:
Pharmacists shall hold the
health and safety of the
public to be their first
consideration in the
practice of their
profession. Pharmacists who
object, as a matter of
conscience, to providing a
particular pharmacy product
or service must be prepared
to explain the basis of
their objections.
Objecting pharmacists have a
responsibility to
participate in a system
designed to respect a
patient's right to receive
pharmacy products and
services.
The
following clauses, reflect
the need to meet a patient's
requirements for pharmacy
products and services while
respecting a pharmacist's
right of conscience:
- A
pharmacist is permitted to
decline providing certain
pharmacy products or
services if it appears to
conflict with the
pharmacist's view of
morality or religious
beliefs and if the
pharmacist believes that his
or her conscience will be
harmed by providing the
product or service.
Objections should be
conveyed to the pharmacy
manager not the patient.
- The
individual pharmacist must
insure an alternate source,
to enable the patient to
obtain the service or
product that they need. Any
alternate means must
minimize inconvenience or
suffering to the patient or
patient's agent.
(Accessed
2009-02-18)
-
Code of Ethics,
Draft 3
22 March, 2005
................................................................NA
(?)
Principle Four
The pharmacist and pharmacy
technician respects the
autonomy, individuality and
dignity of each patient and
provide care with respect
for human rights and without
discrimination. No patient
shall be deprived of
pharmaceutical services
because of the personal
convictions or religious
beliefs of a pharmacist or
pharmacy technician.
Principle Four
Each member respects the
autonomy, individuality and
dignity of each patient and
provides care with respect
for human rights and without
discrimination. No patient
shall be deprived of access
to pharmaceutical services
because of the personal
convictions or religious
beliefs of a member. Where
such circumstances occur,
the member refers the
patient to a pharmacist who
can meet the patient's
needs.
(Accessed
2009-02-21)
New Brunswick
New Brunswick
Pharmaceutical Society
Approved
by Council: November 1999
Developed by: Executive and
Inter-Provincial Pharmacy
Regulatory Committees
The use
of prescribed drugs for
emergency contraception and
euthanasia is an arising
issue that has prompted the
pharmacy regulatory
authorities to address the
balance between the
individual rights of
pharmacists and professional
responsibilities to their
patients.
In
response to the need for
clear and consistent
regulatory policy on this
matter, NAPRA Council
approved a model regulatory
position statement on
November 14, 1999. This
model statement was
developed following
preliminary review by
Council and Pharmacy
Registrars in April of this
year and external
consultation with member
Provincial and Territorial
Regulatory Authorities, the
Canadian Society of Hospital
Pharmacists, the Canadian
Pharmacists' Association and
the Consumers' Association
of Canada, throughout the
summer months. NAPRA's
member Provincial and
Territorial Regulatory
Authorities will now
consider the model statement
for adoption or adaptation
and implementation.
"Pharmacists shall hold the
health and safety of the
public to be their first
consideration in the
practice of their
profession. Pharmacists who
object, as a matter of
conscience, to providing a
particular pharmacy product
or service must be prepared
to explain the basis of
their objections. Objecting
pharmacists have a
responsibility to
participate in a system
designed to respect a
patient's right to receive
pharmacy products and
services.
The
following policy clauses
reflect the need to meet a
patient's requirements for
pharmacy products and
services while respecting a
pharmacist's right of
conscience:
1. A
pharmacist is permitted to
object to the provision of a
certain pharmacy product or
service if it appears to
conflict with the
pharmacist's view of
morality or religious
beliefs and if the
pharmacist believes that his
or her conscience will be
harmed by providing the
product or service.
Objections should be
conveyed to the pharmacy
manager, not to the patient.
2. The
individual pharmacist must
pre-arrange access to an
alternate source, to enable
the patient to obtain the
service or product that they
need. Any alternate means
must minimize inconvenience
or suffering to the patient
or patient's agent."
(Accessed
2009-02-21)
Statement V:
A Pharmacist , Certified
dispenser or Registered
student shall respect the
rights of patients to
receive pharmacy products
and services and ensure
these rights are met.
Guidelines for
interpretation
Pharmacists who object, as a
matter of conscience, to
providing a particular
pharmacy product or service
must be prepared to explain
the basis of their
objections to pharmacy
management, not the patient.
Pharmacists who object, as a
matter of conscience, to
providing a particular
pharmacy product or service
have a responsibility to
participate in a system
designed to respect a
patient's right to receive
pharmacy products and
services. The system must be
pre-arranged to enable the
patient to obtain the
product or service in a
timely and convenient
manner, minimizing suffering
to the patient.
Pharmacists have a duty,
through communication and
coordination, to ensure
continuity of care of
patients during pharmacy
relocation or closure, job
action, natural disasters or
situations where continuity
of care may be problematic.
(Accessed
2009-02-21)
Prince Edward Island
Prince Edward Island
Pharmacy Board
The use
of prescribed drugs for
emergency contraception and
euthanasia is an arising
issue that has prompted the
pharmacy regulatory
authorities to address the
balance between the
individual rights of
pharmacists and professional
responsibilities to their
patients.
In
response to the need for a
clear and consistent
regulatory policy on this
matter, NAPRA Council
approved a model regulatory
position statement on
November 14, 1999. This
model statement was
developed following
preliminary review by
Council and Pharmacy
Registrars in April 1999 and
external consultation with
member Provincial and
Territorial Regulatory
Authorities, the Canadian
Society of Hospital
Pharmacists, the Canadian
Pharmacists Association and
the Consumers' Association
of Canada, throughout the
summer months.
In June
of 2000, the Prince Edward
Island Pharmacy Board
approved the Statement to
provide direction and
guidance on this issue to
Island pharmacists.
"Pharmacists shall hold the
health and safety of the
public to be their first
consideration in the
practice of their
profession. Pharmacists who
object, as a matter of
conscience, to providing a
particular pharmacy product
or service must be prepared
to explain the basis of
their objections. Objecting
pharmacists have a
responsibility to
participate in a system
designed to respect a
patient's right to receive
pharmacy products and
services.
The
following policy clauses
reflect the need to meet a
patient's requirements for
pharmacy products and
services while respecting a
pharmacist's right of
conscience:
1. A
pharmacist is permitted to
object to the provision of a
certain pharmacy product or
service if it appears to
conflict with the
pharmacist's view of
morality or religious
beliefs and if the
pharmacist believes that his
or her conscience will be
harmed by providing the
product or service.
Objections should be
conveyed to the pharmacy
manager, not to the patient.
2. The
individual pharmacist must
pre-arrange access to an
alternate source, to enable
the patient to obtain the
service or product that they
need. Any alternate means
must minimize inconvenience
or suffering to the patient
or patient's agent".
(Accessed
2009-02-21)
Statement V:
Pharmacists respect the
rights of patients to
receive pharmacy products
and services and ensure
these rights are met.
Guidelines for
interpretation
1. Pharmacists who object,
as a matter of conscience,
to providing a particular
pharmacy product or service
must be prepared to explain
the basis of their
objections to pharmacy
management, not the patient.
2.
Pharmacists who object, as a
matter of conscience, to
providing a particular
pharmacy product or service
have a responsibility to
participate in a system
designed to respect a
patient's right to receive
pharmacy products and
services. The system must be
pre-arranged to enable the
patient to obtain the
product or service in a
timely and convenient
manner, minimizing suffering
to the patient.
3.
Pharmacists have a duty,
through communication and
coordination, to ensure
continuity of care of
patients during pharmacy
relocation or closure, job
action, natural disasters or
situations where continuity
of care may be problematic.
(Accessed
2009-02-21)
Newfoundland and
Labrador
Newfoundland and
Labrador Pharmacy Board
-
Code of Ethics
2001 (4 February)
.................................................................SC
Statement V:
Pharmacists respect the
rights of patients to
receive pharmacy products
and services and ensure
these rights are met.
Guidelines for
interpretation
1. Pharmacists who object to
providing a particular
pharmacy product or service
must be prepared to explain
the basis of their objection
to pharmacy management.
2.
Pharmacists who are unable
or unwilling to provide a
particular pharmacy product
or service have a
responsibility to
participate in a system
designed to respect a
patient's right to receive
pharmacy products and
services. The system must be
pre-arranged to enable the
patient to obtain the
product or service in a
timely and convenient
manner, minimizing suffering
to the patient.
3.
Pharmacists have a duty,
through communication and
co-ordination, to ensure the
continuity of care of
patients during pharmacy
relocation or closure, job
action, natural disasters or
situations where continuity
of care may be problematic.
(Accessed
2009-02-21)
IRELAND
Pharmaceutical Society
of Ireland
(Accessed 2009-02-21)
KENYA
Pharmaceutical Society
of Kenya
9. The pharmacist ensures
continuity of care in the
event of labour disputes,
pharmacy closure and
conflict with personal moral
beliefs.
9.1 Obligations:
i. To refer a patient to
another pharmacist.
ii. To ensure that when a
pharmacy closes, the
patients are informed of the
pharmacy to which their
records, if held, have been
transferred.
9.2 StandardsThe
pharmacist:
i. Informs patients of the
opening and closing hours of
his/her pharmacy
ii. On duty should have
his/her name displayed.yed.
iii. Establishes a
working relationship with a
colleague on locum basis to
ensure continuity of
services subject to patients
consent.
(Accessed 2009-02-21)
NEW ZEALAND
Pharmacy Council of New
Zealand
Principle 7: Trustworthiness
The pharmacist shall act in
a manner that promotes
public trust in the
knowledge and ability of
pharmacists and enhances the
reputation of the profession
Specific obligations
7.2 Conscientious objection
*
The pharmacist must, in
advance, advise any
employer, Charge Pharmacist,
local general medical
practitioners and patients
of the pharmacy of any
belief or conscientious
objection which may
influence or impact on their
sphere of practice.
Commentary to Principle 7
7.2 Conscientious
objection
s. 46 of
The
Contraception, Sterilisation
and Abortion Act 1977
provides for a right of
conscientious objection as
follows: (1) Notwithstanding
anything in any other
enactment, or any rule of
law, or the terms of any
oath or of any contract
(whether of employment or
otherwise), noregistered
medical practitioner,
registered nurse, or other
person shall be under any
obligation
To
perform or assist in the
performance of an abortion….
…or
supply or administer or
assist in the supply or
administering, of any
contraceptive, or to offer
to give any advice relating
to contraception if he
objects to doing so on
grounds of conscience.
The
obligation in the Code does
not in any way impinge on or
seek to limit this right,
but requires that where a
pharmacist does object to
supplying contraceptives, or
object to giving advice
relating to contraception on
grounds of conscience, the
pharmacist must advise any
employer, Charge Pharmacist,
local general medical
practitioners and patients
of the pharmacy of this
objection.
(Accessed
2009-02-21)-21)
UNITED KINGDOM
Royal Pharmaceutical
Society of Great Britain
1
August, 2007
......................................................................PA
3.4
Ensure that if your
religious or moral beliefs
prevent you from providing a
particular professional
service, the relevant
persons or authorities are
informed of this and
patients are referred to
alternative providers for
the service they require.
(Accessed
2009-02-20)
UNITED STATES
American Pharmacists
Association
-
Code of Ethics
......................................................................NA
(Accessed
2009-02-24).
APhA Position
APhA recognizes the
individual pharmacist's
right to exercise
conscientious refusal and
supports the establishment
of systems to ensure
patient's access to legally
prescribed therapy without
compromising the
pharmacist's right of
conscientious refusal. When
this policy is implemented
correctly, and proactively,
it is seamless to the
patient, and the patient is
not aware that the
pharmacist is stepping away
from the situation. In sum,
APhA supports the ability of
the pharmacist to step away,
not in the way, and supports
the establishment of an
alternative system for
delivery of patient care.
APhA
policy does not support
lecturing a patient or
taking any action to
obstruct patient access to
clinically appropriate,
legally prescribed therapy.
APhA policy does not
interject the pharmacist
between the patient and the
physician.
(Accessed
2009-02-20)
Q: Can I refuse sale of Plan
B OTC?
A: APhA
supports an individual
pharmacist's ability to
choose not to dispense a
medication for personal,
religious and moral reasons
and also supports the
establishment of systems to
ensure patient's access to
legally prescribed therapy.
Pharmacists with objections
to dispensing any
medications, including Plan
B OTC, should work with
their management to develop
any systems necessary to
accommodate the patient's
and pharmacist's needs...
(Accessed
2009-02-21)
. . . it
is important to note that
the "conscience clause"
which allows pharmacists to
opt out of offering services
that they find morally
objectionable is not limited
to emergency contraception.
It is intended to protect
all health professionals
from being compelled to
violate their beliefs,
including dispensing
medication for assisted
suicide or executions. These
are just some of the other
activities that pharmacists
may choose not to
participate in.
Well-constructed conscience
clauses also support systems
to assure patient access to
legally prescribed
clinically accurate therapy.
(Accessed
2009-02-21)
Arkansas
Arkansas State Board of
Pharmacy
-
News - May, 2005
Conscience Clause.............................................................ND*
The
Arkansas State Board of
Pharmacy receives several
calls each year regarding
the conscience clause for
pharmacists. While there is
a law in Arkansas that
addresses a pharmacist's
right to refuse filling
certain prescriptions, it is
actually a public health law
that has been in place since
1973.
20-16-304. Public policy -
Availability of Procedures,
Supplies, and Information
-Exceptions.
It shall be the policy and
authority of this state that
. . .
(4)
Nothing in this subchapter
shall prohibit a physician,
pharmacist, or any other
authorized paramedical
personnel from refusing to
furnish any contraceptive
procedures, supplies, or
information; and
(5) No
private institution or
physician, nor any agent or
employee of such institution
or physician, nor any
employee of a public
institution acting under
directions of a physician,
shall be prohibited from
refusing to provide
contraceptive procedures,
supplies, and information
when the refusal is based
upon religious or
conscientious objection. No
such institution, employee,
agent, or physician shall be
held liable for the refusal.
(Accessed
2009-02-21)
California
California Board of
Pharmacy
-
California Code of
Regulations, Title 16
..............................PA
(5)
Referrals and Supplies: If
emergency contraception
services are not immediately
available at the pharmacy or
the pharmacist declines to
furnish pursuant to
conscience clause, the
pharmacist will refer the
patient to another emergency
contraception provider. The
pharmacist shall comply with
all state mandatory
reporting laws, including
sexual abuse laws. . .
Colorado
Colorado Board of
Pharmacy
(Accessed
2009-02-20)
Colorado Pharmacists
Society (APhA)
-
E-mail to Protection
of Conscience Project
from Exec. Dir.
2009-02-10 15:18
...................................................................SC
The code
of ethics used by
pharmacists in Colorado is
the one developed by the
American Pharmacists
Association.
Georgia
Georgia State Board of
Pharmacy
(n) Refusal to Fill
Prescription.
It shall not be
considered unprofessional
conduct for any pharmacist
to refuse to fill any
prescription based on
his/her professional
judgment or ethical or moral
beliefs.
(Accessed
2009-02-21)
Iowa
Iowa Pharmacy
Association
-
Code of Ethics
.....................................................................NA
(Accessed 2009-02-20)
Kansas
Kansas Pharmacists
Association
-
Code of Ethics
......................................................................NA
(Accessed 2009-02-20)
Michigan
Michigan Pharmacists
Association
-
Code of Ethics
.....................................................................NA
(Accessed 2009-02-24)
Nebraska
Nebraska Pharmacy
Association (APhA)
E-mail
to Protection of Conscience
Project
from NPhA Finance &
Marketing Manager
2009-02-23
12:30:41...............................................................SC
Nebraska
regulations refer to the
APhA Code of Ethics.
New York
Pharmacists Society of
the State of New York
-
Code of Ethics
.....................................................................NA
(Accessed 2009-02-20)
North Carolina
North Carolina Board of
Pharmacy (APhA)
............SC
Q: Does
North Carolina have a
"Conscience Clause" for
dispensing emergency
contraceptives?
A: The
Board has adopted a policy
on pharmacists' refusal to
dispense prescriptions in
certain circumstances: . . .
Compassionate care and
conscientious objection are
not mutually exclusive.
A pharmacist has the right
to avoid being complicit in
behavior that is
inconsistent with his or her
morals or ethics. It is
unacceptable, however, for
pharmacists to impose their
moral or ethical beliefs on
the patients they serve.
Pharmacists who object to
providing a medication for a
patient on this basis alone,
therefore, should take
proactive measures so as not
to obstruct a patient's
right to obtain such
medication.
The Board
notes that although
pharmacists have a right to
avoid moral or ethical
conflict, they do not have a
right to obstruct otherwise
legitimate prescription
dispensing or delivery
solely on the basis of
conscientious objection.
Board of
Pharmacy staff interprets
this policy to mean that if
a pharmacist refuses to fill
a prescription for emergency
contraception then that
pharmacist has an obligation
to get the patient and the
prescription to a pharmacist
who will dispense that
prescription in a timely
manner.
(Accessed
2009-02-21)
Oregon
Oregon State Board of
Pharmacy
. . .
Just as other health care
professionals and
practitioners in Oregon have
a choice, so do pharmacists
have a choice whether or not
to participate in activities
they find morally or
ethically objectionable.
Oregon pharmacists cannot
however, interfere with a
patient's lawfully and
appropriately prescribed
drug therapy or request for
drugs and devices approved
by the U.S. Food and Drug
Administration (FDA) for
restricted distribution by
pharmacies. . .
The Board
of Pharmacy expects each
Oregon Pharmacist-in-Charge
(PIC) to adopt written
policies and procedures that
address the issues of
pharmacists' moral, ethical
and professional
responsibilities. It is the
Board's belief that pharmacy
policies and procedures
could allow a pharmacist to
exercise his or her choice
to not participate, and at
the same time not interfere
with the patient's right to
receive appropriate and
lawfully prescribed drug
therapy or drugs and devices
approved by the U.S. FDA for
restricted distribution by
pharmacies. These may
include dispensing of the
prescription or drug or
device by another pharmacist
on site or arranging for the
prescription to be dispensed
by a pharmacist at another
site. The Board also expects
Oregon pharmacists to
discuss issues of moral,
ethical and professional
responsibilities with their
Pharmacist-In-Charge and to
understand and comply with
the pharmacy's policies and
procedures.
The Board
expects that pharmacy
policies and procedures will
ensure patients in Oregon
always receive appropriate
and lawfully prescribed
medications and information
or drugs and devices
approved by the U.S. FDA for
restricted distribution by
pharmacies in a timely and
professional manner and that
patients are not burdened by
the pharmacist's individual
beliefs. Interference with a
patient's right to receive
timely, professional
prescription services and
information or drugs and
devices approved by the U.S.
FDA for restricted
distribution by pharmacies
may be considered
unprofessional conduct and
could result in disciplinary
action by the Board. (See
attached "Clarification")
Position Statement History
Originally Adopted September
2005
Revised February 2007
Clarification
For Example, the Board would
consider it unprofessional
conduct for a pharmacist to
lecture a patient about the
pharmacist's moral or
religious beliefs, to
violate the patient's
privacy or to destroy,
confiscate or otherwise
tamper with the patient's
prescription.
The
written policy should
require an objecting
pharmacist to inform the PIC
in advance so that the PIC
can reasonably accommodate
that objection before a
patient presents a
prescription or makes a
request for drugs and
devices approved by the U.S.
FDA for restricted
distribution by pharmacies.
The accommodation may not
include permission to
lecture the patient. The
policy should also ensure
that the patient's
prescription or drug and
device needs are met either
by ordering the drug, if it
is not in stock, pursuant to
the usual pharmacy policies,
by transferring or returning
the prescription to the
patient if the patient
requests, or by referring
the patient to another
pharmacy nearby where the
patient can get the
prescription filled or
receive drugs and devices
approved by the U.S. FDA for
restricted distribution by
pharmacies. In the event of
a referral, the pharmacist
is responsible for
identifying another pharmacy
that has the medication in
stock and will dispense the
prescription or dispense
drugs or devices approved by
the U.S. FDA for restricted
distribution by pharmacies.
(Accessed
2009-02-20)
Oregon State Pharmacy
Association
(Accessed
2009-02-24)
Pennsylvania
Pennsylvania State Board
of Pharmacy
The State
Board of Pharmacy (Board) by
this notice adopts the
following statement of
policy regarding matters of
conscience, to read as set
forth in Annex
A. The
policy statement sets forth
guidelines that should be
considered when a pharmacist
has a religious, moral or
ethical objection to filling
a prescription. These
guidelines are intended to
ensure that patients are not
abandoned or neglected and
that pharmacists are not
forced to engage in
activities that conflict
with their religious, moral
or ethical beliefs.
Background and Purpose
Questions have been raised
regarding the professional
obligations of licensed
pharmacists with respect to
providing services to which
they may be religiously,
morally or ethically
opposed. The Board is
publishing this policy
statement to provide
guidance to pharmacists and
pharmacies on how to handle
the situation when a
pharmacist has an issue with
filling a prescription due
to a religious, moral or
ethical objection. This
statement of policy is not
intended to supersede
relevant laws, rules or
regulations. The Board also
recognizes that professional
judgment is often based upon
a specific set of facts that
requires a particular
analysis and not every
situation can be addressed
with general guidance.
Guidelines
Pharmacists have a
professional responsibility
to ensure that their
patients obtain properly
ordered and therapeutically
appropriate medications in a
timely matter with
appropriate counseling from
a pharmacist. Pharmacists
also have a responsibility
to practice competently and
to protect against
abandoning or neglecting a
patient in need of immediate
care without making
alternate arrangements. When
a pharmacist recognizes that
the pharmacist's religious,
moral or ethical belief,
will result in the refusal
to fill a prescription that
is otherwise available in a
pharmacy, the pharmacist has
a professional obligation to
take steps to avoid the
possibility of abandoning or
neglecting a patient. When a
pharmacist begins practice
in a professional setting,
the pharmacist should take
steps that may include
notification to the owner
and pharmacist-manager if
the pharmacist's beliefs
will limit the drug products
the pharmacist will
dispense.
If a
pharmacy employs a
pharmacist who has
identified circumstances
that would preclude the
filling of prescriptions for
particular products, the
owner and pharmacist-manager
should devise reasonable
accommodations that will
respect the pharmacist's
choice while assuring
delivery of services to
patients in need. This may
include scheduling of
pharmacists to allow a
pharmacist who has a
religious, moral or ethical
objection to practice
simultaneously with another
pharmacist who will fill the
requested prescription,
entering into collaborative
arrangements with pharmacies
in close proximity, or other
accommodations designed to
protect the public.
In
addition, a pharmacist who
has a religious, moral or
ethical objection to filling
a particular prescription
should avoid judgmental or
confrontational activities
with the patient and should
not interfere with another
pharmacist filling the
prescription.
The policy statement set
forth in Annex A is
effective upon publication
in the Pennsylvania Bulletin
(Accessed
2009-02-24)
South Dakota
South Dakota Pharmacists
Association
-
Code of Ethics
.....................................................................NA
(Accessed
2009-02-20)
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