Pharmacy colleges quash conscientious objection
A version of this article originally appeared in the
Reproduced with permission.
Greg J. Edwards
Pharmacists are critically thinking individuals who integrate their
values into their work life-and they are not mere robots who are
glorified order-takers for physicians. We should be promoting such
thinking, not punishing it.--Nancy Metcalfe, pharmacist
Pharmacists are said to be the most trusted professionals in medicine;
they're conscientious; we rely on their discretion and their judgment; they
have our confidence; we respect them; but do pharmacists respect themselves,
let alone one another?
It's a good question, because in Canada, pharmacists, unlike doctors, find
that conscientious objection is a bitter pill for their professional
licensing organizations to swallow.
The pharmacists' governors pay lip service to a pharmacist's right to refuse
to dispense products, but, in fact, a customer's convenience trumps a
pharmacist's freedoms of conscience and religion: pharmacists are free to
object but in the end they must refer or otherwise help customers get the
Manitoba is the only province that recognizes its pharmacists' right to
object without having to refer a customer elsewhere. The Manitoba philosophy
is that simply objecting to a practice isn't enough; that the freedom to
refuse to participate in any way is essential to conscientious objection.
Despite this, however, Ron Guse, registrar of the Manitoba Pharmaceutical
Association, dodged and weaved when asked whether his association would
stand by pharmacists fired or refused employment because of their
conscientious objection. In fact, not one Canadian licensing body contacted
said that it would support a member in trouble for taking a pro-life stand.
The associations' representatives say that any conflicts are the fault of
owners or management. For example, conscientious objectors can be scheduled
to work alongside pharmacist who dispenses any products without question.
Again, however, not one licensing body said it would stand by a pharmacist
in trouble with management or owners.
Management can indeed make reasonable accommodation for dissenting
pharmacists if they want to. UBC medical student Ellen Wasan works part time
as a pharmacist at B.C. Women's hospital in Vancouver. She is not required
to dispense offensive products. Others handle them.
Not all managers take a sophisticated attitude to dissent. Vancouver
pharmacist Cristina Alarcon left the suffocating atmosphere of a hospital
pharmacy for a private drug store where, she said, the mood is "like a
breath of fresh air." She and her colleagues can express views and beliefs
and practice them freely without fear of consequences.
Unions can support pharmacists who practice pro-life medicine, but very few
pharmacists belong to unions. Consequently, their fights are lonely ones.
Their licensing bodies are prone to intimidating them into conforming,
especially if they don't have legal counsel.
Rather than dismiss some customers' complaints as vexatious, the Alberta
College of Pharmacists is calling one of its members before it.
The B.C. Catholic has agreed to postpone publicizing this case, at the
request of the pharmacist's lawyer, until it has been heard. Other Alberta
pharmacists are waiting to see its outcome before they decide on which
action they will take.
Constitutional lawyer Iain Benson has pointed out that Canadian case law
supports religious freedom in the work place. But "pharmacists have yet to
develop a serious approach to respecting conscience and religious beliefs.
The kind of approach their 'official' spokesmen take would be laughed at by
other groups "such as the Canadian Medical Association. Once the Canadian
Pharmacists' Association develops a greater maturity, it will learn that law
and ethics require more respect for pharmacists' consciences." [See Benson's
critique of an article on law
and ethics written by a member of the College of Pharmacists of BC Ethics
Advisory Committee - Administrator]
Janet Epp Buckingham, legal counsel for the Evangelical Fellowship, agreed
with Benson. "However," she added, "if an employer can argue successfully
that dispensing contraceptives or abortifacients is an integral part of the
job" and that to accommodate a conscientious objector "would be overly
onerous" for him, he can discriminate in his hiring "on that basis."
On the other hand, Canadian law requires "reasonable accommodation" of
employees' religious practices.
Pharmacist Alarcon, founder of Pharmacists for Life in B.C., wonders why
medicine is fraught with so many inconsistencies. Beyond the fact that
doctors are given full freedom of conscience, there's the fact that no
pharmacy stocks everything.
Pharmacists are not obligated to go out of their way to supply or to refer
for every product on the market, just, it seems, the morally offensive
products, such as the morning after pill (MAP) and the abortion pill and
birth control. Alarcon wonders why pharmacists have to refer patients for
the morally offensive products, but not the others.
In November, for a third time in as many years, Alarcon is going to appeal
to the B.C. College of Pharmacists to have it recognize its members'
democratic freedoms of religion and conscience. [See
2001-01 on the conduct of the College's Ethics Advisory Committee -
So far most objections are made against abortion drugs and birth control,
which offend only a few, but, sooner or later, medicine will develop drugs
and treatments and procedures that will offend a great many more pharmacists
who will become interested in objecting at that time.
Killing the sick-known by many euphemisms such as euthanasia,
doctor-assisted suicide, assisted suicide, mercy killing-is still murder in
Canada, so it's remains a hypothetical issue for the most part. However, the
MAP and the abortion pill (RU486), and birth control are with us.
Anti-pro-life feminists attack conscientious objection desperately, claiming
that the MAP and RU486 are essential to women's health. However, even the
most hard-hearted abortionist has to admit that abortifacients contain
nothing that prevents, fights or cures disease: no antibiotics, no
antivirals, just elevated doses of the hormones progesterone and estrogen,
which make the womb shed or ward off the fetus or embryo-thus earning them
the abortifacient label.
A doctor who asked not to be named said "the only health risk [to not
getting the abortifacients] is pregnancy, which is a social risk, not a
health risk: 'I won't have money to go to school.' 'My husband will find
out, blah, blah, blah.' It illustrates just how stupid the health argument
In fact, should it need to be said, pregnancy is a very healthy state for
the vast majority of women. What's more, if disease is a legitimate concern,
as it is in a rape case, the victim doesn't go down to her local drug store:
she goes to an emergency ward where "she's tested for HIV (AIDS), and
screened and tested for other major sexually transmitted diseases, and then,
sometimes, treated on the assumption that the rapist was infected."
Finally, if pregnancy is indeed a medical risk, the patient's doctor has to
consider that the MAP contains highly elevated levels of the same hormones
that rise naturally during pregnancy. In effect, by giving the
abortifacient, he could be inducing a hormonal condition that the patient
should be avoiding.
The woman's doctor would be "mimicking the same hormones but at higher
levels and in synthetic form. Anything they suspect that pregnancy is going
to hurt, the MAP is going to hurt," the specialist concluded.
Even though it does nothing to fight disease, the MAP is sold as an
'emergency' contraceptive. That it should be taken within 72 hours of sexual
intercourse is the only urgent aspect of its use.
Two provincial governments have even allowed pharmacists to share primary
responsibility for getting the MAP into women's hands. The former NDP
government of BC and the Parti Quebecois government of Quebec have made
pharmacists prescribers, not just dispensers, of the MAP.
Brenda Osmond, deputy-registrar of the BC College of Pharmacists, said that
a pharmacist can opt out of prescribing the MAP by declining to take the
course that qualifies pharmacists as prescribers. However, if a customer
comes in with a doctor's prescription, he must dispense it or refer.
The Alberta College of Pharmacists said a pharmacist receiving such a
prescription is "the secondary professional," secondary to the prescribing
doctor: the doctor has full freedoms of conscience and religion, but the
pharmacist doesn't, which is insulting" says Vancouver pharmacist Alarcon.
It's also oddly contradictory, she added, considering that pharmacy
organizations are lobbying and jockeying for more responsibility and bigger
roles in medicine, a stand supported by Roy Romanow, the federal
government's commissioner looking into Canada's health care.
However, the MAP dispute may soon become moot if the drug industry succeeds
in getting the approved as an over-the-counter medicine. The industry argues
that it is no more dangerous than Aspirin, ignoring the moral objection that
it causes very early abortions.
Abortion promoters tend to allay such concerns by defining life as beginning
not at conception (fertilization) but at the point when the embryo implants
in the womb.
Ironically, making the MAP so easily available could benefit conscientious
objectors because they could simply choose not to stock it. Non-pro-life
sales clerks could ring in the product, but since nobody can compel a
retailer to handle a product, there is no justification for forcing
pharmacists to do so.
The Canadian Pharmacist's Association has not taken its own stand on
conscientious exemption. Instead, CPA spokeswoman Janet Becigneul said her
organization has adopted a "model" statement written by another voluntary
organization, the National Association of Pharmacy Regulatory Agencies
(NAPRA), the very statement calling for referral that the Manitoba
pharmacists rejected two years ago.
Pharmacist Nancy Metcalfe of Morden, Manitoba, made the proposal that led to
the rejection of the following paragraph: "The individual pharmacist must
pre-arrange access to an alternate source, to enable the patient to obtain
the service or product that they need [sic]. Any alternate means must
minimize inconvenience or suffering to the patient or patient's agent."
Euthanasia, as well as abortifacients, was very much an issue when Ms.
Metcalfe made her appeal: "I believe that people have intrinsic value, be
they one day or 90 years old. I consider any active action against their
lives to be murder. Thus this is an extremely serious issue. Do we really
wish to aid strong Canadians in killing weak Canadians? Where is our
traditional commitment to protect life?"
Metcalfe said that in a recent letter to her, Ron Guse, registrar of the
Manitoba Pharmaceutical Association said, "The patient's right to so-called
service, in this case, the right to terminate another person, overrides a
pharmacist's right to act on deeply-held beliefs. He doesn't seem to realize
that choice is not a value in itself: it depends on what the choice is
Metcalfe said that she is unaware of any other service provider who is
forced to inform a patient where a service can be procured. "Physicians
inform me that they are not required to inform patients who will prescribe
the morning after pill, or where the patient can abort her baby. So, why put
this requirement on us?"
When the Manitoba pharmacists were debating this issue, Metcalfe's
intervention was impassioned
"I ask that you, no matter what you personal beliefs are, support me in
rejecting this coercive measure. I ask that you allow people like myself to
act on our convictions in this critical area. And I'd also ask you to
remember that a vote passing this NAPRA recommendation could well deprive
people like me of our license to practice. You see, I will not direct people
to a source of life-taking medication. I cannot collaborate in the modern
Conscientious pharmacists are not barring access to legal drugs, she added,
but objecting to and refusing to participate in their usage.
Federal legalization of drugs and procedures doesn't make them mandatory,
just permitted, she argued, adding that history abound with practices that,
while "legal", weren't "right".
"Blacks and women were not considered persons; and let us not forget the
infirm, the handicapped, the communists, the Christians and the Jews of the
"If today, the government decreed that we could kill all handicapped people,
would you cheerfully dispense medication?"
Metcalfe pointed out that it was NAPRA, not the law and not the government,
that adopted the attitude that these products are legal and therefore
mandatory for pharmacists to dispense.
Ms. Metcalfe did not expect her resolution to pass, but she did foresee the
"hullabaloo" that followed. The convention couldn't decide the issue so it
was passed it on to an ethics committee. A very public debate also ensued.
[For example, see News Release,
Letter to Winnipeg Sun,
Letter to Edmonton Sun - Administrator]
In the end, much to her surprise, Manitoba registrar Ron Guse wrote her "a
very nice letter," stating that the committee had decided that Manitoba's
pharmacists do not have to dispense or refer if they object to a product.
And now "where I work the doctors are asking pharmacists whether they
stock drugs under dispute and then they tell their patients which pharmacies
stock them. Some doctors stock their own."
Metcalfe, who is a Mennonite, credited the "power of prayer for her success.
Now she and many others are hoping that pharmacists in the other nine
provinces of Canada choose the full freedoms of religion and conscience.