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Medical journal: pharmacists must give out morning-after pill

By on Thursday, 31 January 2013

Under current law pharmacists may refuse to sell the pill but must direct the customer to another provider (Photo: PA)

Under current law pharmacists may refuse to sell the pill but must direct the customer to another provider (Photo: PA)

The right of pharmacists to refuse to sell the morning-after pill to customers on conscience grounds should be abolished, according to academics writing in the Journal of Medical Ethics.

Dr Cathal Gallagher, a pharmacist at the University of Hertfordshire, has written a paper with three other academics arguing that pharmacists who do not distribute the morning-after pill demand “the power of veto over the liberty of others, and over the implementation of public policy”.

Under current law, a pharmacist who is opposed to the morning-after pill can refuse to sell the pill but they must direct the customer to another provider.

But the academics argue that there is a little moral difference between a pharmacist refusing to sell the morning -after pill and a pharmacist directing a customer to where they can buy the pill.

They write: “Either the regulators must compel all pharmacists to dispense emergency contraception to all suitable patients who request it, or a pharmacist must refuse either to supply Emergency Hormonal Contraception or to refer the patient to an alternative supplier and challenge any subsequent sanctions imposed by their regulator.”

Dr David Jones, director of the Anscombe Bioethics Centre said: “This would destroy pharmacy as a profession and reduce pharmacists to the role of an automatic dispensers.

“As it is a key principle of medical ethics that a competent patient has a right to refuse to accept treatment so it is a key principle of medical ethics that a professional has a right to refuse to provide treatment that he or she does not think would benefit the patient. We need conscientious doctors, nurses and pharmacists, even if that means we will sometimes not get what we want.”

  • Jonathan

    I think that you’ve made a bit of mess re-presenting the paper for this audience.  For example:

    “But the academics argue that there is a little moral difference between a pharmacist refusing to sell the morning -after pill and a pharmacist directing a customer to where they can buy the pill.” - No, the academics argue something else; that there is little moral difference between a pharmacist *supplying* the morning-after pill and directing a customer to where they can buy it.

    The paper is arguing for greater moral clarity.  I have annotated in square brackets below to make the argument as originally presented more understandable to your readers…

    They write [that in order to achieve greater moral clarity]: “Either the regulators must compel all pharmacists to dispense emergency contraception to all suitable patients who request it, or a pharmacist must refuse either ["both" is meant rather than "either"] to supply Emergency Hormonal Contraception or ["and" is meant rather than "or"] to refer the patient to an alternative supplier…”

    I think that the article could have better concluded that the regulator should remove the requirement for pharmacists to redirect customers to other, willing, pharmacists.  That would also provide the greater moral clarity they are looking for, whilst being consistent with allowing pharmacists to act in accordance with their conscience in a very important matter such as this.  Alas, for some reason they argue that the regulator can move in one direction only…

  • Mark

    When academia and television are either reduced in their omnipotent
    influence or when Christians convert academia and the media; until then
    no progress will be permanent because any progress made will be rolled
    back by anti-family propaganda in academia and the media. Any ideas on
    how to either reduce their influence or convert them?

  • asa2222

    How “tolerant” of Dr Gallagher…

  • JabbaPapa

    You haven’t understood the logic — the academics ARE in fact arguing that there is no moral difference between refusing to sell the pill and referring to another who will.

    Which is to say that they condemn both.

  • Jonathan

    Thank you for confirming that you haven’t read the article.

  • http://www.catholicismpure.wordpress.com/ Brother Burrito

    The morning after pill is an abortifacient. It deliberately causes the death of the human conceptus.How can anyone be forced to dispense such a drug if they have genuine reason for considering such an act as being accessory to murder?

  • JabbaPapa

    Thank you for confirming that your grasp of logic and textual interpretation is biased and faulty.

  • Jonathan

    How strange, JabbaPappa.  I can only suggest that you re-read the article in the JME.

  • majorcalamity

    If a pharmacist is dispensing a NHS prescription then I feel they cannot cherry pick what they regard as acceptable or not. That is the task of the doctor. If their conscience prohibits this then they should not be accepting NHS work, which might well mean they cannot be a pharmacist.

    Private work, based on their own judgement is a different matter. However they ought to explain their reasoning and suggest that their patient might wish to visit another pharmacist.

  • Jonathan

    I sort of see what you mean. Helpfully, it’s not about being able to “cherry pick what they regard as acceptable or not”.  There is statutory regulation in place dealing with the morning-after pill.  It effectively provides a conscience-clause, enabling pharmacists not to supply the morning-after pill.

    The sting in the tail (for objectors) is that the same regulation requires those pharmacists to direct customers to a willing pharmacist.

    The article in the JME argues that the result is a fudge that satisfies no-one (except, perhaps, the regulator!).  They argue that the conscience-clause should either be done away with, or beefed-up so that those who don’t want to supply it don’t have to direct customers to a willing pharmacist.

    We’re pretty good in this country – usually – at balancing difficult issues like this.

    What you’ve outlined “suggest that their patient might wish to visit another pharmacist” is what is already *required*.  The JME article suggests doing away with this requirement (or removing the conscience clause altogether, which I think highly unlikely!).

  • Jonathan

    Exactly…  Which is why the conscience clause is at present insufficiently strong.  It’s not much (though, perhaps some!) good not “being forced to dispense” if you *are* forced to redirect to somebody else who *will*.

    A slightly better summary than that provided by Madelaine Tehean is provided on the Science Daily website.  I think that the CH article must rely only on the JME abstract rather than the full article.

  • scary goat

    Very confusing.  I can see the logic of the argument that it is pretty pointless refusing to provide it if you are then going to refer the person to someone who will.  I have thought that for a long time.  But quite what they intend to do about it is a bit unclear. 

  • Jonathan

    Quite… they seem to get a bit muddled and seem to think that the only two options are (a) remove the conscience clause (nice and clear; uniform; tidy) or (b) objectors should refuse both to provide the morning-after pill and to refer to a willing supplier – and to accept the consequences from the regulator.

    There seem to me other options: for example… amend the regulation to remove the requirement to refer to a willing supplier.  Or, require non-supplying pharmacists to indicate that clearly at the entrance of the pharmacy… or some other imaginative way of accommodating conscience!

  • scary goat

     Well yes.  I mean is there a shortage of pharmacies in the country, or what?  Can’t people shop around by themselves without being referred?  And to be honest, I’m inclined to think that the more you cater for this sort of “emergency” the more “emergencies” you will get.  If people aren’t so sure that they can just pop in and demand it from anywhere they might think twice in the first place.

  • Jonathan

    “Exactly!…” I said.

    A caveat: the morning after pill is not *strictly* an abortifacient: it will not cause an abortion in pregnant women.  It acts by either inhibiting ovulation or preventing a fertilised ovum from attaching itself to the lining of the womb.For Catholics, I think that the second of these actions is why we might nevertheless loosely call it abortifacient: it can and does act on the fertlised ovum.

    Details, details, I know… but there is a distinction here, so we may as well acknowledge it.

  • Jonathan

    There is some mention made about the difficulty in rural areas of being potentially sent from pillar to post within the 72 hours necessary… I think that’s clutching at straws, myself.

    3 days is plenty of time to travel virtually anywhere in the UK.  I suppose it might be mildly inconvenient to have to try two or three pharmacies, but not much more than that?

  • scary goat

     Would it really be too “inconvenient” for people to muster a little self control in the first place?

  • Alidylan73

    The morning after pill is NOT an abortifacient, and will not bring on abortion if given to a pregnant woman, when are people going to get their heads around this and get their facts right? pregnancy begins when the fertilized egg implants in the lining of
    a woman’s uterus. Implantation begins five to seven days after sperm
    fertilizes the egg, and the process is completed several days later.
    Emergency contraception will not work if a woman is already pregnant.

    A pharmacist is there to dispense medication. He is not responsible for prescribing it, so why all this posturing about conscience?

  • Jonathan

    First paragraph: completely agree, and have posted to similar effect.

    Second paragraph: the morning-after pill is available both with and without a prescription.  

    Conscience kicks in particularly because some people believe that life begins with the egg becoming fertilised (rather than the point at which a fertilised egg implants in the lining of the womb…)

    It’s essentially an issue of “when does a person come into being”?

    Our society has a good tradition of accommodating conscience in cases like this.

  • Jonathan

    by “not much more than that”, I mean “not much more than mildly inconvenient”!

  • David Kennedy

    Actually, it isn’t just “some people” who think that live begins at fertilisation. It’s biological science that states that. Check any textbook on embryology.

    However, it’s probably true to say pregnancy begins at implantation. The start of life and the start of pregnancy aren’t the same thing.

  • Jonathan

    Quite.  Lazy language on my part.

  • Sweetjae

    We are concern about when Life starts not when pregnancy starts. Our belief is Life starts at the moment of the sperm and egg unite, NOT a few days later when the fertilized egg implants in the lining of woman’s uterus. 

    This is the scenario that you don’t get into your head and exactly  the reason why there is posturing about conscience.

  • Aganendran

    Why do Academics feel they have the right to challenge the conscience of Pharmacists, or tell them what to do? It seems that they are not capable of understanding Medical Ethics.