Patients often make their own decisions about managing their medications. Pharmacists could usefully serve as patient advocates, providing information that permits patients to assess risk and enhance their autonomy.

: This paper examines the obligations of pharmacy licensees and pharmacists in the context of conscience-based objections to filling lawful prescriptions for certain types of medications—e.g., standard and emergency contraceptives. Claims of conscience are analyzed as means to preserve or maintain an individual's moral integrity. It is argued that pharmacy licensees have an obligation to dispense prescription medications that satisfy the health needs of the populations they serve, and this obligation can override claims of conscience. Although efforts should be made (...) to respect the moral integrity of pharmacists and accommodate their claims of conscience, it is argued that the health needs of patients and the professional obligations of pharmacists limit the extent to which pharmacists may refuse to assist patients who have lawful prescriptions for medically indicated drugs. (shrink)

This essay seeks to establish that Catholic community pharmacists should refuse to verify, dispense, and counsel on hormonal medications used for contraception on the grounds of professional and personal beliefs as these services constitute immoral immediate material cooperation. In this controversial area of patient care, pharmacists are more frequently being called upon to facilitate medication use for contraceptive purposes. Contraceptive acts are believed by some healthcare providers to be morally harmful to a patient’s well-being. Pharmacists who hold beliefs that contraception (...) does not promote positive patient outcomes are professionally bound to refuse immediate cooperation through providing pharmaceutical services related to contraception. (shrink)

The introduction of conscience clauses after the 1973 US Supreme Court decision in Roe v. Wade allowed physicians and nurses to opt out of medical procedures, particularly abortions, to which they were morally opposed. In recent years pharmacists have requested the same consideration with regard to dispensing some medicines. This paper examines the pharmacists’ role and their professional and moral obligations to patients in the light of recent refusals by pharmacists to dispense oral contraceptives. A review of John Rawls’s concepts (...) of the “original position” and the “veil of ignorance”, along with consideration of the concept of compartmentalisation, are used to assess pharmacists’ requests and the moral and legal rights of patients to have their prescriptive needs met. (shrink)

Considerable ethics-related focus has been directed to the pharmaceutical industry’s relationship with physicians, in part because physicians have the only profession able to prescribe much of what the industry manufactures. In Alberta, however, pharmacists have recently been permitted to modify physician prescriptions for a patient and even to prescribe without physician involvement. This paper will examine how this change in responsibilities could change pharmacists’ relationships with the industry.

It has been 40 years since the seminal papers on pharmacy's status as a profession sparked debate about the pharmacist's role in health care, yet the questions they raised are just as poignant today as they were then. Questions about whether pharmacists are the experts when it comes to drug therapy information can be answered practically by assessing the perception of pharmacists' obligations to patients as being dependent on or independent of physicians' responsibilities. Both options have important implications for (...) pharmacy's status as a profession, the value that pharmacists can add to health care, and a pharmacist's right to deny a patient emergency contraception. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 16.4 (2006) 379-396MuseSearchJournalsThis JournalContents[Access article in PDF]Pharmacists and Conscientious Objection *In March 2005, a Wisconsin pharmacist's act of conscience garnered headlines across the United States. After a married woman with four children submitted a prescription for the morning-after pill, the pharmacist, Neil Noesen, not only refused to fill it, but also refused to transfer the prescription to another pharmacist or to (...) return the prescription to the customer. As more such incidents occurred, many states "... decided to consider and enact laws setting the bounds of pharmacists' and other health care workers' professional obligations" (III, Grady 2006, p. 327). Discussions of objector legislation, also referred to as "conscience clauses," "refusal clauses," and "abandonment laws" (III, Appel 2005, p. 279), are not limited to professional ethics, but also draw from philosophical, theological, and legal perspectives. The purpose of this Scope Note is to present a wide variety of viewpoints on the health provider's right to conscience.More than 40 years ago the development of "The Pill" as the first reliable method of birth control not only ushered in a feminist revolution, but also provided a new focus for concerns of conscience for those who were part of the anti-abortion movement based on religious belief in the sanctity of life. Similarly, in the past ten years, worldwide, and seven years (1999) since the emergency contraception "morning after" pill first became available as a prescription item, there has been an upsurge in the number of medical personnel who refuse to prescribe or dispense it on grounds of personal conscience, whether for religious reasons or not. Their actions bring into play issues of power and control for health care personnel and for patients—in this case women, which also raises women's rights issues. Ironically, studies in France, Sweden, and the United Kingdom have shown that emergency contraception does not reduce the abortion rate—it is too infrequently used (II, Glasier 2006).It is important to underline the difference between the "morning-after" pill or "Plan B," which is made up of two progestin pills containing levonorgestrel (a synthetic derivative of the female hormone progesterone), and RU-486 (Mifiprex [End Page 379] or mifipristone with misoprostol). Plan B, if taken within 72 hours post-coitus prevents implantation, and therefore pregnancy, by suppressing the output of luteinizing hormone, the hormone that triggers the ovulation process. Scientists have been unable to determine whether this action could destroy already fertilized eggs, but even if it does, it uses the same mechanism as occurs with the birth-control pill, that was developed some 45 years ago. By contrast, RU-486 acts up to 49 days after implantation by blocking the action of progesterone in order to terminate the pregnancy and as such is an abortifacient (II, US FDA 1).On 24 August 2006, the U.S. Food and Drug Administration announced approval of the Plan B pill for over-the-counter (OTC ) sales (II, US FDA 2). Although this action makes the drug more widely available, it remains to be seen whether pharmacists who are conscientious objectors and who refuse to dispense it also will refuse to provide it OTC.A survey article by Rebecca Dresser (II, 2005, p. 9) succinctly sums up the problem for conscientious objectors: "Because emergency contraception can act to block implantation of a fertilized egg, people who believe in protection of human life after conception find it morally objectionable."When conscientious objections are raised over abortion or birth control services performed, prescribed, or dispensed, they affect not only the health professionals—physicians, pharmacists, nurses, and health technicians—who may object, as well as their colleagues and/or managers, but also the consumers: the female patients who are then forced to reconsider or to seek an alternative supplier, as well as their spouses or partners. Alta Charo (II, 2005, p. 2473) makes the point that the patient needs to have access to a system of counseling and referral "so... (shrink)

Legislation enabling pharmacists to prescribe is being drafted and passed in Canada and internationally. But is it a good idea for pharmacists to be prescribing psychotropic medications? In this discussion, the term “pharmacist prescribing” is dei ned, the issues of the potential conl ict of interest of pharmacists discussed, and the education and training of pharmacists reviewed. Finally, an experienced psychiatrist weighs in on the discussion with a personal rel ection on this important discussion, concluding that “we should move (...) forward cautiously but in a spirit of collaboration, mutual respect and above all in the best interests of the patient. (shrink)

Researching ethical problems and their frequency could give us a complex picture and greater insight into the types of ethical issues that pharmacists face in providing health care. The overall aim of this study was to assess the pharmacist’s perception of difficulty and frequency of selected ethical issues encountered by the community pharmacists in their everyday practice. A quantitative cross sectional multicenter study was performed using a validated survey instrument - Ethical Issue Scale for Community Pharmacy. The results of (...) the analysis of 690 completely filled out instruments showed the difference between the ethical issues which always occurred, and the ones that pharmacists found most difficult. The majority of respondents were familiar with the Code of Ethics but the correlation between the familiarity and the perceived usefulness of the code in resolving problems in everyday practice was negative. Results showed that patients’ well-being had a high influence on pharmacists’ behavior. The results provided quantitative data by the examination of specific ethical issues and their occurrence. Further empirical research is recommended in order to systematically identify the ethical issues faced by community pharmacists. (shrink)

Some medical services have long generated deep moral controversy within the medical profession as well as in broader society and have led to conscientious refusals by some physicians to provide those services to their patients. More recently, pharmacists in a number of states have refused on grounds of conscience to fill legal prescriptions for their customers. This paper assesses these controversies. First, I offer a brief account of the basis and limits of the claim to be free to act on (...) one’s conscience. Second, I sketch an account of the basis of the medical and pharmacy professions’ responsibilities and the process by which they are specified and change over time. Third, I then set out and defend what I call the “conventional compromise” as a reasonable accommodation to conflicts between these professions’ responsibilities and the moral integrity of their individual members. Finally, I take up and reject the complicity objection to the conventional compromise. Put together, this provides my answer to the question posed in the title of my paper: “Conscientious refusal by physicians and pharmacists: who is obligated to do what, and why?”. (shrink)

Objective: To explore the relationship between pharmacists'' tenure in the community setting and their moral reasoning abilities. Design: Systematic random sample design. Setting: A large southeastern city in the United States. Participants:450 independent and chain community pharmacists identified from the state board of pharmacy list of licenced community pharmacists. Interventions: A mailed questionnaire that included a well-known moral reasoning instrument and collected demographic information. Main Outcome Measures: Moral Reasoning abilities and tenure of community pharmacists. Results: As a group, community pharmacists (...) with greater years of tenure in community practice scored significantly lower on moral reasoning than those pharmacists with fewer years of tenure (p = 0.016). Conclusion: Four plausible explanations for the results are given including: a) a selection of lower ethical reasoners and/or an exodus of higher ethical reasoners from the community setting; b) a retrogression in the moral reasoning skills as community pharmacists obtain tenure in this setting; c) differences between the low and high moral reasoning groups may be due to a cohort effect; and d) the obtained practitioner sample may not have been representative of the population of community pharmacists. (shrink)

This article addresses a set of exploratory questions related to emergency contraception and the right to refuse to dispense such drugs. The paper first address the roles of the pharmacist in American society, i.e., as professional, employee, and business owner, and the pharmacists's identity and belief system; second, the paper reviews the status of state law and proposed legislation concerning patient/consumer access to emergency contraceptives; third, it offers an in-depth stakeholder analysis of the ethical and legal responsibilities of pharmacies (...) to stakeholders; and fourth, the paper provides overview of the salient ethical and legal issues concerning patient/customer access to emergency contraceptives relevant to management. The conclusions discuss questions for further research as well as strategic/human policy recommendations that balances the economic, legal, and ethical concerns of all primary stakeholders of the company/business, such as designing a management system which refers customers in a timely fashion; recognizing "conscience clauses," while ensuring that pharmacists "do no harm" to the consumer; and disseminating management "best practices" on "conscience clauses" through joint professional/industry sponsorship. (shrink)

This review analyzes the social perspective of patient safety and how pharmacists should consider these elements when adopting health information technology (HIT) into their practice.

In the Netherlands, euthanasia has been decriminalized. Termination of life on request and assisted suicide are criminal offences under Dutch law; but if physicians comply with the due care requirements of the Euthanasia Act and report their actions in the manner prescribed by law, they will not be prosecuted. One of the requirements relates to the act of euthanasia itself. If this is to be performed with due medical care, the physician relies on the services of a pharmacist. However, (...) the responsibilities of the pharmacist with respect to euthanasia are not laid down in law. At present, Dutch pharmacists have to make do with professional rules that do not offer adequate solutions for the problems that may arise when euthanasia is performed. (shrink)

Objectives— To explore British community pharmacists' views on PAS , including professional responsibility, personal beliefs, changes in law and ethical guidance.Design— Postal questionnaireSetting— Great BritainSubjects— A random sample of 320 registered full-time community pharmacistsResults— The survey yielded a response rate of 56%. The results showed that 70% of pharmacists agreed that it was a patient's right to choose to die, with 57% and 45% agreeing that it was the patient's right to involve his/her doctor in the process and to use (...) prescription medicines, respectively. Forty-nine per cent said that they would knowingly dispense a prescription for use in PAS were it to be legalised and 54% believed it correct to refuse to dispense such a prescription. Although 53% believed it to be their right to know when they were being involved in PAS, 28% did not. Most pharmacists said that they would wish to see the inclusion of a practice protocol for PAS in the code of ethics of the Royal Pharmaceutical Society of Great Britain in the event of a change in the law on PAS. In addition, 89% would wish to see PAS included in the Conscience Clause of the CE-RPSGB. Males were found to be significantly less likely to favour PAS than females , as were those declaring an ethnic/religious background of consideration when dealing with ethical issues in practice compared with their counterparts .Conclusion— Pharmacists view their professional responsibility in PAS to be more obligatory than a physician's, in having to provide the means for PAS. It is worrying that a proportion of the respondents prefer to remain in ignorance of the true purpose of a prescription for PAS; a finding at odds with current developments within the pharmaceutical profession. A practice protocol for PAS and an extension of the conscience clause should be considered in the event of PAS becoming legal. Such measures would allow the efficient provision of the pharmaceutical service whilst at the same respecting the personal beliefs of those who object to cooperating in the ending of a life. (shrink)

This article addresses a set of exploratory questions related to emergency contraception and the right to refuse to dispense such drugs. The paper first addresses the roles of the pharmacist in American society, i.e., as professional, employee, and business owner, and the pharmacists’s identity and belief system; second, the paper reviews the status of state law and proposed legislation concerning patient/consumer access to emergency contraceptives; third, it offers an in-depth stakeholder analysis of the ethical and legal responsibilities of pharmacies (...) to stakeholders; and fourth, the paper provides overview of the salient ethical and legal issues concerning patient/customer access to emergency contraceptives relevant to management. The conclusions discuss questionsfor further research as well as strategic/human resource management policy recommendations that balances the economic, legal, and ethical concerns of all primary stakeholders of the company/business, such as designing a management system which refers customers in a timely fashion; recognizing “conscience clauses,” while ensuring that pharmacists “do no harm” to the consumer; and disseminating management “best practices” on “conscience clauses” through joint professional/industry sponsorship. (shrink)

This paper represents the responses of 377 pharmacists to a mail survey examining their views concerning ethical conflicts and practices. Besides identifying the sources of ethical conflicts, pharmacists were asked how ethical standards have changed over the last 10 years as well as the factors influencing these changes. Conclusions and implications are outlined and future research needs are examined.

Dr. Garrett Johnson received a call from the Texas Department of Criminal Justice asking if he would be interested in filling prescriptions for pentobarbital. Suddenly he faced a controversial issue - providing a drug used for the lethal injection of convicted criminals. Apparently big pharma was discontinuing the manufacture and sale of drugs used for human executions - primarily due to mounting pressure from death penalty activists and shareholders, legal appeals by inmates, media reports of botched lethal injections, etc. Texas (...) saw the solution by using small local compounding pharmacies that were less visible to the public. Should Garrett fill this lucrative order knowing how the State would use the drugs? The case presents the ethical and strategic issues that Garrett faces - having just graduated and started his own compounding pharmacy - in making this decision. (shrink)

The year 2020 is facing one of the worst public health situations in decades. The world is experiencing a pandemic that has triggered significant challenges to healthcare systems in both high and low‐middle income countries (LMICs). Government policymakers and healthcare personnel are experiencing real‐life ethical dilemmas and are pressed to respond to these situations. Many possible treatments are being investigated, one of which is the use of hydroxychloroquine or chloroquine. These drugs are approved for use by patients with systemic lupus (...) erythematosus (SLE), rheumatoid arthritis, and malaria. The demand for these products has increased, and the stocks are depleting for the patient population for whom the drugs are intended initially. Although both innovator and generic pharmaceutical manufacturers are making plans for increased production, there are challenges with global supply chains disruption and the retention of supplies for local markets. This may cause countries that rely on the importation of pharmaceuticals to be out of stock of supplies for an extended period. There are allegations of off‐label prescribing and hoarding. Pharmacists are the custodians and dispensers of medications and are faced with the task of assessing prescriptions and making decisions about the allocation of these products. This paper seeks to 1) highlight some of the ethical challenges of dispensing hydroxychloroquine by pharmacists during the COVID‐19 pandemic, 2) identify some of the responses to these issues from various regulatory authorities in the USA, and 3) recommend approaches to assist pharmacists in their decision‐making process, especially in LMICs. (shrink)

The year 2020 is facing one of the worst public health situations in decades. The world is experiencing a pandemic that has triggered significant challenges to healthcare systems in both high and low‐middle income countries (LMICs). Government policymakers and healthcare personnel are experiencing real‐life ethical dilemmas and are pressed to respond to these situations. Many possible treatments are being investigated, one of which is the use of hydroxychloroquine or chloroquine. These drugs are approved for use by patients with systemic lupus (...) erythematosus (SLE), rheumatoid arthritis, and malaria. The demand for these products has increased, and the stocks are depleting for the patient population for whom the drugs are intended initially. Although both innovator and generic pharmaceutical manufacturers are making plans for increased production, there are challenges with global supply chains disruption and the retention of supplies for local markets. This may cause countries that rely on the importation of pharmaceuticals to be out of stock of supplies for an extended period. There are allegations of off‐label prescribing and hoarding. Pharmacists are the custodians and dispensers of medications and are faced with the task of assessing prescriptions and making decisions about the allocation of these products. This paper seeks to 1) highlight some of the ethical challenges of dispensing hydroxychloroquine by pharmacists during the COVID‐19 pandemic, 2) identify some of the responses to these issues from various regulatory authorities in the USA, and 3) recommend approaches to assist pharmacists in their decision‐making process, especially in LMICs. (shrink)

This paper critically examines the implications of state efforts to expand prescriptive authority of pharmacists, which will allow them to prescribe various types of hormonal contraceptives. With this expansion, women no longer need to see a physician before being prescribed such contraceptives, but instead, they must answer self-assessment questionnaires at the pharmacy to ensure that their chosen method is safe and appropriate. This paper argues that while these measures to expand pharmacists’ prescriptive authority will surely meet the stated goal to (...) increase access to hormonal contraceptives, the measures may have detrimental consequences that have largely been downplayed. Studies consistently show that the OB-GYN is a significant primary care provider identified by young female patients, and some of the main reasons provided by these young women for going to the OB-GYN is to discuss, or obtain a prescription for, contraceptives. Through the expansion of pharmacists’ prescriptive authority, a likely consequence is that some women will relinquish going to the OB-GYN. However, the OB-GYN provides important services beyond contraceptives, such as preventive screenings for hypertension, cardiovascular diseases, alcohol abuse, mental health, etc., and there is evidence supporting both the effectiveness and cost–benefits of these interventions. By increasing access to contraceptives, the likely result is that many women will have less interaction with a physician and will receive fewer preventive screenings. I do not wish to suggest that these bills should not pass, nor that OB-GYNs should hold contraceptives hostage, only that there are consequences to expanded prescriptive authority that must be anticipated. Further, expanding prescriptive authority obscures the real problem: some individuals have trouble accessing the health care system, not merely trouble accessing hormonal contraceptives. The expansion of prescriptive authority to include contraceptives applies a Band-Aid to treat one aspect of this problem. What is needed is not merely expanded access to hormonal contraceptives, but better access to health care in general. (shrink)

Federal and state laws create a tightly controlled system for distribution of those drugs that have recognized value in therapy, but also have the potential for abuse. The challenges pharmacists face in keeping controlled substances within the closed system are many and complex. Drug abusers and drug dealers have at times seen pharmacists as easy marks for access to abusable drugs. Unfortunately, pharmacists often find themselves in a game with criminals, who use both sophisticated and dangerous methods of inducing pharmacists (...) to divert controlled substances. The effects of this problem on the health-care system have been judicially noted:The frequency of these crimes has terrorized the community of dispensing pharmacists. Some pharmacists have ceased to carry drugs that are highly desired on the black market, although this interferes with their patients’ ability to obtain necessary medicine. This has a serious potential to impede the delivery of health care in many communities around the nation. (shrink)

BackgroundWhile healthcare professionals’ right to invoke the conscience clause has been recognised as a fundamental human right, it continues to provoke a heated debate in Polish society. Although public discourse is filled with ethical and legal considerations on the conscience clause, much less is known about the attitudes of healthcare professionals regarding that matter. The aim of this study was therefore to describe the attitudes of Polish physicians, nurses and pharmacists towards the ethical and legal aspects of the conscience clause.MethodsWe (...) analysed a group of three hundred healthcare professionals: physicians, nurses and pharmacists in Poznan, Poland, using a standard questionnaire comprising of 29 questions about various ethical and legal aspects of the conscience clause and participants’ personal experiences with the conscience clause. The study was conducted between January and March 2020.ResultsThis research shows that although most Polish healthcare workers support the right to invoke the conscience clause they differ significantly in their opinions on to whom and to what medical procedures the conscience clause should apply to. It also demonstrated that while the conscience clause is rarely invoked in Poland, most healthcare professionals declare that the current legal regulations in that sphere are unclear and inaccurate.ConclusionsWhile there is an urgent need to raise the awareness regarding the conscience clause among medical students and healthcare professionals and educate them about such issues, it is even more important to improve the legal system in regard to the CC so that it protects both HCPs’ right to the CC and safeguards patients’ rights to medical services. (shrink)

Developing World Bioethics, Volume 21, Issue 4, Page 193-200, December 2021.