Religious guidance may put pharmacists at risk of punishment

"GPhC's religious guidance may expose pharmacists to fitness-to-practise proceedings"

Lawyer David Reissner unravels a potential shortcoming in the new General Pharmaceutical Council (GPhC) standards on religious beliefs.

In 2013, the GPhC banned a pharmacist from providing emergency hormonal contraception (EHC) for three years because he had given a patient "a distressing explanation of why his religion regarded EHC as morally wrong". The fitness-to-practise committee said the registrant should have referred the patient to another pharmacist.

It is interesting to reflect on this case now, because of the GPhC consultation on religion, personal values and beliefs [which closed last week]. In the consultation, the GPhC asked how pharmacy staff should factor personal values and religious beliefs into their care provision. Sensitive issues may involve a reluctance to provide:

• contraception

• fertility medicines

• hormonal therapies

• mental health and wellbeing services

• substance misuse services

• sexual health services.

The GPhC’s new standards – due to come into effect on May 1 – propose that pharmacy professionals should not be able to refuse services based on their religion, personal values or beliefs. The GPhC suggests that referral to another pharmacist should not be an option.

In some circumstances, these new GPhC rules could be disproportionately onerous to pharmacy staff. They may unfairly expose them to the risk of fitness-to-practise proceedings.

For example, not all services sought by a patient justify the request being prioritised. It does not follow that if any product or service has not been provided, then the person seeking it has not received safe and effective care. A pharmacist might be justified in referring the patient elsewhere, even if that results in a delay before the patient's request is met.

The proposed standards also state that if pharmacists are unwilling to meet certain patient needs, they should not “take up certain working roles”. This seems disproportionately restrictive, because it does not make allowances for pharmacists with certain beliefs who may be the only applicants for a job in an isolated area, or in a city centre with late opening hours.

Pharmacists should be open with prospective employers about ways in which their values may impact upon their ability to provide certain services. But if there are no other applicants for the job, it is surely better that most services are provided than that posts remain unfilled.

David Reissner is senior healthcare partner at law firm Charles Russell Speechlys LLP (david.reissner@crsblaw.com)

43 Comments

Hackney Drug Dealer, Community pharmacist

Having attended a recent GPhC event it was fascinating to hear the moral objectors and imaginary-friend belivers eventually trot out the diatribe of having their human rights violated. The looks of sheer hatred from the throng was a sight to behold as they felt victimised. Moreso than ever they clutched at semantic straws. If you cant stand the heat get out of the kitchen. 'Patient centred care'. QED

Hackney Drug Dealer, Community pharmacist

“Isn't it enough to see that a garden is beautiful without having to believe that there are fairies at the bottom of it too?” - Douglas Addams

EVIDENCE BASED SUPPLY - Patient centred care

Kuldip Singh, Locum pharmacist

Just to put the cat amongst the pigeons here.    

Weren't there Nazi prison guards who tried to justify their part in the holocaust by saying "we were just following orders"? 

I agree one shouldn't enforce Ines views on another but surely as a professional you should be allowed some professional freedom. 

Lucky Ex-Locum, Superintendent Pharmacist

It's a good point. I think there needs to be some of that thing which is sadly lacking nowadays which is common sense. If a pharmacist genuinely, morally does not wish to supply EHC but is able to promptly signpost the customer somewhere that can, there isn't much of a problem, but if the pharmacist starts preaching their values to the customer that is a big no-no. 

A Hussain, Senior Management

If you refuse to provide EHC via a consultation because you think it's wrong then surely you would refuse to check a prescription for it.  I think that there are some pharmacists who just don't want to do the consulatation and this is a way out.  No offence meant to those who hold true religious beliefs, even though I feel that they should be left at the door.

janet maynard, Community pharmacist

My personal gripe is that the EHC is not then on their records, we can't provide on going contraception, have no way of following up etc etc. We can't see other times they have had EHC, have only limited knowledge of the patient and their history. It is a religious issue but not just a religious issue!

 

Simon MEDLEY, Community pharmacist

Any good PGD would include signposting to CASH clinic for future contraception and instructions of when to seek further medical advice - just follow these rules and note on pmr and all you are left with is religious objections

Hackney Drug Dealer, Community pharmacist

YES IT IS !  The supply is entered on the PMR as a supply (NON FP10) as a POM is supplied under a PGD. Most PMR software systems allow this. Supply notes could also be made in a contemporaneous notes section of the PMR if necessary or appropriate.

Lucky Ex-Locum, Superintendent Pharmacist

But what about otc sales? I think that is what this is referring to rather than PGD.

R A, Community pharmacist

I disagree I think the issue relates to the fact that people do not wish to take an active role in providing certain treatment such as morning after pill. If a pharmacist provides morning after pill via OTC or PGD they are a proactive participant in the supply chain for this treatment as the pharmacist ultimately has to authorise the treatment plan and therefore the buck stops with the pharmacist ethically/morally.

On the other hand when it comes to a prescription many pharmacists are able to compromise simply because the medical prescriber is the individual who has authorised the treatment and the moral/ethical responsibility for the treatment lies with the prescriber. As a pharmacist their role is simply to ensure the script is correct and the correct product is being supplied to the patient. However as I said before it is a compromise for many pharmacists because many pharmacists who observe this practice do so very reluctantly. 

R A, Community pharmacist

Despite the changes in wording in my opinion this new standard still gives a pharmacist scope to act as they see fit.

In this particular issue it seems to me the GPhC are advocating that pharmacists who previously did not provide certain services due to religious and personal belief to take a more active role to ensure patient care is not compromised.

Thus in the past when a pharmacist opted out of providing a service they effectively ended all further involvement with the patient but now this contradicts person-centred care. Therefore pharmacist is now responsible for the patient regardless of their personal belief and the action they take must put the need of the patient first. However if you read the entire document it still gives the pharmacist leeway to act as they see fit but the interest of the patient needs to be shown first.

An example of this is considering location and opening hour when accepting work as a pharmacist especially when they do not wish to provide certain services. Therefore if the pharmacy is in a rural location or if the opening hours till late/midnight a pharmacists refusal to provide certain service due to personal/religious belief would create a major barrier for the general public in having access to professional healthcare. Therefore they should think carefully before accepting such position. To this I wholeheartedly agree however I am confused by the purpose of introducing these new standards? Most this stuff is commonsense and most pharmacists I’ve spoke to who do not provide morning after pill for example take an active role in ensuring the patients are referred to nearby store which is able to provide this service seems a bit of an overkill to me. 

Stephen Eggleston, Community pharmacist

Religion is a personal subject, interpreted by the individual to suit their own needs. And that is fine. However, I do not think it is anyones place, moral or ethical, to impose their views on the patient. It IS their place to put forward all options, without bias, so the patient can make an informed decision. It is our job to do our best for our patient which, almost by definition, means we may have to go against what our personal choices may be but that's the point - these are not OUR choices but those of our patients and it is our professional obligation to support our patients, even if we don't agree with their choices

janet maynard, Community pharmacist

Does that mean that becuase it is the patient's choice to overdose on many OTC medicines we should just provide them!!!

 

Stephen Eggleston, Community pharmacist

I appreciate yor are just being facetious but, to take your comment at face value, no, of course not if you know the patient plans to do themselves harm. If, on the other hand, a patient buys some paracetamol, you ask the correct questions and get answers which do not raise your suspicions, you would be ok to supply. The fact that the patient then misused that product, deliberately or otherwise, is not your fault. The best analogy I can come up with is - "I sell guns. I am not a killer  because guns don't kill people. People kill people"

Andrew Paxton, Community pharmacist

I still will not provide EHC, regardless of any decision by the GPhC.

Hackney Drug Dealer, Community pharmacist

Reconsider your front-facing role, perhaps academia or tertiary care might be an option. In primary care the patients will rightly walk away to a non-judgmental service supplier. 

'Patient-centred' care. 

Benjamin Leon D'Montigny, Non Pharmacist Branch Manager

I am in agreement that religion should be personal to oneself and should never be to the detriment of another. I would liken it to a moral vegan refusing to give out capsules.

Ciaran Mc Caul, Community pharmacist

Why are you confusing religion with moral objection

Benjamin Leon D'Montigny, Non Pharmacist Branch Manager

I consider it the same thing. Take EHC for example, most people disagree because they believe it to be morally wrong as dictated by their chosen religion. Any other reason does not hold water against the duty of care one assumes as a pharmacist. Do you agree?

janet maynard, Community pharmacist

No!! There are other reasons for not providing EHC OTC- like not having the patients medical record, the record of EHC not being provided in one plase(the patient could be having one every day from different pharmacies!!) Not being able to provide on going contraception

 

 

Hackney Drug Dealer, Community pharmacist

Ditto supply of any POM etc on FP10 or OTC at any pharmacy the patient chooses. Triage & use professional judgment - NOT moral judgment. Make PMR notes. Advise accordingly, top looking for a get-out clause. 

Stephen Eggleston, Community pharmacist

With respect, do you not think these issues were considered before granting the OTC licence? And how likely is it that a patient will get EHC on a daily basis? Many women who seek EHC do not necessarily want hormonal contraception, being happy to use barrier methods but may simply have had a condom fail - the provision of EHC and the provision of ongoing hormonal contraception are not necessarily linked 

Lucky Ex-Locum, Superintendent Pharmacist

It amounts to the same thing. I am morally massively opposed to any form of hunting or shooting but if I refused to deal with anyone who did this I would be in breach of contract (as well as out of business in this area). Moral views and religious views are the same - a personal issue which should not be forced on others.

Lucky Ex-Locum, Superintendent Pharmacist

It's a similar principle to someone getting a job in a butchers shop then refusing to sell meat because they were vegetarian. I think everyone would think that was unacceptable no matter what your views on the subject.

janet maynard, Community pharmacist

Except that the rules have chnaged sonce we took the job! A butcher taking a job would know he was expected to sell meat- we took on pharmacy long before EHC became available OTC!

Ciaran Mc Caul, Community pharmacist

Unlike the supply of meat from a butchers however the supply of EHC from a pharmacy makes up a very small part of our workload. To exclude pharmacists from working in the community based on a moral objection to supplying EHC but instead referring to an alternate source seems quite discriminatory

Benjamin Leon D'Montigny, Non Pharmacist Branch Manager

This is actually a fair point, luckily there are also hundreds of different sectors other than community where a Pharmacist could work. However would another solution be to provide legislation so that another member of staff could complete the transaction? After all, We only need the Pharmacist clinical approval, not their moral one?

Lucky Ex-Locum, Superintendent Pharmacist

I think the issue is the religious preaching angle rather than referring. If someone doesn't want to sell for whatever reaon, just say there isn't any in stock. It isn't a contractual obligation to actually stock the stuff after all.

Benjamin Leon D'Montigny, Non Pharmacist Branch Manager

Quick question, have you ever seen a Pharmacist refuse to supply a contraceptive or morning after pill on a prescription?

Valentine Trodd, Community pharmacist

If it's on an FP10 wouldn't refusal to supply be a breach of NHS contract? I'm not sure, but it doesn't seem like the moral objection would hold water here - a sale is at your discretion (to a degree), but a prescription is an instruction to supply from a prescriber. Interesting question though!

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