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Answered: Can you force your pharmacist to provide EHC?

EHC morning-after pill

Do you have enough HR and regulatory knowledge to correctly answer this workplace dilemma?

One of the pharmacists at your pharmacy is very religious and prefers not to supply emergency hormonal contraception (EHC).

Previously, he has discreetly declined to supply EHC, without making his views known to patients. However, your pharmacy has had financial cutbacks and some staff members have left. He is now the only member of the team who can supply EHC.

How did C+D readers vote?

Result

Can you force your pharmacist to supply EHC?
Yes
20%
No
80%
Total votes: 80
The answer

The General Pharmaceutical Council (GPhC) tells C+D: "The answer is no."

Standard one of the GPhC's standards for pharmacy professionals, published in May 2017, states pharmacy professionals should "take responsibility for ensuring that person-centred care is not compromised because of personal values and beliefs".

In June, the GPhC also developed new guidance, on religion, personal values and beliefs, which states: "Pharmacy professionals have the right to practise in line with their religion, personal values or beliefs – as long as they act in accordance with equalities and human rights law and make sure that person-centred care is not compromised."

The GPhC adds: "Pharmacy professionals are expected to comply with the standards for pharmacy professionals and not impose their own values and beliefs on other people, and to take responsibility for ensuring that patient care is not compromised.

"Pharmacy professionals must make sure that they keep up to date and comply with the law, and with any NHS or employment policies and contractual responsibilities of their employer that apply to their particular area of work. In the context of religion, personal values and beliefs in pharmacy, it is important that pharmacy professionals understand and keep to the relevant framework of equalities and human rights legislation.

"Employers must also keep to the relevant employment, human rights and equalities law, and must not discriminate against pharmacy professionals because of their stated or perceived personal values or beliefs, including religion.

"Pharmacy professionals should use their professional judgement to make sure the person asking for care is able to receive or access the services they need. This includes considering the impact of their decision on the person asking for care and meeting their legal responsibilities.

"The GPhC guidance explains that this does not mean pharmacy professionals must act against their conscience and must always provide a particular service. The guidance sets out that referral to another health professional may be an appropriate option, and this can include handover to another pharmacist at the same, or another, pharmacy or service provider.

"However, it also makes clear that this may not always be the case; for example, if a service is not accessible or available elsewhere for the patient. Pharmacy professionals must consider whether a referral is appropriate and take responsibility for the outcome of the person’s care.

"If a pharmacy professional is unwilling to provide a certain service, they should take steps to make sure the person asking for care is at the centre of their decision-making, so they can access the service they need in a timely manner and without hindrance. For example, this might include considering any time limits or other barriers to accessing medicines or other services, as well as any adverse impact on the person.

"Pharmacy professionals should think in advance about the range of services they can provide, the roles they feel able to carry out, and how to handle requests for services sensitively. They should not knowingly put themselves in a position where they are unwilling to deliver or arrange timely care for a person.

"Pharmacy professionals should work in partnership with their employers and colleagues to create open and honest work environments. They should be open with their employer about any ways in which their religion, personal values or beliefs might impact on their willingness to provide certain pharmacy services...and work in partnership with their employer to make sure adequate and appropriate arrangements are put in place."

26 Comments
Question: 
Have you encountered resistance from pharmacists to supplying EHC in the pharmacy?

Heather Pharm Tech, Allocation & Distribution

I am well aware that I am a bit late to the debate... However, Mohammed and Gerry, you are my heros! Also, I find it very interesting that no females have commented so far... I'm no 'Femanazi' as they get dubbed, however I do have strong feelings about this debate.

The issue here is duty of care to the female presenting herself - your own beleifs are important yes, totally - HOWEVER... What if this young woman had just been sexually assulted, abused, was underage, isn't in a stable relationship, used a condom and it split etc...?

It always seems that the woman gets made out to be the careless one, but it takes two to tango. What if this woman was your daughter, sister, wife, neice, would you still think so harshly of them?

I think not supplying due to your beliefs is actually quite selfish, if you don't think that person in front of you is worthy of your care, why on earth did you ever become a Pharmacist? We are here to help, not to judge and make these decisions.

It is a womans right to decide what she does after unprotected sex, accidental otheriwse... As Thomas Wilde pointed out, you are not terminating a pregnancy, you are delaying ovulation so as a pregnacy doesn't occur, no harm to a potential new life, no harm to the current life of the woman needing your help.

Put on your big boy pants and be a real pharmacist - take responsiblity for your duty of care.

 

janet maynard, Community pharmacist

Was that an answer?

Jonny Johal, Pharmacy Area manager/ Operations Manager

Interesting question, I guess at some point in the future a court will tell us what the answer is. I don't see how the GPhC can be of any relevance here, irrespective of what their utterances are now.

Gerry Diamond, Primary care pharmacist

I was working in a walk in centre recently, and the nurses for some reason did not want to either see or supply EHC to the patient. As a practising catholic regular attending mass, my faith is quite proactive in its prolife stance, which I may hold personally but as pharmacist I do have a duty of care to patients.

It is not my job or role to preach to a patient in need of treatment, and I am quite clear in my conscience that supply EHC or contraception is the right and ethical thing to do. It is not my role to put my beliefs before patient care.

Andrew Paxton, Community pharmacist

I have never, and never will, provided EHC on my own account.  I believe, with reason, that it is taking the life from a defenceless human being, and I will never do that

Heather Pharm Tech, Allocation & Distribution

Another fusty old man making a particularly life changing and damaging decision for a woman he does not know...

Thomas Wilde, Community pharmacist

You are aware that EHC works by delaying ovulation right? so the entire point is that it prevents conception occuring and that if conception has already occured there aren't any ill effects from EHC. So you aren't doing anything to a foetus because one doesn't exist yet. Unless you also are saying you refuse to dispense female contraceptive pills or sell condoms on the same principle I fail to see your point. I'm not trying to be rude I'm just genuinely interested to understand your logic about protecting innocent foetus's which don't exist when EHC is given.

Mohammed Patel, Community pharmacist

A very controversial comment. If that child is to be born to a single parent with no job, no money, no house, and a rampant drug addiction, would you still feel the same way?

Gerry Diamond, Primary care pharmacist

I beleive that we are no longer allowed religious conscience and we have a duty of care to supply EHC.

Mohammed Patel, Community pharmacist

Yes! Duty of care! Patients MUST come first. If you cannot perform a key role then why did you become a pharmacist? I have a personal belief which prohibits me from doing MURs and supplying methadone. But I must do them anyway because I am a pharmacist!

It's almost like a Jewish cinema worker refusing to sell tickets because a film has pigs in it. Ridiculous.

If you don't agree with EHC THEN DON'T USE IT. Do NOT stop others from being able to use it because of your beliefs. In any case, they can go to another pharmacy, so exactly what are you achieving?

Heather Pharm Tech, Allocation & Distribution

All of this! Well said!

Interleukin -2, Community pharmacist

What happened to abstinence as a form of contraception? No seriously? Considering the miriad of risks outthere the least of which is not STDs and the current ED epidemic why is no one reopening the debate on abstinence!

Leon The Apothecary, Student

I believe the acronym I've heard in regards to this style of education was ABC. Abstinence, be faithful, use a condom.

Mohammed Patel, Community pharmacist

What is so special about the supply of EHC? Why can pharmacists choose to supply or not because of their "beliefs"?

If I converted to Pastafarianism, does that mean I am allowed to refuse to supply other things like methadone or gluten free products? I'm sure lots of pharmacists don't agree with the supply of methadone, but have to do it anyway.

Leon The Apothecary, Student

Would you then say the policy regarding religious belief and medicinal treatment is inconsistent?

Mohammed Patel, Community pharmacist

Absolutely! I have bought beer from a muslim cashier in Malaysia. So I cannot really understand the reluctance to supply EHC. Exactly which religions prohibit that action? Inconsistency is something which is very prevalent within the UK pharmacy industry.

Why would a muslim choose to be a butcher in a primarily caucasian area where everyone loves to buy bacon? They cannot fulfil their role as a butcher as well as the guy down the street! It makes absolutely no sense at all.

Leon The Apothecary, Student

Another question of debate, why does customarily a prescription for EHC not get affected by a person's refusal of morality? One could argue the result is the same, just the format. Is it okay because another has told you to do so?

Ben Merriman, Community pharmacist

Playing Devil's Advocate (for a change...), let me tweak the question slightly. Can you force a pharmacist to do the additional and entirely voluntary training required to be able to act against a PGD/enhanced service for supplying EHC? Let's go one further; can you force a pharmacy to stock an OTC EHC? If the answer to either of these is no, does that not render the initial question a little moot?

Leon The Apothecary, Student

You are absolutely right although in today's climate, how many Pharmacists do have control over their premises considering the number of places that are multiples or owned by another?

Ilove Pharmacy, Non Pharmacist Branch Manager

You could refuse on whatever grounds but you would be sacked especially at a multiple or sent to canary wharf on a trumped up charge.

Snake Plissken, Student

Why stop there. At what point should the pharmacy branch be held responsible for not employing a pharmacist who has no objections to providing EHC? Why shoul the question of force even come into it? If the pharmacy branch knowingly employ a pharmacist that holds these religious beliefs then who exactly is refusing to put the interest of the patient first? The pharmacy or the pharmacist? 

Andrew Paxton, Community pharmacist

does that mean that I am unemployble?

Gerry Diamond, Primary care pharmacist

Yes, your duty of care to the patient should have primacy. And it is gender discriminatory and subordinates a woman's right to have equal access to healthcare services. It is quite disgusting actually.

M P, Community pharmacist

In most places there is another pharmacy a few meters away that will supply.  Patient gets what they want and pharmacist doesn’t have to violate their beliefs. Win win. 

Leon The Apothecary, Student

Some would argue that directly or indirectly, there is no difference. Referring to another in full knowledge of what that patient is looking for, or giving them the tablet for them to choose to take or not is fundamentally the same thing?

Leon The Apothecary, Student

At the risk of opening up a bigger debate, should pharmacists supply EHC irrespective of their beliefs? Could a refusal be considered not in the patient's interest? Are there exceptions to when a person's religious belief must be set aside for the good of a patient?

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