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GPhC to review right to refuse emergency contraception

People The GPhC chief Duncan Rudkin (pictured) has pledged to review pharmacists’ right to refuse to supply emergency contraception, after pharmacy academics called for regulators to end an ethical stalemate.

The General Pharmaceutical Council (GPhC) has pledged to review pharmacists' right to refuse to supply emergency contraception, after pharmacy academics at the University of Hertfordshire called for regulators to end an ethical stalemate.

The GPhC had already planned to consider whether conscientious objection was justified, particularly when it is not an option for nurses, as part of a review into ethical standards later this year, GPhC chief executive Duncan Rudkin said in an exclusive interview with C+D on Friday (February 8).  

His comments came after researchers argued in a paper published online in the Journal of Medical Ethics on January 30 that conscientious objection was an "unfortunate stalemate", but this had not influenced the GPhC's plans, Mr Rudkin said.

"One of the things we need to look at across the board is to ensure that we and the other professional regulators are consistent where we should be" Duncan Rudkin, GPhC

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The GPhC will launch a patient consultation, set to begin at the start of 2014, in an attempt to gauge opinion on whether pharmacists should be allowed to refer patients to other providers if they have a moral or religious objection to dispensing emergency contraception themselves. It was a "huge piece of work" and there were strong views on both sides, Mr Rudkin warned.

"One of the things we need to look at across the board is to ensure that we and the other professional regulators are consistent where we should be and need to be challenging ourselves if there are any different standards and checking whether there's a good reason for that," Mr Rudkin said.

"It may be relevant to pharmacy practice, being very different to hospital nurses, but that's one of the things we'll need to look at – that will undoubtedly be a strand of that work [the ethical standards review]."

The authors of the academic paper argued that regulators in both the UK and Ireland should either compel pharmacists to dispense emergency contraception to all suitable patients who request it or ensure pharmacists who refuse to supply it also refuse to refer the patient to an alternative supplier and face the regulatory consequences.

"The alternative is to remain locked in the current cycles of mutual cognitive dissonance wherein the objectors convince themselves that referral does not constitute supply and the regulators do not place themselves in the position of having to deal with a vocal religious minority of whom they are terrified," they concluded.

But pharmacist Ravi Vaith, who dispenses an average of two EHC a month at Kamson's Pharmacy, Sussex, said community pharmacy should respect pharmacists' conscientious views because good pharmacists would signpost patients to a different pharmacy.

The GPhC said it received a small number of complaints annually about EHC but there had been no formal fitness-to-practise cases.

Do you think pharmacists should have the right to refuse to supply emergency contraception?

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Asmita Patel, Community pharmacist

A client comes in for EHC because they are being responsible and do not want a child. Through your own ethical dilemma you are taking away the right of this client. Who are we to make a decision on their behalf as to whether they should or shouldn't be taking EHC.We go on about a democratic society so let us practice to be one.Professional decisions should be based purely on the case in front of you and conscience should not dictate the decision making process.

John Smith, Locum pharmacist

1)The morning after pill does not treat disease or improve health. Therefore the claim that those who refuse to sell it are putting their morals before the health of the patient is untrue.
2)One mechanism of action through which the MAP works is the prevention of implantation of a newly conceived embryo. To many Christians, and in particular Catholics,Muslims, and those of no faith, this constitutes the earliest form of abortion and is morally equivalent to a late term abortion. Those who refuse to sell the MAP are refusing to participate directly in what they see constitutes a possible and intentional abortion.
3)The issue is not about 'imposing beliefs on someone' or 'morally judging the patient'.These arguments are used as smoke screens by opponents of the conscience clause. It is about having the right to choose not to participate in an act which you think is intrinsically wrong, and of no health benefit to a patient.
4)Dosen't true diversity respect the right of someone to act in accordance with their moral and/or religious beliefs? Isn't this a fundamental human right?
5)This academic study was a biased disgrace, totally one sided, unobjective and did not examine the arguments in favour of the conscience clause. It's authors clearly want the removal of the conscience clause and therefore the study has little credibility.
6)The authors claim that the origin of the study was the 'inevitable' scenario of a patient who would be unable to travel to another pharmacy within 72 hours of being refused the MAP,a rural patient for example. Can anybody here point to a part of the country where it takes three days to travel to another pharmacy/pharmacies?
7)Should gynaecologists be forced to perform abortions when requested? This is the exact same scenario.

John Halter, Non healthcare professional

1) What about women prone to ectopic pregnancies? rumor has it they're not too pleasant, nor viable for healthy pregnancy to term.

Leon The Apothecary, Student

1) Directly, no. But the consequences on a person who is unable to care for a child, either by financial or social reason can be, and have been proven many a time to be severe. In these cases this is in my mind the only responsible thing to do. I'm sorry, but I find that argument very short sighted.

2) By that logic, said pharmacist should also refuse selling condoms to actively avoid consenting to sexual relationships, powdered milk because only breast milk should be used, or directing someone to someone else. This is a weak argument because if you point them to someone else who will offer the morning after pill this is quintessentially the same thing has giving it yourself for a conscientious objector.

3) Part of the image that the public sees of a pharmacist is that of someone who can help them with medicine choices and their use. We can't force people to take certain medicines - that is unethical, however this works both ways. We should not tell people to tell them to take medicine either. A moral vegetarian does not work in a meat processing factory. A conscientious objector should not work in a pharmacy.

I compare it to a supremacist only serving people of a certain origin because that's his belief - something I would hope you all find detestable. Just change the words supremacist for religious person, and origin for condition.

4) A patients asks for advice and help with a health related issue. This case, an unwanted pregnancy. If the conscientious objector has an issue, why not clinically assessed it for it's safety of use with that patient, then give it to another member of staff to sell and provide? This is the same thing as sending them away to another pharmacy cause you this won't stop someone - nearly delay their access to medicine the conscientious objector should be providing as part of his profession.

6) Perhaps not, but considering the costs of fuel, bus and train and plane fares these days, it would be infeasible to do so.

7) Yes, provided it is safe to do so and they have the technical ability to do so.

Paul Reader, Non healthcare professional

If you don't want to do what Pharmacists do, then don't become a Pharmacist.

Dorothy Drury, Locum pharmacist

Pharmacists must realise that they are there to supply any medicine which is for the benefit of the patient and not their own religious stance. Remember the patient is takimg the EHC not the pharmacist. I also think conflicts of imterest should be stated by members of the GPhC when this is discussed.

Stephen Eggleston, Community pharmacist

Conscientious objection - means a person who, beacuse of their conscience, refuses to conform to a requirement - that's OK but one of the "requirements" is that we comply with our code of conduct which states that we should put the patient first - the patient, not our own morals or beliefs. If any pharmacist will not supply EHC on the basis of their beliefs, does that allow them to not dispense/supply other medicines on the basis of their beliefs? For example, would that allow Catholics to refuse to dispense HIV medication (or any other prescription) for homosexuals as homosexuality is against their religious belief? I can't imagine that would ever be allowed so why should pharmacists be allowed to refuse to supply EHC?
We are not the moral guardians of society and should not try to set ourselves up as such

Gordon Adamson, Hospital pharmacist

HIV is not solely a homosexual disease!

Leon The Apothecary, Student

Although, here in Brighton - I don't think I have met a single pharmacist this applies to. Generally speaking this city is pretty diverse in it's acceptance of lifestyle choices. Modern, if you will!

Leon The Apothecary, Student

Personally, I have always been against conscientious objection - to me it feels like you are taking the choice away from the person in question - but it does depend on the area you are in, if you are the only late night pharmacy in a wide area for example, you shouldn't choose to work there if you think you will be in the position to use conscientious objection, quintessentially denying someone of what is seen by most a vital service.

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