More on Plan B: Conscientious Objection by Pharmacists

On January 28th and March 30th of this year I posted the ethical issue of whether physicians or hospitals should deny patients the “morning-after” Plan B pill if the providers had moral objections to the use of the pill.
Now, in the news, is the hot ethical question whether pharmacists who have conscientious objections (CO) about the dispensing of the “morning-after” Plan B pill should be required to fill the prescription or may they refuse. Excerpted from the New York Times, April 19 2005:

“In at least 23 states, legislators and other elected officials have passed laws or are considering measures in a debate that has attracted many of the same advocates and prompted much of the same intensity as the fight over abortion.

In some states, legislators are pushing laws that would explicitly grant pharmacists the right to refuse to dispense drugs related to contraception or abortion on moral grounds. Others want to require pharmacies to fill any legal prescription for birth control, … which requires pharmacies that stock the morning-after pill to dispense it without delay. And in some states, there are proposals or newly enacted laws to make the morning-after pill more accessible, by requiring hospitals to offer it to rape victims or allowing certain pharmacists to sell it without a prescription.”

An ongoing discussion on this issue by ethicists is appearing on a bioethics listserv currently. Two different views are anonymously presented below regarding whether conscientious objection clauses should be within the codes of ethical behavior of a profession, such as the profession of pharmacy.

The View For CO Clauses

“Is there to be no room for conscience-clauses within a profession? Can those occupying
the minority position be granted no latitude? My own sense is that
conscience-clauses come along with pluralism and disagreements resolved by
a majority while giving minorities some room to hold to the view that the
profession itself does not embrace. Conscientious objector status is the
majority's concession to the minority opinion. As such, it comes along
with a recognition that we differ over what is ethical. When a people
realize that they differ over their view of the good, they can agree that
while the majority's view of the good will prevail, others will not be
coerced to follow it in those respects that they find it objectionable. To
the extent to which our times are marked by disagreement, I would think
that CO clauses would abound.”

The View Against CO Clauses

“I don't think there is room for CO clauses for pharmacists that would allow
them to abstain from implementing classes of prescription. In rega to
medicines, I think physicians have a duty not to prescribe poisons and the
like or to prescribe narcotics without a proper license, and a duty to do
the best job technical job they can with prescription choices, taking into
account side effects. For their part, pharmacists have a general duty to
implement the prescriptions presented to them accurately. Within that
general duty, pharmacists also have a duty to apply their particular
knowledge about drug dosages by age and weight and drug interactions (based
on knowledge of all the drugs being taken) and get back to physicians about
possible prescription changes needed for efficacy reasons, and to respond
to queries from patients to the best of their knowledge. I don't think it
rises to a duty but it is certainly a good characteristic of pharmacists if
they take the trouble to suggest generic drugs to the physicians when that
would result in lower consumer prices or copays. Allowing pharmacists to
make CO objections to types of legally prescribed medications opens a
Pandora's box and interferes with these desired roles: what if the
pharmacist's religious beliefs suggested that pain should be fully
experienced, for example, and therefore they should abstain from filling
certain pain prescriptions? What if their beliefs compelled or prohibited
uses of various types of psychoactive drugs? What if the pharmacist
believes in so-called "natural" classes of drugs to the exclusion of
others? Will we need a procedure for determining whether the pharmacist's
beliefs, as with those of military COs, come from a properly established
religion or just a strongly held belief, and will this matter? What kind
of disclosure of their own beliefs must the pharmacist give the patient,
and when? Must they be posted on the pharmacy wall, giving at least some
consumers a chance to take their business to pharmacies that leave their
subjective morality behind. And do we have time for all these processes to
play out? If pharmacists can introduce their own moral filter that
includes information about the patient's marital status and social behavior
(e.g. no contraceptives for unmarried individuals), it implies at best that
dispensing pharmacists have a relationship with patients and their complete
social history in ways that cannot be assured. … I think
pharmacists who cannot or will not fulfill legal drug prescriptions because
of their own particular moral objections to a class of meds or to use of
certain meds in certain social circumstances (as opposed to technical
grounds of objection to what seem to be prescribing errors of too little,
too much, or the wrong med) should get a new occupation. Further, it seems
to me that condoning pharmacists in their adding a subjective moral filter
to prohibit certain prescriptions will undercut all efforts to see the
pharmacist as a health team member whose technical expertise about
pharmaceuticals should be expressed to and heeded by physicians. I have
always been a staunch advocate that pharmacists should raise objections to
a prescription that seems wrong to them and have wanted to elevate the
status of pharmacist at the true medication expert.”

Any more comments on this issue? ..Maurice.