YSK: With a changing landscape of abortion rights, dispensing of abortifacients by a pharmacist may be declined under ‘conscientious objection’

Tried to post this in r/youshouldknow but it got flagged for being political. Was hoping at least one community could get some use out of it!

As a prelude, this post is not meant to reflect any personal belief towards abortion nor to have any political stance – it is only meant to outline the rights of pharmacists or other healthcare providers and the rights of patients in circumstances where morally/religiously ambiguous medication dispensing is present.

After reading another thread in r/whitepeopletwitter, it was clear that there is some misunderstanding as to what the role of the pharmacist in dispensing abortifacient medications is and what rights the pharmacist (and other healthcare providers) have in the face of dispensing medications which may contradict personal moral or religious beliefs.

Pharmacists have complicated jobs – not always well understood by the public – however this is a topic for another post. But pharmacists can also hold religious or moral beliefs that are directly at odds with choices that a physician may make for his or her patient – for instance, the dispensing of Mifegymiso, a commonly used combination of medications for the purposes of medical abortion.

Pharmacists may refuse to dispense any prescription that is brought to them – however this is rarely done unless there is a clear issue with the script (for instance, it does not meet the legal requirements of a written prescription, there is forgery suspected, the medication choice is not sound, the dosing or directions of the medication are not sound, or the medication has dangerous interactions with other medications or disease states). There also exists another reason for declining to fill a prescription – under the grounds of ‘conscientious objection’. In general – the situations in which this objection are made are generally in two circumstances: refusal to dispense medication for abortion (Plan B/Ella (to an extent, while not technically an abortifacient some practitioners may deem that it goes against some personal feelings) , Mifegymiso/Misoprostol/Methotrexate for abortion purposes) or the dispensing of medications meant to purposely end a life in the form of MAID.

If a pharmacist refuses to dispense a prescription under these grounds, then they are stating that they have a conscientious objection to the patient receiving the treatment which their physician has ordered. Obviously there arises a conflict here: the objector, while standing for their own beliefs, is directly impeding the patient in their right to receive medical care. This creates an ethical dilemma which is well known and has both pros and cons:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5931075/

So how is the patient meant to proceed in circumstances like this? Ideally, the objecting pharmacist will have already communicated these objects to their employer/manager ahead of time should the circumstances arise (and are in fact obligated to do so) and made arrangements to direct these patients to an appropriate provider in a timely manner which does not impede patient care.

The ACP code of ethics makes these two statements which are equally in the benefit of the pharmacist and the patient (https://abpharmacy.ca/articles/conscientious-objection-comes-responsibilities):

  • 5.3 Assist each patient to obtain appropriate pharmacy services from another pharmacist or health professional within a timeframe fitting the patient’s needs if I am unable to provide the pharmacy service or will not provide the service due to a conscientious objection.

  • 5.4 Arrange the condition of my practice so that the care of my patients will not be jeopardized when I will not provide certain pharmacy services due to a conscientious objection.

The BC code of ethics makes a similar provision (https://library.bcpharmacists.org/6_Resources/6-1_Provincial_Legislation/5019-Code_of_Ethics_Detailed.pdf):

(g) Registrants must provide pharmacy services requested by patients and may only refuse to provide these services for any of the following reasons:

iii. The provision of the product or service is contrary to the sincerely held conscientious or religious belief of a registrant, in which case the registrant must ensure that:

  • they have informed and explained to the pharmacy manager and employer of their conscientious or religious belief before they accept employment;

  • if the belief is formed after employment is accepted, they inform the pharmacy manager and employer at the earliest opportunity;

  • they do not discuss their personal beliefs or ask patients to disclose or justify their own beliefs;

  • they participate in a process designed to exercise their freedom of conscience and religion in a manner that respects the patient’s right to receive products and services in a timely manner and in a way that minimizes suffering and hardship to the patient;

  • they fulfill their duty of care to the patient in a manner that is nonjudgmental, continuous and non-discriminatory;

  • in the event of failure of the system developed to ensure the timely delivery of the product or service, and notwithstanding the registrant’s conscientious or religious beliefs, they provide patients with enough information and assistance to allow them to make informed choices for themselves;

  • they cooperate in effective transfers of care initiated by the patient and are not required to make a referral; and

  • They do not rely on conscientious or religious beliefs in order to discriminate against any patient on morally irrelevant grounds including those outlined in Standard 3, Guideline g of this Code.

Although these circumstances are relatively rare – they can come across as objectionable or discriminatory for the uninformed. Ideally there would be no objection from healthcare providers to the provision of care for which the patient is eligible due to personal beliefs. However, pharmacists are more than pill dispensing machines and have their own biases whether they are implicit or explicit.

Ultimately, the takeaway is that circumstances of conscientious objection are possible, although if guidelines and ethical codes are abided by then there should always (or at least ideally always) be a plan for the smooth transition of patient care to ensure that physician ordered treatment is obtained in a timely and non-confrontational manner.

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