Duty vs. Conscience
Ukens, Carol, Drug Topics
Some pharmacists who believe they have a right to refuse to dispense medications are taking the offensive to secure a conscience clause. Such a clause will allow them to duck under the same legal umbrella shielding physicians and nurses. In the process, they are forcing the profession to take notice of moral dilemmas that are only going to grow more complex.
In Wisconsin, an anti-abortion group is backing a bill to protect pharmacists who refuse to dispense certain drugs against retaliation by employers or lawsuits filed by patients seeking damages. In Ohio, anti-abortion pharmacists are being urged to oppose passage of a new pharmacy practice act because it does not contain a conscience clause. In addition, a California R.Ph.-pharmacy manager made national headlines last May when he refused to dispense so-called morning-after pills to a patient who blew her cork and the whistle.
The original Wisconsin conscience clause singled out pharmacists for protection, but the bill has been redrafted to include other health professionals, said Michelle Grothe, Pro-Life Wisconsin spokeswoman. The first draft stated that a pharmacist could not be required to engage in "a practice of pharmacy" if he or she objects on moral or religious grounds and has stated such an objection in writing. That broad provision has been narrowed to the specific situations of abortion, abortifacient drugs, nutrition and hydration, euthanasia, and sterilization.
In Ohio, Pharmacists for Life International, an anti-abortion group based in Powell, has hit the e-mail trail, urging R.Ph.s to oppose the proposed revision of the state's practice act because it does not include a conscience clause. A sample letter intended to be sent to legislators states, in part, "It is also noteworthy that in Ohio, pharmacists do not enjoy the same legal professional status as physicians and nurses with respect to matters of individual conscience and ethics in their practice. Until the autonomy of the pharmacist as a therapeutic decision-maker is given due legal respect ... it would be best not to expand the scope of the practice of pharmacy at this time."
Ohio pharmacists already have discretion when it comes to whether to dispense an Rx, said Franklin Wickham, executive director of the state pharmacy board. "Essentially there is no law in Ohio requiring that pharmacists have to fill a prescription," he said. "The board of pharmacy would address it in terms of public health and whether people who need medications can get them. I personally feel that this will become a bigger and bigger issue, especially in terms of assisted suicide."
A search of state pharmacy practice acts failed to turn up any reference to a conscience clause or conscientious objector provisions, said Carmen Catizone, executive director, National Association of Boards of Pharmacy. The NABP model practice act does not specifically address the issue either. However, he said that professional conduct provisions, which address the moral responsibilities of the pharmacist to the patient, are quite common in state practice acts.
"Unlike the [American Medical Association], pharmacists do have a duty through standards of practice and implications in the state practice acts to refer patients back to the doctor when problems arise or the pharmacist is not sure that the treatment is in the patient's best interest," said Catizone. "However, there are no requirements for pharmacists to make such referrals when it becomes an issue of the pharmacist's objecting morally to a course of therapy, unless, once again, the therapy is not in the best interest of the patient."
Legislative efforts to enact a pharmacist's conscience clause may present more problems than solutions, said Catizone. "It has been our experience that it is difficult, if not impossible, to legislate morality or moral issues that are not clear-cut," he said. "It is not illegal to hold certain philosophical or religious beliefs that may be contrary to the majority or minority. …