Patients have a right to obtain prescribed medications on a timely basis, assuming that no risk factors are present that would contraindicate their use.
Pharmacists have a right to exercise conscientious refusal (eg, for ethical, moral, or religious reasons) in declining to dispense prescribed medications.
These 2 statements are not contradictory. Policies and procedures have been developed that ensure the right of pharmacists to exercise conscientious refusal and also meet the needs of patients and the interests of employers of pharmacists.
Most of the discussions on these topics pertain to the use of emergency contraception (eg, Plan B). The right of pharmacists to exercise conscientious refusal, however, must also be viewed in what, for many, will provide a clearer contextsituations such as the use of medications for the execution of criminals via lethal injection or for physician-assisted suicide or euthanasia. Clearly, these are life-or-death situations.
The discussions on emergency contraception address many issues including, but not limited to, its mechanisms of action, whether the product may inhibit the implantation of a fertilized egg (a secondary mechanism of action), when life begins, abortion, and patients' rights. Strong differences of opinion surround these issues. Some pharmacists who exercise conscientious refusal in declining to dispense a prescription for emergency contraception do so because they believe that life begins when an egg and sperm unite and that an action to inhibit implantation of a fertilized egg terminates that life (ie, a life-or-death situation). Although some may disagree with this position, they must not be permitted to deny the rights of others to hold differing views. For a pharmacist who declines to have a role in the use of emergency contraception, there can be no reason that is more important than a belief that a life is at risk.
Pharmacists must have the right to exercise conscientious refusal! Actions that would deny pharmacists, or anyone else, the right to make decisions based on conscience have very harmful implications for both individuals and our society.
Very few situations have arisen in which pharmacists have exercised conscientious refusal in declining to dispense emergency contraception. In addition, of the rare situations that have been publicized, I am not aware of even one experience in which a woman was not able to obtain this product on a timely basis.
I can discuss differences of opinion regarding these issues with individuals such as my friend, Bob Tendler, in a manner that is characterized by mutual respect. Regrettably, however, some people outside our profession are determined to widely publicize these rare experiences, using scare tactics that suggest that a crisis exists. They bash pharmacists in general and vilify the pharmacists who have exercised conscientious refusal. Because the actual experiences are so rare and without consequences, they resort to conducting "surveys" or creating hypothetical scenarios (eg, such pharmacists might decline to dispense antiretroviral agents to patients with AIDS because they disapprove of their lifestyle [this has not happened]). These efforts are irresponsible, misleading, and insulting and must be challenged.
Whether anyone has the right to exercise his or her conscience should not even be an issue. It is time to move on!
Dr. Hussar is the Remington Professor of Pharmacy at the Philadelphia College of Pharmacy at the University of the Sciences in Philadelphia.
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