Abstract
It is widely accepted in the pharmacy profession that pharmacists have the right to conscientiously refuse to participate in certain practices on grounds of conscience. This is allowed in recognition of differences in moral and religious views and out of respect for moral integrity. However, the “conscience clause” does not necessarily sit easily in a professional code of ethics owing to the potential tensions between a professional’s personal moral integrity and her professional obligations. At the heart of these tensions are philosophical questions about the nature of conscience and integrity.
These in turn lead to important practical ethical questions about the adequacy of a conscience clause to protect integrity and patient’s rights and guard against wrongdoing, whether conscientious refusals should be publicly announced in advance and what the acceptable bases of a conscientious refusal might be. Such questions apply not just to the professional, but also to pharmacy students, who may hold conscientious objections to some aspects of their training.
It is concluded that the conventional compromise that is commonly in place in the pharmacy profession is a workable but imperfect solution and that better understanding of the concepts and competing obligations may be achieved by learning more about conscientious decision-making by pharmacists in practice.
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Notes
- 1.
- 2.
Suppose that, despite her efforts to engage with the subject, Sally has not heard all sides of the arguments in the debate and they are arguments that would persuade her to change her mind.
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This may seem a particularly hard line when applied to those who find their values conflict with practices that have been introduced after they joined the profession due perhaps to innovations in medical treatment.
- 4.
In Great Britain, the General Pharmaceutical Council requires pharmacists to ensure that referrals allow patients to access treatment within an appropriate timeframe that will not compromise contraceptive cover or effectiveness of the treatment. In making this assessment, pharmacists are advised to consider factors such as the practice opening hours and the patient’s ability to get there (Royal Pharmaceutical Society of Great Britain 2014: 136).
- 5.
This is not necessarily a major concern for pharmacists. For instance, research has revealed moral passivity among some pharmacists who do not always engage in moral decision-making even when they regarded something as ethically problematic. Instead, pharmacists admitted shifting the moral responsibility to the prescribing doctor (Cooper et al. 2008b: 443).
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Interestingly, this is not regarded as an insurmountable problem when similar criteria are applied in the third part of the conventional compromise.
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However, it is worth noting that sharing one’s personal beliefs is not always regarded as appropriate. For example, the British Medical Association’s guidance for doctors who conscientiously object is that they should not share their moral views unless they are explicitly invited to do so (BMA 2015).
- 8.
A similar criterion of goals of the profession has also been suggested (Wicclair 2006: 244).
- 9.
I thank Dien Ho for raising this point.
- 10.
For example, the accepted basis for conscientious refusals by pharmacists in Great Britain is broad: “make sure that if your religious or moral beliefs prevent you from providing a service, you tell the relevant people or authorities and refer patients and the public to other providers” (Royal Pharmaceutical Society of Great Britain 2014: 112).
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Deans, Z. (2017). Conscientious Refusals in Pharmacy Practice. In: Ho, D. (eds) Philosophical Issues in Pharmaceutics. Philosophy and Medicine, vol 122. Springer, Dordrecht. https://doi.org/10.1007/978-94-024-0979-6_10
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