Conscientious objection in the pharmacy


Religious guidance may put UK pharmacists at risk of punishment, says C + D author… but what about Aussie pharmacists?

According to the UK publication Chemist + Druggist, in 2013 the General Pharmaceutical Council (GPhC) banned a pharmacist from providing emergency hormonal contraception (EHC) for three years because he had given a patient “a distressing explanation of why his religion regarded EHC as morally wrong”.

Now the Council is bringing in new standards – due to come into effect on May 1 – proposing that pharmacy professionals should not be able to refuse services based on their religion, personal values or beliefs.

The GPhC also suggests that referral to another pharmacist should not be an option, reports C + D.

Its consultation paper on religion, personal values and beliefs for pharmacists (released December 2016) says the following:

People receive safe and effective care when pharmacy professionals: (….)

• recognise their own values and beliefs but do not impose them on other people

• take responsibility for ensuring that person-centred care is not compromised because of personal values and beliefs.

“While we recognise the importance of a pharmacy professional’s religion, personal values and beliefs, we want to ensure people can access the advice, care and services they need from a pharmacy professional in whatever setting, and when they need them,” it continues.

“In some circumstances, these new GPhC rules could be disproportionately onerous to pharmacy staff. They may unfairly expose them to the risk of fitness-to-practise proceedings,” writes author David Reissner from UK law firm Charles Russell Speechlys in Chemist+Druggist.

UK pharmacists have taken umbrage at the new rules, which also state that they “need to be met [by pharmacists] at all times, not only during working hours”.

Reports reveal that the Pharmacists’ Defence Association (PDA) is taking the Council to Court next week over the new standards.

Could something similar happen here? Pharmaceutical Society of Australia Research and Policy Officer Anna Ezzy, who worked on the PSA’s latest Code of Ethics, says conscientious objection is covered in the current code for Australian pharmacists.

Ms Ezzy says the right for pharmacists to refuse services is covered in the integrity principles embedded within the Code of Ethics.

These are outlined as follows:

Integrity Principle 1:

A pharmacist acts with honesty and integrity to maintain public trust and confidence in the profession.

And specifically, a pharmacist (g) declares any actual, perceived or potential conflicts of interest in a clear, easy to understand, open and timely manner.

Integrity Principle 2:

A pharmacist only practises under conditions which uphold the professional independence, judgement and integrity of themselves and others.

And specifically, a pharmacist (a) exercises professional autonomy, objectivity and independence, and manages actual, perceived or potential situations of conflict of interest.

“The code recognises the right of pharmacists to refuse supply based on personal beliefs,” says Ms Ezzy.

“However, they need to facilitate adequate alternative care.”

It also makes a difference where the refusal occurs, she says.

For example, in a metropolitan area, the pharmacist may refuse supply but point the patient to a pharmacy across the road. But there can be more difficulties in rural areas.

Have you ever felt the need to refuse supply for personal reasons?

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67 Comments

  1. pagophilus
    18/03/2017

    It is the “need to facilitate adequate alternative care” bit that is disturbing. How can you facilitate that which you are not willing to do yourself?

    I wrote a detailed submission to a current joint parliamentary inquiry into religious freedom. I hope the points I made receive some discussion. The inquiry is still open for comment so if anyone has anything interesting to say google it and write something.

    We need to start defining what a right is. Is anything a patient/customer wants a right, and is everyone required to give them what they want, or are they responsible in finding a provider willing to provide them what they want?

    • Rod Scaife
      18/03/2017

      Couldn’t agree more. Isn’t this what we do all the time? ie. correct things that are not right on prescriptions, advise customers that what they are wanting is not appropriate or actually contraindicated, refuse supply for suspected abuse etc. If we are ever required to just robotically give out whatever a patient, or even a doctor, requests, then all our training is meaningless. This logic must apply in all areas where our consciences and knowledge tell us that supplying something could cause hurt or harm to that person, even if they don’t agree with our judgement. My right to not supply must never be lost.
      Rod

      • Truthfiend
        19/03/2017

        So anti vaxxers have the right to not supply with no consequences?

        • Rod Scaife
          21/03/2017

          In the scenario you suggest I would hope education and discussion would be enough, but if not, then yes,I would still defend this person’s right to refuse supply, because the alternative scenario that is being pushed in England and elsewhere seems to advocate that the rights of the consumer are paramount and totally over-ride the pharmacists rights and discretion to refuse supply. This is extreme, unacceptable and, quite frankly, dangerous and needs to be resisted as a principle, even if there are some instances where we might not agree with an individual pharmacists decision.

          • Willy the chemist
            23/03/2017

            I agree with you Rod. The health professional is first and foremost a human being with the same rights as the patient.
            This is a slippery slope what they are doing in England.
            There is one proviso. I believe that just as any health professional has a right to refuse supply and thus risk loss of business, so with anti vaxxers, they can also miss out on incentives or payments. This does not impinge on their right to object.

          • Kate Tognarini
            23/03/2017

            Except that with the EHC the consequences of refusal of supply are not just loss of “business” but an actual pregnancy if the customer cannot get it somewhere else in a timely manner. Kind of a big consequence regardless of how she came to be in the situation of needing it in the first place (lets not judge). What is the consequence for you of supplying and therefore stopping a pregnancy occurring (because that’s how it works) against your moral judgement? Surely it is better to stop an unwanted pregnancy than to need an abortion or having an unplanned child with little support? Your rights do matter, absolutely, but I get the feeling that because we are placed in a position of relative power we need to find a way to help rather than hinder and always without judgement.

          • Willy the chemist
            23/03/2017

            Thank you Kate. Your response is thoughtful and considerate.
            I think this area is an especially difficult one. I do dispense EHC and contraceptives. Morally I won’t actively terminate a life unless there are extenuating circumstances e.g unviable pregnancy or unmitigated health risks.
            But the decision should still be afforded to each individual base on his conscience. We are after all NOT robots. We are humans and in humanity, we prevail in plurality and diversity.

  2. Jarrod McMaugh
    18/03/2017

    Religious objections should never be called conscientious objections in the first place.

    How can it be conscientious to deny someone something that they feelmis correct for them, just because you have a religious belief?

    Therapeutic grounds are the only reason to “object” to treatment.

    By definition an objection on religious grounds is an objection to an otherwise therapeutically valid treatment… Otherwise why resort to a conscientious objection in the first place? Therefore facilitating access to someone who isn’t going to infringe on someone else’s rights to therapeutic care is an appropriate directive from an ethical guidelines.

    • John Wilks
      19/03/2017

      Religious and conscientious objections are not mutually opposed. For example I object to suppling the IUD and RU-486 because of my religious view that all human life is sacred from the moment of conception (when sperm and ovum unite) and these devices terminate human life – the former before implantation and the latter after the event. I object on conscientious grounds because the underpinning of all medical practice is ‘primun non nocere’ – first, do no harm. Both of these items harm the most vulnerable patient – the unborn human person, as well as causing harm to the woman. On the latter point the list of problems with IUDs is extensive (perforated uterus, recurrent UTIs, enhanced exposure to STIs) and there have been documented deaths from RU-486, some of which were due to Clostridium sordellii. (Fischer M, Bhatnagar J, Guarner J, et al. Fatal toxic shock syndrome associated with Clostridium sordellii after medical abortion. 2005;353:2352-2360. and US FDA says one abortion pill death unrelated. Reuters Health Information. April 10, 2006. Available at: http://www.medscape.com/viewarticle/529580. Accessed April 10, 2006.)

      To conclude, right conscience and rational religious beliefs do not clash but rather, work in harmony to protect patients.

    • Willy the chemist
      19/03/2017

      I take umbrage at “therapeutic grounds are the only reason to “object” to treatment.

      There it goes, it is political correctness and a form of reverse discrimination of people of certain beliefs, e.g. in the case of Catholics healthcare professionals who object to supplying an abortifacient.

      In the majority of cases, if we are being really serious, is undergoing abortion therapeutic? Or is it a lifestyle choice?

      Now I don’t wish to underplay the fact that abortion is almost always a traumatic decision for women and /or men. But to call it therapeutic is stretching in many cases.

      • Jarrod McMaugh
        23/03/2017

        I take umbrage at you taking umbrage. See how little it achieves?

        The problem with any religious objection is that it is about you. That’s not very conducive to good healthcare.

        I think you might be confused about political correctness. Political correctness is where you take the basic human experience, then make excuses for special interest groups. You’ve shown it here when talking about Catholics, as if they have some special exemption from applying their clinical knowledge in how medications work and then incorrectly labelling something an abortifacient. There are very few abortifacient agents that a pharmacist would be involved in supplying, yet many contraceptives get mislabeled in this context.

        Realistically, I almost get as angry about pharmacists misunderstanding hr mechanism of action of these medications than the moralising that they dish out at others.

        If you would also like to discuss the therapeutics of an abortion, then we can do that too… But I would point out that just because you say you don’t want to underplayed the weight of the decision people make, doesn’t mean that you didn’t just underplayed the weight of that decision. You don’t get to imply that people are making a blade lifestyle choice and then excuse it away.

        Pregnancy has several significant impacts on the body of a woman. Hopefully I don’t need to explain them all to you. Of note is thr fact that it puts a significant strain on the patients endocrine system, nutrient demand and storage, cardiovascular system, and musculoskeletal system. For some people it impacts on mental heslth, fitness, or preexisting comorbidities.

        For some people, the impact this can have may never be fully reversed.

        Apart from.this, society has deemed that an individual person is capable of deciding for themselves if this is the right decision. Your religious beliefs do not give you the right to be a barrier to someone else’s health care decisions.

        • Willy the chemist
          23/03/2017

          We are discussing from different points. I’m not talking about mechanism of action or definition of when life begins.
          But one shall never force another to take an action that is against his conscience. Sure I never for once believe that the individual (the conscientious objector) has a right to impose his or her view upon the person seeking a medical outcome.
          However in discussing the therapeutics of an abortion, you deem to downplay the impact on another patient (the unborn).
          And I don’t say that all abortions are for lifestyle choices as there are some justifiable medical reasons. However impacting on body, fitness, increased demands on the body are but choices. In life we make choices everyday, not all choices are without risks or pain.
          Mental health issues, preexisting comorbidities and contraindications are not lifestyle choices.

          Jarrod, just like a surgeon who should have a right not to operate on a patient with apotemnphilia, even in the correct medical situation. He or she should have the right to refer this patient to one who will perform the amputation.

          Just because I am a health professional does not make me a lesser human being.

          • Jarrod McMaugh
            23/03/2017

            Any person’s right to health outranks another person’s right to religion

          • Wilson Tan
            23/03/2017

            That’s the slippery slope.

          • Jarrod McMaugh
            23/03/2017

            I’m not saying one person is worth more than another. I am saying that rights to specific things are stratified.

          • Willy the chemist
            23/03/2017

            Jarrod, this is like 50 shades of grey. At which point does another person’s basic rights outrank the other?
            Who’s the judge of this stratification?

            To your point, I think the basic rights of a homeless person outranks our rights to a comfortable home. We should be sharing our homes with all homeless persons.

            To your point, I think the basic rights to a terminally ill person to unaffordable life prolonging treatment outranks the rights of a nation to a balanced budget. So every form of life saving treatments should be afforded all these individuals.

            This form of thinking is simplistic.

          • Jarrod McMaugh
            23/03/2017

            Yet none of these things are within your power to provide or to deny.

            So lets look at your argument – you feel that no person’s rights outweigh another.

            If this is the case, why does the rights of an unborn, unformed human, outweigh the rights of an actual person (ie the patient requesting the medication you would deny).

            You have to answer either that they don’t, and the person capable of making a decision wins by virtue of their ability to make this decision, or that the unborn person’s rights carry more weight, which would make your previous points incongruous with this one (ie it’s a hypocritical argument).

          • Wilson Tan
            24/03/2017

            Whether outside our power or circle of influence is besides the point. And besides, is it really outside the collective power of society or really outside our comfort zone?

            I find that it is a hypocritical argument when you claim that rights to specific things are stratified but then argue against a right to natural life. That is that the right to decide on the basis of lifestyle choice (not medical) outranks another right to live.

            Whether a person is able to defend her rights to live is immaterial to her natural human rights. Basic Human rights to natural life is irrevocable and enduring.

          • Wilson Tan
            24/03/2017

            Jarrod, I’d like to raise the point that your argument that an unborn person’s rights somehow is lower.

            What is to stop the argument that an elderly person’s rights is lower?
            Or a poor person’s rights is outranked by a right man’s?
            Or a lower educated?
            Or a certain religion?
            Or a certain race?

          • Jarrod McMaugh
            24/03/2017

            My point specifically has been that there is no difference between any persons’s right to X

            I have specifically said two things:
            1) any person’s rights to healthcare outranks another person’s right to religion.

            It is not the people who are ranked differently, but the thing they want to exercise/access. For instance the rights of someone to clean drinking water outweigh another person’s right to dump effluent in the water supply

            2) an unborn human isn’t a person until it is capable of surviving without the mother. Requiring a mother to carry an unborn to term against their will is putting the right to autonomy of two humans against each other, and forcing the mother to continue is tantamount to servitude.

            I would point out that these are all moot points anyway, since in Australia the only capacity for a pharmacist to be involved in an abortion is to dispense MS-2-STEP, which requires specific accreditation.

            The use of OCP or ECP do not cause an abortion. anyone who believe they do are fundamentally misunderstanding how these medications work and should consider CPE in this area.

          • Willy the chemist
            24/03/2017

            I understand your points about rights which is not about people. But do you understand mine? Does not a right to natural life outranks a lifestyle choice (in absence of unmitigated risks)*?

            But in saying this, this issue is NOT as black and white. That is, it is a bit more messy and complicated. My point is that we should NOT be making judgement on anyone and not compelling someone to act against her conscience.

            For one, an unborn human is a person. Whether she is a person in law is not the point. Increasingly EU is recognising an unborn person, even in inheritance. By the same argument, a child is not considered a full person. This argument is just semantics.
            Yes, this person will be totally dependent upon another.
            In saying this, you seem to contradict yourself when you state in black and white that health outranks another person’s right to religion.

            Does right to natural life not outrank a lifestyle choice (ie. in the absence of unmitigated health risks)?

            The decision is NOT an easy one. I will never put judgement on the poor woman and/or man who have to be making this decision. Neither should I be placing judgement on another whether she be an active participant in this.

            Ethics and morals are never black and white. So when people take inflexible, intolerant and hard attitude towards a moral issue, we’ve got to try to balance the view.

          • Jarrod McMaugh
            25/03/2017

            Willy, you will continue to fail to see the point I am making while you refer to the decision to end a pregnancy as a lifestyle choice.

            Two points you could keep in mind

            All people are born with equal human rights

            One of these rights is the right to bodily integrity – the autonomy to decide how your body is utilised.

            These two points are important in the consideration of the right to end a pregnancy

          • Willy the chemist
            25/03/2017

            Jarrod, let’s put aside prejudices and judgment for a moment. Look at it from objective eyes.

            All humans are created equal. All humans are entitled to equal rights.
            The phrase “All humans are created equal” is called an “immortal declaration”

            Secondly this is where we begin to differ BUT not because we are diametrically opposed. It is because of an incorrect application of logic.
            “One of these rights is the right to bodily integrity – the autonomy to decide how your body is utilised.” I agree, 100%. It is a very important rights.

            But surely when you “stratified” these rights, the rights to a natural life is greater than the rights to bodily integrity. (And we are not saying different people have different rights.)

            You say that this is NOT about people but about the rights. I now ask you to be completely impartial and follow your own argument. This isn’t about people but about the stratification of rights.
            Rights to natural LIFE is greater than our rights to BODILY integrity, without question.

            Ps: Ending a pregnancy because the timing is wrong, to further a career, to finish further education, marriage breakdowns are some non-therapeutic decisions. Not saying for a moment, if you look at my replies that these are easy or non-valid reasonings.*

          • Jarrod McMaugh
            27/03/2017

            I would reiterate one of the points I made earlier, and how this applies to my logic

            All people are born with equal rights.

            I would point out that my logic is not applied incorrectly. We may process logic in a different manner, but neither of them is incorrect.

          • Willy the chemist
            27/03/2017

            I respect that comment. Thanks Jarrod

          • Willy the chemist
            25/03/2017

            The second angle of this issue is the health professional.
            Primum non nocere. First, do no harm.

            The act of abortion (not contraception) is doing terminal and irreversible harm to a human.
            We know that from an early stage of pregnancy, the individual develops feelings, pain, fear and dreaming.

          • Dr Phil 42
            26/03/2017

            So you don’t buy any clothes from third world countries….

          • Wilson Tan
            27/03/2017

            I provide monthly financial support to 6 children from impovished nations.
            One can’t boycott out of poverty. Imagine if no one buys any produce from Australia!

          • Dr Phil 42
            26/03/2017

            ” saying this, you seem to contradict yourself when you state in black and white that health outranks another person’s right to religion.” last I checked we live in a secular state. Have you thought about living in a caliphate?

          • Wilson Tan
            27/03/2017

            Are doctors bad in algebra equation or just you?
            In considering the person’s rights to an elective abortion as a DOCTOR you ignored the other human. That’s the other side of the equation.
            You might as well live in a caliphate because of your inflexible and intolerant view of others. A caliphate doesn’t tolerate differing views.

            The last I heard we live in a plural tolerant society with freedom of views and opinions.

          • Dr Phil 42
            27/03/2017

            Look up Ad Homenim … do you insult everyone who disagrees with you?

          • Willy the chemist
            28/03/2017

            Ditto really. Returning the favour

          • Dr Phil 42
            28/03/2017

            Wow – I just checked – I counted 5 insults directed to me, I don’t consider calling someone a vegetarian as an insult but your reply,
            Stating I am effectively innumerate
            Picking on my mistake for lack of a comma

            In return I admit my “simplistic” reply was a cheap sarcastic shot, but that was in response to what I considered was condescension

            Oh yeah and typecasting me as a money grubbing doctor…

            And “maybe” means I am trying to keep an open mind. And yes implying others (you) are fixed and absolute and everything you accused Jarrod of being. Then you ask me would I – and without a context – yep, I might, but that also means I might not. It depends… give me a very specific scenario and with one or two qualification I would tell you. Yes sometime I decide, like you do when dispensing an S3, but I believe I do that based on medical criteria only, not on personal belief…

          • Willy the chemist
            28/03/2017

            Those who live in glass house should not throw stones. You peppered me with 6 blogs all at once.
            You assume such a superior attitude and besides insinuating that I should hang a big sign, insinuating I’m a hypocrit, live in a caliphate, a male chauvinist by asking if I’m a male and if I should ask my wife or daughters (if I have one) and even that I should be a vegetarian. That I should not be dispensing any medicines that maybe contraindicated in pregnancy & that I am not qualified to supply to fertile women.
            Jarrod and I had robust discussion but calling it an inflexible attitude is not an insult.
            You resorted to personalised attacks. That is the definition of Ad Homenim.

            You insinuate that I’m not qualified to be a health professional simply because I have a difference of opinions. The crux is you afford yourself a maybe. What is medical criteria for lethal injection, medical assisted suicide or apotemnphilia?

            This issue has degenerate into one group wishing to have choice but depriving the other group of their rights. This isn’t about therapeutics. I’m not imposing my views on others and saying you should not be able to perform abortions, that abortions should be illegal, that health professionals who supply or perform pregnancy terminations should not be wearing a “white coat” or should go get another profession.

            People who can’t see another person’s point of view and then adopt a hard concrete attitude like get out of this profession or insinuate that they be threatened with collegial boycott, they are the narrow minded and judgmental.

            Ps: I live in a female dominated households with 4 adults and teenagers. At least 3 holds similar views to me, one has a different view (one of my daughters who believe that humans should be valued according to their abilities and merits. She values an adult being higher than a baby or unborn. )

          • Dr Phil 42
            29/03/2017

            You win 6 versus 5 … I must be a closed minded idiot – sorry to waste your time and energy…..

          • Willy the chemist
            28/03/2017

            You were not arguing the issue but conducting personal attacks. Then you stand on high almighty and complain like a sook like some poor school kid being bullied.
            Well you are a bully and I don’t back down from a bully.

          • Dr Phil 42
            26/03/2017

            Yes it is simplistic

          • Wilson Tan
            27/03/2017

            Yes speaking to narrow minded, angry and inflexible individuals one have to be simplistic.

          • Wilson Tan
            23/03/2017

            Oh and I noted that you have ignored to answer the terribly difficult question of the right of the unborn. By definition she is the most vulnerable. And by definition she is a human being too.
            So now we class a person’s rights according to her status in society?

            If one is to be brutally honest, in many circumstances a choice base on lifestyle (ie in the absence of unmitigated health risks) an individual exercises her rights to abort. Now her choice and hence her rights to better lifestyle outranks another individual’s rights to life?

          • Andrew
            23/03/2017

            If only you lot cared as much about those who have already been born.

          • Jarrod McMaugh
            23/03/2017

            Yes, because an unborn human at the point at which an abortion can be legally carried out has no rights. very simple.

          • Willy the chemist
            23/03/2017

            By your argument, an illegal arrival or a refugee without status is afforded no human rights?
            What is legal isn’t always moral. Legality is fluid as opposed to the basic rights of a human which should be enduring and inviolable. Human rights precede legality.

            An unborn human is still a human being. Human rights is afford each person regardless of legality.

            Anything less is just convenient semantics.

            It’s very simple, each human being is entitled to an irrevocable basic human rights.

          • Jarrod McMaugh
            23/03/2017

            Willy, that’s what I call an opinions… And in the case of refugees you aren’t correct, because a refugee still has a legal status as a person, while an unborn human doesn’t.

          • Willy the chemist
            23/03/2017

            And hence by trying to impose one’s opinion upon another…eg. denying her the right to her conscience, one is imposing his or her opinion upon the other.

            In my opinion, an unborn person is a human being, and as such she is entitled to an enduring human rights.
            Legality is second to human rights.

          • Dr Phil 42
            26/03/2017

            If it matters that much to you, perhaps you should stop selling any medication not in category A and B C D and X all have the potential to harm a human being (by your measure) or maybe just not to fertile women?

          • Wilson Tan
            27/03/2017

            It seems you have an issue with people having difference of opinions.
            Have you heard of freedom of religion, speech and expression? Why should I be a vegetarian? By the same logic you are a cannibal.

            And not all male thinks like I do. Jarrod is male and I respect his opinion. I like to have a discussion and while I don’t always have to agree I’m open to his opinions. Who knows I might make him see my point or me his point.

            For your information, I live in a household with 4 females. At least 3 holds same views. That’s their prerogative. Don’t assume mate.

            It’s never black or white. It’s people with hard attitudes that is intolerant under the umbrella of progressiveness.

            And finally Dr Phil, oh I can call you a doctor right? Do you need a lesson in when human life begins? Is it at birth?

          • Wilson Tan
            27/03/2017

            Category A is contraindicated in pregnancy?! Ok DOCTOR

          • Dr Phil 42
            27/03/2017

            I’ve added a comma sorry to be so illiterate

          • Dr Phil 42
            26/03/2017

            You must be a vegetarian as well – and certainly not eggs….

          • Wilson Tan
            27/03/2017

            By the same logic you must be a cannibal.

          • Dr Phil 42
            26/03/2017

            I think there is a logical error in your argument … you have a right to. Or choose such treatments for yourself but when you refuse for others you are imposing your will on someone else, by my reckoning that means you consider the customer requesting the MAP to be lesser.

          • Wilson Tan
            27/03/2017

            It’s not imposing your will on others. Neither should you be compelled to act against your conscience.
            I’m not saying that I get to decide. But one must have the right to supply.

            I’m sure not all doctors will be able to carry out suicide assisted procedure, or the lethal injection or even limb amputation in the case of apotemnphilia.

          • Willy the chemist
            27/03/2017

            Actually Dr Phil, may I ask you if you would perform medically assisted suicide or limb amputation in the case of apotemnphilia? Or in the case of a legally sanctioned termination of life eg lethal injection?

          • Dr Phil 42
            27/03/2017

            If it were legal, maybe…

          • Willy the chemist
            28/03/2017

            The crux is the word maybe. Why are you so special that you get to decide?
            It’s hypocritical in the truest sense, that you afforded yourself a choice.

        • Willy the chemist
          23/03/2017

          “Political correctness is where you take the basic human experience, then make excuses for special interest groups”
          Political correctness is where the distortion of truth of the word “basic human experience”, with this broad stroke the most vulnerable is being renegated from the fact that it is also a human being with human experience.
          Political correctness is where the “special interests” of pro camp (whatever maybe) override the rights of the “special interest group” that is the conscientious or religious objectors groups.

          • Dr Phil 42
            26/03/2017

            I really think you should have a big sign out front of your pharmacy saying something like “no abortifacients supplied here” – in fact tell me where you work and I promise to inform all the doctors and health services providers around you of your opinions. You may have to employ more pharmacists to cope with the demand…. if you don’t want to do this because it might harm sales then you are a hypocrite to your values….

          • Wilson Tan
            27/03/2017

            By the same token you should have a big sign in front that says, “Abortions performed here for a fee”.
            Last time I read APHRA allows practitioners to act within their conscience. Maybe you should join the Red Army where they force abortions on women with subsequent child.

  3. Slim Jim
    19/03/2017

    Your religion or religious beliefs are a personal matter between you and whatever…

    Leave “it” at home when you come to work.

    If your religious beliefs or religion are so strong that they have the potential to over-ride your ability to adequately perform a job or profession that does not involve religion, then find one that does!

    • Willy the chemist
      19/03/2017

      I disagree.
      Our religious beliefs maybe a personal matter but so is your opinion/judgement. In making a “valued” judgement that one should leave “it” at home when you come to work, an absence of belief is in itself a “valued” judgement.

      For example, one’s belief to object to supplying the drug RU-486 on the basis that human life is sacred and that these devices terminate human life is not without credence…no matter what your belief.

      First do no harm. From the moment of conception, a foetus is a human life.
      In this case, placing one’s rights over the foetus’ right to live is making a “valued” judgement. That in itself should be a personal matter between you and whatever….

      So a healthcare professional must have the right to exercise his or her rights to not supply or render a service if it meant it is against his/her belief. However I agree that he/she must at least provide an alternate adequate care, must not overtly try to impose her belief upon the patient.

      • Dr Phil 42
        26/03/2017

        You must be male, have you asked your wife/partner/daughters what they thing?

  4. Kate Tognarini
    20/03/2017

    I can’t believe what I’m reading. Really? Your religious beliefs give you the right to judge and withhold medication? Every argument I write ends up sounding very angry so I’m just going to ask you to really think about whose wellbeing you are really putting first and whether this decision is really yours to make in the absence of true medical contraindications. Women are very capable of making their own decisions and weighing up risks and benefits without judgement. Please just stick to the medical facts.

  5. Simon O'Halloran
    20/03/2017

    The pharmacy I work in has a sticker on the front door to identify that it is participating in the needle and syringe exchange program and NDSS. Perhaps a similar sticker to identify ‘religious objection’ in store might equip people to make an informed decision to enter and thus avoid the scenario of an awkward discussion and the likelihood of non supply. Or a list of services and medications that will not be supplied.

    • Dr Phil 42
      26/03/2017

      And if they don’t condone the pharmacy attitudes they can vote with their feet!!!

  6. Jenny Madden
    20/03/2017

    There should be no problem with conscientious or religious objection, as long as the pharmacist is up front with an employer. Throughout my >45 years of practice as a pharmacist, I have never had to work in an unsupportive environment. I extol the pharmacy community for their respect of diversity. If I am asked to work in community pharmacy (HMRs & RMMRs are my first preference), I tell the owner/manager of my conscientious beliefs. Only one pharmacy has declined to employ me , and very surprisingly that pharmacy always had two pharmacists on the floor.

  7. John Wilks
    26/03/2017

    There appears to be some confusion surrounding the key terms in this debate – abortifacient, pregnancy, embryo, etc and this confusion ergo leads to faulty argumentation and conclusions. To aide informed discourse I include the following (lengthy) referenced explanation of these key terms, and importantly, the historical manipulation of these terms. The footnotes do not copy across so I have placed them at the end but the numbering links are broken. Emailing me if you wish for a proper document (jfwilks57@gmail.com)

    ———————-

    Contraception (L, contra, against; concipere, to take in) is a process, device or intervention whose action is solely to prevent the unification of sperm and the secondary oocyte, commonly referred to as an ovum. Condoms, spermicides, cervical diaphragms and male or female sterilization are contraceptive practices because their only action is to impede the sperm and the secondary oocyte from unifying. Note, the term ovum is a colloquial expression that has no true relationship with any stage of female sex cell generation, development or involvement in human embryonic conception. Key embryologists recommend against its use. Note also, in many instances, I have placed the word ‘contraception’ in apostrophes, to indicate that its use, whilst ubiquitous, is descriptively incorrect.

    Zygote a single cell formed by the fusion of the male and female genetic material. The full human chromosomal number of 46 is restored and as a consequence, a new human life has begun. “A zygote is the beginning of a new human being (i.e., an embryo).” The zygote is formed within the Fallopian tube.

    Conception is the beginning of a pregnancy, taken to be the precise moment that a spermatozoon enters the female secondary oocyte, resulting in the formation of a viable human zygote. Reputable educationalists concur on this critical point. Moore and Persaud state that: “Human development begins at fertilization, the process during which a male gamete or sperm … unites with a female gamete or oocyte … to form a single cell called a zygote. This highly specialized, totipotent cell marks the beginning if each of us as a unique individual.”

    Prof. R. Rahwan, Emeritus Professor of Pharmacology and Toxicology, Ohio State University concurs with this definition: “… fertilization marks the point of conception in that a new diploid (full chromosomal number) organism (the zygote) is formed which will develop, mature, and undergo senescence at a predictable rate.”
    O’Rahilly and Muller, authors of Human Embryology and Teratology reflect the same thinking: “Fertilization is an important landmark because, under ordinary circumstances, a new genetically distinct human organism is thereby formed.”

    Fertilization is the process that begins when a sperm makes contact with a secondary oocyte and concludes with the intermingling of the male and female chromosomes. This process takes approximately 24 hours to complete.
    Abortifacient drugs or devices are defined as those whose action is operative after conception has occurred. The pre-eminent embryologists Keith L. Moore and T.V.N. Persaud concur with this description:

    “Postcoital birth control pills (“morning after pills”) may be prescribed in an emergency (e.g., following sexual abuse). Ovarian hormones (estrogen) taken in large doses within 72 hours after sexual intercourse usually prevents implantation of the blastocyst, probably by altering tubal motility, interfering with corpus luteum function, or causing abnormal changes in the endometrium. These hormones prevent implantation, not fertilization. Consequently, they should not be called contraceptive pills. Conception occurs but the blastocyst does not implant. It would be more appropriate to call them ‘contraimplantation pill.’ Because the term abortion refers to a premature stoppage of a pregnancy, the term abortion could be applied to such an early termination of pregnancy.”

    Blastocyst is the precise description of the multicellular human embryo four days after fertilization. The blastocyst moves across the uterus for two days before it begins the process of implantation. Implantation of the human blastocyst begins about six days after fertilization. Implantation takes place during the implantation window. “The implantation window is a short interval during the mid-secretory phase, when the endometrium is most receptive to blastocyst implantation. It begins on days 20–24 of an ideal menstrual cycle or 6–10 days after the LH (luteinising hormone) surge and is believed to last less than 48 hours.” This receptive uterine “window” is “… achieved through a coordinated action of P4 (progesterone) and E2 (estrogen).”

    1. The re-defining of key reproductive terminology.

    A substantial range of the world’s most respected medical textbooks use definitions which are close to identical when it comes to defining conception, pregnant and pregnancy. Seven of these are cited in the footnotes. To break from these definitions is to move outside the accepted linguistic norms of embryology. Ideology supplants universal, objective scientific facts.

    From the preceding quotes it is evident that conception and fertilization are synonymous. Conception of a new human person is a result of the process of fertilization and marks the beginning of a pregnancy. The need to note this point is primarily a ‘political’ one – some scientists misuse the term conception. They disassociate conception, and hence the beginning of pregnancy, from fertilization and re-associate it with implantation.

    2. An historical perspective.

    One can trace the earliest origins of this semantic corruption of key embryology terminology to the 1969 book “The Second Genesis – the coming control of life”, by Albert Rosenfeld.

    This book was written only a few years after the invention of the birth control pill (BCP). The author, with remarkable perception and honesty, foresaw that there was a “problem” with the newly discovered birth control pill. The problem was that the BCP could terminate embryonic human life by inhibiting implantation. As Rosenfeld wrote:

    “Because these substances (the pill) do not prevent the sperm from penetrating and fertilizing the ovum – the classic definition of conception – they are not strictly contraceptives. What they do is prevent the newly fertilized egg from implanting itself in the uterus. Since the interference occurs after conception, some hold that such practice constitutes abortion. A way around this impasse has been suggested by Dr. A.S. Parkes of Cambridge: Equate conception with the time of implantation rather than the time of fertilization – a difference of only a few days.”

    This initial corruption of foundational embryology definitions suggested by Rosenfeld represented a stark break from the hitherto accepted scientific view which stated that conception of a new human person was the result of the process of fertilization which marked the beginning of a pregnancy.

    Conception was synonymous with fertilization, and therefore, pregnancy, as Dr Rosenfeld clearly understood.

    Soon thereafter this manipulation of pregnancy-related terminology acquired an imprimatur of apparent scientific legitimacy with the publication of the text Obstetric-Gynecologic Terminology, published by the American College of Obstetrics and Gynecology (ACOG) in 1972.

    In this text, conception was specified to be “the implantation of the blastocyst.” Conception was not, according to this revised definition, synonymous with fertilization. Consequently, pregnancy was re-defined as “the state of a female after conception and until termination of the gestation.” As a consequence of this new definition, any interference with the viability of the human embryo, from the time of its creation until the time of implantation, was no longer an abortifacient action. According to this ‘new’ definition, no pregnancy (apparently) existed; hence no abortifacient actions are possible.

    Having re-defined conception, which began the process of dismantling the continuum of fertilization, conception and pregnancy, a further reworking of pregnancy was initiated and approved at a meeting of the International Federation of Gynecology and Obstetrics (FIGO), in 1985. The Committee on Medical Aspects of Human Reproduction was asked by FIGO to “develop an accurate definition of pregnancy.” One might question whether “develop” is Orwellian “Newspeak” for the creation of a definition which would accommodate expanding methods of abortifacient birth control. The following citation is instructive.

    “The Committee agreed on the following: ‘Pregnancy is only established with the implantation of the fertilized ovum.’ Based upon the above definitions of ‘conception’ and ‘pregnancy’, an abortifacient acts to interrupt a pregnancy only following implantation.”

    Consistent with the 1972 actions of the ACOG, many proponents of the ‘pregnancy begins at implantation’ doctrine now regularly reference back to this text to justify their position. This is the only reference used to support their alteration to the factual embryological meaning of conception. It is clearly an example of “Newspeak”, where re-defining of words occurs to suit a pro-abortion agenda. Obviously, when the meaning of a word is changed, the truth is changed. The social and moral ramifications of such actions are wide-ranging and, as those involved in this field of bio-ethics can testify, it is an arduous task to re-orientate words back to their true, scientific foundation. Why? Because over the last four decades the intention to influence key opinion makers in society, such as those cited below, has been well targeted and highly successful.

    “It is to be hoped that these official definitions (from the American College of Obstetrics and Gynecology –1972) and the new scientific data will provide a realistic and scientific foundation for a clearer understanding of the mechanism(s) of action of IUDs among the lay public, theologians, politicians, and health care providers in general.” (Emphasis added).

    As a consequence of the ACOG action in 1972, and the subsequent redefining of pregnancy in 1985, there has been an increasing trend in the deviations from definitional orthodoxy. Some examples of the re-defining of pregnancy are:

    “The prevention of pregnancy before implantation is contraception and not abortion.” (Glasier 1997)

    “Predictably, some opponents of abortion allege that emergency contraception is tantamount to abortion…even if emergency contraception worked solely by prevention the implantation of a zygote, it would still not be abortifacient … Pregnancy begins with implantation, not fertilization … fertilization is a necessary but insufficient step toward pregnancy.” (Grimes, 1997)

    “Emergency contraception works by inhibiting or delaying ovulation or by preventing implantation. Despite some assertions to the contrary, it is not itself a form of abortion.” (Guillebaud, 1998)

    “…conception is used synonymously with implantation, nor fertilization.” (Trussell, 1999)

    “Six to seven days elapse between a coital act and establishment of a pregnancy, defined as implantation.” (Grimes, 2002)

    “Emergency contraception works by preventing ovulation, fertilization or implantation and does not disturb an implanted egg. Emergency contraception is not abortion: according to definitions endorsed by the federal government and national medical organizations, life begins when a fertilized egg implants in the uterine lining. Thus, if taken in early pregnancy, neither the woman nor the embryo is harmed.” (Pruitt, 2005)

    Two pivotal aspects contained within the quote from Pruitt demand comment.

    First, women are harmed by the use of so-named emergency contraception. Adverse effects caused by the morning-after pill range from nausea, diarrhoea, vomiting and breast soreness, to reported cases of ectopic pregnancy, requiring life-saving surgery.

    Second, if the human embryo (disparagingly referred to as a “fertilized egg”) fails to implant, it dies.
    In my view, the quotes from Grimes, Pruitt, Glasier, Guillebaud and Trussell are, in the strictest sense of the word, non-sense. They are ideologically based definitions. They are not founded on reputable embryology. A woman is pregnant because fertilization has been completed and conception has occurred, not because implantation has taken place. Implantation is, from both a time and developmental perspective, separate to conception/fertilization. Implantation of the human embryo takes place around the sixth day after fertilization with the human embryo now a multi-cellular structure known as a blastocyst.

    As Mosby’s correctly states: “Pregnancy – the gestational process, comprising the growth and development within a woman of a new individual from conception through the embryonic and fetal periods to birth.”

    One final semantic deception needs mentioning. Those who seek to promote postcoital birth control re-name the human embryo a “pre-embryo”, a “fertilized ovum” or a “fertilized egg.” These are deceptive terms without any basis in human science. Indeed the term ‘pre-embryo’ was coined in the late 1970s by frog embryologist Clifford Grobstein and has had a profoundly expansive and damaging influence on human sexual reproductive ethics. These definitions are solely ideological and are fully in conflict with contemporary human embryology. As biochemist, biologist and Professor of Medical Ethics Dr Dianne N. Irving has noted: “The scientific fact is that there is no such thing as a “pre-embryo” in the real world. The term is a complete myth. It was fabricated out of thin air in order to justify a number of things that ordinarily would not be justifiable.”
    To recall: “Human development begins with fertilization, a process during which a sperm unites with an oocyte (ovum).” (Their emphasis). This distinction in terminology is critical. The full range of bioethical issues linked to the MAP is centred upon this point.

    Ref
    Rahwan RG. Chemical contraceptives, interceptives and abortifacients. Division of Pharmacology, College of Pharmacy, The Ohio State University, Columbus, Ohio 43210 USA. 1998
    O’Rahilly R, Muller F. Human Embryology and Teratology. (Wiley-Liss, New York, 1994), p.16
    Larsen WJ. Human Embryology. (New York: Churchill Livingstone, 1997), p.1
    O’Rahilly, op.cit., p.19
    Carlson BM. Human Embryology and Developmental Biology. (Mosby’s Books) 1994, p.31
    Moore KL, Persaud TVN. The Developing Human: Clinically Orientated Embryology (6th edition. Philadelphia: W.B. Saunders Company 1998), p.2
    Mosby’s Medical, Nursing and Allied Health Dictionary (5th ed. KN Anderson (ed) St. Louis, Missouri, USA 1998). p.379
    Moore, op.cit., p.18
    Rahwan, op.cit.
    O’Rahilly, op.cit., p.5
    Ibid, p.19
    Moore, op.cit., p.34
    Mosby’s, p.393
    Rahwan, op.cit.,p.7
    Moore, op.cit., p.532
    http://embryo.chronolab.com/implantation.htm (Viewed February 27, 2010)
    Aghajanova L, Hamilton AE, Giudice LC. Uterine receptivity to human embryonic implantation: Histology, biomarkers, and transcriptomics. Sem Cell Dev Biol. 2008; Apr;19(2):204-11
    Tamm K, Room M, Salumets A, Metsis M. Genes targeted by the estrogen and progesterone receptors in the human endometrial cell lines HECIA and RL95-2. Reproductive Biology and Endocrinology. 2009;7:150 http://www.rbej.com/content/pdf/1477-7827-7-150.pdf (Accessed February 21, 2010)
    Butterworths Medical Dictionary 2nd Ed 1978 MacDonald Critchley (ed).
    Gould Medical Dictionary 4th Ed.1979. McGraw-Hill Book Co
    Stedman’s Medical Dictionary 26th Ed 1995. Williams and Wilkins (Pub).
    Harrup’s Dictionary of Medicine and Health Ist Ed. 1988. London
    Mellon’s Illustrated Medical Dictionary 3rd Ed (1993) New York.
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    Pearce’s Medical and Nursing Dictionary and Encyclopedia. 15th Ed. 1983. p. 99 Faber and Faber.
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    Rosenfeld A. The Second Genesis: The Coming Control of Life. Vintage Books 1975 ISBN 0-394-71214-5 p.128
    Hughes EC, ed. Obstetric-Gynecologic Terminology. Philadelphia: FA Davis. 1072
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    Trussell J, Rodriguez G, Ellertson C. New Estimates of the effectiveness of the Yuzpe regimen of emergency contraception. Contraception 1998; 57:363-369
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    Glasier A. Emergency postcoital contraception. NEJM 1997; 337:1058-1064
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    Guillebaud J. Time for emergency contraception with levonorgestrel alone. Lancet 1998; 385:416
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    Grimes DA, Raymond EG. Emergency Contraception. Ann Intern Med. 2002;180-189
    Pruitt SL, Mullen PD. Contraception or abortion? Inaccurate descriptions of emergency contraception in newspaper articles, 1992-2002. Contraception. 2005;71:14-21
    Sheffer-Mimouni G, Pauzner D, Maslovitch S et al. Ectopic pregnancies following emergency levonorgestrel contraception. Contraception. 2003;67:267-269
    Larsen, op.cit., p.19.
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    Harper C, Ellerston C. Knowledge and perceptions of emergency contraceptive pills among a college-age population: A qualitative approach. Family Planning Perspectives. 1995; 27:149-154
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    Irving D. When Does a Human Being Begin? ‘Scientific’ Myths and Scientific Facts. International Journal of Sociology and Social Policy (1999), 19:3/4:22–47
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