Not on my watch…

man holding 'no' sign

An Internet storm is caused by a US pharmacist’s refusal to supply, but could it also happen in Australia?

A US woman says she was publicly shamed and left in tears after a pharmacist refused to fulfil her prescription for miscarriage-inducing medicine for “ethical” reasons.

Nicole Mone Arteaga, 35, posted her account of the incident on Facebook, where it has been shared more than 30,000 times, liked more than 50,000 times and generated 14,0000 comments.

Ms Mone Artega, was prescribed an undisclosed miscarriage-inducing medication after finding out her eight-week old foetus was lacking a heartbeat.

However when she went into a Walgreens pharmacy in Peoria, Arizona, pharmacist Brian Hreniuc refused to fill her prescription because he is anti-abortion.

“(Mr Hreniuc) asks me if I’m pregnant, (to) which I say yes and he tells me: ‘I’m not giving you this one. I can’t give you this one,” she told a US television network.

“I stood at the mercy of this pharmacist explaining my situation in front of my 7 year old, and five customers standing behind only to be denied because of his ethical beliefs,” Ms Mone Arteaga wrote on June 23, according to News Limited sources.

“I left Walgreens in tears, ashamed and feeling humiliated by a man who knows nothing of my struggles but feels it is his right to deny medication prescribed to me by my doctor”.

Closer to home, the Pharmacy Board of Australia Code of Conduct says that good practice is to not allow “moral or religious views to deny patients or clients access to healthcare, recognising that practitioners are free to decline to provide or participate in that care personally”.

The Board says that pharmacists must, if they object conscientiously to supplying a product, inform patients or clients and, if relevant, colleagues of the objection, and not use that objection to impede access to treatments that are legal.

PSA national president Dr Shane Jackson said the approach in Australia is to encourage pharmacists to be “pragmatic not dogmatic”, told AJP.

“People are within their rights to refuse to supply these products themselves however they do need to be mindful of their obligations to provide information and support to patients and to ensure continuity of care,” he said.

According to the PSA code of ethics Care principle 2: “A pharmacist: informs the patient when exercising the right to decline provision of certain forms of health care based on the individual pharmacist’s conscientious objection, and in such circumstances, appropriately facilitates continuity of care for the patient”.

In it’s specific guidance document for S3 emergency contraception (levonorgestrel and ulipristal), PSA states that: “In the event that an out-of-stock situation or moral belief of a pharmacist leads to the non-supply of a product or service, the pharmacist must accept responsibility for ensuring continuity of care – that is, timely access to the required medicine or service.

This may involve the use of initiative to identify another reasonably available source for the required medicine or service, particularly in rural or remote areas or in other situations where access to alternate service providers may be limited”.

Arizona state law allows pharmacists to deny prescriptions based on moral or religious grounds. It is one of only six states to have that law, the News Limited article stated.

Walgreens’ corporate office is reportedly investigating the incident but admitted Ms Mone Arteaga should have been immediately referred to another employee within the store.

Read more from AJP on pharmacist’s duty of care and conscientious objections

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  1. pagophilus

    Facilitates continuity of care is vague and should be so. Referring to another pharmacist/provider is essentially facilitating supply even if you’re not willing to do it yourself. If you have a moral objection to something you cannot just facilitate supply as you are still helping someone obtain something you have a moral objection to, thus you are still part of the process. You can not hinder supply but you don’t want to be involved yourself. This is the problem, but society is on dangerous ground if it starts to force people’s involvement in processes they have a moral objection to.

    • Philip Smith

      If you have a moral objection to cutting down trees don’t be a lumber jack, if you get my drift.

      • pagophilus

        99% of the work of a pharmacist entails no moral objections.

        Also, it’s rare scenarios such as this (and hypotheticals such as what if this, what if that, what if it’s due to rape etc) which make headlines. I dare say that the vast majority of abortions are simply because the child was unplanned/not wanted. Where is the responsibility on the part of the parents not to create the child in the first place? Why is it placed on the pharmacist to remove it?

        • Kate Tognarini

          None of these decisions are made lightly and contraception is not 100% effective so sometimes accidental pregnancies do occur. Is it your job to decide who is worthy of help based on your moral compass? You are of course entitled to your beliefs and so can refuse to supply but don’t judge and don’t stand in the way, refer to someone who can help or put a big sign on your front door declaring your stance: “our pharmacist has a moral objection to the supply of life-ending medications” and see how that goes down.

          • pagophilus

            I’d be happy to put up a sign saying “I refuse to dispense life-ending medications”. Contraception is one thing, but ending life is another altogether. I don’t end life and I won’t be an accessory to it either. If someone wants to end life they can do it without my involvement. I won’t stand in their way but I won’t play a part either. Whether that is a young life, old life, terminal life, doesn’t matter.

          • Jarrod McMaugh

            Unless they sell drugs though, right?

            You’ve gone on record saying that Singapore and the current situation in the Philippines is an example.of effective deterence.

          • pagophilus

            So you’d do it the other way. Wouldn’t kill those guilty of serious crimes (because it’s inhumane) but happy to end the life of the innocent?

      • Jarrod McMaugh

        I don’t agree with pagophilus on this, but I’m going to uncharacteristically support him (sort of) by saying that this response doesn’t work either.

        Practice changes. What was acceptable when someone registered may not be when they are practicing decades later.

        As an example, Victoria is 12 months away from having Voluntary Assisted Dying, which will see pharmacists dispensing medications intended to end a person’s life.

        So, should those opposed to dispensing life-ending medication retire now and find a new career?

        This is an extreme example, and the law is specifically written in a way that protects the choice not to be involved in this process, but it still demonstrates that we are all subject to changes that we may not agree with, and yet be expected to abide by due to our profession.

        In my opinion, pagophilus’ point doesn’t absolve anyone of their obligations under the PSA’s Code of Ethics, and remains unconvincing as a reason to breach them.

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