Pharmacists have “duty of care” to women patients

While Australian pharmacists have a right to refuse supply of medicines based on personal beliefs, representatives emphasise the importance of facilitating supply elsewhere

Several commenters have responded to an AJP article covering conscientious objection and religious guidance in the pharmacy with widely varying opinions.

Some said that religion has no place in the pharmacy, while others said they value their right to refuse supply based on personal beliefs.

“How can it be conscientious to deny something that they feel is correct for them, just because you have a religious belief?” wrote Jarrod McMaugh. “Therapeutic grounds are the only reason to ‘object’ to treatment.”

However another responded saying, “Religious and conscientious objections are not mutually opposed.”

“For example I object to supplying 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 … Both of these items harm the most vulnerable patients – the unborn human person, as well as causing harm to the woman. On the latter point the list of problems with IUDs is extensive.”

And Willy the Chemist wrote, “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.”

Dr Safeera Hussainy, a pharmacist and pharmacy practice researcher at Monash University in Melbourne, says it’s important to clarify that emergency contraception is not an abortifacient.

“Evidence shows emergency contraception tablets are not abortifacients, they do not harm an existing pregnancy that has been established – it’s a myth,” she told the AJP today.

“There are various types of IUDs, and the copper IUD can be used as emergency contraception as well, which is great. They are actually a really safe method of contraception as well. They can work hormonally as well as inhibit sperm movement. And again, they are definitely not abortifacients.”

Dr Hussainy says pharmacists should be seen as public health advocates, and the number one goal is to educate pharmacists and rectify any misinformation surrounding contraceptives.

“Even with education, if they’re still not happy [to supply EC] because of religious beliefs, for example, their duty is to facilitate supply by referring the woman to another pharmacy,” she says.

“Emergency contraceptives are also time-sensitive so they need to send them to the nearest pharmacy or sexual health clinic. They can also get a fellow pharmacist to dispense it if that works for them, providing it is in stock.”

One AJP commenter asked, “How can you facilitate that which you are not willing to do yourself? We need to start defining what a right is.”

“Couldn’t agree more,” replied another. “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.”

However, PSA guidelines on provision of emergency contraception align with Dr Hussainy’s assertion that pharmacists have a duty of care.

“In the event that an out of stock situation or moral belief of a pharmacist leads to the nonsupply 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,” says the PSA in its official guidance on the provision of pharmacist-only medicine Levonorgestrel.

“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.”

Dr Hussainy also points pharmacists towards the International Consortium for Emergency Contraception for “evidence-based information to dispel myths”.

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