Should objectors be forced to display their position?


Pharmacists that object to providing certain reproductive products would have to display signs that outline what they won’t supply, under an ACT Labor proposal

ACT pharmacies that have a conscientious objector on staff may soon be required to display a visible sign that outlines the products they don’t supply, under a motion being moved today by ALP representative Bec Cody in the state’s Legislative Assembly.

Ms Cody is proposing that pharmacies that don’t want to prescribe certain reproductive health medications, products or procedures display a “clearly visible” sign, in plain language, that outlines what they do or don’t supply.

She tells AJP her goal is to “look at ways that we can better assist our members of the community to not feel embarrassed or humiliated when they’re asking for certain products.”

“The main objective for me is that people of all genders deserve the right to respectful advice from pharmacists,” says Ms Cody.

“There are some pharmacists who may not necessarily agree with the use of condoms, or the pill, or the morning-after pill.

“I’m not saying that pharmacists are necessarily doing things that are meant to be upsetting or humiliating for people, it’s just that there are times where … there may be a need for a woman to go in after the morning-after pill for example, and the pharmacist may tell the woman ‘oh you know, it’s very bad for you to have unprotected sex, and maybe you should have thought about using a condom’.

“The pharmacist is trying to do the right thing there, but the woman might just feel that as an attack on herself.

“This isn’t meant to be about what is morally right and what is morally wrong, this is really just an opportunity so that both pharmacists and consumers don’t have to have embarrassing conversations at all.

“And also so that the pharmacist doesn’t have to have a conversation that they may not ethically want to have.”

Simon Blacker, ACT Branch President and National Councillor for the Pharmacy Guild of Australia, says that while he understands the intent of the motion, he fears it may cause confusion with patients.

“From the point of view of a patient, some of these matters can be sensitive. We certainly want the patient to have the best health outcome in a setting and manner that’s empathetic and convenient,” Mr Blacker tells AJP.

However he adds that suggesting regulation around signage is too “black and white”.

“If you’ve got signage on a pharmacy business but you have a varied roster with varied professionals, how do you cater to that? I understand the intent to make it easier for the patient with a sensitive matter, but I think it actually complicates things.

“So the impact to community pharmacy could be to cause more confusion and in some cases, some more patient angst because there is confusion and that’s the last thing we want,” says Mr Blacker.

“I don’t think the beliefs of community pharmacists are generally going to get in the way of assisting patients with their health and thus to have regulation around signage seems unnecessary.

“Community pharmacists in general and in the ACT are very keen to help patients where they can with any health concern.”

John Guy, Professional Officer with pharmacist indemnity insurance provider PDL, says the signage regulation suggestion could be an issue.

“It might depend on the individual pharmacist,” he tells AJP.

“Unless you change the sign depending on who was on duty, some people would provide [the medication] and then the next person on the shift might not.

“They could have a blanket statement saying that ‘beware that some pharmacists may not provide those products due to their beliefs’, not saying ‘everyone’ but ‘some’.”

Mr Guy adds that while there are pharmacists who may have moral objections to supplying some medications, there is a need to provide alternative supply.

He warns that pharmacists who refuse “point blank” can be reported to the Pharmacy Board for unprofessional conduct.

“That’s their right to refuse supply. But they should provide some alternative by referring to a pharmacy that they know will provide that service.

“They can’t just say: ‘I don’t believe in that. You’re wrong, go away.’ They have to do it tactfully and carefully, without being judgemental. They shouldn’t impose their views on people, but they should just politely decline and say that they are unable to dispense it, but [provide an alternative].”

ACT pharmacy proprietor Elise Apolloni says the most important thing is for pharmacists to remember their duty of care, as well as the importance of patient privacy.

“It’s in the Professional Practice Standards that we need to have our patient’s welfare at the forefront of everything that we do, and we need to consider at all times their privacy and their level of comfort. It’s pharmacists’ duty of care to connect patients to timely access of medicines.”

Ms Cody says the signage suggestion will help both parties in the equation.

“This is about protecting both the pharmacist and the consumers,” she says.

“I think both sides of the coin, both the consumer and the pharmacist, should have a right to have their own view and not affect each other.”

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7 Comments

  1. Daniel Hackett
    15/08/2018

    I don’t get how this works. If they have to supply an alternative, does it have to be comparable? Does it have to have the same effect? If so, what difference does it make? What’s an alternative to a condom, abstinence? What’s an alternative to the morning after pill, drinking bleach? Clearly the pharmacist is being allowed to neglect their professional duty here. Something that we will not tolerate in any other field. I agree they should put a sign up identifying themselves, these idiots need to be exposed. But what if they are the only pharmacist in town, what then?

    • Jarrod McMaugh
      15/08/2018

      I’ve worked in a situation where a pharmacy owned by my employer was in a single-pharmacy town close to the town where I managed one of their other pharmacies, and I’d occasionally do shifts there.

      The pharmacist who managed this pharmacy stated a conscientious objection to ECP. Despite the fact that none of the other pharmacists shared his view (including the pharmacology & mode of action that shows this is no different than OCP), we weren’t in a position to enforce a policy that he would supply.

      Instead, the local hospital was contacted, and we negotiated a way for women to have access to this medication via telehealth consultations.

      While this is clearly not ideal, pharmacists must always have the right to conscientious objection – as explained in a response I’m about to make above…..

    • Sheshtyn Paola
      15/08/2018

      It’s providing an alternative by referring to a pharmacy that they know will provide that service.

      Not providing an alternative product.

  2. sylvie comeau-hall
    15/08/2018

    Pharmacist who refuse to supply what is in the best interest of the patient should reconsider their career choice. Pharmacy is based on science and best practice, and retrograde beliefs should not interfere with any advice given. Pharmacy owners should ensure that their employees understand their responsibilities, which could be clearly stated in their contract of employment, and failure to comply should incur a penalty.

    • Jarrod McMaugh
      15/08/2018

      I understand this viewpoint, but I’m going to have to play devil’s advocate for my response.

      Firstly, I personally believe that every pharmacist should ensure that they understand the mechanism of action of all medications, which will contribute a lot towards overcoming a lot of objections that arise from ignorance and stigma.

      This applies to ECP, pharmaceutical abortion, opioid replacement therapy, etc.

      I’ve seen pharmacists make various objections, including supplying hormone therapy to people who are intersex or transgender; to people accessing medicinal cannabis; to people accessing heroin-assisted treatment (not yet legal here), and other therapies that have good evidence, are needed therapeutically, or are otherwise legal to supply. All of these, I personally feel pharmacists should be comfortable with supplying – all other clinical issues being equal.

      BUT

      we are entering a period of time where there will be pharmacists in Australia who are part of the process for supplying medication for the purposes of voluntary assisted dying.I am involved in the process of developing the regulations for this process. Despite my own willingness to be involved in this process, I think there will be a significant proportion of people who will not.

      There are philosophical debates we can have about “what is in the best interest” of a patient, but the reality is, there are always going to be people who feel that the best interest of a patient is non-supply of a medication (even if they are misguided). Do we create a system where we force all health professionals to be involved with any intervention that is legal? I feel that is untenable, not because it would infringe on pharmacists’ rights (it would), but because it would prevent the development of new areas of medicine due to conservatism.

      • sylvie comeau-hall
        22/08/2018

        Perhaps in the instance of assisted dying medication, pharmacies can choose to participate or not, as is the case with methadone. Not everyone is in a position to provide the service (which requires more then filling a prescription or supplying OTC) and customers generally know who can provide it or not.

  3. William
    15/08/2018

    Pretty typical of the group thought controlling bunch it ACT. Marxism at work.

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