Conscientious Refusals in Pharmacy Practice

Zuzana Deans

It is common for pharmacists as well as other healthcare professionals to be given the right to conscientiously object to any procedure that falls under their professional remit. This is usually facilitated by a conscience clause within a code of ethics. By their nature, conscientious refusals, or conscientious objections, are usually made in relation to the most polarising issues. In recent years, pharmacists have been criticised for exercising their right to make conscientious refusals, with the media spotlight on the refusal to supply contraception, including emergency hormonal contraception (EHC) (BBC News 2010; Stein 2005; Stokes 2008). When this topic is discussed, there are often two debates running in parallel. One concerns the moral or religious acceptability of the procedure to which the objection is being made (e.g. supply of EHC), and the other concerns whether it is morally justifiable to have a conscience clause in place at all. It is this second debate that is the subject of this chapter.

This chapter offers a critical review of the current thinking on the philosophical and practical ethical questions about the validity of conscientious refusals. It is organised into four main sections. First is an examination of two key concepts on which a conscience clause is commonly thought to be based: conscience and integrity. Following this is a discussion addressing some practical ethical questions: whether the conventional form of the conscience clause is adequate for meeting patients’ rights, protecting the pharmacist’s integrity and guarding against wrongdoing; whether pharmacists should publicly announce their objections in advance; and how we should decide what the acceptable bases for making an objection should be. Next, consideration is given to whether the provision of conscientious refusal should apply equally to students, who arguably have the right to conscientiously refuse to participate in some aspects of their pharmacy training. The chapter finishes

Z. Deans (*)

Centre for Ethics in Medicine, School of Social and Community Medicine, Faculty of Health Sciences, University of Bristol, Bristol, UK e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it

© Springer Science+Business Media B.V. 2017

D. Ho (ed.), Philosophical Issues in Pharmaceutics, Philosophy and Medicine 122, DOI 10.1007/978-94-024-0979-6_10

by stepping back from the detail of the debate and suggesting some ways in which progress can be made in understanding this complex practical philosophical problem. The arguments presented share their origin with those in the debate about conscientious objections among physicians, and the same basic principles apply to any profession. Where the discussion differs slightly is in how these principles play out in practice, given the particular circumstances of the pharmacy and the obligations pharmacists have that compete with their right to conscientiously object.

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