Conscientious Objections in an Educational Context
So far, the discussion has been about qualified pharmacists and their obligations as professionals. In this final section, the focus turns to students of pharmacy. Empirical evidence shows that students are supportive of the right for professionals to conscientiously object, but this is limited to students reflecting on the appropriateness of conscientious objections among qualified pharmacists (Hope et al. 2014). There is also some evidence of medical students’ views, again only on qualified professionals (Strictland 2012; Nordstrand et al. 2014), and little is known about how inclined pharmacy students are to conscientiously object to carrying out procedures as part of their training. Nevertheless, this is an area worth exploring further since there are additional arguments to consider in the educational context. Wicclair puts forward a compelling set of reasons for allowing conscientious objections among students, including that diversity in student population should be encouraged, and that students’ views should be taken seriously and should not be dismissed as outliers and that student objections can and do lead to changes in practice (Wicclair 2011: 171-172).
The key difference between the qualified pharmacist and the pharmacist in training is in the purpose of the procedure. A qualified pharmacist aims to meet her obligations towards the patient and the public, while the student pharmacist aims to ensure she receives the training to obtain the skills, knowledge and experience necessary for becoming a competent pharmacist. Where the qualified pharmacist has a conscientious objection, she may be able to ensure her aims are met by a colleague. For a student pharmacist, it would be far less plausible for her to find a substitute to carry out the educational exercise and for the objecting student to still gain the necessary skills and experience. Wherever possible, it is the procedure that would have to be substituted, not the person. For example, a number of medical schools in the USA now use interactive computer programmes instead of dog labs (in which a dog would be anesthetised, cut open and examined while still alive. It would then be killed once the demonstration was over). Similarly, students could examine a member of the same sex instead of a member of the opposite sex where sexual characteristics are not relevant to the educational exercise. This is, however, limited. For example, it is hard to see how a student who objects to participating in reading, lectures and examinations on diseases caused by sexual activity or alcohol (Foggo and Taher 2007; Strickland 2012: 24) could gain a comprehensive education. In addition, Card claims that opting out of some procedures is to miss important lessons in professionalism. “By refusing to perform examinations on members of the opposite sex, such students are failing to engage [with] the question of what constitutes a touch that is professional and non-sexual—one that exemplifies a ‘cool intimacy’ that is still compatible with closeness to a patient” (Card 2012: 604).
It might be argued that a student who has an objection to certain procedures would be wise to choose a career that excluded these practices and, as such, avoid training in the area that gives rise to the objections. The common example in medicine is the student who has a conscientious objection to termination of pregnancy and so chooses not to go into a career in obstetrics and gynaecology and opts out of some aspects of training in this field. However, even if pharmacists could avoid the practice they had an objection to, this would be to miss the point of their programme, which is to educate pharmacists to be fit for practice. Commenting on doctors’ training in the UK, the General Medical Council states that “the point of a medical course is to produce a doctor fit for clinical practice. What doctors then choose to do with their career is a matter for them” (General Medical Council 2006). Importantly, opting out of learning about a certain procedure on the grounds that one will object to performing it once qualified is not supportive of the conventional compromise, since this requires pharmacists to make the supply/perform action when a referral is not appropriate.
In the debate on conscientious objections among students, the emphasis is on education: educating students on the full range of skills and competencies but also educating students about moral values. A conscientious objection by a student presents an educational opportunity. The arguments for conscientious objection among qualified healthcare professionals apply to students but with the possibility of being overridden by arguments for educational need. In cases in which the exemption can be upheld without cost to the student’s training (e.g. noncore skills), the student could be asked to defend her position with well-articulated arguments that stand up to challenge from peers, thus serving as part of the educational process.