COUNTERPOINT: Pharmacists Must Have the Right to Exercise Conscientious Refusal

Patients have a right to obtain prescribedmedications on a timelybasis, assuming that no risk factorsare present that would contraindicatetheir use.

Pharmacists have a right to exerciseconscientious refusal (eg, for ethical,moral, or religious reasons) in decliningto dispense prescribed medications.

These 2 statements are not contradictory.Policies and procedures have beendeveloped that ensure the right of pharmaciststo exercise conscientious refusaland also meet the needs of patients andthe interests of employers of pharmacists.

Most of the discussions on these topicspertain to the use of emergency contraception(eg, Plan B). The right of pharmaciststo exercise conscientiousrefusal, however, must also be viewed inwhat, for many, will provide a clearercontext—situations such as the use ofmedications for the execution of criminalsvia lethal injection or for physician-assistedsuicide or euthanasia. Clearly,these are life-or-death situations.

The discussions on emergency contraceptionaddress many issues including,but not limited to, its mechanisms ofaction, whether the product may inhibitthe implantation of a fertilized egg (a secondarymechanism of action), when lifebegins, abortion, and patients' rights.Strong differences of opinion surroundthese issues. Some pharmacists whoexercise conscientious refusal in decliningto dispense a prescription for emergencycontraception do so because theybelieve that life begins when an egg andsperm unite and that an action to inhibitimplantation of a fertilized egg terminatesthat life (ie, a life-or-death situation).Although some may disagree withthis position, they must not be permittedto deny the rights of others to hold differingviews. For a pharmacist who declinesto have a role in the use of emergencycontraception, there can be no reasonthat is more important than a belief thata life is at risk.

Pharmacists must have the right toexercise conscientious refusal! Actionsthat would deny pharmacists, or anyoneelse, the right to make decisions based onconscience have very harmful implicationsfor both individuals and our society.

Very few situations have arisen inwhich pharmacists have exercised conscientiousrefusal in declining to dispenseemergency contraception. In addition, ofthe rare situations that have been publicized,I am not aware of even one experiencein which a woman was not able toobtain this product on a timely basis.

I can discuss differences of opinionregarding these issues with individualssuch as my friend, Bob Tendler, in amanner that is characterized by mutualrespect. Regrettably, however, somepeople outside our profession are determinedto widely publicize these rareexperiences, using scare tactics thatsuggest that a crisis exists. They bashpharmacists in general and vilify thepharmacists who have exercised conscientiousrefusal. Because the actualexperiences are so rare and withoutconsequences, they resort to conducting"surveys" or creating hypotheticalscenarios (eg, such pharmacists mightdecline to dispense antiretroviral agentsto patients with AIDS because they disapproveof their lifestyle [this has nothappened]). These efforts are irresponsible,misleading, and insulting and mustbe challenged.

Whether anyone has the right to exercisehis or her conscience should not evenbe an issue. It is time to move on!

Dr. Hussar is the Remington Professorof Pharmacy at the Philadelphia Collegeof Pharmacy at the University of theSciences in Philadelphia.