Tip of the Week: Communicating Conscientious Objection Policies

The term ‘conscientious objection’ has significant foundation in the US Department of Defense, when describing someone objecting to military service during mandatory drafts on the grounds of freedom of thought, religion, or conscience. Conscience clauses also are legal clauses in some states, permitting pharmacists, physicians, and/or other health providers not to provide certain medical services for reasons of religion or conscience.

In some cases, conscience clauses permit providers to refuse to refer patients to unopposed providers, and those who choose not to do so may not be disciplined or discriminated against. The provision is most frequently concerned with issues relating to reproduction, such as abortion, sterilization, contraception, and stem cell-based treatments, but also may include other forms of care.

In an article published by the New England Journal of Medicine, the authors sound off on conscientious objection in health care. They state that unlike conscripted soldiers, health care professionals voluntarily choose their roles and thus become obligated to provide, perform, and refer patients to the standards of the profession. They discuss conscience clauses adopted over the years by various entities, including the right in some areas for student physicians not to undergo training in abortion services, the Balanced Budget Act that allowed insurers and plan sponsors to deny coverage based upon religious or moral convictions, and the 2009 Provider Conscience regulations that provided protection against persons unwilling to participate in rendering care or engaging in research to which they objected.

The authors point out inconsistencies within the medical profession and in professional organization guidelines with regards to conscientious objection. They observed that one pharmacists' association, for example, stated in 1994 that the well-being of the patient was at the center of practice, but in 1998 approved the right of pharmacists to exercise conscientious refusal. They assert that proponents of conscientious objection point toward emerging issues like assisted suicide and use of marijuana for treatment, but that these latter issues concern medical value, not cultural acceptance. They thus claim that as a health professional, religious beliefs are secondary.

This management tip will not argue for or against conscientious objection, including all of its nuance, including refusal to treat but issuing referral to others. It will, however, affirm the need for ethical judgment that recognizes the need for altruistic practice.

Pharmacy managers must be clear on, and effectively communicate state law and company policy to provide employees with what they are required to do (or not do) and the repercussions for doing, or failing to do so. Lack of clear policy and absence of effective communication by managers can end up harming the patient, alienating the pharmacy staff, and jeopardizing the pharmacy business.

Additional information about medication therapy management and management functions can be found in Pharmacy Management: Essentials for All Practice Settings, 5e. You or your institution can subscribe to AccessPharmacy to access the textbook.

Shane P. Desselle, RPh, PhD, FAPhA, is Professor of Social/Behavioral Pharmacy at Touro University California. He is author of Chapter 1: The “Management” in Medication Therapy Management and Management Functions in the textbook Pharmacy Management: Essentials for All Practice Settings, 5e.

REFERENCE

Stahl RY, Manuel EJ. Physicians, not conscripts—Conscientious objection in health care. New Engl J Med. 2017;376:1380-1385.