To dispense or not to dispense...
PUBLISHED: 08:42 07 July 2017
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Opinion: Is it right that pharmacists can plead conscience, asks Nick Conrad.
I was drawn to a news story which snuck under the radar this week. This issue is a classic ‘contract’ versus ‘conscience’ battle facing some pharmacists, which was brilliantly highlighted on the BBC Radio Norfolk Sunday Breakfast programme.
I pen this week’s article with genuine interest, a will to impartially provoke a healthy debate rather than trying to influence opinion. In a U-turn on proposed policy, Britain’s pharmacy regulator has declared that pharmacists should not be forced to dispense medicine and substances against their consciences. This includes drugs such as the morning-after pill or even contraceptives. The pharmacist can object if it goes against their religious beliefs, forcing the customer to go elsewhere.
Critics argue that this issue could adversely affect us in rural Norfolk. In a location where only one pharmacist is dispensing, any individual who is turned away might face a long trek to another pharmacy. This raised a key question investigated by presenter Anthony Isaacs. Is it right that an individual’s belief structure is imposed onto others? Britain is, in practice, a secular society but maybe not a secular state. The monarch promises to uphold Christianity; however this country protects, enshrines and respects broad perspectives. This liberality is underpinned by our law. Access to healthcare, without judgement, is imperative - so does this latest ruling threaten that?
The General Pharmaceutical Council guidelines wish to protect those of faith from the ‘moral dilemma’ they would face in dispensing a substance which contravenes their ethics. A good example is the ‘morning-after pill’ – a ‘liberator’ to some, ‘murder’ to others. But getting the balance right is imperative. Many have legitimately questioned if too much emphasis is placed upon protecting the feelings of pharmacists rather than protecting the public’s health.
There are safeguards in place. The pharmacists must demonstrate that their actions don’t affect the care of patients and don’t break equality laws, but objectors argue this is a paradox. What value is equality when ‘equal’ access to drugs is determined by who is present behind the dispensing counter? The opposing view is that some religious commentators have suggested the guidelines don’t go far enough to protect people of faith.
Perhaps you think that all pharmacists should be forced to deliver all services, no matter what their beliefs? Is it right that our personal views trump what is expected of us in the workplace? But where does this end - can a doctor start withholding services? In trying to define the parameters do we in fact create a new grey area?
The guidance appears to contradict the precedent. You’ll remember the Christian guesthouse owners who had to pay damages for turning away a gay couple. Hazelmary and Peter Bull refused to let gay civil partners stay in a double room at their Cornwall guesthouse in 2008. The married couple said they regard any sex outside marriage as a “sin” – the guesthouse was their home and they didn’t want any such activity under ‘their roof’. They were widely condemned. Then we had the Northern Irish bakers, another Christian couple who were found to be on the wrong side of the law. They refused to make a cake bearing a pro-gay marriage slogan.
But whatever you think of their views, why are they any less legitimate than the pharmacist?
I don’t doubt pharmacists have a strong sense of commitment to the patient. While I disagree with the assertion that such pharmacists are “in the wrong line of work,” I wonder if they are practising in the wrong setting. Would they be better served, if possible, practising in an area where this dilemma is unlikely to occur? Very few pharmacists refuse to dispense so this is a debate on ethics rather than an active problem. What BBC Radio Norfolk highlighted was an isolated vocational issue which, if applied across healthcare, would fundamentally reform the relationship between practitioner and patient.