I recently wrote an article expressing my delight that Washington State pharmacists will no longer be forced to dispense products or provide services they find morally objectionable. My elation at the Washington victory was quickly numbed, however, when an edited version ran as a “Point of View” on the Canadian Healthcare Network website. It is one thing for the public to oppose our freedom of conscience, quite another for pharmacists to be shooting themselves in the foot.

Only 42 per cent of pharmacists who voted on the network’s site agreed that “they should have the right to refuse to sell products or provide services they consider morally objectionable”. Sadly, the other 58 per cent believe they should be forced to do what they believe to be wrong — “Well, Mr. Smith, I hate to do this to you, but if you really insist, take this overdose and don’t bother calling me in the morning.”

My happiness at the Washington victory was further squelched by the plethora of intolerant, and in some cases highly dogmatic, statements posted by fellow pharmacists. While some offered considered views that mirrored common misgivings among the public, others shot assertions from the hip, epitomizing the very judgemental attitude they so fear in their opponents. “Pharmacists are to be non-judgemental” — except, it seems, when criticizing one another.

A common thread running through the posts is deep consternation about conscience, showing, at the very least, that the authors have one. Yes, every living, rational, being has this capacity for self-reflection, regardless of dogmatic beliefs. But, alas, some have decided it is best to leave their conscience at the pharmacy door. They propose that we all live by one set of mores at work and another set at home.

One person writes: “If moral issues are a concern, provide a reasonable alternative…”

And, were euthanasia legalized, what might that be when Mr Smith insists on his overdose? — “Ah, er, sorry Mr Smith, I’m afraid I cannot offer you this service, but Frankie’s Pharmacy down the street most certainly will! Have a nice day… Um, see you in the next life… I hope?”

“In some cases”, the comment continues,” you just have to separate work from home, and the professional judgment involved cannot be swayed by moral beliefs.”

Yet no one makes judgments in a vacuum. What, then, will professional judgment be swayed by: Consumerism? Feminism? Drug-company-ism? The next ideological “ism”?

Let me stress that I agree it would be unethical to deny the sick treatment. But because neither fertility nor pregnancy constitutes an illness, I refuse to pander to the feminist ideology that forces us to view and treat them as such.

It is a rather scary thought, is it not, that pharmacists should leave their morals at home. (Care to help yourself to that left over morphine in the back of the safe? How about chewing on low-dose Concerta?) Do we want robots in the pharmacy, people devoid of ethical or philosophical insight who simply follow orders and take no responsibility for their actions? Did we learn nothing from the crimes of the Nazi doctors who separated moral judgement from professional “duties”?

If reason allows us to reflect upon our professional actions in the area of therapeutics, moral conscience accompanies us always so we can discern the goodness or baseness of our own actions. So, when a pharmacist decides not to provide you with an overdose, he uses both his moral judgement and professional judgement simultaneously.

Pharmacists who refuse to dispense products they believe to be harmful are putting the health of the patient first. A pharmacist who will not sell the morning after pill, for example, chooses not to stock it because he believes that life is precious from the moment of conception. This is not a religious feeling or belief, but an ethical opinion that is just as worthy of respect as any other.
P>What if a pharmacist decides to not dispense a medication simply out of caprice or bigotry? The oft-cited hypothetical example is someone who will not dispense anti-retrovirals to AIDS patients. I can only say that no pharmacist with an upright conscience would ever deny necessary treatment to a patient on a whim.

Sean Murphy of the Protection of Conscience Project has summed up well the contradictory position of those who demand ethical conformity without demonstrating “the superiority of the ethical judgements [they] propose to force upon unwilling colleagues.”

They could, he says, at least explain “how professional ethics will be improved if the only candidates admitted to professions are those who promise to do what they believe to be wrong.”

Cristina Alarcon is a Vancouver pharmacist and writer. She holds a Masters in Bioethics.

Cristina Alarcon is a community pharmacist living and working in Vancouver.  She is a clinical instructor of pharmacy practice for the faculty of Pharmaceutical Sciences at the University...