Home' Australian Pharmacist : Australian Pharmacist Sept 2013 Contents 74 Australian Pharmacist September 2013 I ©Pharmaceutical Society of Australia Ltd.
circumstances the pharmacist should
inform the consumer of the objection and
appropriately facilitate continuity of care
for the consumer.'
One might then ask: if I have a personal
objection to a certain issue, why should
I be responsible for 'continuity of care'?
The question is highly pertinent in
Australia, where it could well be difficult
for a patient to find an alternative supplier
of RU486 -- according to the TGA and NPS
websites, it will only be made available
to those who have 'arrangements'
with the sponsor and the registered
physician. Of particular importance is
the rural/remote setting in Australia
where, by nature of the circumstances,
pharmacies are already fewer and
futher between. The odds of finding
convenient alternative suppliers of the
agent are less likely than the average
Even in a metropolitan suburb, take for
example a hypothetical but not unlikely
case, where a pharmacy enters an
agreement with sponsor and physician,
and at some point in time the owner
or managing pharmacist needs to take
annual leave. The locum pharmacist has
a strong moral objection to the supply
and use of RU486. What happens to a
patient who presents with a prescription
for the product in such a situation?
Let's say (hypothetically) the pharmacist
shrugs despondently and walks away, or
pretends there is no stock, or assertively
informs the patient about his/her
perspective on abortion, and refuses to
assist the patient find another supplier
(e.g. 'I'm only a locum here today and
don't know') -- where does that leave
Nancy Berlinger, a renowned bioethicist
and Director of the Hastings Center of
Bioethics recently stated: 'Conscientious
objection in health care always affects
someone else's health or access to care
because the refusal interrupts the delivery
of health services.'
Conscientious objection in health care
always has a social dimension and cannot
be framed solely as an issue of individual
rights or beliefs. At what point does
refusal to consent to treatment constitute
medical neglect? At what point does a
provider's moral objection to providing a
treatment interfere with a patient's access
to treatment, and violate professional
ethical standards? Laws and professional
guidelines on conscientious objection
in health care must balance the respect
for an individual's beliefs against the
well-being of the general public.
Striking a balance
There appears to be clear
acknowledgement of the right of the
healthcare provider to conscientious
objection in Australia. There are however
certain constraints to this right in light
of the obligation to respect patient
autonomy and right to access medicine
and healthcare. Health care providers with
moral objections to providing specific
services have an obligation to minimize
disruption in delivery of care to patients as
well as burdens on other providers.
Pharmacists with moral objections
to specific services in the pharmacy
must alert their colleagues and
employers/supervisors upfront to these
objections in the interests of minimising
miscommunication, disruption or delay in
supply or jeopardising patient autonomy
and right to healthcare. Because health
care providers recognise a duty not
to abandon patients, suggests that a
professional who has invoked the right
to refuse to provide a service must not
interfere with the patient's ability to
obtain it elsewhere. This specification
recognises that it is professionally
inappropriate for health care providers
who step away from services to then step
between a patient and another health
care provider, whether by refusing to
cooperate with the transfer of a patient's
care, refusing to make a referral, or making
a patient feel uncomfortable or ashamed
about seeking health care.
In conclusion, pharmacists who have
a moral objection to the supply of the
commonly known as RU486, can invoke
their right to conscientious objection.
In doing so, they must be sensitive to
patients' rights and respect patient
dignity first and foremost. They must
ensure continuity of care for the patient
in all circumstances and avoid disruption
to patient care. It is strongly advised
that pharmacists notify colleagues and
employees, and plan ahead in the case
of practising in a pharmacy which has
entered an arrangement with Marie Stokes
International and physicians registered for
It is also of great importance that our
professional organisations develop
standard practice guidelines for the
provision of this abortifacient. There are
many issues that need to be clarified, such
as when to take the pills, what to expect,
signs to look out for etc. Even though the
physician will no doubt have gone through
the critical counselling points, it is the
pharmacist's responsibility to dispense and
counsel, and confirm the patient is fully
aware of all aspects of the agent and how
Pharmacists are after all the gatekeepers.
1. Therapeutic Goods Administration. Registration of medicines
for the medical termination of early pregnancy. 30 Aug 2012.
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16. R v Bayliss and Cullen (1986) 9 Qld Lawyer Reps 8.
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21. State of Queensland. Criminal Code (Medical Treatment)
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