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MEDICINE, LAW, AND ETHICS

Dispensing with Conscience: A Legal and Ethical Assessment

Director, Northwest Center for Bioethics, Portland, OR; Adjunct Professor of Philosophical Theology, Western Seminary, Erasmus Mundus Scholar in Bioethics, Katholieke Universiteit Leuven, Leuven, Belgium

Donald G Grant, JD BSN

Partner, Grant & Elcock, PLLC, Vancouver, WA

Reprints: Dr. Wernow, Northwest Center for Bioethics, 5511 SE Hawthorne Blvd., Portland, OR 97215, ncb{at}teleport.com

BACKGROUND: For over 30 years, pharmacists have exercised the right to dispense medications in accordance with moral convictions based upon a Judeo-Christian ethic. What many of these practitioners see as an apparent shift away from this time-honored ethic has resulted in a challenge to this right.

OBJECTIVE: To review and analyze pharmacy practice standards, legal proceedings, and ethical principles behind conflicts of conscientious objection in dispensing drugs used for emergency contraception.

DATA SOURCES: We first searched the terms conscience and clause and Plan B and contraception and abortion using Google, Yahoo, and Microsoft Networks (2006–September 26, 2008). Second, we used Medscape to search professional pharmacy and other medical journals, restricting our terms to conscience, Plan B, contraceptives, and abortifacients. Finally, we employed Loislaw, an online legal archiving service, and did a global search on the phrase conscience clause to determine the status of the legal discussion.

DATA SYNTHESIS: To date, conflicts in conscientious objection have arisen when a pharmacist believes that dispensing an oral contraceptive violates his or her moral understanding for the promotion of human life. Up to this time, cases in pharmacy have involved only practitioners from orthodox Christian faith communities, primarily devout Roman Catholics. A pharmacist's right to refuse the dispensing of abortifacients for birth control according to moral conscience over against a woman's right to reproductive birth control has created a conflict that has yet to be reconciled by licensing agents, professional standards, or courts of law.

CONCLUSIONS: Our analysis of prominent conflicts suggests that the underlying worldviews between factions make compromise improbable. Risks and liabilities are dependent upon compliance with evolving state laws, specific disclosure of a pharmacist's moral objections, and professionalism in the handling of volatile situations. Objecting pharmacists and their employers should have clear policies and procedures in place to minimize workplace conflicts and maximize patient care.

Key Words: conscientious objection, emergency contraception, Plan B, refusal clauses

Published Online, October 21, 2008. www.theannals.com, DOI 10.1345/aph.1L049