The fox and the grapes: an Anglo-Irish perspective on conscientious objection to the supply of emergency hormonal contraception without prescription

Abstract

Emergency hormonal contraception (EHC) has been available from pharmacies in the UK without prescription for 11 years. In the Republic of Ireland this service was made available in 2011. In both jurisdictions the respective regulators have included 'conscience clauses', which allow pharmacists to opt out of providing EHC on religious or moral grounds providing certain criteria are met. In effect, conscientious objectors must refer patients to other providers who are willing to supply these medicines. Inclusion of such clauses leads to a cycle of cognitive dissonance on behalf of both parties. Objectors convince themselves of the existence of a moral difference between supply of EHC and referral to another supplier, while the regulators must feign satisfaction that a form of regulation lacking universality will not lead to adverse consequences in the long term. We contend that whichever of these two parties truly believes in that which they purport to must act to end this unsatisfactory status quo. Either the regulators must compel all pharmacists to dispense emergency contraception to all suitable patients who request it, or a pharmacist must refuse either to supply EHC or to refer the patient to an alternative supplier and challenge any subsequent sanctions imposed by their regulator.

Conscientious objection In The Profession Of Pharmacist. A Survey of Pharmacists' Opinions On The Conscience Clause In Poland

“…Despite the ful llment of the above-mentioned indications, one should not forget to present the patient with alternative options of obtaining a given drug from another pharmacist or in another pharmacy. This information is consistent both with the judgment of the European Court of Human Rights, which concerned the case of Pichon and Sajous v. France [6,7], and with the provisions of medical law in Great Britain, where the General Pharmaceutical Council (GPhC) veri es the circumstances of pharmacists invoking the clause conscience based on the review of fertility, conception and termination drugs [8,9].…”

Status of Emergency Contraceptives in Europe One Year after the European Medicines Agency's Recommendation to Switch Ulipristal Acetate to Non-Prescription Status

“…Additionally, most pharmacists may not refuse (for whatever reason, e.g. no need to use, ethical aspects [25], etc.) to dispense EMCs if requested without prescription.…”

Long-acting reversible contraception: Findings from the Understanding Fertility Management in Contemporary Australia survey

“…Similarly, Kavanaugh et al 20 found that women who were not affiliated with a religion were more likely to be LARC users than those who were affiliated with a religion. These results may reflect the teaching of some religions that artificial means of contraception are unacceptable, including the possibility that health care providers may not comply with a patient's request for certain methods of contraception because of their own religious beliefs 32,33 . Health care providers need not only to be sensitive to a patient's religious beliefs when discussing contraceptive options but also to declare whether their own beliefs limit what they can recommend or prescribe.…”