For some time we have been concerned at CMF about a possible weakening of conscience protection for pharmacists in the UK. In December 2016 the pharmacy regulator, the General Pharmaceutical Council (GPhC), issued new draft standards and guidance that changed a previous ‘right to refer’ with a ‘duty to dispense’. The GPhC admitted at the time that removing the right to refer represented ‘a significant change’.
During a consultation on this draft guidance, CMF and others had meetings with the GPhC, and many individuals and organisations wrote to the GPhC expressing concern about their failure to recognise conscience rights. Dr Peter Saunders warned in a blog post that the draft proposal to remove pharmacists’ conscience rights was ‘disproportionate, unethical, unnecessary and quite possibly illegal’. We were also concerned that the changes could have prevented Christians from pursuing a career in pharmacy altogether. Other health professionals feared that if such changes were implemented by the GPhC it could have repercussions for freedom of conscience for doctors and nurses in the longer term.
So it has come as something of a relief to see the final guidance issued on 22 June 2017 by the GPhC: ‘In practice: Guidance on religion, personal values and beliefs.’
The new guidance should be read alongside the Standards for pharmacy professionals that all pharmacy professionals must meet. Standard 1 says: ‘Pharmacy professionals must provide person-centred care.’ The new guidance for Standard 1 emphasises at the outset the need for: ‘ensuring that person-centred care is not compromised because of personal values and beliefs’ (p5), however the guidance also makes it clear that: ‘Pharmacy professionals have the right to practise in line with their religion, personal values or beliefs’ (p7). The guidance clarifies that under Article 9 of the European Convention on Human Rights (ECHR) a pharmacist’s right to freedom of thought, conscience and religion is protected.
This is a marked shift in tone and emphasis from the draft guidance that had so concerned us.
The new guidance puts the legal framework at the beginning, unlike the draft where it consisted of one brief page towards the end, with the sole legal precedent cited in draft guidance being the British Equality Act 2010. As well as Article 9 of the ECHR, the final guidance also cites the Equality Act, which protects individuals from direct and indirect discrimination and harassment because of nine ‘protected characteristics’, including religion or belief.
Crucially, there is now clear recognition that referral to another service provider is still an option: ‘We want to be clear that referral to another health professional may be an appropriate option, and this can include handover to another pharmacist at the same, or another, pharmacy or service provider.’ (p8).
So individual pharmacists should still be able to refer customers to other pharmacists if they request, for example, abortifacient drugs such as the morning after pill, or hormone blocking drugs which are used by transsexual patients.
The new guidance for pharmacists is now similar to the General Medical Council’s Good Medical Practice guidance for doctors. The GMC guidance permits doctors to: ‘opt out of providing a particular procedure because of [your] personal beliefs and values, as long as this does not result in direct or indirect discrimination against, or harassment of, individual patients or groups of patients’ (para 8). In such situations, a doctor must ensure the patient understands his/her right to see another practitioner and must: ‘Make sure that the patient has enough information to arrange to see another doctor who does not hold the same objection as you.’ (para 12).
Many conscientious objectors find even referral unacceptable, and consider that a referral is effectively participating in, or complicity with, the procedure to which they are objecting. For doctors there is no legal obligation to refer under the GMC guidance (see here for more detail) as long as enough information is given to the patient to arrange to see another doctor. The GPhC guidance suggests it is probably similar for pharmacists. It states (my emphasis added):
‘Pharmacy professionals should use their professional judgement to decide whether a referral is appropriate in each individual situation, and take responsibility for the outcome of the person’s care. This includes considering the impact of their decision on the person asking for care, and meeting their legal responsibilities.
There are a number of factors for pharmacy professionals to consider when deciding whether a referral is appropriate in the circumstances. In particular, pharmacy professionals should make sure:
- people receive the care they need as a priority
- people are provided with all the relevant information to help them access the care they need, and
- people are treated as individuals, fairly and with respect’ (p8).
Rightly, the guidance for pharmacists also emphasises the importance of openness and sensitive communication with colleagues and employers:
‘Pharmacy professionals should also:
- Tell their employer, as soon as possible, if their religion, personal values or beliefs might prevent them from providing certain pharmacy services, and
- work in partnership with their employer to make sure adequate and appropriate arrangements are put in place
I have written in more detail elsewhere about the importance of clarifying carefully with colleagues the extent of involvement in controversial procedures, to avoid potential future conflict and to negotiate reasonable accommodation for exercising freedom of conscience.
Encouragingly, in a statement accompanying the publication of the new guidance, the Chief Executive of the GPhC, Duncan Rudkin, highlighted the positive contribution pharmacists’ faith can make in their position of care:
‘We recognise and respect that a pharmacy professional’s religion, personal values and beliefs are often central to their lives and can make a positive contribution to their providing safe and effective care to a diverse population.’
This new guidance represents a victory for freedom of conscience. It reflects a rebalancing from the draft which now takes on board the rights of pharmacists and the need to balance those with the rights and best interests of service users.
Nevertheless, I suspect that the change from the draft may well have primarily been due to the legal protection for freedom of conscience provided by the EA and ECHR, and without that welcome protection pharmacists who do not wish to dispense treatment for moral reasons would be in a very difficult and different situation now. Steve Fouch has written here that we are already seeing an erosion of the freedom of conscience for nurses and midwives in the UK, which is part of a bigger threat worldwide to undermine freedom of conscience. Toni Saad has recently warned that there is ample cause for concern; the momentum is not on the side of conscience. But for now, we can be grateful this guidance respects the right of pharmacists to refuse to engage in certain procedures which violate their most profound moral convictions.