Conscientious objection – A vignette-based, pilot study of international pharmacists’ perspectives


  • Dr. Sami Isaac University of Sydney, New South Wales, Australia
  • Ardalan Mirzaei University of Sydney, New South Wales, Australia
  • Prof. Andrew McLachlan University of Sydney, New South Wales, Australia
  • Assoc. Prof. Betty Chaar University of Sydney, New South Wales, Australia



Conscientious objection, Ethical dilemma, Pharmacy practice, Refusing supply, Thematic analysis


Background: Conscientious objection (CO) in healthcare has always been a controversial topic. Some healthcare professionals perceive CO as a freedom of conscience, others believe their duty-of-care overrides personal perspectives. There is a paucity of literature pertaining to pharmacists’ perspectives on CO. This study aimed to inform the development of a proposed questionnaire exploring pharmacists’ decision-making in complex scenarios around CO and reasons for their choices.

Methods: This was a cross-sectional, mixed methods pilot study of international pharmacists, using an online, vignette-based questionnaire on scenarios related to medical termination, emergency contraception, IVF surrogacy for a same-sex couple and voluntary assisted dying (VAD).

Results: Sixty-two FIP 2019 conference delegate pharmacists participated in this pilot study. Approximately half them believed pharmacists have the right to CO. Most pharmacists agreed to supply the prescriptions across all four vignettes. Regarding continuity of care, majority of pharmacists agreed (97%) it was necessary for equity of access. Strong self-reported religiosity had a statistically significant relationship with pharmacists’ decisions not to supply for medical termination, IVF surrogacy and VAD.

Conclusion: This pilot study revealed insights into the various perspectives of international pharmacists on CO in healthcare and informed the development of a survey for future administration.

Author Biographies

Dr. Sami Isaac, University of Sydney, New South Wales, Australia

Sydney Pharmacy School, Faculty of Medicine and Health

Ardalan Mirzaei, University of Sydney, New South Wales, Australia

Sydney Pharmacy School, Faculty of Medicine and Health

Prof. Andrew McLachlan, University of Sydney, New South Wales, Australia

Sydney Pharmacy School, Faculty of Medicine and Health

Assoc. Prof. Betty Chaar, University of Sydney, New South Wales, Australia

Sydney Pharmacy School, Faculty of Medicine and Health


Australian Government Institute of Family Studies. (2017, June 2017). Child Family Community Australia (CFCA) resource sheet-Age of consent laws. The Australian Institute of Family Studies.

Berlinger, N. (2008). Conscience clauses, health care providers, and parents. In M. Crowley (Ed.), From birth to death and bench to clinic: The hastings center bioethics briefing book for journalists, policymakers, and campaigns (pp. 35‒40). The Hastings Center

Blaschke, S.M., Schofield, P., Taylor, K., & Ugalde, A. (2019). Common dedication to facilitating good dying experiences: Qualitative study of end-of-life care professionals’ attitudes towards voluntary assisted dying. Palliative Medicine, 33(6), 562‒569.

Cantor, J., & Baum, K. (2004). The limits of conscientious objection‒May pharmacists refuse to fill prescriptions for emergency contraception? New England Journal of Medicine, 351(19), 2008‒2012

Cantor, J.D. (2009). Conscientious objection gone awry--restoring selfless professionalism in medicine. New England Journal of Medicine (NEJM), 360(15), 1484‒1485.

Card, R.F. (2007). Conscientious objection and emergency contraception. The American Journal of Bioethics, 7(6), 8‒14.

Card, R.F. (2012). Is there no alternative? Conscientious objection by medical students. Journal of Medical Ethics, 38(10), 602‒604.

Combs, M.P., Antiel, R.M., Tilburt, J.C., Mueller, P.S., & Curlin, F.A. (2011). Conscientious refusals to refer: Findings from a national physician survey. Journal of Medical Ethics, 37(7), 397‒401.

Courtenay, G. (1978). Questionnaire construction. In G. Hoinville & R. Jowell (Eds.), Survey research practice (pp. 27‒54). Heinemann

Darzé, O., & Barroso-Júnior, U. (2018). Prevalence, attitudes, and factors motivating conscientious objection toward reproductive health among medical students. Revista Brasileira de Ginecologia e Obstetrícia, 40(10), 599‒605.

Davidson, L.A., Pettis, C.T., Joiner, A.J., Cook, D.M., & Klugman, C.M. (2010). Religion and conscientious objection: A survey of pharmacists’ willingness to dispense medications. Social Science & Medicine, 71(1), 161‒165.

Dobrowolska, B., McGonagle, I., Pilewska-Kozak, A., & Kane, R. (2020). Conscientious object in nursing: Regulations and practice in two European countries. Nursing Ethics, 27(1), 168‒183.

French, V.A., Anthony, R.S., Berrios, S.E., Crockett, L.D., & Steinauer, J.E. (2016). A Sense of obligation: Attitudes and referral practices for abortion services among women’s health providers in a rural US state. Clinical Obstetrics Gynecology Reproductive Medicine, 2(4), 204-210.

Fujioka, J.K., Mirza, R.M., McDonald, P.L., & Klinger, C.A. (2018). Implementation of medical assistance in dying: A scoping review of health care providers' perspectives. Journal of Pain and Symptom Management, 55(6), 1564‒1576.

Glaser, B., & Straus, A. (1967). The discovery of grounded theory: Strategies for qualitative research. Adline

Green, J., & Thorogood, N. (2018). Qualitative methods for health research. Sage

Griggs, S.K., & Brown, C.M. (2007). Texas community pharmacists' willingness to participate in pharmacist-Initiated emergency contraception. Journal of the American Pharmacists Association, 47(1), 48‒57.

Hagen, G.H., Hage, C., Magelssen, M., & Nortvedt, P. (2011). Attitudes of medical students towards abortion (Medisinstudenters holdninger til selvbestemt abort.). Tidsskr Nor Laegeforen, 131(18), 1768‒1771.

Hanlon, T.R., Weiss, M.C., & Rees, J. (2000). British community pharmacists' views of physician-assisted suicide (PAS). Journal of Medical Ethics, 26(5), 363–369.

Holt, K., Janiak, E., McCormick, M.C., Lieberman, E., Dehlendorf, C., Kajeepeta, S., Caglia, J.M., & Langer, A. (2017). Pregnancy options counseling and abortion referrals among US primary care physicians. Family Medicine, 49, 527‒536

Homaifar, N., Freedman, L., & French, V. (2017). “She's on her own”: A thematic analysis of clinicians' comments on abortion referral. Contraception, 95(5), 470–476

International Pharmaceutical Federation (FIP). (2014a). FIP Statement of Professional Standards-Codes of ethics for pharmacists. International Pharmaceutical Federation (FIP).

International Pharmaceutical Federation (FIP). (2014b). Pharmacist ethics and professional autonomy: Imperatives for keeping pharmacy aligned with the public interest. International Pharmaceutical Federation (FIP).

International Pharmaceutical Federation (FIP). (2019). The Ethics Forum–What does it mean to exercise conscientious objection? Abu Dhabi 2019 Congress Session: C8.

Isaac, S., McLachlan, A., & Chaar, B. (2019). Australian pharmacists’ perspectives on physician-assisted suicide (PAS): Thematic analysis of semistructured interviews. BMJ Open, 9(10), e028868.

Keogh, L.A., Gillam, L., Bismark, M., McNamee, K., Webster, A., Bayly, C., & Newton, D. (2019). Conscientious objection to abortion, the law and its implementation in Victoria, Australia: Perspectives of abortion service providers. BMC Medical Ethics, 20(1), 11.

Lamb, C., Evans, M., Babenko-Mould, Y., Wong, C., & Kirkwood, K. (2019). Nurses' use of conscientious objection and the implications for conscience. Journal of Advanced Nursing, 75(3), 594–602.

Lawrence, R., & Curlin, F. (2009). Physicians' beliefs about conscience in medicine: A national survey. Academic Medicine Journal¸ 84(9), 1276–1282.

Lee, R.Y., Moles, R., & Chaar, B. (2015). Mifepristone (RU486) in Australian pharmacies: The ethical and practical challenges. Contraception, 91(1), 25–30.

Munro, M.L., Dulin, A.C., & Kuzma, E. (2015). History, policy and nursing practice implications of the plan B® emergency contraceptive. Nursing for Women's Health, 19(2), 142–153.

National Health Service. (2021). If i use a sexual health service will they tell my parents? Crown.

New South Wales Parliament. (2022). Legislative Council Standing Committee on Law and Justice Report no 79 - Voluntary Assisted Dying Bill 2021.

Nordstrand, S.J., Nordstrand, M.A., Nortvedt, P., & Magelssen, M. (2014). Medical students' attitudes towards conscientious objection: A survey. Journal of Medical Ethics, 40(9), 609‒612.

O'Brien, B.C., Harris, I.B., Beckman, T.J., Reed, D.A., & Cook, D.A. (2014). Standards for reporting qualitative research: A synthesis of recommendations. Academic medicine: Journal of the Association of American Medical Colleges, 89(9), 1245–1251.

Pharmaceutical Society of Australia. (2017). Code of Ethics for Pharmacists. Pharmaceutical Society of Australia.

Piecuch, A., Gryka, M., & Kozłowska-Wojciechowska, M. (2014). Attitudes towards conscientious objection among community pharmacists in Poland. International Journal of Clinical Pharmacy, 36(2), 310‒315.

Shanawani, H. (2016). The challenges of conscientious objection in health care. Journal of Religion and Health, 55(2), 384‒393.

Sharma, A., Minh Duc, N.T., Luu Lam Thang, T., Nam, N.H., Ng, S.J., Abbas, K.S., Huy, N.T., Marušić, A., Paul, C.L., Kwok, J., Karbwang, J., de Waure, C., Drummond, F.J., Kizawa, Y., Taal, E., Vermeulen, J., Lee, G.H.M., Gyedu, A., To, K.G., Karamouzian, M. (2021). A Consensus-based checklist for reporting of survey studies (CROSS). Journal of General Internal Medicine, 36(10), 3179‒3187.

Sheatsley, P.B. (1983). Questionnaire construction and item writing. Handbook of survey research, 4(1), 195‒230

Smith, V.P. (2006). Conscientious objection in medicine: Doctors' freedom of conscience. British Journal of Medicine, 332(7538), 425.

Strickland, S.L. (2012). Conscientious objection in medical students: A questionnaire survey. Journal of Medical Ethics, 38(1), 22–25.

Sudman, S. (1976). Applied sampling. Academic Press

Verweel, L., Rosenberg-Yunger, Z.R.S., Movahedi, T., & Malek, A.H. (2018). Medical assistance in dying: Examining Canadian pharmacy perspectives using a mixed-methods approach. Canadian Pharmacists Journal/Revue des Pharmaciens du Canada, 151(2), 121‒132.

Yin, R.K. (2015). Qualitative research from start to finish. Guilford publications




How to Cite

Isaac, S., Mirzaei, A., McLachlan, A., & Chaar, B. (2023). Conscientious objection – A vignette-based, pilot study of international pharmacists’ perspectives. Pharmacy Education, 23(1), p. 383–406.



Research Article