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

Authors

  • Dr. Sami Isaac University of Sydney, New South Wales, Australia https://orcid.org/0000-0002-9870-6129
  • Ardalan Mirzaei University of Sydney, New South Wales, Australia
  • Prof. Andrew McLachlan University of Sydney, New South Wales, Australia https://orcid.org/0000-0003-4674-0242
  • Assoc. Prof. Betty Chaar University of Sydney, New South Wales, Australia

DOI:

https://doi.org/10.46542/pe.2023.231.383406

Keywords:

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

Abstract

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

References

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. https://aifs.gov.au/cfca/publications/age-consent-laws

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. https://doi.org/10.1177/0269216318824276

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. https://doi.org/10.1056/NEJMp0902019

Card, R.F. (2007). Conscientious objection and emergency contraception. The American Journal of Bioethics, 7(6), 8‒14. https://doi.org/10.1080/15265160701347239

Card, R.F. (2012). Is there no alternative? Conscientious objection by medical students. Journal of Medical Ethics, 38(10), 602‒604. https://doi.org/10.1136/medethics-2011-100190

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. https://doi.org/10.1136/jme.2010.041194

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. https://doi.org/10.1055/s-0038-1673367

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. https://doi.org/10.1016/j.socscimed.2010.03.027

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. https://doi.org/10.1177/0969733019845136

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. https://doi.org/10.15761/COGRM.1000151

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. https://doi.org/https://doi.org/10.1016/j.jpainsymman.2018.02.011

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. https://doi.org/10.1331/1544-3191.47.1.48.griggs

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. https://doi.org/10.4045/tidsskr.10.1161

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. https://doi.org/10.1136/jme.26.5.363

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). https://www.fip.org/file/1586

International Pharmaceutical Federation (FIP). (2014b). Pharmacist ethics and professional autonomy: Imperatives for keeping pharmacy aligned with the public interest. International Pharmaceutical Federation (FIP). https://www.fip.org/file/1368

International Pharmaceutical Federation (FIP). (2019). The Ethics Forum–What does it mean to exercise conscientious objection? Abu Dhabi 2019 Congress Session: C8. https://abudhabi2019.fip.org/programme-session/the-ethics-forum-what-does-it-mean-to-exercise-conscientious-objection-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. https://doi.org/10.1136/bmjopen-2018-028868

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. https://doi.org/10.1186/s12910-019-0346-1

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. https://doi.org/10.1111/jan.13869

Lawrence, R., & Curlin, F. (2009). Physicians' beliefs about conscience in medicine: A national survey. Academic Medicine Journal¸ 84(9), 1276–1282. https://doi.org/10.1097/ACM.0b013e3181b18dc5

Lee, R.Y., Moles, R., & Chaar, B. (2015). Mifepristone (RU486) in Australian pharmacies: The ethical and practical challenges. Contraception, 91(1), 25–30. https://doi.org/https://doi.org/10.1016/j.contraception.2014.08.003

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. https://doi.org/https://doi.org/10.1111/1751-486X.12186

National Health Service. (2021). If i use a sexual health service will they tell my parents? Crown. https://www.nhs.uk/live-well/sexual-health/confidentiality-at-sexual-health-services/

New South Wales Parliament. (2022). Legislative Council Standing Committee on Law and Justice Report no 79 - Voluntary Assisted Dying Bill 2021. https://www.parliament.nsw.gov.au/tp/files/81572/Report%20No%2079%20-%20Provisions%20of%20the%20Voluntary%20Assisted%20Dying%20Bill%202021.pdf

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. https://doi.org/10.1136/medethics-2013-101482

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. https://doi.org/10.1097/acm.0000000000000388

Pharmaceutical Society of Australia. (2017). Code of Ethics for Pharmacists. Pharmaceutical Society of Australia. https://www.psa.org.au/downloads/codes/PSA-Code-of-Ethics-2017.pdf

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. https://doi.org/10.1007/s11096-013-9878-5

Shanawani, H. (2016). The challenges of conscientious objection in health care. Journal of Religion and Health, 55(2), 384‒393. https://doi.org/10.1007/s10943-016-0200-4

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. https://doi.org/10.1007/s11606-021-06737-1

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. https://doi.org/10.1136/bmj.332.7538.425-a

Strickland, S.L. (2012). Conscientious objection in medical students: A questionnaire survey. Journal of Medical Ethics, 38(1), 22–25. https://doi.org/10.1136/jme.2011.042770

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. https://doi.org/10.1177/1715163518754917

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

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Published

06-08-2023

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. https://doi.org/10.46542/pe.2023.231.383406

Issue

Vol. 23 No. 1 (2023)

Section

Research Article

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