The Canadian Pharmacists Association has been asked by the Canadian Organization for Life and Family to ensure that pharmacists disclose to patients the fact that the morning-after pill can cause the death of the early embryo by preventing implantation. COLF, which addresses life issues for the Canadian Conference of Catholic Bishops, also asked the Association about its policy on freedom of conscience for pharmacists who do not wish to dispense the morning-after pill. [COLF letter]
Category: Canada
Project Letter to the Western Standard
14 May, 2004
Should doctors be forced to abandon their faith? by Terry O’Neill draws attention to the problem of freedom of conscience in health care.
A bit of history is instructive. The first protection of conscience clause debated in the House of Commons was introduced by M.P. Robert McCleave as an amendment to the Omnibus Bill that legalized abortion in Canada in 1969. Mr. McCleave believed that abortion should be legalized, but also believed that ‘freedom of choice’ should be extended to health care workers.
Compare Mr. McCleave’s notion of ‘choice’ with that espoused by Joyce Arthur. Speaking for the “Pro-choice Action Network,” she refuses to respect the choices of health care professionals who do not wish to participate morally controversial procedures. She seems to believe that freedom of conscience is a problem to be solved by abolishing it, at least in the case of those who don’t agree with her. Arthur’s position is doubly ironic, since Henry Morgantaler justified his defiance of Canadian abortion law in a 1970 article titled, A Physician and His Moral Conscience.1
Referral is not a satisfactory solution for many physicians who have grave moral objections to a procedure. Objecting physicians hold themselves morally culpable if they facilitate an abortion by referring a patient for that purpose. Nor is this an unusual view. Consider the controversy in Canada over the deportation and torture of Maher Arar. This suggests that few believe that one can avoid moral responsibility for a wrongful act by arranging for it to be done by someone else.
Certainly, Joyce Arthur does not consider abortion to be a wrongful act. However, she has not explained why others should be forced to abide by her moral views.
Unfortunately, between the writer’s desk and publication, a couple of factual errors were introduced into the story.
In the first place, the Project followed the case from the outset, and the student was provided with the same kind of service extended to others in similar situations. His relationship with the Project has been cordial, but it is incorrect to describe me as “a friend of the would-be doctor.” We have never met.
More important, the final paragraph attributes to me statements that I did not make. While I am, nonetheless, in agreement with a number of the points made, I did not suggest that a devout Muslim doctor might refuse to treat women, nor make any statement to a similar effect.
It would be most unfortunate if this falsely attributed statement were to contribute to the already adverse social pressures experienced by Muslims in North America. Muslim health care workers and students are welcome to contact the Protection of Conscience Project. One of the Project advisors is Dr. Shahid Athar, a regent and former vice-president of the Islamic Medical Association of North America and the Chair of its Medical Ethics Committee
Notes
1. The article appeared anonymously in The Humanist. Quoted in Pelrine, Eleanor wright, Morgantaler: The Doctor Who Couldn’t Turn Away. Canada: Gage Publishing, 1975, P. 79
Ethics Profiling in the Health Care Profession
Conscience Legislation Needed to Stop Abuse of Authority
Ottawa
12 May, 2004
The recent near-failing of a medical student at a Canadian university, solely because the student has pro-life convictions, shows how intolerant some people have become about choices they dislike. For years, Canadian Physicians for Life has received anecdotal complaints from students who suspect that their medical school admission interview went badly after they truthfully answered questions which probed for pro-life beliefs. This recent case was blatant and completely documented, created undue anxiety for the student, and only ended after many months of unsuccessful appeals of the teachers’ intolerant actions. A modern democracy should have a keen interest in protecting vulnerable students from coercion by preceptors and professors who are unaware of, or insensitive to, the concept of freedom of conscience.
We don’t screen immigrants to Canada on the basis of race or religion. Why should such litmus tests be applied to citizens applying to enter key professions? Ethics profiling is no less objectionable than racial profiling.
Freedom of conscience, it seems, is now granted freely only to those whose views are acceptable to an authoritarian, secularist establishment. Others must endure the enormous costs and stress of legal challenges or implore sympathetic fellow citizens to petition those in power on their behalf. Until this situation is corrected, the Canadian experiment in pluralism will remain in a delayed adolescence.
Sincere proponents of multiculturalism and pluralism understand the importance of protection of conscience. But they must come to recognize that too many in positions of power need statutory reminders to treat fairly those who disagree with them about the damage abortion does to women and children.
Basic conscience protection such as that provided in Bill C-276 begins to address the problems of abuse of authority and ethics profiling which lead to the kind of injustice seen in the recent case of the medical student. Such abuses must be explicitly treated in law, not left to an ad-hoc scramble by the victim and his or her friends.
The time is long overdue for the Parliament of Canada to follow the lead of countries like the United Kingdom, Australia, and New Zealand, and 46 American states to protect and clarify freedom of conscience for Canadian health care workers. In addition to necessary employment protection, the proposed Canadian legislation corrects deficiencies found in many such laws by explicitly protecting persons of conscience from exclusion from health sciences education and from discrimination by professional licensing bodies.
Canadian Physicians for Life 29 Moore Street, R.R. # 2 Richmond ON K0A 2Z0 ph/fax: 613-728-LIFE (5433) info@physiciansforlife.ca
Some corrections and clarifications
Project letter to the Calgary Herald
Sean Murphy*
While I am pleased to see that Laura Wershler is willing to accommodate freedom of conscience among health care workers, I must correct some misleading statements included in her article (“The morning after: Pro-life agenda misrepresents the emergency contraceptive pill, or ECP”,Calgary Herald, 13 February, 2004).
In the first place, http://www.consciencelaws.org is the URL of the Protection of Conscience Project, not “Repression of Conscience”. Contrary to Ms. Wershler’s assertion, this is a non-denominational human rights project, not a not a pro-life initiative. Pro-lifers are interested in the Project and sometimes link to our website, but the Project does not take a position on the morality of controversial procedures. It is enough to recognize the controversy, and advocate the accommodation of conscientious objectors. At least one pro-life pharmacist does not use the Project pamphlet about the morning-after pill precisely because the pamphlet does not argue against its use.
Second, Ms. Wershler’s article incorrectly attributes to the Project the use of the terms “abortion drug” and “emergency contraceptive (ECP)”. The Project does not use either term, except when quoting other sources. They are confusing, and complicate articulation of freedom of conscience issues.
“Abortion drug” is an appropriate description of mifepristone (RU486), which is designed specifically to cause the abortion of an embryo that has implanted in the uterus. The morning-after pill has not been designed for that purpose, and does not act in that way.
“Emergency contraception” is a fabulously successful marketing term. However, 94% of the women who take the morning-after pill do not require it to prevent childbirth. This statistic, provided by the drug’s advocates,[1] belies the notion of ’emergency’ that is often used to browbeat conscientious objectors. As to “contraceptive”, Ms.Wershler herself acknowledges that these drugs have three mechanisms of action, one of which may prevent implantation of the early embryo, thus causing its death. This is considered by many conscientious objectors to be the moral equivalent of abortion, a term acknowledged as appropriate by some authorities,[2] though the usage is not uncontested. The Project refers to these drugs generically as the ‘morning-after pill’ because this term is widely understood. We describe the morning-after pill as “potentially abortifacient”, in the sense that it may cause the death of the early embryo, but does not necessarily do so.
A final note to prevent further confusion: the meaning of “abortifacient” in a medical or scientific context is not the same as its meaning in a moral context. In a medical context, a drug that prevents fertilization (acts contraceptively) 95 to 99 times out of a hundred would be called a contraceptive rather than a abortifacient. But in a moral context, when the outcome may be death, a drug may be treated as an abortifacient if there is even a 1% chance of it killing the embryo by preventing implantation. A number of disputes that arise about the morning-after pill are a regrettable consequence of failing to recognize these distinctions.
Notes
1. Apply a calculator to the following statement: “In 16 months of ECP services, pharmacists provided almost 12,000 ECP prescriptions, which is estimated to have prevented about 700 unintended pregnancies.” Cooper, Janet, Brenda Osmond and Melanie Rantucci, “Emergency Contraceptive Pills- Questions and Answers”. Canadian Pharmaceutical Journal, June 2000, Vol. 133, No. 5, at p. 28.
2. Keith L. Moore and T.V.N. Persaud, The Developing Human: Clinically Oriented Embryology (6th ed.) (Philadelphia: W.B. Saunders Company, 1998), p. 532. Quoted in Irving, Diane N., A “One-Act Drama:The Early Human Embryo:’Scientific’ Myths and Scientific Facts:Implications for Ethics and Public Policy, Medicine and Human Dignity.” International Bioethics Conference, ‘Conceiving the Embryo’, Centre Culturel, Woluwe-St. Pierre, Brussels, Belgium: October 20, 2002 (9:30 A.M.)(Revised 23 October, 2002) Note 23.
When rights collide
© Copyright 2004 Calgary Herald
Reproduced with permission
Nigel Hannaford
A few years ago, a customer asked Co-op pharmacist Maria Bizecki to fill a prescription for an abortion drug. For Bizecki, a Roman Catholic and active pro-lifer, this was akin to being invited to become an accessory to murder. She declined.
It was a risky stand against the prevailing view of pharmaceutical professional associations, and employers retailing drugs. Yet, ultimately it led to a small step forward for Albertans’ religious freedom.
The Alberta College of Pharmacists (ACP), for instance, her profession’s ethics watchdog, emphasizes a client’s right to have pharmaceutical needs met. It grants conscience leeway to its members, though this did not save Bizecki from facing complaints about her stand.
More particularly, the conscience clause is little help to pharmacists dealing with unsympathetic employers.
The letter one Pro-Life Ontario pharmacist got from his boss (quoted in the Pro-Life paper, Interim) eloquently expresses the all-business perspective: “You are not employed by the company to make moral or philosophical decisions about whether birth control is appropriate for the customer . . . we are engaged in a retail activity.”
The letter concluded with a threat of termination, noting that if the pharmacist couldn’t separate his beliefs from his job, he should “think long and hard about whether you could continue in your capacity.”
Co-op was comparatively gentle. Bizecki had been straightforward with them about her views, and was known in the community as a pro-life activist. She was suspended with pay.
She doesn’t talk about the complaints which led to her being investigated by the ACP; the details are subject to her duty of confidentiality. Still, when in 2000, a pro-choice website challenged the conscience rights of pharmacists, the prompt arrival of the first complaint was no surprise.
The situation was a pickle of contending rights and obligations.
Obviously, if a prescribed drug is legal, a client has a right to buy it, and a druggist to sell it. But, only the wilfully blind wouldn’t admit honest people can sincerely disagree over abortion. As employees are not mere instruments of an employer’s will, but have a right of conscience, even an obligation, how does one loosen the tangle?
One way is to choose. When human rights commissions do so, religious freedoms sometimes lose. The case of a Catholic school board
compelled to allow a gay student to bring his boyfriend to a prom, is illustrative.
The other way is negotiation. It took nearly three years for Bizecki’s lawyer, Gerry Chipeur, the college and Co-op to work it out, but there was a happy ending. That is, something which worked for everybody, and it serves as a useful template.
The reasonable accommodation of Bizecki’s principles was a written agreement in which she recognized the public’s right to have a prescription filled by a pharmacist, and that she could not and should not obstruct it. But, employers have a duty to reasonably accommodate employee scruples, and Co-op agreed not to demand she fill prescriptions for drugs which effect abortions. Thus, with the college’s blessing, she would always be part of a two-person dispensary.
Chipeur adds this might not be a reasonable accommodation for a one- person pharmacy: “However, in Canada employers have always had a duty to be reasonable, so long as there’s no undue burden. This is the first time that I’m aware, that there has been such an accommodation. If there’s a similar breakdown in Alberta in the future, it would be unwise for any health employer to not accommodate a pro-life position. I’d just say this to pro-lifers: Don’t take a job in an abortion clinic and then say you don’t want to do abortions.”
What distinguishes this case from some of the head-on rights collisions we’ve seen in Canada, is that the parties would accept a solution, not hold out for a victory. Canada aspires to be a tolerant country.
This is what tolerance looks like.
Related Links:
- Calgary Co-operative Association accommodates pharmacist freedom of conscience
- Pro-life pharmacistthought she’d be blacklisted
- Pharmacy colleges quash conscientious objection
- Report Faults Pharmacists’ Ethics Committee
- Stonewalling Leads to Call for New Freedom of Information Law
- In Defence of the New Heretics: A Response to Frank Archer