Protection of Conscience Project
Protection of Conscience Project
Service, not Servitude

Service, not Servitude

College of Pharmacists of British Columbia

Freedom of conscience and religion

Annotated Extracts and Links

Full Text
Download PDF
Code of Ethics (June, 2016)
Standard 1: Registrants Protect and Promote the Health and Well-Being of Patients

(g) Registrants must provide pharmacy services requested by patients and may only refuse to provide these services for any of the following reasons:

i. the drug or product requested is not available

ii. the registrant does not possess the knowledge, skills and abilities to provide the service or product

iii. the provision of the product or service is contrary to the sincerely held conscientious or religious belief of a registrant, in which case the registrant must ensure that:

  • they have informed and explained to the pharmacy manager and employer of their conscientious or religious belief before they accept employment;

  • if the belief is formed after employment is accepted, they inform the pharmacy manager and employer at the earliest opportunity;

  • they do not discuss their personal beliefs or ask patients to disclose or justify their own beliefs

  • they participate in a process designed to exercise their freedom of conscience and religion in a manner that respects the patient's right to receive products and services in a timely manner and in a way that minimizes suffering and hardship to the patient

  • they fulfill their duty of care to the patient in a manner that is non-judgmental, continuous and non-discriminatory;

  • in the event of failure of the system developed to ensure the timely delivery of the product or service, and notwithstanding the registrant’s conscientious or religious beliefs, they provide patients with enough information and assistance to allow them to make informed choices for themselves;

  • they cooperate in effective transfers of care initiated by the patient and are not required to make a referral; and

  • they do not rely on conscientious or religious beliefs in order to discriminate against any patient on morally irrelevant grounds including those outlined in Standard 3, Guideline g of this Code.

iv. the patient is unable or unwilling to provide payment for the requested pharmacy service or product

v. the patient is abusive physically or mentally to the registrant

Project Annotations

The CPhBC Code of Ethics was revised in the months following the decision of the Supreme Court of Canada to order the legalization of euthanasia and physician assisted suicide.  In addressing the issue of freedom of conscience and religion, the College avoided the temptation to write policy based on concerns about a particular pharmacy service.  Instead, it drafted a broadly worded policy that can be applied to a range of services and procedures.

Appropriate stress is placed on the obligation of objecting pharmacists to provide timely notice of their position to the employer or pharmacy manager.  This facilitates accommodation of freedom of conscience and religion and the making of alternative arrangements for patients seeking morally contested services.

The provision that forbids discussion of personal beliefs with patients is apparently intended to prevent pharmacists from attempting to convert patients to their viewpoints.  The wording does not leave room for the kind of legitimate and respectful conversation that may sometimes occur between a pharmacist and patient who have a sound professional relationship. On the other hand, it does not appear to preclude disclosure of a pharmacist's belief when necessary to explain why they are unwilling or unable to supply the requested product.  The nature of pharmacy practice allows management to develop strategies that may make even this minimal disclosure unnecessary.  This can result in a seamless provision of services that may leave patients unaware that freedom of conscience has been exercised and respected.  [See Calgary Co-operative Association Re: Maria Bizecki]

The contentious issue of referral is satisfactorily resolved by making it clear that objecting pharmacists are not obliged to initiate referrals or transfers of care (which, for many, would entail unacceptable complicity) but must cooperate in transfers of care initiated by others.