Report 2001-01
Re: College of Pharmacists of British Columbia -
Conduct of the Ethics Advisory Committee
26 March, 2001
Abstract
Full Text
An instruction from the Ethics Advisory Committee of
the College of Pharmacists of British Columbia was
published in the March/April, 2000 issue of the
College newsletter, the Bulletin. This
instruction included statements that impugned the
integrity of conscientious objectors within the
profession. The Registrar of the College later
acknowledged that she had no evidence to support the
statements made in the bulletin, but refused to
retract them and apologize.
Similar statements
were made in an article by one of the Ethics
Advisory Committee members that appeared in the Canadian Pharmaceutical Journal. The author of
the article has ignored requests that evidence be
provided to support the statements.
Publication of unsubstantiated imputations of
dishonesty contradicts ethical principles that ought
to govern the conduct of an Ethics Advisory
Committee, and appears inconsistent with Value VII
of the Code of Ethics of the College of Pharmacists
of B.C. The subsequent refusal to retract and
apologize is troubling for the same reasons.
However, Committee members appear to have acted as a
result of ignorance rather than malice. This may be
related to the nature of the Committee.
The Ethics Advisory Committee is an ad hoc
group. There is no policy governing selection of its
members or appointments to the Committee, and its
members lack formal qualifications in ethics,
philosophy, or related disciplines. There is no
policy governing its operation. This policy vacuum
lends itself to ethical nepotism and the exclusion
of people whose views differ from those of the
College establishment. It has an adverse impact on
those who seek to live and work in conformity to
transcendent ethical principles, particularly
religious believers.
INTRODUCTION
The last decade saw increasing interest in
drug-induced abortion and growing pressure -
occasionally successful - to legalize euthanasia and
assisted suicide. Execution by lethal injection is
practised in some jurisdictions, and developing
reproductive technologies may require pharmaceutical
products.
Pharmacists who have moral or ethical
objections to some or all of these procedures have
been forced to re-examine their drug distribution
practices. Some have concluded that they will not
dispense drugs for these purposes, because to do so
would constitute participation in an immoral act.
For the same reason, others have decided that they
will neither dispense the drugs, nor refer patients
for them.
The growing concern among some in the profession
is illustrated by an increasing number of protection
of conscience laws or policies. These provide
safeguards against discrimination or retaliation,
though the degree of protection depends upon the
wording of the 'conscience clause'.
The provision of health care in Canada is within
the jurisdiction of provincial governments. Each
province has a pharmacy association or college that
is legally responsible for the regulation of the
profession. These bodies establish and enforce
guidelines for competent and ethical pharmacy
practice, including conscientious objection.
The Code of Ethics of the College of Pharmacists
of British Columbia subordinates freedom of
conscience to the delivery of pharmacy products and
services. It does so by demanding that conscientious
objectors refer patients to another pharmacist to
obtain morally controversial products, and supply
the product themselves if another pharmacist is
unavailable.1
This problem is beyond the scope of this report.
THE ISSUES
This report is concerned with only two points:
a) Prejudicial statements made by the Ethics
Advisory Committee
b) Ethics Advisory Committee structure and
policy
a) Prejudicial statements made by the Ethics
Advisory Committee
The Ethics Advisory Committee published an
instruction to secure compliance to its rule on
conscientious objection. [Appendix
"B"]. Referring to pharmacists who have moral
objections to some pharmacy services, the
instruction, purporting to present their argument,
included the following passage:
They should be able to dissuade patients
requesting these services by denying their
availability, or providing information under the
guise of patient counselling . . .
Confirming the imputation of dishonesty, the
Bulletin continued:
. . . the profession cannot allow pharmacists
to lie about the existence of these services or
promote their moral viewpoint in an attempt to
persuade patients not to seek recognized
pharmacy services they find objectionable.
No evidence was provided to support these
statements, which portrayed conscientious objectors
as liars or dishonest manipulators. The statements
were repeated and amplified - again, without
evidence - in an article in a national pharmacy
journal in May, 2000:
A third concern is that pharmacists should be
able to deny certain legitimate pharmacy
services exist . . . or at least to be able to
attempt to dissuade such patients, under the
guise of patient counselling, by stating
religious or moral beliefs as if they were
scientific facts. This establishes that lying is
justified if pharmacists object to providing
contentious services. Denying such services
exist is an outright lie, and attempting to
dissuade patients by arguments based on personal
religious or moral beliefs offered as scientific
fact is a dishonest attempt to obtain informed
consent . . .
The professional [sic - should read public?]cannot consider it just bad luck if
patients are denied recognized pharmacy
services, or receive misleading or incorrect
information from pharmacists who object to the
services.2
The publication of the Bulletin and the
article in the Canadian Pharmaceutical Journal
impugned the integrity of conscientious objectors,
exposing them to the contempt of their colleagues
and the public. This was reflected at the convention
of the Canadian Pharmacy Association in June, 2000,
where the Journal article was cited; two
objectors were told during lunch that they should
leave the profession.3
b) Ethics Advisory Committee structure and
policy
The publication of unsubstantiated imputations of
dishonesty is inconsistent with the raison d'être
of an ethics committee. When such an anomaly is
observed, it is appropriate to determine if it may
be the result of attitudes, structures and policies
influencing the committee.
ADDRESSING THE
ISSUES
a) Prejudicial statements made by the Ethics
Advisory Committee
A spokesperson for Concerned Pharmacists for
Conscience protested the College Bulletin:
. . . I wish to make several points
absolutely clear. CPC's objective is for
pharmacists to have the right to refuse to
participate in procedures they find morally
repugnant, without repercussions. CPC equally
respects the freedom of conscience of
pharmacists who wish to participate, and those
who do not wish to participate, in morally
controversial procedures. CPC does not promote
blocking access or availability, or prevent
other pharmacists from participating.
. . . Can you provide proof that
conscientious objectors are guilty of judging,
preaching or dissuading patients? [emphasis in
original]. . . your College has made such
accusations . . . by implying conscientious
objectors dissuade patients under the "guise of
patient counselling", "lie about the existence
of services to patients" and attempt to "promote
their moral viewpoint."4
Since the Registrar did not acknowledge receipt
of this letter, the spokesperson wrote again,
repeating her request that the College provide proof
of the statements made in the bulletin. She also
referred to the Canadian Pharmaceutical Journal
article:
Frank Archer's prejudicial and religiously
discriminatory article . . . is an erroneous
legal analysis of human rights law. . . Am I
correct in understanding that the College of
Pharmacists of B.C. supports the opinions of
Frank Archer?5
The letter was not answered, and the College did
not modify the statements made in the Bulletin
in light of the information provided by Concerned
Pharmacists for Conscience.
Beginning in April, 2000, the Administrator
attempted a dialogue with the College of Pharmacists
of British Columbia, focussed on its March/April
2000 Bulletin. The Registrar of the College
broke off correspondence in July, having written two
letters that she believed "provided all the
necessary information."[Appendix
"C"]
The Administrator acknowledged her position, but
pointed out that her letters had not addressed the
prejudicial statements made in the Bulletin.
He requested that the Registrar provide evidence to
support them, or retract them and apologize. This
request, repeated in two subsequent letters, was
ignored. [Appendix
"C"]
In October, 2000 the Administrator filed a
request under the Freedom of Information and
Protection of Privacy Act to obtain access to
all documents held by the College on subjects
related to protection of conscience issues, dating
from 1 January, 1995. The last of over 240 pages was
received by the Administrator at the end of January,
2001. None of the documents contained anything to
substantiate the offending passages in the Bulletin or the
Canadian Pharmaceutical
Journal article.
The Administrator wrote to the Registrar to point
this out, and asked her to confirm that the College
had no evidence to support the statements made in
the Bulletin. When the Registrar failed to
respond clearly, the Administrator challenged her
with the assertion that the College could not
justify the statements in the Bulletin and
that their publication was unethical. He asked if
the College would retract them and apologize. The
Registrar refused to do so. [Appendix
"C"]
The author of the Canadian Pharmaceutical
Journal article did not respond to four letters
from the Administrator, who, as a matter of
courtesy, had sent him a copy of a critique of his
Journal article. [Appendix
"D"] The editor of the Journal did not
respond to letters directing his attention to the
problem, but has recently agreed to review the
matter. [Appendix
"E"] [A response has now appeared in an
editorial
in the CPJ April, 2001 issue -
Administrator -]
b) Ethics Advisory Committee structure and
policy
The response to the Administrator's access to
information request disclosed that the creation of
the Ethics Advisory Committee was mooted during the
discussion of a five person task force revising the
College's Code of Ethics.6
The Council approved the formation of the Committee
with the terms of reference suggested by the
Registrar, later revised. [Appendix
"A"]
The College has not established the
structure of the Ethics Advisory Committee,
qualifications for membership, nor set a term of
office for its members. There is no policy or
process to identify or select members of the
Committee, nor a policy requiring that the reasons
for rejection of applicants be recorded. There are
no bylaws governing its operation. [Appendix
"C"]
It appears that members of the task force
revising the College Code of Ethics simply continued
as members of the Ethics Advisory Committee,
augmented by additional appointments.7
There were seven members of the Committee as
of November, 2000.
The members of the Ethics Advisory Committee
are all registered pharmacists or former
pharmacists. They all hold a Bachelor of Science
in Pharmacy degree and have extensive experience
as pharmacy practitioners.8
The Registrar of the College has been unwilling
make enquiries about their formal qualifications in
ethics, philosophy or related disciplines. When
pressed - repeatedly - to provide this information ,
she would say only that all of them "have
encountered and responded to a variety of ethical
dilemmas in the course of their practice as
pharmacists". [Appendix
"C"]. One concludes that none of them have
formal qualifications specific to their role as
ethics advisors.
This report has a narrow
focus: the publication of unsubstantiated
imputations of dishonesty. These are liable to
encourage bias against conscientious objectors,
impose a strain on collegial relations, and
adversely impact the workplace environment. The
statements offend against ethical notions of
justice, non-maleficence and beneficence, and appear
contrary to Value VII of the Code of Ethics of the
College of Pharmacists of British Columbia.9
The injustice visited upon conscientious objectors
by the Ethics Advisory Committee becomes more
evident if one re-reads the offending passages as if
they had been directed at an identifiable group. For
example, similar accusations against Asians in the
profession would have generated widespread criticism
of the College, even if it had some evidence that
this or that Asian pharmacist had been found to be
dishonest. Negative stereotyping of groups on the
basis of isolated incidents is no more acceptable
than blind prejudice.
While the misrepresentations of the Committee
were unjust, offensive and harmful, it would go
beyond the evidence to suggest that they were
deliberate. Committee members appear to have acted
from ignorance rather than malice. This is indicated
by two reviews of the Journal article, one by
a constitutional lawyer, that found serious errors
in explanations of human rights and labour law, as
well as unfamiliarity with basic philosophical
concepts that impact ethical reasoning.10
Moreover, one laments the emphasis in the Bulletin and Journal article on the
paradigm of the law of contract, to the exclusion of
ethical reflection on freedom of conscience. The
authors seem completely unaware of ethical
traditions that see freedom of conscience - always
understood as a properly formed conscience - as
constituent of the nature and dignity of the human
person. Nor do they seem to grasp that a pharmacist
has only one conscience, by which he must be guided
in both private and professional affairs.
Thus, the misrepresentations of the Committee,
while damaging, are just a symptom of the underlying
problem: the hegemony of 'establishment ethics', and
the resulting tendency to suppress all other ethical
traditions.11
The absence of College policy governing the
Ethics Advisory Committee encourages the development
of this ethical nepotism - 'old boys' networking
that ensures the de facto exclusion from the
Committee of anyone who would seriously challenge
its understanding of ethics. Among the excluded
classes of people are those who adhere to
transcendent ethical or moral principles and apply
them in daily life and work- precisely those people,
in other words, for whom freedom of conscience is a
most fundamental good. This is likely to have a
disproportionate impact on religious believers.
SUMMARY
1. The Ethics Advisory Committee of the College of
Pharmacists of British Columbia impugned the
integrity of conscientious objectors within the
profession in statements made in an instruction
published in the March/April, 2000 issue of the
College newsletter, the Bulletin.
2. In an
article published in the Canadian Pharmaceutical
Journal, a member of the Committee expanded upon
and amplified these statements.
3. The College has not produced evidence to
support the statements made in the Bulletin..
The Registrar of the College of Pharmacists of
British Columbia has refused to retract the
offending statements or apologize for their
publication.
4. The author of the Canadian Pharmaceutical
Journal article has not substantiated the
statements made in that publication, and has ignored
repeated requests that he provide evidence to
support the statements made.
5. The statements made in the Bulletin are
likely to encourage bias against conscientious
objectors, impose a strain on collegial relations,
and adversely impact the workplace environment.
There is evidence that this has occurred.
6. Publication of unsubstantiated imputations of
dishonesty contradicts ethical principles that ought
to govern the conduct of an Ethics Advisory
Committee, and appears contrary to Value VII of the
Code of Ethics of the College of Pharmacists of
British Columbia. The subsequent refusal to retract
and apologize is troubling for the same reasons.
Nonetheless, the objectionable statements appear to
have resulted from ignorance rather than malice.
7. The Ethics Advisory Committee is an ad hoc
group. There is no policy governing selection of its
members or appointments to the Committee, and its
members lack formal qualifications in ethics,
philosophy, or related disciplines. There is no
policy governing its operation.
8. The policy vacuum in which the Ethics Advisory
Committee operates is conducive to ethical nepotism
and exclusion of diverse ethical viewpoints, with a
disproportionate and adverse impact on religious
believers.
RECOMMENDATIONS
1. The Council of the College of Pharmacists should
require the Registrar to retract the offending
passages in the Bulletin of March/April,
2000, and apologize for their publication.
2. The
Council of the College of Pharmacists should require
the author of the article "Emergency Contraceptives
and Professional Ethics A Critical Review", Canadian Pharmaceutical Journal, Vol. 133, No.
4, May, 2000 , to retract the offending passages in
the article and apologize for their publication.
3. The Council of the College of Pharmacists
should enact policies governing the operation of the
Ethics Advisory Committee. These policies should
include reference to:
a) Qualifications for membership
b) Reflection of true ethical diversity in
the appointment of Committee members, so that
religious believers and others adhering to
transcendent ethical or moral norms are not
excluded from membership
c) Procedures for selection and rejection of
applicants
d) Keeping record of formal qualifications of
sitting members in ethics, philosophy or related
disciplines, or the absence thereof
e) Terms of office
f) Formal consultation with religious and
other ethical authorities
g) Accommodation of diverse ethical
viewpoints within the profession, so that
religious believers are not excluded from the
profession
4. The Council of the College of Pharmacists
should review procedures governing admission to
faculties or schools of pharmacy and enact policies
to ensure that religious believers and others
adhering to transcendent ethical or moral norms are
not excluded from teaching or education.
5. The Council of the College of Pharmacists
should direct that the Registrar and members of the
Ethics Advisory Committee responsible for the
publication of the offending passages in the Bulletin and
Canadian Pharmaceutical Journal
be recused from participation in disciplinary
hearings or commentary involving Value IX of the
Code of Ethics.