Submission to the Select Special Freedom of Information and Protection
of Privacy Act Review Committee (Alberta)
1. To understand what is at
issue in the debate, one must become familiar with
five key terms that are given completely different
meanings by those speaking for or against the
'morning-after-pill'. The terms are
abortion,
conception,
contraception,
fertilization, and
pregnancy.
Generally speaking, MAP advocates define
'conception' to mean implantation of the developing
embryo (often incorrectly termed a 'fertilized
egg') in the uterus, and define contraception as
any mechanism that prevents implantation. Similarly,
they assert that pregnancy (often called 'established
pregnancy') does not begin until implantation, and
abortion as something that only occurs after that
point. Conscientious objectors usually define
conception as fertilization (union of sperm and egg)
and assert that pregnancy begins at that point. They
restrict the meaning of contraception to an
intervention that prevents fertilization, and define
abortion to include an intervention after
fertilization that prevents implantation or
otherwise destroys the developing embryo or fetus.
Ironically, objectors are often accused of being
'unscientific' or ignorant, even though standard
embryological texts indicate that their terminology
is correct.
2. "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. Cooper was quoted by Globe and
Mail Columnist Michael Valpy to the effect that
4,600 prescriptions for the 'morning-after-pill' in
BC were believed to have prevented 300 pregnancies.
Valpy, Michael, "The Long Morning After", Globe
and Mail, 15 December, 2001.
3. In November, 1999, the NAPRA
Council approved what has been called a 'conscience
clause', part of which requires a pharmacist with
moral objections to a drug to "pre-arrange access to
an alternate source" of the drug for a patient.
(NAPRA Model Statement Regarding Pharmacists'
Refusal to Provide Products or Services for Moral or
Religious Reasons) A number of objecting
pharmacists reject the demand that they take
positive steps to facilitate what they consider to
be a morally objectionable act.
The attitude of the College of Pharmacists of
B.C. toward conscientious objectors was conveyed in
a newspaper headline: "Pharmacists' college warns
renegades about not dispensing morning-after pill" (The
Province, 23 November, 2000). Its Ethics
Advisory Committee published a bulletin that made a
number of unsubstantiated and prejudicial statements
(see
Appendix "B").
4. E-mail from Maria Bizecki
(Concerned Pharmacists for Conscience) to the
Administrator, 3 July, 2000
5. Archer, Frank, "Emergency
Contraceptives and Professional Ethics", Canadian
Pharmaceutical Journal, May 2000, Vol. 133, No.
4, p. 22-26; "Whose Rights Are They, Anyway?" Pharmacy Practice, 8 January, 2001; Have your
say- Openers: "Ethics and Patient Care", Pharmacy
Practice, June, 2001)
6. Editorial, Pharmacy
Practice, July 2000
7. Safeway Pharmacy Policies and
Procedures, Section IV: Pharmacy Operations 4.6.1,
Conscientious Objectors and Accommodation. 1
January, 2000.
8. Letter to the Administrator
from Linda Toby Oswald, Vice-President Public
Relations and Government Affairs, Canada Safeway, 8
August, 2000. It is interesting to note that the
withdrawn policy was actually consistent with what
was being demanded by the Ethics Advisory Committee
of the College of Pharmacists of BC.
9. Letter to the Administrator
from Terry Creighton, Senior Vice-President, Public
Affairs, Shoppers Drug Mart, 22 August, 2000. It
appears that the company was not aware of the legal
status of NAPRA and its policies.
10. Letter to the Registrar
from Barry Creighton, Concerned Pharmacists for
Conscience, 17 February, 2000
11. Quoted in Loukidelis,
David,
Is the Door Opening or Closing? Assessing the State
of Access to Information in Canada. Keynote
Presentation, FOIP 2000 Conference, Edmonton,
Alberta May 29, 2000. (accessed 30 December, 2001)
12.Dagg
v. Canada (Minister of Finance) [1997] 2 S.C.R.
403. The quotations are from the dissenting
judgement of La Forest, L'Heureux-Dubé, Gonthier and
Major JJ., but the majority (Lamer C.J. and Sopinka,
Cory, McLachlin and Iacobucci JJ.) agreed with the
minority's approach to interpreting the Access to
Information Act.
13.Final
Report of the select Special Freedom of Information
and Protection of Privacy Act Review Committee
(March, 1999) (accessed 31 December, 2001)
14. Loukidelis, supra
15. http://www.oipc.ab.ca/about/welcome.htm
(Accessed 9 April, 2002)
16. Letter from Registrar to
Legislative Assembly re: FOIPP Act, 29October, 1998
(Submission 144)
17. Letter to the Administrator
from David Loukidelis, Information and Privacy
Commissioner for British Columbia, 25 February, 2002
18. Rubin, Ken,
"Access-to-information laws: they're there, if MDs
want to use them." CMAJ 2002;166(1):77-8
30 March, 2000
To: Alberta Pharmaceutical Association
From: Administrator, Protection of Conscience
Project
I am writing with respect to NAPRA's Model
Statement Regarding Pharmacists' Refusal to Provide
Products or Services for Moral or Religious Reasons,
approved by the NAPRA council in November, 1999.
In the first place, I note that the introduction
of the statement clearly implies that NAPRA sees no
significant moral difference between contraception
(however that term is defined) and euthanasia.
Moreover, it clearly implies that, should euthanasia
be legalized, a pharmacist will have an ethical
obligation to assist someone to obtain drugs for
that purpose, either by directly dispensing the drug
or by referring the patient to another source.
Second: the demand that the conscientious
objector is responsible for making alternate
arrangements for the patient appears inconsistent
with jurisprudence that places the onus for making
alternative arrangements on the employer or
institution - not the conscientious objector.
Third: the proposed policy appears to have been
developed without regard to the teaching of major
religious and ethical traditions that assign a moral
weight to co-operation with what they judge to be
evil. In effect, the policy amounts to an
administrative decree that seeks to nullify every
contrary moral position.
Substantive questions about the objective
morality of contraception, euthanasia or other
procedures are not addressed by the Protection of
Conscience Project, so it is not necessary to enter
into such a discussion with respect to the NAPRA
policy. However, if it is the intention of your
organization to adopt the NAPRA policy within your
jurisdiction, I request that you explain the moral
or ethical principles by which you would compel a
conscientious objector to do something that he finds
morally repugnant.
I also ask that you justify the exclusion from
your profession of religious believers and others
having conscientious convictions about the value of
human life, for that will surely be a consequence of
the policy you are proposing.
Finally, I would appreciate it if you would
explain what you understand your obligations to be
to members of your association vis-Ã -vis the human
rights legislation that exists in different
provinces, and the Charter of Rights.
Note: Two further letters were sent to the
College/Association in 2000, requesting the courtesy
of a reply to the letter of 30 March. The letters
were not acknowledged. Project copies of the letters
were destroyed by a computer virus in September,
2001.
18 May, 2000
To: Mr. Greg Eberhart, Alberta Pharmaceutical
Association
From: S.Y. [private citizen]
As a certified professional and a small business
owner with a number of employees and as a retired
school teacher of Junior students and as the wife of
a businessman who employs close to one hundred
employees during the course of the year, I have some
great concerns about Preven and/or any such
morning-after pill. Please answer my questions.
1. Preven has been approved as a contraceptive.
However, if contraception can and usually does take
place soon after intercourse, is not Preven then
acting as an abortifacient since it prevents
implantation of a fertilized embryo? Why/why not?
2. If Preven (and other such drugs) is being
prescribed to young girls, are they made aware of
how the drug actually works and of what it does to
the conceived child? Who makes them aware and how
are the young girls made aware of the consequences
of the drug as to its aftereffects on their own
body?
3. What if pharmacists, because of moral or
religious or social concerns do not want to dispense
such drugs as Preven? What does you organization do
to protect their job security as well as help them
in their moral dilemma?
Please answer my questions and concerns.
3 August, 2000
To: College of Pharmacists of Alberta
From: Concerned Pharmacists for Conscience
The purpose of this letter is to clarify the
position of the College of Pharmacists of Alberta,
in regards to the NAPRA Model Statement Regarding
Pharmacists' Refusal to Provide Products or Services
for Moral or Religious Reasons.
Please explain why you permit opting out of
dispensing drugs, but require pharmacists to refer.
Not only is referral inconsistent with existing
human rights jurisprudence, it is contrary to the
teaching of major religions and ethical traditions.
Before you attempt to make pharmacists live by
NAPRA's model statement, name the law that decides
that the patient's or NAPRA's, or the College of
Pharmacists of Alberta's morals are superior to the
individual pharmacist's morals. Please clarify the
position of the College of Pharmacists of Alberta,
in regards to conscientious objectors and the NAPRA
model statement.
NAPRA's model statement implies that there is no
significant difference between contraception and
euthanasia, two of many such morally controversial
products and procedures. This statement is in direct
opposition to the Charter of Rights and Freedoms,
which guarantees freedom of conscience and religion
as a fundamental right. Please clarify the position
of the College of Pharmacists of Alberta in regards
to conscientious objectors and the NAPRA model
statement.
As spokesperson for Concerned Pharmacists for
Conscience, 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.
This is fundamentally different from the
mentality of opponents of a conscience clause, who
try to force their morality on conscientious
objectors. It is such opponents who are doing
exactly what they accuse conscientious objectors of
doing. One must be careful before accusing
conscientious objectors of judging, preaching or
dissuading patients without providing proof. For
example, the BCPhA has made such accusations in
their March/April 2000 college bulletin, and Frank
Archer accuses "ethical pharmacists" of
disrespecting patients and "attempting to persuade
patients to share their personal religious
viewpoints" in the CPJ (Sept. 1997) and Pharmacy
Practice (April 1999).
The Canadian Medical Association has made it
clear that it does not endorse the NAPRA model
statement. Furthermore, the CMA protects its
practitioners from forced participation or referral,
as does the American Society of Health System
Pharmacists which expects employers to reasonably
accommodate conscientious objectors and acknowledge
the primacy of individual conscience regarding
assisted suicide. Why has the College of Pharmacists
of Alberta not followed suit? Is economic
self-interest a higher priority than protecting
freedom of conscience and religion in the profession
of pharmacy?
The June 2000 issue of CPJ demonstrates that
access should not be a barrier to conscientious
objection, by providing a list of options for
patients, particularly those in remote areas.
Placing responsibility on the patient to obtain
morally controversial products prior to wanting to
use them, is an option that can circumvent
difficulties for all parties involved.
The CPhA states that "accurate drug information
on mechanism of action of ECP's is provided to
pharmacists and women". CPC also believes ethical
concerns should also be made known to the patient,
with the ultimate decision left up to the patient,
not the health care worker. For example, Calgary
Health Services makes mention of this ethical aspect
to patients requesting post-coital interception. Is
the College of Pharmacists of Alberta reluctant to
mention this, when post-coital interception may be
morally abhorrent to patients and pharmacists of the
Christian, Muslim and Orthodox Jewish faiths?
I look forward to your response.
7 September, 2000
To: Alberta College of Pharmacists
From: Concerned Pharmacists for Conscience
Our group has not received a reply to our August
3, 2000 letter about freedom of conscience and
religion in the pharmacy workplace, as it relates to
NAPRA's Model Statement Regarding Pharmacists'
Refusal to Provide Products or Services for Moral or
Religious Reasons.
NAPRA's model statement implies that there is no
significant difference between contraception and
euthanasia, two of many such morally controversial
products and procedures. This statement is in direct
opposition to the Charter of Rights and Freedoms,
which guarantees freedom fo conscience and religion
as a fundamental right. Please clarify the position
of the Alberta College of Pharmacists, in regard to
the NAPRA model statement.
Please explain why you permit opting out of
dispensing drugs, but require pharmacists to refer.
Not only is referral inconsistent with existing
human rights jurisprudence, it is contrary to the
teaching of major religions and ethical traditions.
Before you attempt to make pharmacists live by
NAPRA's model statement, please name the law that
decides that the patient's or NAPRA's morals are
superior to the individual pharmacist's morals.
Please clarify the position of the College of
Pharmacists of Alberta, in regards to the NAPRA
model statement.
The Canadian Medical Association has made it
clear that it does not endorse the NAPRA model
statement. Furthermore, the CMA protects its
practitioners from forced participation or. Why has
the College of Pharmacists of Alberta not followed
suit? Is economic self-interest a higher priority
than protecting freedom of conscience and religion
in the profession of pharmacy?
I look forward to your response.
2 May, 2001
To: Alberta College of Pharmacists
From: Administrator, Protection of Conscience
Project
Enclosed is an access to information request
(three pages), two letters from individuals granting
permission for the release of their personal
information, and a money order for $25.00.
I look forward to hearing from you. Please
contact me if you have any questions or require
further information.
9 June, 2001
To: Alberta College of Pharmacists
From: Administrator, Protection of Conscience
Project
Enclosed is an access to information request and
a letter from an individual granting permission for
the release of her personal information.
I look forward to hearing from you. Please
contact me if you have any questions or require
further information.
6 June, 2001 (Received after the letter of 9
June, 2001, was mailed)
To: Administrator, Protection of Conscience
Project
From: Registrar, Alberta College of
Pharmacists
I am writing in response to the "Request to
Access Information" form that you sent to our office
dated May 2, 2001. Our office received this request
on May 10, 2001.
I can advise you that the Alberta College of
Pharmacists is not subject to the Freedom of
Information and Protection of Privacy Act to
which your "request" refers. Accordingly, I am
returning your money order.
Your access to information request covers a
significant period of time and may require
examination of voluminous materials. The Alberta
College of Pharmacists is not staffed to respond to
access to information requests, and accordingly, is
not prepared to commit the necessary resources to
this task. In addition, some of the documents that
you seek would fall within confidential or
privileged categories of information.
I trust that you have the minutes of the Annual
General Meeting of the Alberta Pharmaceutical
Association from 1995. Should Mr. Creighton and Ms.
Bizecki wish to have copies of any other minutes of
Annual General Meetings, I would be happy to provide
them. If you would be so kind as to identify the
specific portions that you require, I will have
copies made and have them sent to Ms. Bizecki and
Mr. Creighton.
Access to Information Request
Alberta College of Pharmacists
Date of Request: 2 May, 2001
From: Protection of Conscience Project
Freedom of Conscience
1. Correspondence, e-mail, notes, minutes,
bulletins, reports, summaries, extracts, policy
statements, recommendations, from or to any party,
whether on paper, stored in an electronic retrieval
system, or on computer disks, CD's, audiotapes or
videotapes, dated from 1 January, 1994 to the
present, concerning
a) freedom of conscience and/or religion,
conscientious or moral/ethical/religious objection,
"conscience clauses"; Sean Murphy, the Protection of
Conscience Project, Concerned Pharmacists for
Conscience, Maria Bizecki or Barry Creighton;
b) refusal of pharmacists or health care workers
to dispense medication or devices for moral,
ethical, or religious reasons;
c) pharmacists or health care workers dispensing
'emergency contraception', the 'morning after pill',
'post-coital interception', Preven, Plan 'B' or
RU486 (Mifepristone);
d) pharmacists or health care workers dispensing
drugs or devices for voluntary or involuntary
euthanasia, assisted suicide, suicide, or
reproductive technologies.
Protection of conscience resolution
2. Correspondence, e-mail, notes, minutes,
bulletins, reports, summaries, extracts, policy
statements, recommendations, from or to any party,
whether on paper, stored in an electronic retrieval
system, or on computer disks, CD's, audiotapes or
videotapes, dated from 1 January, 1994 to the
present, concerning a resolution about protection of
conscience for pharmacists passed at the Annual
General Meeting of the Alberta College of
Pharmacists in 1995.
Disciplinary Matters [Note that the original
request was accompanied by a signed release from Ms.
Bizecki]
3. Complaints, evidence, opinions, findings, or
judgements, and correspondence, e-mail, notes,
minutes, bulletins, reports, summaries, extracts,
policy statements, recommendations, from or to any
party, whether on paper, stored in an electronic
retrieval system, or on computer disks, CD's,
audiotapes or videotapes, dated from 1 January, 1994
to the present, concerning
a) the professional conduct of pharmacist Maria
Bizecki;
b) the formation of any group charged with
examining, commenting upon, or providing advice
about the professional conduct of Maria Bizecki;
c) policy and criteria for identifying or
selecting individuals for the purpose of the
consultation described in 3(b);
d) the academic and professional qualifications
and experience of the individuals referred to in
3(b) and (c) relevant to their role in examining or
commenting upon ethical or moral issues.
Ethics Committees
4. Correspondence, e-mail, notes, minutes,
bulletins, reports, summaries, extracts, policy
statements, recommendations, from or to any party,
whether on paper, stored in an electronic retrieval
system, or on computer disks, CD's, audiotapes or
videotapes, dated from 1 January, 1994 to the
present, concerning
a) formation of an ethics advisory committee, or
of any committee charged with examining, commenting
upon, or providing advice about ethical issues in
pharmacy;
b) policy on qualifications for appointment to a
committee described in 4(a)
c) policy on the process to be followed in
applying for membership in a committee described in
4(a);
d) policy on the process to be followed in
appointing members to a committee described in 4(a);
e) the number of current members of any committee
of the Alberta College of Pharmacists described in
4(a), and their academic and professional
qualifications and experience relevant to their role
in examining or commenting upon ethical or moral
issues;
f) the number of rejected applications for
membership on committees of the Alberta College of
Pharmacists described in 4(a) received by the
College since 1 January, 1994, and the reasons for
rejection.
Ethics Consultation
5. Correspondence, e-mail, notes, minutes,
bulletins, reports, summaries, extracts, policy
statements, recommendations, from or to any party,
whether on paper, stored in an electronic retrieval
system, or on computer disks, CD's, audiotapes or
videotapes, dated from 1 January, 1994 to the
present, concerning
a) consultation by the Alberta College of
Pharmacists or its representatives with individuals,
institutions, associations or organizations for the
purpose of obtaining advice, guidance, suggestions
on ethical or moral issues, including but not
limited to freedom of conscience and conscientious
objection;
b) policy and criteria for identifying
individuals, institutions, associations or
organizations for the purpose of the consultation
described in 5(a);
c) the number of times consultation of the type
described in 5(a) has occurred, and the subject(s)
of the consultation in each case;
d) the academic and professional qualifications
and experience of the consultants referred to in
5(a) and (c) relevant to their role in examining or
commenting upon ethical or moral issues.