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Protection of Conscience Project

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Service, not Servitude
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Submission to the Select Special Freedom of Information and Protection of Privacy Act Review Committee (Alberta)


VIII. Notes (Table of Contents)

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


Appendix "A"

Appendix "B"

Appendix "C"

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-à-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.

 

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