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

Service, not Servitude

Submission to the Alberta College of Pharmacists

Re: Draft Code of Ethics

27 February, 2009


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ABSTRACT

The Draft Code of Ethics does not address the situation of a pharmacist who, for reasons of conscience, refuses to fill a prescription for assisted suicide, euthanasia or post-coital interception. Further, it fails to define key terms, thus complicating its application in such a case.

The failure to define or limit key terms strongly suggests that pharmacists will be expected to enhance access to assisted suicide or euthanasia, even if they object to the procedures for reasons of conscience. At the least, a limitless obligation to "enhance access" provides limitless opportunities to prosecute objectors for professional misconduct.

This is particularly troubling because references to accommodation of freedom of conscience in the current Code have been removed from the Draft Code. It is not unreasonable to believe that deletion of reference to accommodation of freedom of conscience and the construction of the Draft Code are intended to force objecting pharmacists to enhance access to euthanasia, assisted suicide, post-coital interception, etc., and to compel them to assist the patient to obtain such services in a timeframe acceptable to the patient.

To impose this requirement would effectively close the profession of pharmacy to anyone who finds such conduct morally unacceptable. It would present current members who would refuse to facilitate assisted suicide, euthanasia or post-coital interception with the choice of compromising their personal integrity or leaving the profession.

Arguments commonly advanced to support the notion that pharmacists should be forced to refer services to which they object for reasons of conscience are faulty or inadequate, in that they fail to fully address the issue of complicity in wrongdoing and the nature of the human person.

A long philosophical tradition, stretching from at least Immanuel Kant to R. vs. Morgentaler and beyond, insists that the nature of the human person is such that no one should be exploited by another by being reduced to the status of a tool or thing: that it is reprehensible to use a human person for ends chosen by others. Within this tradition, self-sacrifice has never been understood to include the sacrifice of one's integrity. To abandon one's moral or ethical convictions in order to serve others is prostitution, not professionalism: servitude, not service.

In the tradition of Kant, C.S. Lewis, Martin Luther King, Cyril Joad and Karol Wojtyla, and following Madame Justice Wilson in R. vs. Morgentaler, to demand that pharmacists provide or assist in the provision of procedures or services that they believe to be wrong is to treat them as means to an end and deprive them of their "essential humanity."

A pharmacist's conscientious refusal to refer patients or assist them in obtaining euthanasia, assisted suicide, post-coital interception, etc. should not constitute professional misconduct. The College of Pharmacists of Alberta should not demand that a pharmacist actively facilitate a service or procedure he believes to be wrong. The Draft Code of Ethics should be revised to ensure that the document cannot be used for this purpose.

The College of Pharmacists of Alberta should include in its Code of Ethics a unambiguous policy of accommodating freedom of conscience through systemic cooperation that does not require active participation by an objecting pharmacist in conduct he believes to be wrong. The policy should not apply to pharmacists who own, manage or are employed in pharmacies that clearly and publicly identify the scope of their practice to exclude certain services.

In any case, neither the ambiguous provisions of the Draft Code nor its silence on freedom of conscience can be construed to restrict the exercise of fundamental freedoms acknowledged and guaranteed by the Canadian Charter of Rights and Freedoms. While even fundamental rights and freedoms are not unlimited, the Charter requires that their limitation by state authorities (like the College of Pharmacists of Alberta) be "demonstrably justified" and be "prescribed by law." The Draft Code attempts nothing by way of demonstration, and it would strain credulity to argue that mere silence and ambiguity constitute a valid legal prescription for the suppression of freedom of conscience.


TABLE OF CONTENTS
Abstract
I. Introduction
II. The context
III. Part V (Draft Code)
IV. Part VIII (Draft Code)
V. Purpose and effect of the Draft Code
VI. The issues
VII. Responding to the issues
VIII. The new 'rights' language
IX. Belief: religious and otherwise
X. Establishment consensus and the ethics of the profession
XI. Social contract
XII. Social contract and socialized medicine
IX. Fiduciary duty
XIV. "Negligence close to abandonment"
XV. Legality
XVI. Balance
XVII. Limits to expression
XVIII. The problem of complicity
XIX. The needs of the patient: anthropology counts
XX. The human person
XXI. Summing up: mandatory referral or assistance
XXII. The need to explicitly address freedom of conscience
XXIII. In search of consensus
XXIV. The way forward
XXV. Summing up: accommodating pharmacists and patients
XXVI. Recapitulation
Appendix "A" The Exercise of Freedom of Conscience in Pharmacy
Appendix "B" The Exercise of Freedom of Conscience in Pharmacy
Appendix "C" The Exercise of Freedom of Conscience in Pharmacy
Appendix "D"
Notes

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