Sir, – In his advocacy of access to contraception without prescription, the general secretary of the Irish Pharmacy Union, Darragh O'Loughlin, opined that "a pharmacist who for ethical or religious reasons cannot provide a specific service to a patient must direct that patient to someone else" ("Prescriptions should not be necessary to get the pill", Opinion & Analysis, August 14th). This echoes the so-called "conscientious objection" clause for medics in the existing (and in the proposed) abortion legislation.
This notion of conscientious objection is merely paying lip-service to the more profound notion of freedom of conscience in article 18 of the Universal Declaration of Human Rights. It is worth recalling that that declaration was drawn up after the violations of conscience that defined the Nazi regime (see the preamble and article 1 of same). It is dangerous to mess with a person’s freedom of conscience, since, apart from anything else, it is the basis of human responsibility and so of a humane society.
The superficiality of the dominant notion of conscientious objection is most evident in the case of a pharmacist giving a potentially dangerous drug to someone who demands it. If the pharmacist knows that the medication could do physical or psychological damage to that person, then the pharmacist is morally obliged not to dispense it. The same would also apply to the case where a doctor has prescribed a drug to a patient but the pharmacist, more familiar than the prescriber with the patient’s medication history, recognises that it would harm the patient (eg when a locum GP prescribes fentanyl to a patient with a history of opioid abuse). It should be evident that it would also be gravely unethical for the pharmacist to refer the same patient to another colleague to dispense the prescription.
Pharmacists, as professionals committed to evidence-based medicine, will be aware of the latest research demonstrating the increased risks of breast cancer, strokes and myocardial infarction in users of oral contraception (see for example the New England Journal of Medicine, December 7th, 2017, and June 14th, 2012). In the light of such evidence, to promote access to oral contraceptives without prescription is highly irresponsible. The proposal from the Minister for Health, that these agents should be dispensed free of charge, is even more irresponsible.
The proposal advocated by the general secretary of the Irish Pharmacy Union may well augment the profits of pharmacy businesses but it would do so at significant detriment to women’s healthcare in Ireland and to the professional standing of Irish pharmacists. – Yours, etc,
D VINCENT
TWOMEY, SVD,
(Professor Emeritus
of Moral Theology),
Dublin 4.