PHARMACY WORKFORCE RIGHT OF CONSCIENCE AND THE PATIENT’S RIGHT OF ACCESS TO THERAPY

To support processes that protect patients’ access to legally prescribed treatments while reasonably accommodating members of the pharmacy workforce exercising rights of conscience; further,

To affirm the value of shared decision-making that protects patient well-being and continuity of care while balancing the rights of conscience held by members of the pharmacy workforce and other healthcare professionals; further,

To recognize the right of pharmacy workforce members to decline participation in non-emergency care delivery activities they consider morally, religiously, or ethically objectionable; further,

To support the principle that a member of the pharmacy workforce exercising rights of conscience must remain respectful of, and responsive to, and serve the legitimate health care needs and preferences of the patient and shall provide appropriate referral or transfer of care without any actions to persuade, coerce, or otherwise impose personal values, beliefs, or objections on the patient.

Rationale

ASHP affirms members of the pharmacy workforces’ right to decline to participate in therapies they consider to be morally, religiously, or ethically troubling but recognizes that a right of conscience must balance a pharmacist’s or pharmacy technician’s deeply held beliefs with his or her professional duty and the patient’s autonomous right to access legally prescribed and medically indicated treatments. To achieve this balance, systems to protect the patient’s right to timely access to therapy should be developed in advance of non-emergent clinical scenarios where a member of the pharmacy workforce might exercise the right of conscience. The right of conscience therefore creates an affirmative responsibility on the part of the pharmacist or pharmacy technician to proactively notify his or her employer about therapies of concern. In addition, a pharmacist and pharmacy technician exercising the right of conscience must respect and serve the legitimate healthcare needs and desires of the patient and must provide a referral without any actions to persuade, coerce, or otherwise impose on the patient the pharmacist’s or pharmacy technician’s values, beliefs, or objections. For the purposes of this policy, “referral” is defined in manner similar to that used by the American Academy of Family Physicians (Consultations, Referrals, and Transfers of Care; 2012 COD): a referral is a request from one member of the healthcare workforce to another to assume responsibility for management of one or more of a patient’s specified problems, for a specified period of time, until the problem(s)’ resolution, or on an ongoing basis, and represents a temporary or partial transfer of care to another member of the healthcare workforce for a particular condition. When conscience requires a pharmacist or pharmacy technician also to decline to refer the patient to a specific provider who can provide the legally prescribed and medically indicated treatment, the pharmacist or pharmacy technician should offer impartial guidance to patients about how to inform themselves regarding access to the therapy. The National Catholic Bioethics Center suggests that healthcare providers declining to refer may assist patients with accomplishing a transfer of care to another provider or institution of the patient’s choosing by providing a general list of other providers or institutions based on geographic vicinity or area of specialty, so long as the list is not developed based on the criterion of whether the providers are known or believed to offer the therapy in question. Institutions should have processes in place to ensure that the transfer of care process does not interfere with the patient’s right to obtain legally prescribed and medically indicated treatments. Any accommodations made on the basis of a pharmacist’s or pharmacy technician’s decision to exercise the right of conscience should be nonpunitive.