Pharmacist's religious/moral objection to emergency contraception

[lilly0]

A while ago I went into Boots to buy the MAP. The pharmacist on duty wouldn't prescribe to me for religious reasons but pointed another pharmacy to me no biggy I thought but then I thought about it. Why would a pharmacist object to emergency contraception it isn't an abortion pill they don't seem to mind selling condoms and dispensing the pill ?
Is there any reason not to sell the MAP ?

It is only discrimination if they are selling something but only selling it to some people. It isn't discrimination if they choose not to sell to anyone.

Not the law. Sorry.

In this country we have two forms of discrimination: direct, and indirect. Direct is something that clearly and obviously is aimed at one group, and disadvantages them. This would include refusing an essential form of healthcare that only one group can take.

Indirect is something that is on the face of it fair, but actually disproportionately impacts one group. Transport for London came a cropper when changing shift patterns a couple of decades ago, because it transpired that it massively affected those with childcare responsibilities, who were overwhelmingly women. They lost a case on that basis.

This is direct discrimination, because it's a product only women take, but actually, under the law, it's still discrimination if one group is disproportionately badly hit. You can't just say, well, it applies to everyone so no problem. It's more complex than that.

Is there a legal basis for the staff member to do this?

Yes.

The first is that pharmacists have a contract with the NHS to dispense medications on prescription, so they are not independent. They work to a contract. They are in effect franchised to sell NHS funded drugs.

Pharmacists who work in chemist shops don't have an NHS contract. Although obviously chemist shops themselves usually do that is not always the case. Those that don't can dispense private prescription or just sell over the counter prescription. If people are buying the MAP this wouldn't come under the NHS contract so not really anything to do with the NHS.

over the counter prescription over the counter drugs

YOu got what you needed. There is no problem.

" It is only discrimination if they are selling something but only selling it to some people."

en.oxforddictionaries.com/definition/discrimination

From the govt page on the equalities act:

"1. Types of discrimination ('protected characteristics')

It is against the law to discriminate against anyone because of:

age
being or becoming a transsexual person
being married or in a civil partnership
being pregnant or on maternity leave
disability
race including colour, nationality, ethnic or national origin
religion, belief or lack of religion/belief
sex
sexual orientation
These are called ‘protected characteristics’.
You’re protected from discrimination:

at work
in education
as a consumer
when using public services
when buying or renting property
as a member or guest of a private club or association"

Pharmacists who work in chemist shops don't have an NHS contract. Although obviously chemist shops themselves usually do that is not always the case. Those that don't can dispense private prescription or just sell over the counter prescription. If people are buying the MAP this wouldn't come under the NHS contract so not really anything to do with the NHS.

I was responding to (and quoted) this comment:

Business have the right to decide what they wish to sell and that includes chemist shops.

There was no reference to either the morning after pill or the pharmacist on that bit, so your response isn't really anything to do with my own comment.

Apologies, rereading it I did say 'pharmacist' rather than 'pharmacy' so that part was my own mistake.

In this country we have two forms of discrimination: direct, and indirect. Direct is something that clearly and obviously is aimed at one group, and disadvantages them. This would include refusing an essential form of healthcare that only one group can take.

So if a healthcare professional choose not to perform a cervial smear or anything else that is only required by women is guilty of sex discrmination. I don't think so. If that was the case pharmacist wouldn't be able to legally refuse the MAP but they can.

The law is complicated with many exemptions but I have to say I agree this being legal is wrong and not in the spirit of the law on discrimination. His religion shouldn't trump op's medical needs.

Thanks for all your thoughts , I will be emailing boots my thoughts , I don't see the MAP as an abortion at all I see it as preventing a pregnancy it's the same ingredients in the mini pill just higher concentrations.
I never thought the MAP would be such an issue in 2018 , a woman taking control of her own reproductive health before there is a pregnancy.

So if a healthcare professional choose not to perform a cervial smear or anything else that is only required by women is guilty of sex discrmination. I don't think so.

You think it's lawful for a GP to refuse to perform any smear tests, when employed by the NHS to do so? Based on their own preferences, and not the best interests of the patients?

They can refuse to refer for a termination, but they must pass the patient to another practitioner who has no such issue. But I don't know if it's ever been challenged in terms of legality. The thing is, you need locus standii to pursue something legally - to have an interest in the situation in a very personal sense - and not many women in that position would want their names attached to the resulting case. The thing with the civil law is that breaches need to be challenged for it to be applied. It's not like criminal law, where the police and CPS have responsibility for application.

If that was the case pharmacist wouldn't be able to legally refuse the MAP but they can.

It's actually never been challenged in court - if it were, they might well lose. All sorts of things are done until a court case stops it - ask HMRC, for a start. Holiday pay for temp workers employed less than 3 months only came about because a union took an agency to court, back in 2002, and a court found in the employee's favour. Same with the gay couple who took the B&B to court, and won.

And there was a consultation last year by the General Pharmaceutical Council, because they are concerned that this is happening increasingly often, and are looking to alter the guidance to remove the stated exemption, which is what is currently used to support the practice. The consultation closed to the public last March - be interesting to see what the outcome is.

The law is complicated with many exemptions but I have to say I agree this being legal is wrong and not in the spirit of the law on discrimination.

If it's never been challenged in court, nobody knows if it's legal or not. The General Pharmaceutical Council aren't a legislative body. They're a professional one. It would need a court case to establish whether this is discriminatory in a legal sense. That's how equalities law works.

I disagree. Especially as we’re talking about Boots here and not a little independent pharmacist. I’d complain

I’m a pharmacist and have worked with observant Muslim colleagues who have refused to supply the MAP and in the hospital setting RU486 and strong potassium injection.
I don’t believe you should be able to pick and choose which bits of the job you do.
We are there for the patient and to ensure they come before everything (see Pharmacist’s code of ethics) and to do this there are times you have to detach yourself from the emotional side.
I would hate to think how you end up feeling if you’re refused the MAP on religious grounds- judged and guilty I would guess. And hoping that there is an open pharmacy down the road.

You think it's lawful for a GP to refuse to perform any smear tests, when employed by the NHS to do so? Based on their own preferences, and not the best interests of the patients?

I think that many male GPs do refuse to perform them. This may be due to the fact that if they do it they have to have a women present but they are still allowed to refuse based on their own preference and training if someone else in the practice can do it. I don't think that many male doctors train to insert coils etc either and again they are allowed to do that. Nobody says every GP has to perform every procedure. They are allowed to refer and it can't really be argued that it affects the health of the patients if there are female doctors in the practice who will perform the procedure.

It's actually never been challenged in court - if it were, they might well lose. All sorts of things are done until a court case stops it - ask HMRC, for a start. Holiday pay for temp workers employed less than 3 months only came about because a union took an agency to court, back in 2002, and a court found in the employee's favour. Same with the gay couple who took the B&B to court, and won.

I'm sure that the General Pharmaceutical Council have consulted legal experts on it though and presumably, they have been told it isn't illegal to refuse and that is why the guidance is quite ambiguous.

And there was a consultation last year by the General Pharmaceutical Council, because they are concerned that this is happening increasingly often, and are looking to alter the guidance to remove the stated exemption, which is what is currently used to support the practice. The consultation closed to the public last March - be interesting to see what the outcome is.

I thought it has been published actually (as posted by another poster).

But GPs aren't expected to have specialist gynae training. That's reasonable because it's a area of special interest, and general practice covers a huge field - my mother was practice manager for a very large central London practice for many years and the GPS had a wide range of areas of specialist interest, so reception staff tried hard to match patient need with additional training/research base. It's not unreasonable to be unable to provide a service for which you are not qualified. But if someone needs a smear test and you are qualified to perform it, I'd be fairly surprised if you could refuse on personal preference grounds alone! Not having had the recommended skills update every 3 years, so referral to ensure smears are done by staff who have so the service is as well-run as possible, is patient-centred care. It's about the best clinical interests of the patient. "I just don't fancy it..." is not. I'm sure you see the difference.

Incidentally I checked, and there is now updated guidance for pharmacists on ethical issues. The GPC say: referral is still an option, but may not always be enough; for example, if a service is not accessible or available elsewhere or, if due to the person’s vulnerability, a referral would effectively obstruct timely access to the service. It's therefore narrowed the exemption rather markedly.

It also points out that the Equality Act protects an absence of belief equally with a faith belief, and that gender is also a protected characteristic. They also stress that it's professional guidance, and not legal advice.

www.pharmacyregulation.org/sites/default/files/in_practice-_guidance_on_religion_personal_values_and_beliefs.pdf

Taking MAP is to avoid pregnancy, maybe pregnancy wasn't even going to happen on this occasion. It's taken the day after sex, so nothing has started yet and so can't be counted as the same as abortion.
He should have given it to you or at the very least, get a different member of staff to serve you. Luckily there was another pharmacy open near by.

I'm sure that the General Pharmaceutical Council have consulted legal experts on it though and presumably, they have been told it isn't illegal to refuse and that is why the guidance is quite ambiguous.

They actually stress that they are not offering any form of legal advice, simply guidance on how to seek to balance professional practice and personal belief. They're very clear on that piece of arse-covering.

And yes, of course they will have consulted lawyers. Which is why they also stress that they aren't offering guidance on the law....

Before i comment, i'll just mention that am vegan because I oppose cruelty to any creature, animals in factory farms, but far more so human babies and their parents. One of the ways the MAP works is to prevent implantation of a fertilized egg. And it can cause nausea, vomiting, cramps and passing blood clots. And it's not OK to sell it without a medical check. There are different types of MAP. Maybe you are susceptible to DVTs and shouldn't take MAPs containing oestrogen. But then, the progestin-only MAPs don't prevent implantation of the fertilized egg as effectively as those combined with oestrogen. But too much oestrogen can cause DVT.

Reasons it's probably never been challenged in court :

Civil cases require a LOT of money and time to pursue - women have less wealth than men.

As pp said - their name could/would be made public and that could have HUGE repercussions on them and their loved ones inc their career.

"If it's never been challenged in court, nobody knows if it's legal or not. The General Pharmaceutical Council aren't a legislative body. They're a professional one. It would need a court case to establish whether this is discriminatory in a legal sense. That's how equalities law works." I understand that - to a degree - but the legislature could have written it into the equalities act that this exemption wasn't allowed.

Also a professional body can set their own parameters, they could do more if they wanted to.

But GPs aren't expected to have specialist gynae training. That's reasonable because it's a area of special interest, and general practice covers a huge field - my mother was practice manager for a very large central London practice for many years and the GPS had a wide range of areas of specialist interest, so reception staff tried hard to match patient need with additional training/research base. It's not unreasonable to be unable to provide a service for which you are not qualified. But if someone needs a smear test and you are qualified to perform it, I'd be fairly surprised if you could refuse on personal preference grounds alone!

They may not get training because of personal preference though. Also, pharmacists need training to sell the MAP so similar to GPS they can refuse on the grounds that they are not trained. Obviously they can't do this if they work for an employer but if independent it would be easy to avoid.

Any Pharmacist applying for work at Boots should be told ‘we sell the morning after pill, if you don’t agree with it, find work elsewhere.’

Well really? the point here is that asking a pharmacist to prescribe something that they are religiously against is discriminatory against them as an employee - Boots won’t chose to discriminate in that way and 90% of the time the pharmacist can do their job without an issue. It’s perfectly acceptable that they may refer the customer elsewhere.

You wouldn’t tell a churchgoing Christian that they can’t have a job in a 7 day a week business because they can’t work Sunday, you make an adjustment to allow them their religious observance.

Well don’t Boots for equal opps!

Well done