The Conscientious Pharmacist





The Conscientious Pharmacist


The case under study is about Thomas Anselm, a Winconsin pharmacist, who refuses to fill a birth control prescription from a primary care physician for a patient, Eve Gaunilon. His refusal lies primarily on his religious beliefs. Thomas is a devout Catholic and feels the act is against his conscience. This case is about conscience and limits of its protection. Conscience as some scholars put, is the voice that informs a person of what is morally right or wrong in the ongoing motive or conduct. Conscientious refusal practiced by a healthcare professional refers to the act of refusal of any kind expected by standard of care or requested by a patient. Thomas Anselm committed both forms of refusal because he declined to yield to the patient’s requests and declined a valid prescription that the woman possessed. This presents conflict between conscience and the professional’s core moral values. These values, grounded in religion or other bases, count profoundly to anyone. They form part of personal integrity and self-identity and, hence, need protection.

Most people would support that there are instances where one has the right to apply religious or ethical refusals to fulfill certain obligations. Indeed, few would comply with any form of medication prescribed by a physician, who was forced into doing so. Influences one’s access to medical care and health is not the only impact that comes with professional-conscientious refusal. It has a wide social impact. For instance, if a pharmacist working in a rural area asserts such professional-conscientious refusal to women in that area, then women in the entire society will lack access to legally prescribed medication. Therefore, this situation develops into a social problem. Anselm’s decline to fill the physician’s prescription, refer the patient, and transfer the prescription hindered Eve’s access to healthcare subjecting her to an unwanted preventable pregnancy. The pregnancy would have ruined the life of Eve, a student. This is a common problem in the society because people get unplanned babies.


A Case of Conscientious Refusal: Rights and Responsibilities

The article elucidates professional-conscientious refusal according to Margaret R. McLean, director of bio-ethics at the Markkula Center for Applied Ethics. Margaret looks at the matter critically and offers her own viewpoints bout the above case under study. She argues that women face the largest part of negative impacts of professional-conscientious refusal, as shown in the case above. She also says that the prescription could have been for menorrhagia, dysmenorrhoea, polycystic ovaries, and much more, apart from the contraception that people ordinarily know of. According to her, Americans focus on rights-talks and not responsibility-talks that cases like this need. She further gives the core ethical commitments in medicine, which include doing justice, respecting patient autonomy, and subjecting patients to no harm. This implies that medical professionals must treat people fairly, work for a common good, provide access to healthcare, as well as prescribe medications, understand and respect patients, act in the best interest of patients, and avoid foreseeable problems.

Additionally, the document suggests the proper way of treating pharmacists in case of problems about moral beliefs. The document proposes that pharmacists must get liberty on stepping away from filling prescriptions that break moral beliefs but the stepping away must go with responsibility of promoting every patient in a caring, confidential, and compassionate way. The Concern for protecting patient’s dignity and patient’s wellbeing must take center stage in professional practice. Margaret tells employers to develop policies and processes that encourage personal decision of a pharmacist while giving the kind of care needed by the patient. To her, stepping away does not mean coming in between a patient and her healthcare through a refusal of offering or transferring care or make her uneasy or ashamed. The patient needs protection from preventable harm in the extent that the professional feels the patient is safe.

She finally gives her last remarks on the case. She finds issues of conscience most annoying, though not terrible than medically assisted healthcare reform or death. She preserved the act of healthcare professionals not offering healthcare based on personal beliefs, but also protected patients put in harm’s way by conscientious refusal. Her viewpoints inclined to the protection of patients who suffer due to conscientious refusal. She proposed professionals must base their actions on responsibility and not conscience. She concludes by saying that the pharmacist under scrutiny should consider another line of responsibility because his beliefs interfered with his responsibility.

Legal Protection for Conscientious Objection by Health Professionals

This is an article written by Allison Grady, a senior assistant editor of Virtual Mentor and a research assistant American Medical Association in Chicago, Illinois. According to her, conscience clause are rules that give healthcare workers the mandate of avoiding certain processes, mostly end-of-life and reproductive therapies, on grounds of ethical, religious, or moral beliefs. She further says that a doctor’s right of avoiding particular treatments where emergency does not occur, and with other treatment options available, gets support from state and federal laws including the Code of Medical Ethics by American Medical Association. To her, workers in healthcare profession, pharmacists included, have no legal support that allows them to practice conscientious objection. Moreover, the paper points out the increasing number of pharmacists independently opting out of patient drug therapies because of moral objection. Consequently, legislations that grant healthcare workers same platform on moral objection are on the rise. The legislations need careful attention from healthcare workers by striving to integrate both the susceptible patient and conscientious objector.

Allison Grady looks at reactions of various agents on the matter. For instance, she gives the enactments from the proposed under Michigan law on the above case. Licensed professionals, students operating in a health care facility, and other healthcare workers had chances of practices conscientious objection. Those who chose to stay away from a particular process or action requested of them informed their supervisors, through writing, of the exact procedure they object. The notice is usually filed upon employment, when a moral, religious, or ethical system gets integrated which could interfere with the request of the employer or within a day of request of participation in an act. The objection is usually valid for the employment-term unless the objector rescinds the decision. The employer uses the filed objection to look for an alternative or make the objector take part as a last resort. According to the document, conscientious objection does apply to emergency cases, public health emergency, or the objection based on civil rights. The new proposed law restricts employers from discriminating against acts of conscientious objectors and terminating employment for employees, in at least two months before confirming that the objection takes 10% or more of the worker’s hours of duty.

further depicts the point of view of The New York Times. He sees the reaction by this company as less philosophical. The document, specifically, cites an April 2005 editorial, which proposes that a pharmacy should seek another line of duty when his personal beliefs interfere with his responsibility. This is irrational according to the above document.

The article concludes by pointing out one must not turn a blind eye to the fact that neither a healthcare provider nor a pharmacist is a tool, but do jobs while holding ethical and moral values that sometimes interfere with their responsibilities. She proposes that morals and conscience of a healthcare provider must come into consideration, so long as victims of objections get cared for and not ashamed because of what someone sees as an illegal lifestyle choice. The article is very instrumental in bringing out facts on the case.

Left 2 Right; The case of the Conscientious Pharmacist

The article is because of the meticulous analysis of Don Herzog on the matter above. Don says that the act by the pharmacist does not make religious observance. Observance covers one who needs praying during time of work. Furthermore, he purports that antidiscrimination law does not take anything or everything done for religious reasons as a religious observance. He asserts that one should not subscribe to the principle that everyone has exemption from law in cases where their religious objections get breached. He proposes that people should always reason through objections and see how those objections affect the interest of others. The case to him presents to scenarios: one says that pharmacists must affect legal prescriptions from physicians, and the other says that employers must give pharmacists the right to conscientious objection.

He offers a solution to the problem by suggesting freedom of contract, which respects autonomy and supports human welfare. However, he sees that this solution does not consider religion. Don suggests that government and the church should dialogue on how to integrate religion freedom of contract so that both parties get a satisfaction. Legislation that makes Thomas Anselm fill such prescriptions infringes on freedom of contract. He further argues that such matters have remained in the hands of private institutions for long. He wants government to look at the matter. Don concludes by proposing that Wisconsin put in place rules that make pharmacist offer treatment to patients, even if those treatments have religious or moral obligations. Finally, he states that Thomas should quit pharmacy if he does not accept that.


Stakeholders Options available for the primary stakeholder (Thomas Anselm) Consequences of those options

Thomas Anselm (pharmacist)

Eve Gaunilon (patient)

Bill Hume (assistant manager)

The pharmacist can fill the prescription.

He can refer the patient to a different store.

He can also refuse the prescription.

He can file an objection to his employer. Filling the prescription respects the autonomy of the patient, but is sinful to the pharmacist because it is against his religious beliefs.

Referring the patient to another store makes her feel ashamed.

Refusal will harm the patient in that she will not void a foreseeable risk; pregnancy.

Filing and objection means that the procedure is transferred to another pharmacist.

The stakeholders in the above case are Thomas Anselm, the pharmacist, Eve Gaunilon, the patient, and Bill Hume, store assistant manager. The primary stakeholder is Thomas Anselm, who faces problem that interferes with his personal beliefs. Dispensing morning pills to Eve is sinful and against his religion. Thomas has many other options. He can transfer treatment to another store, offer advice to the patient and make her understand why he could not do such a thing, put an objection in writing to his employer, and much more. Instead, he refused. His refusal was not in a dignified way. He did not speak to the patient effectively and make her understand the reason behind his refusal. Moreover, he did not respect the autonomy of the patient. The most suitable action was transferring the treatment. The action by the physician was against the law and this led Eve to filing a lawsuit against Thomas.

Decision making

The best decision that the primary stakeholder should have taken is filling the prescription for the patient. This is because the prescription came from a legal source; physician. Moreover, the patient was a college student who still had passion of pursuing her studies. Refusing the dispensation meant that the patient would become vulnerable to a preventable risk; pregnancy. The decision is best because it gives the patient a feeling of autonomy. The patient feels that he has full control of his health. Pharmacist must allow patients to express their wishes and respect them. Furthermore, the decision is not based on religious, or ethnic backgrounds, but in the best interest of the patient.


The decision provided above is in the best interest of the patient. However, it is infamous in the eyes of the pharmacist. The practice is sinful because it violates his religious beliefs. Another problem with the above decision is that it promotes prostitution. The use of morning Pill is on the rise because it prevents pregnancy. This enhances prostitution. Moreover, the decision is in breach of pharmacist’s freedom of choice. The fact that pharmacist must dispense prescribed drugs does not give them choice. Choice means that the pharmacist could transfer treatment.


The above case is very significant. It teaches much about medical practices. Conscientious refusal is something many people are not aware of. In case of practicing pharmacy, it teaches one the difference between personal interests and responsibility. The pharmacist let his religious beliefs overtake his responsibility. According to law, not any case that is against religion has considered. The case teaches one to embrace responsibility to the extent that it is not overridden by personal quests. Practicing pharmacy means that any legal prescription needs dispensation. Moreover, one has to act in a way that benefits many people. A social problem is more significant than a personal problem.


Consequentialist and Non-Consequentialist Theories

These are two wide groups of theories of ethics illustrate the wrongness or rightness of situations or actions. A consequentialist theory decides the wrongness or rightness of an action according to consequences. For instance, utilitarianism—according to Jeremy Bentham, action would be modest if it beneficial for a large population. Another form of consequential ethics emanates from the query whether damage to trees is equal to that of people. John Stuart Mill, an English philosopher, purported that a dissatisfied-philosopher carries more moral weight than a satisfied pig. An act that brings adverse effects to a few people while offering small benefits to many satisfies the theory. Biodiversity is one other example; it adds to human welfare, but has no inherent value. Another form of consequentialism is hedonism, which states that people should maximize on pleasure. The surprising nature of this theory is that it takes all acts as right, including murder, but the determining factor is the result.

Conversely, a non-consequential theory judges the wrongness or rightness of action by of characteristic inherent to the action, but not the consequences of the action. Libertarianism shows that people act according to their will as long as they allow others to act so. Biodiversity contributes significant value only to point that it allows one to express his wishes freely. Contractarianism states abolishment of policies that do not allow for compensation. According to John Rawls, it is not easy to understand the value of biodiversity. It is difficult to proof philosophically its intrinsic value, although it sounds good and prompts a nice feeling.

Consequentialism gives people give people guidance when faced with a moral decision like the one above. For instance, the judge should choose an action that maximizes good consequences. It also gives good guidance on how to live. People use it on basing their lifestyles.

Applying consequentialist theory to the above case implies that the result of the phamarcist’s actions seek consideration. It means that the pharmacist is morally right in his actions, but what might make him is the result of his actions. The act is morally right because the patient did not incur anything apart from shame. There is punishment for the intent in cases of non-consequentialist theory. The pharmacist is morally wrong because his refusal could lead to the patient’s unwanted pregnancy and hence ruin her life.

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