Posted: 3 March 2017
"As each has received a gift, use it to serve one another, as good stewards of God's varied grace." 1 Peter 4: 10 (ESV)
Freedom of Conscience
Pharmacy professionals (pharmacists and pharmacy technicians) play a vital role in our healthcare service. Until now, their regulatory body, the General Pharmaceutical Council (the GPC), has recognised that the religious beliefs of pharmacy professionals may, quite properly, and as a matter of good conscience, prevent them from providing some pharmacy services such as abortion drugs, contraception, fertility medicines, hormonal therapies, substance misuse services, and sexual health services.
The pharmacy professionals' regulatory body, is now proposing to radically restrict freedom of conscience rights, which has far-reaching implications for the practice and provision of medicine in the UK. Indeed, the GPC has said that its proposals mean that: "In some cases, this might mean [Christian pharmacy professionals] are unable to take up certain working roles."
Protection of Patient Rights
Pharmacy professionals have to comply with standards of conduct, ethics and performance set by the GPC. Their conduct is judged against these standards and a failure to comply with these standards places their registration and their livelihood at risk.
Existing standards enable a pharmacy professional to refer a patient if they are unable to provide a service because of their religious or moral beliefs. The right to refer is subject to stringent safeguards which are balanced in favour of the needs and rights of patients: current GPC Standards require pharmacy professionals, who are unable to provide a service because of their religious or moral beliefs, to "tell the relevant people or authorities and refer patients and the public to other providers". According to the 2010 GPC Guidance on this point this means:
1. Before accepting employment pharmacy professionals should tell their employers, relevant authorities, and colleagues about their religious beliefs if it would prevent them from providing a pharmacy service (pharmacy professionals are required to ensure that all staff are aware of their views and are trained to deal with initial requests for services affected by their beliefs), and find out about alternative service provision;
2. When refusing a service, pharmacy professionals should explain to the patient their reason for doing so openly and honestly. Patients mustn't be discouraged from seeking further information or advice, referrals have to be made in a timely manner, and a pharmacist is required to check, when referring to another pharmacy, that a pharmacist is available and that they have the medicine required by the patient.
In May 2017 new standards will be issued by the GPC. Following consultation about these new standards, the GPC launched additional consultation on religion, personal values and beliefs for pharmacy professionals. In this consultation exercise, the GPC propose to shift the balance of interests further in favour of the needs and rights of the patient by requiring pharmacy professionals to "take responsibility for ensuring that person-centred care is not compromised because of personal values and beliefs". In practice, the GPC's proposal means that each time a pharmacy professional refers a patient they will have to make a difficult ethical, legal, medical and practical decision about whether the refusal to provide a service is the right option or enough to ensure person-centred care is not compromised. According to the consultation document, the GPC have indicated that person-centred care will be compromised if a refusal:
- results in a person not receiving the care or advice they need as a priority when they need it; or
- breaches human rights or equality legislation.
Far Reaching Implications
This proposal is drafted in an impracticably wide way, and has far reaching implications for pharmacy professionals. Pharmacy professionals will routinely be required to make difficult decisions about whether to refuse a service on the grounds of their religious belief in the context of a busy professional life. If a pharmacist refuses to provide a service, such as emergency contraception to a patient, hormone treatment blocking puberty for a child, or a sexual health service, there is considerable potential for a patient then to argue that they were not treated as a priority, that they did not receive the treatment when they needed it, and that the refusal breached their human or equality rights.
The GPC has explicitly said that "under the new proposals, a referral to another service provider might not be the right option". This proposal would therefore leave those professionals who continue to refer in line with current Guidance open to the risk of discrimination, complaints, discipline, dismissal, and even loss of livelihood.
The Legal Issues
The GPC's proposals potentially infringe the human rights of Christian pharmacy professionals (and others with conscientious objections) as well as their rights under UK Equality Law, particularly the Equality Act 2010.
It is notable that, throughout its consultation document, the GPC prefers to use the phrase "personal values" rather than the recognised legal term "conscience" which better reflects the seriousness of religious and moral beliefs which are worthy of protection in law.
Under Article 9 of the European Convention on Human Rights, freedom of thought, conscience and religion is a protected human right. Religious freedom includes the ability to manifest one's religion, and this is not limited to acts of worship or devotion, but can include the right to conscientious objection (see Bayatan v Armenia [GC], (2012) 54 E.H.R.R. 15.). Manifestation of religious belief is subject only to such limitations as are prescribed by law and are necessary in a democratic society in the interest of public safety, for the protection of public order, health or morals, or for the protection of the rights and freedoms of others. In this respect, it is unclear why any further interference with the Article 9 right of pharmacy professionals is necessary in the interest of public safety, or for the protection of patient health, rights and freedoms given the considerable safeguards for patient care that are already in place.
In UK law, religion and belief are protected characteristics under Section 10 of the Equality Act 2010. If the GPC amends its Standards and Guidance as proposed, pharmacy professionals who refuse to provide a service on the grounds of religious belief will potentially suffer discrimination by their qualification body, and by their employer.
There may be some differences among Christian pharmacy professionals about where precisely the boundaries of conscience should be drawn, and about what is acceptable as a matter of conscience and what is not. Yet the right to conscientiously object is an important democratic freedom: it has, for instance, allowed pacifists to refuse to serve in wars and doctors to refuse to participate in abortions. It is therefore imperative that we robustly defend conscience rights for all people (Christians and non-Christians) in order that certain professions are not slowly closed off to persons of conscience from all backgrounds.
Pray: That the GPC will listen to concerns about the implications for pharmacy professionals and conclude that the proposed policy is an unnecessary interference with the rights of pharmacy professionals.
Learn more: Dr Peter Saunders, the CEO of the Christian Medical Fellowship provides an informative comment on these proposals in his article at: http://pjsaunders.blogspot.co.uk/2017/02/regulators-proposals-to-remove.html
Respond: by 7 March 2017 to the Consultation. The GPC emphasise the importance of people responding to their consultation so that they can know whether they've got this policy right. Please register your views online: http://surveys.pharmacyregulation.org/s/valuesbeliefs/
The CARE Public Policy Team have also provided a detailed briefing for those wishing to respond to the consultation exercise: https://www.care.org.uk/pharmaceutical