Issue link: https://maltatoday.uberflip.com/i/699546
maltatoday, SUNDAY, 3 JULY 2016 17 JEANELLE MIFSUD PHARMACISTS could be free to abstain from selling the morning- after pill on grounds of religious conscience, but ultimately the State is obliged to provide a legal alternative. Amid controversy prompted by a judicial protest filed by the Women's Rights Foundation and 102 women demanding the li- censing of the MAP, the Cham- ber of Pharmacists has directed members to decide for themselves whether to dispense the emergen- cy contraceptive or not. Supporters of the MAP – which include political parties, women's organisations and youth groups – are insisting that the pill is not abortive because it works by de- laying ovulation, thereby avoiding pregnancy. Several health profes- sionals have explained the MAP is classed as a hormonal contracep- tive. But the scientific community has been the least vocal on the MAP in a country that retains a general aversion towards anything that is potentially akin to 'abortion' in common parlance. The Chamber of Pharmacists' 'conchie' directive only seems to further the percep- tion that the MAP can be justifi- ably withheld in a country that retails condoms even inside su- permarkets. Pichon-Sajous The classic case on conscien- tious objection in reproductive health is that of Bruno Pichon and Marie-Line Sajous, who owned a Bordeaux pharmacy and refused to sell contraceptives prescribed by doctors because they claimed it was against their religious beliefs. The pharmacists claimed they were abiding by French law that prohibits the sale of substances that facilitate abortion. The three women who were re- fused their prescriptions filed a complaint, and the Bordeaux Po- lice Court decided that the law only concerned "abortifacients" and that "ethical or religious prin- ciples are not legitimate grounds to refuse to sell a contraceptive. There is no legislation which au- thorises pharmacists to refuse to supply contraceptives …". In 2001, the two owners took the French state to the European Court of Human Rights after their final appeal was dismissed by the Court of Cassation. Pichon and Sajous claimed their freedom to manifest their religious beliefs had been violated by the French state when it convicted them for refusing to sell the contraceptives. The ECHR declared the case in- admissible, saying that Article 9 – which protects freedom of con- science and its expressions – does not always guarantee the right to practise this in public. The court said that given that contraceptives were legal and sold only with a prescription and only in pharma- cies, pharmacy owners could not prioritise their beliefs over their professional obligations. The question put to pharmacists is whether they believed that the Chamber had been fair in saying that they were right in refusing to dispense the morning-after pill, even if it is licensed for sale by the medicines authority. And the answers have proved to vary drastically. A pharmacist from Remedies Pharmacy, who did not wish to be named was unsure about her role in such a decision. "I don't agree with the morning-after pill at all… [however] it's difficult to say no. One needs to look at the misuse of the product." Others seemed to indicate that each pharmacist should get to decide for themselves whether to sell the morning-after pill or not. "It is really down to the pharma- cist's personal values," Vanessa Sultana, from Gozo Chemist Pharmacy, said. But one pharmacist told Malta- Today that it was her professional obligation to provide what doc- tors prescribe, and that ultimately the decision is not that of the pharmacist. "The whole issue is one based on ethics. It's not something I, as a pharmacist, can decide. It's a decision to be taken between the woman and her gynaecologist," the pharmacist from Ghaxaq's Beta Pharmacy, who also wished to stay anonymous, said. Another pharmacist from St Julian's Pharmacy who also wished to remain unnamed, on the other hand, said she agreed with the morning-after pill, but that she supported her colleagues who would object to selling it on grounds of conscience. "It is their right, as stated in the code of ethics, as long as they refer the patient to someone who will dispense it." Pharmacists cannot be pressured Indeed it would seem that this is the prevalent spirit as laid down in a Council of Europe resolution on conscientious objection, which al- though non-binding, is politically significant. It establishes that no person, hospital, or institution can be pressured, held responsible or dis- criminated against for refusing to perform, accommodate, or assist in certain treatment or the distri- bution of certain products. But the same resolution empha- sises the state's responsibility to ensure that patients can access medical care in a timely manner. In itself this echoes the more definite wording of a general rec- ommendation from the Commit- tee on the Elimination of Discrim- ination against Women (CEDAW committee) which established that it is "discriminatory for a state party to refuse to provide le- gally for the performance of cer- tain reproductive health services for women… If health service providers refuse to perform such services based on conscientious objection, measures should be introduced to ensure that women are referred to alternative health providers." Critics of conscientious objec- tion in reproductive healthcare are more zealous on the conse- quences of withholding the emer- gency contraceptive pill. But even an 'extreme' opinion such as that of an abortion doctor, seems to make its own rational case against objectors. Dr Chris- tian Fiala, of the Gynmed Ambu- latorium, says that since women are the vast majority of patients in reproductive healthcare, consci- entious objection rises to the level of gender discrimination. "It is a refusal to treat that should be seen as unprofes- sional. A just society and an evidence-based medical system should deem it as 'dishonour- able disobedience', an ethical breach that should be handled in the same way as any other professional negligence or mal- practice." News Conscientious objectors or dishonourable disobedience? Would it be lawful for pharmacists not to dispense an otherwise legal and licensed morning-after pill? Ultimately it should always be the state that must provide women with the emergency contraceptive "It is pharamcists' right, as stated in the code of ethics, as long as they refer the patient to someone who will dispense it."