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French pharmacists wrangle over ‘conscience’ clause in drafting ethics code

Kenzo Tribouillard, AFP | A photo taken on August 10, 2015 shows the green cross logo of a pharmacy in Paris.

France’s national pharmacists association on Thursday backtracked on a proposed refusal clause after critics – including government ministers – warned the measure could be exploited to deny women birth control.

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A measure that would have allowed French pharmacists to “refuse to perform a pharmaceutical act liable of endangering human life” has been dropped after exposing ideological divisions within the profession and drawing stern words from France’s minister for women’s rights.

Last week the country’s National Order of Pharmacists asked members to vote in favour or against the text as the group drafts a new ethics code, which must be submitted for approval to France’s Health Ministry in September.

French pharmacists have been considering adding a refusal clause, sometimes called a conscience clause, to their own internal ethics code. Unlike doctors, nurses and other medical professionals in the country, pharmacists do not enjoy such a privilege.

Summer is usually a quiet time in France as workers go on notoriously long holidays, but the online ballot sparked immediate uproar.

A group of pharmacists launched a petition demanding that the ballot be taken offline and that the conscience clause be withdrawn from the draft ethics code. The petition gained more than 10,000 signatures within three days, with France’s Socialist government soon storming into the controversy.

“This petition, if carried out to its end, would open the door for pharmacists to refuse the day-after pill, birth control pills, intrauterine devices and even condoms,” Women’s Rights Minister Laurence Rossignol said in a strongly worded statement on Tuesday.

Citing the “misunderstandings” and even “politicisation” of the debate, the pharmacists group announced on Thursday it was ending the online ballot and abandoning the conscience clause as it is currently worded, but the debate appears to be far from over.

‘Vague language’

Among those who launched the petition against the conscious clause is the Paris-based pharmacist @HygieSuperBowl, who wished to be identified only by his Twitter handle.

He said some pharmacists in France already deny birth control to patients citing religious beliefs and, while they represent a minority voice, have long sought a conscience clause to protect them.

Indeed, a pharmacist near the southwest city of Bordeaux made headlines in March after it was revealed he had denied intrauterine devices and morning-after pills to women with doctor prescriptions. That is illegal in France, and the man was suspended for one week by the National Order of Pharmacists.

@HygieSuperBowl said he and like-minded colleagues were “horrified” at the “vague” language in the conscious clause proposed by the Order. “‘Endanger human life’ are the exact words that anti-abortion groups push around all the time,” he told FRANCE 24.

“We understood immediately that this language is a signal that will encourage pharmacists who deny abortion medication and birth control to patients,” he said. “Our job is not to complicate a patient’s life. Our personal conviction should never interfere in the process.”

The pharmacists group denied this week that the text was intended to shield birth control objectors, but rather to enrich the prickly euthanasia debate. It’s a claim @HygieSuperBowl found hard to believe.

“Perhaps that was the Order’s intent, but in that case why didn’t they come out and say it? In all the draft texts that have been submitted for our review ‘end of life’ has never appeared, and the words ‘endanger human life’ go way beyond that,” he said.

From Malta to Canada

The Parisian pharmacist said that the refusal clause could lead to other worrying situations, such as denying syringes to methadone users based on personal whims. He believes the existing ethics code – which allows French pharmacists to reject prescriptions when they think they will do more harm than good – is enough.

Other countries have also struggled with the issue.

Canadian women were reportedly denied morning-after pills last year because pharmacists considered them to be overweight. Two contested studies say the treatment, sold over-the-counter in Canada, is largely ineffective in heavier women.

More recently, the Malta Chamber of Pharmacists directed its members to decide for themselves whether or not to dispense the morning-after pill.

And last month, the Supreme Court of the United States rejected a case brought by Washington State pharmacists citing religion in refusing to fill prescriptions for emergency contraception.

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