Conscience clause for pharmacists

A draft reform for the pharmacists’ code of ethics has generated an unexpected controversy in the past few days on whether a conscience clause is necessary in their ethical code.

This reform is currently being implemented by the National Council for the Order of Pharmacists. The code of ethics, applicable for all pharmacists, lists the general obligations and prohibitions for the profession, as well as specific provisions by profession. The first code of ethics for pharmacists dates from 1953. It was modified in 1995. This set of professional rules and obligations is prepared by the National Council for the Order of Pharmacists in accordance with article L. 4235-1 of the Public Health Code law. It helps maintain the security of professional acts for the patient’s interest, and constitutes a foundation of trust for the public. For the Council’s president, Isabelle Adenot, the ethics code is the “most precious federating heritage, strength when the pharmacist has doubts or uncertainties.” At the end of 2015, the Order of Pharmacists deemed that “faced with changes in the profession and in society, it has become necessary to proceed with modifications” of this text.

In the official process, it is up to the Oder to prepare a reform for the new code of ethics, which would then be validated by the Government then issued under the form of a decree by the Council of State, according the advisory opinion of the Competition Authority. The provisions of this code are then introduced in the Public Health Code (articles R4235-1 + seq).

To write this new draft code, in December 2015,the Order launched an on-line survey to consult approximately 75,000 pharmacists on their list.

This consultation elucidated many requests from pharmacists, including that of instituting a conscious clause. Another working group was created in parallel to consult students, interns, and organizations which represent the pharmacy profession.

The results of this dialogue revealed that 85% of the 3395 pharmacists responding to the survey wished to have a conscience clause instituted for the benefit of the pharmacist. This large majority was seen no matter the age interviewed or the affiliated sector (salaried incumbent or assistant, in metropolitan France or French overseas departments, in distribution, industry, biology or health centers).

Following this consultation and the work carried out by the Order, a “Draft Reform for the new ethics code and other provisions to insert in the public health code” was written. The Council deliberated on July 4, 2016, adopting it entirely with the exception to the article concerning the conscience clause, since they were not able to obtain the needed majority.

The first version for the article on the cause of conscience states: “Without prejudice to patients’ rights to access or continuity of health care, the pharmacist can refuse to carry out a pharmaceutical act liable to endanger human life. He must thus inform the patient, and do everything possible to assure that the patient will be taken care of in a timely manner by another pharmacist. Otherwise, the pharmacist shall be required to perform the pharmaceutical act”.  

On July 12, all pharmacists received a letter from the Order inviting them to decide in favor or against this article, via the Order’s extranet website.

This initiative received criticisms very quickly on the social media networks, and a petition addressed to the president of the National Council for the Order titled “We refuse the conscience clause for pharmacists” was launched. This petition emanates from a “Collective group of pharmacists against the conscience clause” created for the event that have no internet site, no spokesman, and the members present themselves are “twitter signers”, the majority of whom are anonymous or use pseudonyms.

On July 19, the Minister for Women’s Rights, Laurence Rossignol, published a press release, in which she expresses astonishment at the consultation launched by the Order of Pharmacists, and asserts in a surprising manner that if “put into effect, it would clearly open the possibility that pharmacists could refuse to deliver emergency contraception (day-after pill), birth-control pills, IUD’s, or even condoms”.

In reply to the minister, the president of the National Council for the Order of Pharmacists recalled the same day that “the debates which took place within the Order regarding this legal article were never focused on contraception but on the end of life, a situation which is often very sensitive to manage by city and hospital pharmacists.”

She specifies that “these non-documented comments by the Minister are appalling at this level of State responsibility and they create a climate of completely detrimental misinformation for patients and for the public”.

For further information:

Press Release from Alliance VITA on July 21st

Our expert notice: Recognized Conscience Clauses in France