Every so often, scandalised reports of patients claiming their pharmacist has refused to dispense certain medication on moral grounds hit the press.
Stories like these inevitably reignite the debate about a pharmacist's ethical convictions versus their professional obligations. So what legal issues do situations like this raise?
The terms of service that NHS pharmacies operate under include an obligation to provide prescribed medication with reasonable promptness. There are circumstances where a supply by a pharmacist can be refused but these do not include issues of conscience.
The main question is about a pharmacist's individual responsibilities. This was much debated before the release of the General Pharmaceutical Council's (GPhC) revised guidance in 2017 but in recent years has appeared to be settled.
There is a balancing exercise between the rights of the pharmacist as an individual with their own values and beliefs, all of which are protected by human rights and equality legislation, against the rights of the patient, which are also protected by law.
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The GPhC's position on this has been clear since it published its guidance: pharmacists have an ethical duty to provide person-centred care and make the care of the person their first priority.
The refusal by a pharmacist to provide a service on moral or religious grounds can run contrary to this obligation.
The GPhC guidance says a pharmacist should “recognise their own values and beliefs”.
It adds that they “should not impose them on other people” and “take responsibility for ensuring that person-centred care is not compromised because of personal values and beliefs”.
A patient in these circumstances should be treated sensitively and the guidance makes it clear that it is the pharmacist’s responsibility to ensure care is not compromised.
But what happens if, for example, a patient looking for contraceptive medication is under the age of consent? Can a pharmacist refuse to supply?
Most pharmacists will be familiar with the Gillick case from 1983, when it was ruled that: “A girl under 16 of sufficient understanding and intelligence may have the legal capacity to give valid consent to contraceptive advice and treatment”.
A pharmacist has a professional obligation to ensure that consent is validly given.
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There are differences across the UK jurisdictions but, generally, those under 16 are not presumed to have the capacity to consent but must demonstrate their competence in terms of maturity and understanding.
The person with parental responsibility could give consent if the pharmacist feels the child does not have capacity.
Cases such as these have been considered previously by fitness-to-practise committees.
Any pharmacist who is referred for investigation and whose case continues can expect a proportionate outcome. However, a key factor in referral to a committee and any ultimate sanction is the wider public interest.
In one case, while refusing to supply emergency hormonal contraception (EHC), a pharmacist was reported to have told a patient that she was ending a life and he did not direct the patient to another pharmacy or provide other options.
Conditions were imposed on his registration. These included a ban on providing EHC in future, refraining from providing advice to patients based on his personal beliefs and notifying employers and prospective employers that the allegations had been proven.
Cases like these go to show that, far from being settled, issues of religion, belief and personal values will continue to be an area that needs careful consideration.
This is a general overview. Independent legal advice should be sought for any specific concerns.
Susan Hunneyball is a solicitor at Gordons Partnership LLP
