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Isaac S, Mirzaei A, McLachlan AJ, Chaar BB. Conscientious objection - a cross-sectional, vignette-based, mixed methods exploration of Australian pharmacists' perspectives. J Pharm Policy Pract 2024; 17:2323086. [PMID: 38572377 PMCID: PMC10989204 DOI: 10.1080/20523211.2024.2323086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Background: Conscientious objection (CO) in healthcare is a controversial topic. Some perceive CO as freedom of conscience, others believe their professional duty-of-care overrides personal-perspectives. There is a paucity of literature pertaining to pharmacists' perspectives on CO. Aim: To explore Australian pharmacists' decision-making in complex scenarios around CO and reasons for their choices. Method: A cross-sectional, qualitative questionnaire of pharmacists' perspectives on CO. Vignette-based questions were about scenarios related to medical termination, emergency contraception, IVF surrogacy for a same-sex couple and Voluntary Assisted Dying (VAD) Results: Approximately half of participants (n = 223) believed pharmacists have the right to CO and most agreed to supply prescriptions across all vignettes. However, those who chose not to supply (n = 20.9%), believed it justifiable, even at the risk of patients failing to access treatment. Strong self-reported religiosity had a statistically significant relationship with decisions not to supply for 3 of 4 vignettes. Three emergent themes included: ethical considerations, the role of the pharmacist and training and guidance. Conclusion: This exploratory study revealed perspectives of Australian pharmacists about a lack of guidance around CO in pharmacy. Findings highlighted the need for future research to investigate and develop further training and professional frameworks articulating steps to guide pharmacists around CO.
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Affiliation(s)
- Sami Isaac
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ardalan Mirzaei
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Andrew J. McLachlan
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Betty B. Chaar
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Czekajewska J, Walkowiak D, Domaradzki J. The Association Between Religion and Healthcare Professionals' Attitudes Towards the Conscience Clause. A Preliminary Study From Poland. Int J Public Health 2023; 68:1606526. [PMID: 38105906 PMCID: PMC10721677 DOI: 10.3389/ijph.2023.1606526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023] Open
Abstract
Objectives: This study was designed to determine the relationship between religion and healthcare practitioners' attitudes towards conscience clauses in Poland. Methods: We developed a survey assessing impact of religion on attitudes healthcare professionals towards the conscience clause. These questions were explored using a sample of 300 Polish healthcare professionals. Results: The results indicate that religiosity was a significant predictor of acceptance of conscience clauses. It also influenced healthcare practitioners' opinions on medical professionals that should be granted the right to conscience clauses and medical services that may be denied on moral grounds. There was also a significant relationship between healthcare practitioners' religiosity and their eagerness to use conscience clauses in a situation of moral conflict. Finally, religious healthcare practitioners were more concerned about the personal consequences of using this right in a medical environment. Conclusion: This study shows that at the same time, both religious and non-religious healthcare professionals believed that the Polish regulations regarding conscience clause are unclear and inaccurate, therefore leading to misinterpretation and abuse regulation of law.
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Affiliation(s)
- Justyna Czekajewska
- Department of Social Sciences and Humanities, Poznan University of Medical Sciences, Poznań, Poland
| | - Dariusz Walkowiak
- Department of Organization and Management in Health Care, Poznan University of Medical Sciences, Poznań, Poland
| | - Jan Domaradzki
- Department of Social Sciences and Humanities, Poznan University of Medical Sciences, Poznań, Poland
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Schaaf M, Lavelanet A, Codjia L, Nihlén Å, Rehnstrom Loi U. A narrative review of challenges related to healthcare worker rights, roles and responsibilities in the provision of sexual and reproductive services in health facilities. BMJ Glob Health 2023; 8:e012421. [PMID: 37918835 PMCID: PMC10626880 DOI: 10.1136/bmjgh-2023-012421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 10/07/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION This paper identifies and summarises tensions and challenges related to healthcare worker rights and responsibilities and describes how they affect healthcare worker roles in the provision of sexual and reproductive health (SRH) care in health facilities. METHOD The review was undertaken in a two-phase process, namely: (1) development of a list of core constructs and concepts relating to healthcare worker rights, roles and responsibilities to guide the review and (2) literature review. RESULT A total of 110 papers addressing a variety of SRH areas and geographical locations met our inclusion criteria. These papers addressed challenges to healthcare worker rights, roles and responsibilities, including conflicting laws, policies and guidelines; pressure to achieve coverage and quality; violations of the rights and professionalism of healthcare workers, undercutting their ability and motivation to fulfil their responsibilities; inadequate stewardship of the private sector; competing paradigms for decision-making-such as religious beliefs-that are inconsistent with professional responsibilities; donor conditionalities and fragmentation; and, the persistence of embedded practical norms that are at odds with healthcare worker rights and responsibilities. The tensions lead to a host of undesirable outcomes, ranging from professional frustration to the provision of a narrower range of services or of poor-quality services. CONCLUSION Social mores relating to gender and sexuality and other contested domains that relate to social norms, provider religious identity and other deeply held beliefs complicate the terrain for SRH in particular. Despite the particularities of SRH, a whole of systems response may be best suited to address embedded challenges.
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Affiliation(s)
- Marta Schaaf
- Department of Sexual and Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Antonella Lavelanet
- Department of Sexual and Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Laurence Codjia
- Department of Health Workforce, World Health Organization, Geneva, Switzerland
| | - Åsa Nihlén
- Department of Sexual and Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Ulrika Rehnstrom Loi
- Department of Sexual and Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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Harless JC, Hughes PM, Wilson C, Carpenter D, Ostrach B. Eligible Prescriber Experiences with Substance Use Disorder Treatment and Perceptions of Pharmacy Barriers to Buprenorphine. South Med J 2022; 115:584-592. [PMID: 35922043 DOI: 10.14423/smj.0000000000001433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The primary aim of this study was to better understand North Carolina providers' specific substance use disorder (SUD) and opioid use disorder treatment practices and buprenorphine prescribing. Furthermore, this study aimed to provide novel information regarding US South and rural providers' opioid use disorder treatment behaviors and perceptions of patient experience at community pharmacies. METHODS An online survey consisting of closed-ended and open-ended questions was used. Surveys were delivered to healthcare providers' e-mails and self-administered. Surveys were administered through an online survey platform. RESULTS In total, 332 healthcare providers, who were eligible to be X-waivered to prescribe buprenorphine, completed the online survey. Survey participants reported not having their X-waiver to prescribe buprenorphine or actively prescribing buprenorphine. The majority of participants were uncertain of potential barriers to filling buprenorphine prescriptions. Providers treating a mix of rural and urban patients reported being less likely to screen for SUDs. Although there were no rurality differences in SUD screening, providers who treat mostly rural patients reported a lack of SUD treatment options in their area. CONCLUSIONS Early detection of SUDs can help prevent negative health outcomes for patients. Regardless of patient rurality, providers should screen for SUDs and familiarize themselves with the patient's experience when filling a buprenorphine prescription, along with possible barriers. Furthermore, providers should incorporate questions about their patient's ability to receive buprenorphine to help ensure that patients are receiving proper and necessary treatment.
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Affiliation(s)
- J Chase Harless
- From the Department of Public Health, East Tennessee State University, Johnson City, Tennessee, the Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, the Charles George Veterans Affairs Medical Center, Asheville, North Carolina, and the Department of Medical Anthropology & Family Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Phillip M Hughes
- From the Department of Public Health, East Tennessee State University, Johnson City, Tennessee, the Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, the Charles George Veterans Affairs Medical Center, Asheville, North Carolina, and the Department of Medical Anthropology & Family Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Courtenay Wilson
- From the Department of Public Health, East Tennessee State University, Johnson City, Tennessee, the Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, the Charles George Veterans Affairs Medical Center, Asheville, North Carolina, and the Department of Medical Anthropology & Family Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Delesha Carpenter
- From the Department of Public Health, East Tennessee State University, Johnson City, Tennessee, the Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, the Charles George Veterans Affairs Medical Center, Asheville, North Carolina, and the Department of Medical Anthropology & Family Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Bayla Ostrach
- From the Department of Public Health, East Tennessee State University, Johnson City, Tennessee, the Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, the Charles George Veterans Affairs Medical Center, Asheville, North Carolina, and the Department of Medical Anthropology & Family Medicine, Boston University School of Medicine, Boston, Massachusetts
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Dalessandro C, Thorpe R, Sanders J. "For Me, It's Having Something Meaningful": Women's Emotional Understandings of Sex and the Sexual Acceptability of Contraception. JOURNAL OF SEX RESEARCH 2022; 59:445-456. [PMID: 34357808 PMCID: PMC8818050 DOI: 10.1080/00224499.2021.1958194] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
While the sexual acceptability of contraception - or, the impact of contraceptive methods on individuals' sexual experiences - is a growing area of research, less frequently do studies engage the importance of individual emotions around sex when it comes to perceptions of sexual acceptability. Building on Higgins and Smith's model of sexual acceptability and drawing upon insights from the sociology of gender, we used qualitative interview data with 30 women in Utah (USA) to explore the importance of emotional understandings of sex for women's assessments of the sexual acceptability of different contraceptives. Here we posit that emotional understandings of sex are not just individualistic - they are also structured by experiences with sexual partners and broader gendered expectations. This work adds insight into the importance of emotions in sexual acceptability and suggests the need for an amendment to Higgins and Smith's model that reflects the synergistic nature of the micro/individual, meso/interactional, and macro factors related to sexual acceptability. We conclude that assessing the sexual acceptability of contraceptives requires a nuanced multi-level interaction framework.
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Affiliation(s)
- Cristen Dalessandro
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E, 2B200, Salt Lake City, UT USA 84132
| | - Rachael Thorpe
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E, 2B200, Salt Lake City, UT USA 84132
| | - Jessica Sanders
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E, 2B200, Salt Lake City, UT USA 84132
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Community pharmacists’ provision of sexual and reproductive health services: a cross sectional study in Alberta, Canada. J Am Pharm Assoc (2003) 2022; 62:1214-1223. [DOI: 10.1016/j.japh.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 11/18/2022]
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7
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Achey TS, Robertson AT. Conscientious Objection: A Review of State Pharmacy Laws and Regulations. Hosp Pharm 2021; 57:268-272. [PMID: 35601727 PMCID: PMC9117776 DOI: 10.1177/00185787211024217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Most states have adopted conscience clauses since the Roe v. Wade paradigm in the 1970s; however, not all clauses are respective to pharmacists. The purpose of this report is to quantify the presence of conscientious objection among US states with respect to pharmacist’s right to refuse to dispense. Fifty Boards of Pharmacy administrative codes were consulted for review. If Web sites were ambiguous or undeterminable, E-mail requests were sent on active legislation per National Association of Boards of Pharmacy contact information. Eleven states have conscience clauses present in their pharmacy administrative code—nearly double than last published in 2006. Requirements vary throughout the states including drug-specific limitations, requirement in writing, or notification in advance. Some states alternatively require duty to dispense. Less than one-fourth of United States boards of pharmacy provide a conscience clause or similar intended language in laws or policies. Within those states, pharmacists have a right to refuse to perform certain services based on religious, ethical, or moral objections. Imprecise language throughout the nation allows the rights to vary widely.
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Affiliation(s)
- Thomas S. Achey
- Pharmacy Services, Princeton Baptist Medical Center, Birmingham, AL, USA
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8
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Maxwell C, McKendrick J, Hanlon C, Penson P, Fleming V. Exploring pharmacists' views surrounding conscientious objection to abortion and implications in practice. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:258-264. [PMID: 33876827 DOI: 10.1093/ijpp/riab009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 03/06/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND General Pharmaceutical Council standards (UK) state 'pharmacy professionals have the right to practise in line with their religion, personal values or beliefs as long as they …make sure that person-centred care is not compromised', indicating a potential conflict for pharmacists who wish to exercise their right to conscientious objection (CO) to abortion while maintaining a duty of care to their patients. OBJECTIVE The objective of this study was to explore pharmacists' views of conscientious objection to abortion and whether this included the supply of EC and the impact on practice. METHOD Eighteen UK pharmacists were interviewed using semistructured interviews. Interviews were transcribed verbatim, imported into NVivo11 and analysed using thematic analysis. KEY FINDINGS Five themes were identified: beliefs as to what constitutes abortion, influences on beliefs, conflicts of conscience, accommodating conscience and professional obligations. Views were polarised in relation to the role of emergency contraception (EC) as an abortifacient. Religion was often viewed as the reason underpinning CO to abortion. Conflicts in relation to CO to abortion included the role of referral and EC and employability for objectors. Some pharmacists viewed their role of providing patient choice as incompatible with the right of CO to abortion. CONCLUSIONS This study shows the conflicts and challenges surrounding CO to abortion in professional pharmacy practice. While the majority of pharmacists believe CO to abortion should and could be accommodated, this can prove challenging in certain working environments, both in relation to ensuring a duty of care to patients is upheld and due to the ongoing debate concerning EC and whether it has a definitive role in abortion or not.
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Affiliation(s)
- Clare Maxwell
- School of Nursing and Allied Health, Liverpool John Moores University, Liverpool, UK
| | - Jane McKendrick
- School of Nursing and Allied Health, Liverpool John Moores University, Liverpool, UK
| | - Claire Hanlon
- School of Nursing and Allied Health, Liverpool John Moores University, Liverpool, UK
| | - Peter Penson
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - Valerie Fleming
- School of Nursing and Allied Health, Liverpool John Moores University, Liverpool, UK
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Bonine S, Bell M, Fishler K, Berninger T, Erickson L. Conscience clauses in genetic counseling: Awareness and attitudes. J Genet Couns 2021; 30:1468-1479. [PMID: 33830600 DOI: 10.1002/jgc4.1414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 02/20/2021] [Accepted: 02/24/2021] [Indexed: 11/10/2022]
Abstract
Conscience clauses are laws that allow healthcare providers to refuse to participate in legal medical services based on moral or ethical objections. Genetic counselors encounter a variety of ethical and moral issues, including counseling about abortions. Currently, three states (Oklahoma, Nebraska, and Virginia) have genetic counseling conscience clause laws that allow genetic counselors to refuse to counsel about abortions. Conscience clause laws applying to physicians and pharmacists have been studied; however, they have not been studied in genetic counseling to date. We conducted an exploratory study assessing conscience clause awareness, attitudes, perceived obligations if utilizing a conscience clause, and alignment with the National Society of Genetic Counseling (NSGC) Code of Ethics. Genetic counselors (n = 274) currently practicing in the United States completed an online survey recruited through the NSGC listserv. The majority of participants were not aware that conscience clauses exist for genetic counseling (90%). There was uncertainty about whether genetic counselors had the right to utilize a conscience clause in practice (24% said yes, 31% said no, and 45% were unsure/needed more information). The majority reported an obligation to refer a patient if implementing a conscience clause (90%), although there were discrepancies among what constitutes an appropriate referral. When asked about the interaction between conscience clauses and the NSGC Code of Ethics, 45% believe they are separate and one does not supersede the other, 31% felt the Code of Ethics supersedes, 8% felt conscience clauses supersede, and 16% were unsure. Our study shows overall uncertainty with how conscience clause laws may be applied in clinical practice. Further clarity and education, especially in states where these laws exist, is critical to navigate the interaction between conscience clause laws and genetic counseling practice.
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Affiliation(s)
- Shea Bonine
- Augustana University, Sioux Falls, SD, USA.,Sanford Health, Sioux Falls, SD, USA
| | - Megan Bell
- Augustana University, Sioux Falls, SD, USA.,Sanford Health, Sioux Falls, SD, USA
| | | | - Taylor Berninger
- Augustana University, Sioux Falls, SD, USA.,University of California San Diego, San Diego, CA, USA
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Gülpınar G, Keleş Ş, Yalım NY. Perspectives of community pharmacists on conscientious objection to provide pharmacy services: A theory informed qualitative study. J Am Pharm Assoc (2003) 2021; 61:373-381.e1. [PMID: 33895101 DOI: 10.1016/j.japh.2021.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/25/2021] [Accepted: 03/21/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND In recent years, pharmacists have been opting out of certain pharmacy services, particularly, providing contraceptives, for moral reasons. No research has been conducted on the perceptions of community pharmacists toward conscience objection in a secular state with a mostly Muslim population. OBJECTIVE This study aimed to provide an in-depth understanding of the factors related to the beliefs of community pharmacists on conscientious objection to provide pharmacy services contrary to their personal beliefs based on the theory of planned behavior. METHODS Semistructured interviews were conducted with a purposive sampling of community pharmacists. A hybrid deductive and inductive qualitative analysis approach was used on the data that were recorded and transcribed verbatim. Constructs related to attitude, subjective norm, and perceived behavioral control were explored. RESULTS In total, 25 community pharmacists were interviewed. Factors affecting pharmacists' decision to provide pharmacy services when their personal beliefs included the desire to maintain moral integrity, beliefs about consequences for health care service, profit, patient pressure, precedence of professional values, and care for religious sources. CONCLUSION Most of the community pharmacists were against the behavior of conscientiously objecting to provide pharmacy services in Turkey because of possible negative consequences on health care. The pharmacists who were willing to act based on their personal beliefs were expecting from various third parties to fulfill certain responsibilities to facilitate to adopt the behavior. This novel study highlights the urgent need for more research and training for community pharmacists serving patients in different socioeconomic contexts in both developed and developing countries.
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Sobeski LM, Schumacher CA, Alvarez NA, Anderson KC, Bradley B, Crowe SJ, Merlo JR, Nyame A, Rivera KS, Shapiro NL, Spencer DD, Dril E. Medication access: Policy and practice opportunities for pharmacists. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Adwoa Nyame
- American College of Clinical Pharmacy Lenexa Kansas USA
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12
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Fino LB, Basheti IA, Chaar BB. Exploring Ethical Pharmacy Practice in Jordan. SCIENCE AND ENGINEERING ETHICS 2020; 26:2809-2834. [PMID: 32533448 DOI: 10.1007/s11948-020-00231-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/30/2020] [Indexed: 06/11/2023]
Abstract
Patient-centered pharmacy practice involves increased pharmacist engagement in patient care. This increased involvement can sometimes require diverse decision-making when handling various situations, ranging from simple matters to major ethical dilemmas. There is literature about pharmacy ethics in developed Western countries. However, little is known about pharmacists' practices in many developing countries. For example, there is a paucity of research conducted in the area of pharmacy ethics in Jordan. This study aimed to explore the manner in which ethical dilemmas were handled by Jordanian pharmacists, the resources used and their attitudes towards them. Semi-structured, face to face interviews were carried out with 30 Jordanian registered pharmacists. The transcribed interviews were thematically analysed for emerging themes. Four major themes were identified: legal practice; familiarity with the code of ethics; personal judgement, cultural and religious values; and Experience. Findings showed that ethical decision-making in pharmacy practice in Jordan was decisively influenced by pharmacists' personal moral values, legal requirements and managed by exercising common sense and experience. This pointed to gaps in Jordanian pharmacists' understanding and application of basic principles of pharmacy ethics and highlighted the need for professional ethics training, incorporating pharmacy ethics courses in pharmacy undergraduate curricula, as well as professional development courses. This study highlighted that paternalism, personal values and legal obligations were major drivers influencing decision-making processes of Jordanian pharmacists. Findings also highlighted an inclination towards lack of respect for patient autonomy. This illuminated the need for increasing pharmacists' literacy in professional ethics.
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Affiliation(s)
- Leen B Fino
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
- Faculty of Pharmacy, Applied Science Private University, Amman, 11931, Jordan
| | - Iman A Basheti
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
- Faculty of Pharmacy, Applied Science Private University, Amman, 11931, Jordan
| | - Betty B Chaar
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.
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13
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Jacob B, Huynh TV, White A, Nwaesei AS, Lorys R, Barker W, Hall J, Bush L, Allen WL. Pharmacy and Nursing Students' Perceptions Regarding the Role of Spirituality in Professional Education and Practice. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2020; 84:ajpe7777. [PMID: 33012792 PMCID: PMC7523665 DOI: 10.5688/ajpe7777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 03/15/2020] [Indexed: 05/10/2023]
Abstract
Objective. To compare first-year student pharmacists and nursing students with respect to their spirituality and perceptions of the role of spirituality in professional education and practice. Methods. This was a five-year, cross-sectional study. All first-year student pharmacists and nursing students were invited to participate in the survey during the first week of the fall semester in 2012 through 2016. Descriptive and inferential statistics were used to analyze the data. Results. A total of 1,084 students participated, including 735 student pharmacists and 349 nursing students. Significant differences in baseline demographics were noted between the groups. Students in both groups reported having frequent spiritual experiences. A significantly larger percentage of nursing students reported these experiences compared to student pharmacists. Furthermore, compared with student pharmacists, nursing students were more likely to anticipate that spirituality would play a role in their academic course work (76% vs 58%) and professional practice (90% vs 74%). Conclusion. Student pharmacists and nursing students reported having frequent spiritual experiences, and both groups anticipated that spirituality would be incorporated into their education and professional practice.
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Affiliation(s)
- Bobby Jacob
- Mercer University, College of Pharmacy, Atlanta, Georgia
| | - Tuong-Vi Huynh
- Mercer University, College of Pharmacy, Atlanta, Georgia
| | - Annesha White
- University of North Texas System, College of Pharmacy, Fort Worth, Texas
| | | | - Robyn Lorys
- Mercer University, College of Pharmacy, Atlanta, Georgia
| | - Wesley Barker
- Mercer University, College of Professional Advancement, Atlanta, Georgia
| | - Jeffrey Hall
- Mercer University, Tift College of Education, Atlanta, Georgia
| | - Lucy Bush
- Mercer University, Tift College of Education, Atlanta, Georgia
| | - W. Loyd Allen
- Mercer University, McAfee School of Theology, Atlanta, Georgia
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Meier S, Ball E, Jamieson KL, Sunkel SL, DeMaria AL. Translating policy to practice: theory-based formative research to improve messaging and over-the-counter access to emergency contraception in Florence, Italy. EUR J CONTRACEP REPR 2020; 25:285-292. [PMID: 32496887 DOI: 10.1080/13625187.2020.1774538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Italy's 2015 emergency contraception (EC) policy made EC available without prescription for individuals aged 18 years and older; however, women living in Italy continue to face barriers to accessing EC. The purposes of this study were to understand EC knowledge, attitudes and behaviours among women living in Italy and explore the impact of the 2015 policy. METHODS Researchers conducted 30 interviews with women living in Florence, Italy, aged 18-50 years and using the Italian health care system. Researchers used an expanded grounded theory approach to understand women's EC experiences, with diffusion of innovations (DOI) serving as a conceptual lens. Researchers completed open and axial coding to identify emerging themes. RESULTS Participants had low awareness of the 2015 EC policy and suggested increased messaging in strategic locations to overcome this barrier. They held positive and negative attitudes towards EC: while some perceived the advantage of EC compared with unintended pregnancy, others expressed concerns about irresponsible behaviour and safety. Finally, conscientious objection impacted access, despite women's desire for autonomous EC decision making. CONCLUSION The findings offer practical recommendations to guide EC messaging in Italy to increase women's access to EC. Recommendations include using theory- and audience-based methods to overcome gaps in policy knowledge and real and perceived barriers to EC access. Incorporating DOI as a theoretical framework with women's voices presents a novel opportunity to enhance policy and EC dissemination.
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Affiliation(s)
- Stephanie Meier
- Division of Consumer Science, Purdue University, West Lafayette, IN, USA
| | - Emily Ball
- College of Pharmacy, Purdue University, West Lafayette, IN, USA
| | | | - Scotlyn L Sunkel
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA
| | - Andrea L DeMaria
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
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Tak CR, Kessler LT, Scott MA, Gunning KM. Pharmacist-prescribed hormonal contraception: A review of the current landscape. J Am Pharm Assoc (2003) 2019; 59:633-641. [PMID: 31300307 DOI: 10.1016/j.japh.2019.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/12/2019] [Accepted: 05/21/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The objective of this article is to review the current supply-side, demand-side, and regulatory landscape of pharmacist-prescribed hormonal contraception (HC) in the United States. SUMMARY Pharmacists appear to be supportive of pharmacist-prescribed HC. However, support does not necessarily indicate likelihood to implement the practice, even when reimbursement mechanisms exist. The likelihood of implementation can be increased with education and training of HC prescribing. Previous investigations suggest that women broadly support accessing contraception within a pharmacy. Expanded access, where available, can improve rates of use and adherence. Women at higher risk for unintended pregnancy, such as younger women and women without health insurance, are likely to use the pharmacy to procure HC. Despite a willingness to pay for HC consultations with pharmacists, costs can remain a significant barrier for many women. CONCLUSIONS Expanding access to HC through pharmacist-prescriptive authority could help curb the rates of unintended pregnancy in the United States. Pharmacists are well positioned for such a role; however, significant barriers for pharmacists and patients remain. Examination of current implementation methods will assist policy makers in overcoming these barriers.
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Fejzic J, Barker M. Pharmacy practitioners' lived experiences of culture in multicultural Australia: From perceptions to skilled practice. PLoS One 2019; 14:e0217673. [PMID: 31216322 PMCID: PMC6584003 DOI: 10.1371/journal.pone.0217673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 05/16/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The Code of Ethics of pharmacy practitioners in Australia recognises the obligation to provide care to patients in a culturally safe and responsive manner. The aim of this exploratory study was to examine how Australian community pharmacists understand and experience the concept of 'culture' in their everyday practice environment. METHODS Voluntary, semi-structured interviews were conducted at community pharmacy placement sites in South-East Queensland, Australia. Pharmacists were asked to recall an incident that evoked their cultural awareness during the course of their practice. The question stated, verbatim: "We are preparing our students to be pharmacists in a highly multicultural community. Can you think of an incident where you learnt something about another person's culture or it made you more aware of your own culture? Please briefly describe the incident." Reportable responses were collected from 59 of the 92 visited pharmacists. These responses were audio-recorded and transcribed. The data were collated and analysed through iterative, reflexive, thematic analysis using constant comparison. RESULTS AND SIGNIFICANCE The responses provided a rich selection of lived experiences within Australian multicultural pharmacy practice, describing professional dilemmas, fears and the strategies employed to overcome practice challenges. Six main response categories were identified: (i) Language/communication challenges, (ii) Cultural attitudes and behaviours, (iii) Exposure to culture due to pharmacy location, (iv) Religion, gender, and age, (v) Prejudiced/perceived racist attitudes and discrimination towards 'other' cultures, (vi) Perceived 'sameness' of different cultures. The study has provided valuable insights into community pharmacists' experiences of culture in their day-to-day professional practice, also highlighting the associated strategies used to maintain a high standard of practice. There is merit in ensuring that the pharmacy curriculum and professional development programs are designed to respond to the ethical obligation of pharmacists to practise in a culturally safe, responsive manner that acknowledges and incorporates the importance of culture, cultural differences and intercultural relations, while addressing culturally unique needs in a skilled and professional manner.
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Affiliation(s)
- Jasmina Fejzic
- School of Pharmacy, The University of Queensland, Woolloongabba, QLD, Australia
| | - Michelle Barker
- Griffith Business School, Department of Business Strategy and Innovation, Griffith University, Gold Coast, QLD, Australia
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Czarnecki D, Anspach RR, De Vries RG, Dunn MD, Hauschildt K, Harris LH. Conscience reconsidered: The moral work of navigating participation in abortion care on labor and delivery. Soc Sci Med 2019; 232:181-189. [PMID: 31100698 DOI: 10.1016/j.socscimed.2019.03.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 02/20/2019] [Accepted: 03/21/2019] [Indexed: 11/28/2022]
Abstract
How do caregivers make decisions about participating in morally contested care, such as abortion? Debates about conscience in the delivery of health care generally assume that participation decisions stem from religious beliefs and moral values. Few studies have examined this question in the context of everyday practice. Drawing on 50 interviews with the staff of a labor and delivery unit offering abortion care-including nurses, maternal-fetal medicine specialists, obstetrics and gynecology residents, and anesthesiologists-we show that respondents have varied definitions of "participation" in abortion care and that participation decisions are driven by an array of factors beyond personal beliefs. We present a conceptual model of "moral work" that shows conscience to be an emerging, iterative process influenced not only by beliefs-religious and non-religious-but also by personal and work experiences and social and institutional contexts. Our study brings new insights into understanding conscience and participation in contested care.
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Affiliation(s)
- Danielle Czarnecki
- McGill University, Social Studies of Medicine Department, Biomedical Ethics Unit, Canada.
| | - Renee R Anspach
- University of Michigan, Ann Arbor, Department of Sociology, USA; University of Michigan, Ann Arbor, Department of Women's Studies, USA
| | - Raymond G De Vries
- University of Michigan, Ann Arbor, Department of Sociology, USA; University of Michigan, Ann Arbor, Center for Bioethics and Social Sciences in Medicine, USA; Maastricht University/CAPHRI School for Public Health and Primary Care, Netherlands; University of Michigan, Ann Arbor, Department of Obstetrics & Gynecology, USA
| | - Mercedez D Dunn
- University of Michigan, Ann Arbor, Department of Sociology, USA
| | | | - Lisa H Harris
- University of Michigan, Ann Arbor, Center for Bioethics and Social Sciences in Medicine, USA; University of Michigan, Ann Arbor, Department of Obstetrics & Gynecology, USA; University of Michigan, Ann Arbor, Department of Women's Studies, USA
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Purnell MC, Johnson MS, Jones R, Calloway EB, Hammond DA, Hall LA, Spadaro DC. Spirituality and Religiosity of Pharmacy Students. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2019; 83:6795. [PMID: 30894770 PMCID: PMC6418838 DOI: 10.5688/ajpe6795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 06/27/2018] [Indexed: 05/15/2023]
Abstract
Objective. To characterize the religiosity and spirituality of final year pharmacy students and examine the impact on performance in pharmacy school and future practice. Methods. An electronic survey was sent to 308 students in their final year of pharmacy school at four universities (two private and two public institutions). Results. There were 141 respondents to the survey for a response rate of 46%. Key findings are religiosity/spirituality did not impact academic performance, students felt supported in their spiritual/religious beliefs, religiosity/spirituality had a positive impact on students' emotional/mental well-being, attending pharmacy school decreased organized religion, less than half of the students would work for a pharmacy not allowing the "right to refuse to dispense," students felt religiosity/spirituality could affect health/medication adherence, and most students were not familiar with how to conduct a spiritual assessment. Conclusion. Pharmacy schools should find ways to acknowledge and support religiosity/spirituality for pharmacy students and for promoting holistic patient well-being.
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Affiliation(s)
- Miriam C Purnell
- University of Maryland Eastern Shore School of Pharmacy, Princess Anne, Maryland
| | - Mark S Johnson
- Bernard J. Dunn School of Pharmacy, Shenandoah University, Winchester, Virginia
| | - Ryan Jones
- Bernard J. Dunn School of Pharmacy, Shenandoah University, Winchester, Virginia
| | - Emily B Calloway
- University of Maryland Eastern Shore School of Pharmacy, Princess Anne, Maryland
| | | | - Leah A Hall
- University of Charleston School of Pharmacy, Charleston, West Virginia
| | - Daniel C Spadaro
- University of Arkansas for Medical Sciences College of Pharmacy, Little Rock, Arkansas
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de Castro F, Place JM, Allen-Leigh B, Barrientos-Gutierrez T, Dues K, Eternod Arámburu M, Hernández-Avila M. Perceptions of adolescent 'simulated clients' on barriers to seeking contraceptive services in health centers and pharmacies in Mexico. SEXUAL & REPRODUCTIVE HEALTHCARE 2018; 16:118-123. [PMID: 29804755 DOI: 10.1016/j.srhc.2018.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 02/06/2018] [Accepted: 03/13/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine adolescent simulated clients' perceived barriers to quality care as they sought information on contraceptives in public-sector healthcare facilities and pharmacies in Mexico. STUDY DESIGN We used a qualitative research design and conducted semi-structured interviews with eight young women who posed as simulated clients at health centers and pharmacies in Mexico City. Grounded Theory was used to analyze the transcripts. RESULTS Barriers to receiving information about contraceptives included healthcare professionals who gave administrative pretexts to avoid providing services. Simulated clients also felt judged by healthcare professionals and reported a lack of simple, understandable and pertinent information. Healthcare professionals did not ensure clients understood and had no further questions about using contraceptives, which resulted in clients' poor perceived self-efficacy, as well as a lack of confidence in the healthcare system to help them. CONCLUSIONS When healthcare professionals fail to provide services according to the World Health Organization's five basic criteria of adolescent friendly care, adolescents perceive important barriers in their access to contraceptive methods. Quality of sexual health care in Mexico would benefit from efforts to improve healthcare professionals' knowledge, attitudes and skills related to adolescent friendly service delivery.
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Affiliation(s)
- Filipa de Castro
- Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico; Universidad No. 655 Colonia Santa Maria Ahuacatitlan, Cerrada Los Pinos y Caminera, C.P. 62100 Cuernavaca, Morelos, Mexico
| | - Jean Marie Place
- Ball State University, Department of Nutrition and Health Science, Muncie, IN, USA; Department of Nutrition and Health Science, Cooper Science Building, CL 325, Ball State University, Muncie, IN 47306, USA.
| | - Betania Allen-Leigh
- Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico; Universidad No. 655 Colonia Santa Maria Ahuacatitlan, Cerrada Los Pinos y Caminera, C.P. 62100 Cuernavaca, Morelos, Mexico
| | - Tonatiuh Barrientos-Gutierrez
- Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico; Universidad No. 655 Colonia Santa Maria Ahuacatitlan, Cerrada Los Pinos y Caminera, C.P. 62100 Cuernavaca, Morelos, Mexico
| | - Kiya Dues
- Ball State University, Department of Nutrition and Health Science, Muncie, IN, USA; Department of Nutrition and Health Science, Cooper Science Building, CL 325, Ball State University, Muncie, IN 47306, USA
| | - Marcela Eternod Arámburu
- National Institute of Women of Mexico, Blvd. Adolfo Lopez Mateos 3325, Piso 5., San Jeronimo Lidice, Distrito Federal. CP 10200, Mexico
| | - Mauricio Hernández-Avila
- Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico; Universidad No. 655 Colonia Santa Maria Ahuacatitlan, Cerrada Los Pinos y Caminera, C.P. 62100 Cuernavaca, Morelos, Mexico
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Vuković Rodríguez J, Juričić Ž. Perceptions and attitudes of community pharmacists toward professional ethics and ethical dilemmas in the workplace. Res Social Adm Pharm 2017; 14:441-450. [PMID: 28551410 DOI: 10.1016/j.sapharm.2017.05.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/20/2017] [Accepted: 05/20/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Formal training in pharmacy ethics is relatively new in Croatia, and the professional code of ethics is more than 20 years old. Very little is known about how practicing pharmacists implement ethical considerations and relevant professional guidelines in their work. OBJECTIVES This study aimed to provide the first description of the perceptions and attitudes of Croatian community pharmacists toward ethics in pharmacy practice, how often they face certain ethical dilemmas and how they resolve them. METHODS A cross-sectional survey of 252 community pharmacists, including community pharmacists and pre-licensing trainees, was conducted in Zagreb, Croatia. This group accounts for 18% of licensed pharmacists in Croatia. The survey questions included four sections: general sociodemographic information, multiple-choice questions, pre-defined ethical scenarios, and ethical scenarios filled in by respondents. RESULTS More than half of pharmacists (62.7%) face ethical dilemmas in everyday work. Nearly all (94.4%) are familiar with the current professional code of ethics in Croatia, but only 47.6% think that the code reflects the changes that the pharmacy profession faces today. Most pharmacists (83.3%) solve ethical dilemmas on their own, while nearly the same proportion (75.4%) think that they are not adequately trained to deal with ethical dilemmas. The pre-defined ethical scenarios experienced by the largest proportion of pharmacists are being asked to dispense a drug to someone other than the patient (93.3%), an unnecessary over-the-counter medicine (84.3%), a generic medicine clinically equivalent to the prescribed one (79.4%), or hormonal contraception over the counter (70.4%). CONCLUSIONS The results demonstrate a need to improve formal pharmacy ethics education and training in how to assess ethical issues and make appropriate decisions, which implies the need for stronger collaboration between pharmacists and their professional association. Our results also highlight an urgent need to revise and update the Croatian code of ethics for pharmacists.
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Affiliation(s)
| | - Živka Juričić
- Faculty of Pharmacy and Biochemistry, University of Zagreb, A. Kovačića 1, HR-1000 Zagreb, Croatia
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Harris LF, Awoonor-Williams JK, Gerdts C, Gil Urbano L, González Vélez AC, Halpern J, Prata N, Baffoe P. Development of a Conceptual Model and Survey Instrument to Measure Conscientious Objection to Abortion Provision. PLoS One 2016; 11:e0164368. [PMID: 27736992 PMCID: PMC5063579 DOI: 10.1371/journal.pone.0164368] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 09/24/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Conscientious objection to abortion, clinicians' refusal to perform legal abortions because of their religious or moral beliefs, has been the subject of increasing debate among bioethicists, policymakers, and public health advocates in recent years. Conscientious objection policies are intended to balance reproductive rights and clinicians' beliefs. However, in practice, clinician objection can act as a barrier to abortion access-impinging on reproductive rights, and increasing unsafe abortion and related morbidity and mortality. There is little information about conscientious objection from a medical or public health perspective. A quantitative instrument is needed to assess prevalence of conscientious objection and to provide insight on its practice. This paper describes the development of a survey instrument to measure conscientious objection to abortion provision. METHODS A literature review, and in-depth formative interviews with stakeholders in Colombia were used to develop a conceptual model of conscientious objection. This model led to the development of a survey, which was piloted, and then administered, in Ghana. RESULTS The model posits three domains of conscientious objection that form the basis for the survey instrument: 1) beliefs about abortion and conscientious objection; 2) actions related to conscientious objection and abortion; and 3) self-identification as a conscientious objector. CONCLUSIONS The instrument is intended to be used to assess prevalence among clinicians trained to provide abortions, and to gain insight on how conscientious objection is practiced in a variety of settings. Its results can inform more effective and appropriate strategies to regulate conscientious objection.
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Affiliation(s)
- Laura Florence Harris
- UC Berkeley-UCSF Joint Medical Program, School of Public Health, Berkeley, CA, United States of America
| | | | - Caitlin Gerdts
- Ibis Reproductive Health, Oakland, CA, United States of America
| | | | | | - Jodi Halpern
- UC Berkeley-UCSF Joint Medical Program, School of Public Health, Berkeley, CA, United States of America
| | - Ndola Prata
- UC Berkeley-UCSF Joint Medical Program, School of Public Health, Berkeley, CA, United States of America
- Bixby Center for Population Health and Sustainability, School of Public Health, University of California, Berkeley, CA, United States of America
| | - Peter Baffoe
- Global Doctors for Choice/Ghana, Bolgatanga, Upper East Region, Ghana
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Attitudes towards conscientious objection among community pharmacists in Poland. Int J Clin Pharm 2015; 36:310-5. [PMID: 24234945 PMCID: PMC3984665 DOI: 10.1007/s11096-013-9878-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 10/30/2013] [Indexed: 12/02/2022]
Abstract
Background The European Council Resolution 1763 (2010), “The right to conscientious objection in lawful medical care”, provoked a discussion among Polish pharmacists on the necessity for granting them the right to refuse to dispense medicinal products which invoke conscientious objection. Objective To explore attitudes of Polish pharmacists towards the conscience clause. Setting Pharmacies with public e-mail addresses in various parts of Poland (Lower Silesia Province, Mazovia Province, Kuyavia-Pomerania Province, and West Pomeranian Province). Method An online survey questionnaire addressed to 1,454 pharmacies. The participants were asked 8 questions, including a question addressed only to pharmacy managers and owners. Main outcome measure Attitudes towards the right to conscientious objection for pharmacists. Results Ultimately, responses of 126 pharmacists (83 women, 43 men, average age-39 years of age) were taken into consideration. Most participants (92 %) have never refused to fill a prescription due to their beliefs; however, 15 % of participants state that if the conscience clause were legally sanctioned, they would exercise this right. Most participants (73 %) think that pharmacists should not have the right to conscientious objection. Almost half of participants who support implementation of the conscience clause would grant this right to pharmacists on a conditional basis, if the pharmacists were obliged to present other real options to the patient about obtaining a specific product. Conclusion Pharmacists are rather reluctant to the idea of implementing the conscience clause, but despite a clear majority of its opponents, there seems to be a necessity for introducing such a regulation.
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Losey CS, Hoehns JD, Schlobohm C, Witry M. Investigation of Simulated Pharmacist Decision Making Involving Prescriptions With a High Probability of Causing Patient Harm. J Pharm Technol 2014; 30:207-215. [PMID: 34860908 PMCID: PMC5990156 DOI: 10.1177/8755122514541548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
Background: Medication errors pose a significant risk to patients, resulting in morbidity, mortality, and unnecessary health care utilization. Pharmacists, using their professional judgment, have an important role as a final check for identifying and resolving these problems. Little is known, however, about pharmacist perspectives and experiences with dispensing or withholding potentially dangerous prescriptions. Objectives: To (a) evaluate the extent to which pharmacists would not dispense a likely harmful prescription which has been confirmed by the prescriber and (b) assess pharmacist attitudes and experiences with dispensing likely harmful prescriptions. Methods: An anonymous, self-administered, 25-item survey was emailed to members of a state pharmacy association and a pharmacy college alumni list. A series of static prescription vignettes (1 reasonable and 4 likely dangerous doses) were presented and asked if they would fill each prescriber-confirmed prescription. Pharmacists also were asked a series of Likert-type, open-ended, multiple choice, and demographic items regarding their professional experiences and role perceptions. Results: There were 497 usable responses. Three of the 4 dangerous prescriptions were withheld by the majority of pharmacists (sumatriptan as the exception). No demographic variable was universally associated with filling dangerous vignette prescriptions; rather, there were vignette-specific differences. The majority of pharmacists reported refusing to fill a potentially harmful prescription during their career. Conclusions: There appears to be meaningful variation in how pharmacists react when presented with likely harmful prescriptions. More research is needed to better understand this role, its determinants, and the potential effects on patient safety.
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Affiliation(s)
| | - James D. Hoehns
- University of Iowa College of Pharmacy, Iowa City, IA, USA
- Northeast Iowa Medical Education Foundation, Waterloo, IA, USA
| | - Cory Schlobohm
- University of Iowa College of Pharmacy, Iowa City, IA, USA
| | - Matthew Witry
- University of Iowa College of Pharmacy, Iowa City, IA, USA
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Lee RY, Moles R, Chaar B. Mifepristone (RU486) in Australian pharmacies: the ethical and practical challenges. Contraception 2014; 91:25-30. [PMID: 25248673 DOI: 10.1016/j.contraception.2014.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 05/27/2014] [Accepted: 08/03/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The recent legalization of mifepristone has given women in Australia a new option for termination of pregnancy. Pharmacists are well positioned to provide information and supply mifepristone for patients. However, there are ethical and legal concerns in Australia regarding the supply of mifepristone, as pharmacists may choose to conscientiously object to supplying mifepristone and are subject to differing abortion laws between states and territories in Australia. The objective of this study was to explore attitudes and knowledge of Australian pharmacists about mifepristone. STUDY DESIGN Semistructured interviews were conducted with 41 registered pharmacists working in a pharmacy or hospital in Sydney, Australia. When data saturation was achieved, audiotaped transcripts were deidentified and transcribed verbatim. Data were thematically analyzed using a framework approach for applied policy research and categorized into the following themes: contextual, diagnostic, evaluative and strategic. RESULTS Analysis of the transcripts yielded four themes: (a) pharmacists' contextual view on pregnancy termination, the role of the pharmacist and impact on the pharmacy workplace; (b) diagnostic reasons for differing views; (c) evaluation of actual and perceived pharmacy practice in relation to the supply of mifepristone and (d) strategies to improve pharmacists' services, awareness and education. CONCLUSION Australian pharmacists in this study perceived themselves to have a potentially important role as medicine experts in patient health care and safety in medical termination of pregnancy. However, there was a general lack of clinical, ethical and legal knowledge about medical termination of pregnancy and its legislation. IMPLICATIONS To ensure patient safety, well-being and autonomy, there is an imperative need for pharmacist-specific training and guidelines to be made available and open discussion to be initiated within the profession to raise awareness, in particular regarding professional accountability for full patient care.
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Affiliation(s)
| | | | - Betty Chaar
- The University of Sydney, Faculty of Pharmacy.
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Chavkin W, Leitman L, Polin K. Conscientious objection and refusal to provide reproductive healthcare: a White Paper examining prevalence, health consequences, and policy responses. Int J Gynaecol Obstet 2014; 123 Suppl 3:S41-56. [PMID: 24332234 DOI: 10.1016/s0020-7292(13)60002-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Global Doctors for Choice-a transnational network of physician advocates for reproductive health and rights-began exploring the phenomenon of conscience-based refusal of reproductive healthcare as a result of increasing reports of harms worldwide. The present White Paper examines the prevalence and impact of such refusal and reviews policy efforts to balance individual conscience, autonomy in reproductive decision making, safeguards for health, and professional medical integrity. OBJECTIVES AND SEARCH STRATEGY The White Paper draws on medical, public health, legal, ethical, and social science literature published between 1998 and 2013 in English, French, German, Italian, Portuguese, and Spanish. Estimates of prevalence are difficult to obtain, as there is no consensus about criteria for refuser status and no standardized definition of the practice, and the studies have sampling and other methodologic limitations. The White Paper reviews these data and offers logical frameworks to represent the possible health and health system consequences of conscience-based refusal to provide abortion; assisted reproductive technologies; contraception; treatment in cases of maternal health risk and inevitable pregnancy loss; and prenatal diagnosis. It concludes by categorizing legal, regulatory, and other policy responses to the practice. CONCLUSIONS Empirical evidence is essential for varied political actors as they respond with policies or regulations to the competing concerns at stake. Further research and training in diverse geopolitical settings are required. With dual commitments toward their own conscience and their obligations to patients' health and rights, providers and professional medical/public health societies must lead attempts to respond to conscience-based refusal and to safeguard reproductive health, medical integrity, and women's lives.
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Affiliation(s)
- Wendy Chavkin
- Global Doctors for Choice, New York, USA; College of Physicians and Surgeons, Columbia University, New York, USA; Mailman School of Public Health, Columbia University, New York, USA.
| | | | - Kate Polin
- Global Doctors for Choice, New York, USA
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Brown SD, Donelan K, Martins Y, Sayeed SA, Mitchell C, Buchmiller TL, Burmeister K, Ecker JL. Does professional orientation predict ethical sensitivities? Attitudes of paediatric and obstetric specialists toward fetuses, pregnant women and pregnancy termination. JOURNAL OF MEDICAL ETHICS 2014; 40:117-122. [PMID: 23572566 DOI: 10.1136/medethics-2012-101126] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND To determine (1) whether fetal care paediatric (FCP) and maternal-fetal medicine (MFM) specialists harbour differing attitudes about pregnancy termination for congenital fetal conditions, their perceived responsibilities to pregnant women and fetuses, and the fetus as a patient and (2) whether self-perceived primary responsibilities to fetuses and women and views about the fetus as a patient are associated with attitudes about clinical care. METHODS Mail survey of 434 MFM and FCP specialists (response rates 60.9% and 54.2%, respectively). RESULTS MFMs were more likely than FCPs to disagree with these statements (all p values<0.005): (1) 'the presence of a fetal abnormality is not an appropriate reason for a couple to consider pregnancy termination' (MFM : FCP-78.4% vs 63.5%); (2) 'the effects that a child born with disabilities might have on marital and family relationships is not an appropriate reason for a couple to consider pregnancy termination' (MFM : FCP-80.5% vs 70.2%); and (3) 'the cost of healthcare for the future child is not an appropriate reason for a couple to consider pregnancy termination' (MFM : FCP-73.5% vs 55.9%). 65% MFMs versus 47% FCPs disagreed that their professional responsibility is to focus primarily on fetal well-being (p<0.01). Specialists did not differ regarding the fetus as a separate patient. Responses about self-perceived responsibility to focus on fetal well-being were associated with clinical practice attitudes. CONCLUSIONS Independent of demographic and sociopolitical characteristics, FCPs and MFMs possess divergent ethical sensitivities regarding pregnancy termination, pregnant women and fetuses, which may influence clinical care.
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Affiliation(s)
- Stephen D Brown
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, , Boston, Massachusetts, USA
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Chiarello E. How organizational context affects bioethical decision-making: Pharmacists' management of gatekeeping processes in retail and hospital settings. Soc Sci Med 2013; 98:319-29. [DOI: 10.1016/j.socscimed.2012.11.041] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 11/06/2012] [Accepted: 11/07/2012] [Indexed: 10/27/2022]
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Gallagher CT, Holton A, McDonald LJ, Gallagher PJ. The fox and the grapes: an Anglo-Irish perspective on conscientious objection to the supply of emergency hormonal contraception without prescription. JOURNAL OF MEDICAL ETHICS 2013; 39:638-642. [PMID: 23365465 DOI: 10.1136/medethics-2012-100975] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Emergency hormonal contraception (EHC) has been available from pharmacies in the UK without prescription for 11 years. In the Republic of Ireland this service was made available in 2011. In both jurisdictions the respective regulators have included 'conscience clauses', which allow pharmacists to opt out of providing EHC on religious or moral grounds providing certain criteria are met. In effect, conscientious objectors must refer patients to other providers who are willing to supply these medicines. Inclusion of such clauses leads to a cycle of cognitive dissonance on behalf of both parties. Objectors convince themselves of the existence of a moral difference between supply of EHC and referral to another supplier, while the regulators must feign satisfaction that a form of regulation lacking universality will not lead to adverse consequences in the long term. We contend that whichever of these two parties truly believes in that which they purport to must act to end this unsatisfactory status quo. Either the regulators must compel all pharmacists to dispense emergency contraception to all suitable patients who request it, or a pharmacist must refuse either to supply EHC or to refer the patient to an alternative supplier and challenge any subsequent sanctions imposed by their regulator.
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Mayhew S, Osei I, Bajos N. Attitudes des professionnels de santé à l'égard de la contraception d'urgence au Ghana et au Burkina Faso. POPULATION 2013. [DOI: 10.3917/popu.1301.0123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Marcell AV, Waks AB, Rutkow L, McKenna R, Rompalo A, Hogan MT. What do we know about males and emergency contraception? A synthesis of the literature. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2012; 44:184-193. [PMID: 22958663 DOI: 10.1363/4418412] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
CONTEXT Unintended pregnancy rates are high in the United States. It is important to know whether improving males' access to emergency contraceptive pills may help prevent unintended pregnancy, especially in cases of -condom failure. METHODS A search of the PubMed, PsycINFO and Cumulative Index of Nursing and Allied Health Literature databases was conducted to identify studies published from January 1980 to April 2011 concerning males and emergency contraception. Forty-three studies met the specified criteria and examined relevant knowledge, attitudes, beliefs, intentions or behaviors, from the perspectives of males, clinicians or pharmacists. RESULTS The proportion of males who were familiar with emergency contraception ranged from 38% among teenagers to 65-100% among adults. Small proportions reported that they and their partner had used or discussed using emergency contraceptive pills (13-30%) or that they themselves had ever purchased them (11%). Most providers (77-85%) reported general knowledge about emergency contraceptives, but the proportions who knew the time frame within which the pills can be prescribed were smaller (28-63%). Most males approved of emergency contraceptive use following contraceptive failure (74-82%) or unprotected sex (59-65%), or in cases of rape (85-91%), but both pharmacists and college students reported concerns that females might feel pressured to use the method. No study examined clinicians' attitudes and behaviors (e.g., counseling or advance provision) regarding males and emergency contraception. CONCLUSIONS Studies are needed to determine whether male involvement in emergency contraception can reduce rates of unintended pregnancy and to assess health professionals' ability to counsel males about the method.
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Affiliation(s)
- Arik V Marcell
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Davis S, Schrader V, Belcheir MJ. Influencers of ethical beliefs and the impact on moral distress and conscientious objection. Nurs Ethics 2012; 19:738-49. [DOI: 10.1177/0969733011423409] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Considering a growing nurse shortage and the need for qualified nurses to handle increasingly complex patient care situations, how ethical beliefs are influenced and the consequences that can occur when moral conflicts of right and wrong arise need to be explored. The aim of this study was to explore influencers identified by nurses as having the most impact on the development of their ethical beliefs and whether these influencers might impact levels of moral distress and the potential for conscientious objection. Nurses whose ethical beliefs were most influenced by their religious beliefs scored higher in levels of moral distress and demonstrated greater differences in areas of conscientious objection than did nurses who developed their ethical beliefs from influencers such as family values, life and work experience, political views or the professional code of ethics.
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Du Mont J, Macdonald S, Myhr T, Loutfy MR. Sustainability of an HIV PEP Program for Sexual Assault Survivors: "Lessons Learned" from Health Care Providers. Open AIDS J 2011; 5:102-12. [PMID: 22216082 PMCID: PMC3249643 DOI: 10.2174/1874613601105010102] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 06/29/2011] [Accepted: 08/02/2011] [Indexed: 11/22/2022] Open
Abstract
This study explored challenges to continuing an HIV post-exposure prophylaxis (PEP) program of care provided to sexual assault survivors in the province of Ontario, Canada. Data were collected as part of an implementation and evaluation of a universal offering of HIV PEP (known as the HIV PEP Program) at 24 of 34 provincial hospital-based sexual assault treatment centres. Experienced health care providers were surveyed (n = 132) and interviewed in four focus groups (n = 26) about their perceptions of what, if any, factors threatened their ability to maintain the HIV PEP Program. All focus groups were audio-recorded and the recordings transcribed. The transcriptions and open-ended survey responses were analyzed using content analysis. Administrator, nurse, physician, social worker, and pharmacist respondents perceived important barriers to sustainability of the HIV PEP Program. Eight constructs were identified within four broad themes: resources (inadequate funds, overworked and unacknowledged staff), expertise (insufficient external supports, insufficiently trained and knowledgeable staff), commitment (lack of institutional support, physician resistance to offering HIV PEP), and accommodation (lack of flexibility in addressing specific client and community needs, inaccessibility and lack of clarity of tools). We discuss the implications of these findings and the actions that were taken to address the challenges.
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Affiliation(s)
- Janice Du Mont
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sheila Macdonald
- Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, Ontario, Canada
- Faculty of Nursing Science, University of Toronto, Toronto, Ontario, Canada
| | - Terri Myhr
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Mona R Loutfy
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Chin KL. Sexual/reproductive health and the pharmacist: what is known and what is needed? JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2011. [DOI: 10.1111/j.1759-8893.2011.00050.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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