Why Canadian pharmacists are celebrating an updated code of ethics

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After 17 years of championing the freedoms of British Columbia pharmacists, Cristina Alarcon is celebrating a victory.

The code of ethics of the College of Pharmacists of British Columbia was finally updated, so Alarcon said she and her peers are finally free to act according to their consciences.

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"The reason we have freedom of conscience is not just to protect ourselves," Alarcon told The B.C. Catholic, newspaper of the Archdiocese of Vancouver. "It is to protect the public. If you cannot tell a patient what your concerns are about a certain product, how is that protecting the public?"Alarcon began speaking up for the conscience rights of her peers in 2000.

One year earlier, the morning-after pill had been re-branded and promoted as a good thing for women and pharmacists. Alarcon, who does not dispense birth control for reasons of conscience, wanted the public to know not every pharmacist was thrilled with the product.

Around the same time, she re-read the provincial pharmacists' code of ethics.

"I realized I couldn't work according to this code of ethics because it's telling me that if no one is available to dispense a product, I have a moral objection to, I must dispense it," she said.

Alarcon decided something needed to be done so pharmacists with moral objections to certain drugs would not be forced to dispense them.

She started attending the College of Pharmacists' annual general meetings. For seven years, she brought forward suggestions to amend the code of ethics to guarantee freedom of religion and conscience. Every year, the proposals were shot down.

She wrote letters to the editors of local newspapers, sent out press releases, and got interviews with national media.

"No freedom of conscience means little protection for the public," she explained. "It certainly is not protecting women not to tell them all the possible side effects of a certain product" like the morning-after pill.

"This was one of my concerns: no studies. Absolutely no oversight at all as to what effects this overdose of birth control pills has on women's health, on their future fertility, and on their future offspring," Alarcon said.

She teamed up with like-minded pharmacists and formed Concerned Pharmacists for Conscience. Team members sent out press releases sharing their views on various ethical issues.

At times, Alarcon said the media misquoted her or portrayed her as a "hooligan pharmacist who was totally practicing contrary to her code of ethics."

She also published articles in pharmacy journals and wrote a blog for the Canadian Health Care Network.

"This gave me the ability to influence public opinion" and "find out how pharmacists feel."

In 2005, Alarcon flew to her home country of Spain and pursued a master's degree in bioethics. She said most of her peers were also health care professionals.

When she returned to Vancouver in 2008, she went with a lawyer to her college's ethics advisory committee to discuss conscience rights. The pair explained the danger of keeping the current code of ethics if assisted suicide became legal.

"It made people think. Some of them said: 'No, I would not dispense euthanasia drugs!'" The presentation went well, but not far enough. So, Alarcon took a break from one-issue activism.

She made connections with pharmacists who disagreed with her on ethics, but it turned out, had much in common with her when it came to running a business. Together, they discussed professionalism, regulations, and fair treatment of staff.

In June 2016, the ethics advisory committee's chairman stepped down and Alarcon, after five years on that team, was asked to chair the next meeting.

She did, and used the opportunity to bring up the code of ethics in light of the recent legalization of assisted suicide.

"The college realized that the code of ethics would not work with the new situation. They realized you can't force someone to kill."

And so, the code was changed.

Alarcon said she is aware that other health care professionals are not as fortunate. The College of Physicians and Surgeons of Ontario, for example, is behind a push to force doctors who disagree with abortion and assisted suicide to either perform them or refer the patient to someone who will.

Even some B.C. pharmacists are not aware of their rights yet, said Alarcon. "There's still a lot of educating to do."

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Krawczynski is reporter for The B.C. Catholic.

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