Thursday, 13 December 2018
Health (Regulation of Termination of Pregnancy) Bill 2018: Report and Final Stages
I wish to touch on some of the points made on Committee Stage. This amendment relates to the role of the pharmacist, in particular. I understand the Irish Pharmacy Union has written to the Minister on the issue and is awaiting a response. I have noted that the Minister's thinking seems to be along the lines that the code of conduct for pharmacists covers this issue. I know that on Committee Stage Senator Reilly referred to the code as providing for a conscientious objection, but that is not the case. I have since been contacted by pharmacists and their representative bodies to clarify a number of points and raise their valid concerns on the issue of conscientious objection.
The first point is that the current code which is the equivalent of the 2009 set of guidelines of the Pharmaceutical Society of Ireland does not reference conscientious objection and/or freedom of conscience, religion or belief. The second point is that the new draft code which was available during the summer for public comment does not reference conscientious objection and/or freedom of conscience, religion or belief. I have with me a copy of the draft code. Pharmacists believe there is no explicit reference to their right to conscientious objection in either the 2009 code of conduct or the new draft code of conduct. Of course, the main issue for pharmacists who have a conscientious objection to the Bill, irrespective of whether it will or will not be mentioned in the code of conduct, is that the matter has not been addressed. Following public consultation during the summer, the 2018 draft code of conduct was published.
It reads: "Always put the patient first and make their health, wellbeing and safety your primary focus". I agree fully with and support such a requirement.
The draft code continues:
Make sure patients' needs are recognised, assessed, responded to and that their dignity is preserved and values respected. Decision making must be evidence based. Apply your knowledge and skills to ensure the patient receives safe and effective care. Recognise that your decisions and behaviour can influence patient care even if you do not work in direct contact with the patient.
The main principle refers to communication and appears to shift in the 2018 draft code is as follows:
Communicate effectively so that patients receive safe and appropriate care. Build successful working relationships with patients, colleagues and other healthcare professionals in order to deliver person-centred care. Ask relevant questions, listen carefully and respect confidentiality. Welcome questions from patients and respond to them.
Pharmacists who have concerns emphasise the shift in care to encourage adapting treatment to suit a person's individual needs. In their view, it blurs the line of who bears final decision-making responsibility for offering or denying a treatment. By way of example, I will outline one of the concerns of pharmacists. Codeine is safe in certain circumstances and a patient may want to take it to treat a cold. However, a professional will tell him or her that it is not appropriate and will refuse to supply it.
The pharmacists outlined additional concerns about the 2018 draft code, which reads:
Work in partnership with patients and members of all healthcare disciplines in order to ensure that the patient receives safe and effective care. Collaborate with your colleagues and other healthcare professionals.
In order to satisfy this principle, you: 1. Must enable patients to make their own choices about their healthcare and wellbeing by involving them and supporting them in decision making ...
5. Must refer patients to an alternative provider if you cannot provide a professional service or medicinal product so that patient care is not jeopardized or compromised.
6. Must work cooperatively with your colleagues and other healthcare professionals and you should respect their skills, expertise and contribution to patient care.
That is a major concern for pharmacists and to completely rewrite the 2009 code of conduct. The new draft code of conduct seems to have been completely rewritten in order to bring this legislation into consideration.
The pharmacists noted that in healthcare the patient was referred to when the practitioner was unable to provide what they considered to be the necessary or appropriate diagnosis of treatment. Where the practitioner does not think a treatment is appropriate, he or she does not refer, which is normal practice. Clearly the new section that has been inserted into the draft code of conduct is all about forcing practitioners to act against their own professional and conscientious judgment and the issue of termination of pregnancy is reinforced. It appears that the draft code is in line with the Minister's thinking as it almost forces pharmacists to act without having the fallback position of conscientious objection. There is nothing in the new code of conduct to protect pharmacists with a conscientious objection. The Irish Pharmacy Union has raised this matter, about which it has written to the Minister, but as of today before coming into the Chamber it has not received an assurance. That leaves them in a very difficult position because they are being forced against their conscience and will to do something in which they explicitly do not want to be engaged.
Our amendments revolve around conscientious objection. I refer, in particular, to amendment No. 28. Amendments Nos. 29 to 31, inclusive, also deal with pharmacists. Amendment No. 32 deals with medical practitioners and doctors who have a conscientious objection. They have been unfairly categorised for having a conscientious objection to the legislation. That is very unfair on medical practitioners throughout the country who genuinely conscientiously object to it. There is a medical doctor seated in the Visitors Gallery who has a conscientious objection to it. It would be very wrong if such persons were forced to undertake something about which they have strong views. Our amendments are merely about respecting their religious and moral beliefs and professional judgment.
In addition, some of our amendments cover student doctors, but I suspect they have been ruled out of order. However, on Committee Stage we talked about student doctors, nurses and midwives and I know that the Minister gave an undertaking to Deputy Donnelly when he raised some of these concerns in the other House. The Minister agreed with him on student midwives and nurses.