A scoping review of conscientious objection in pharmacy practice

Conscientious objection (CO), the refusal to participate in activities conflicting with one's ethical, religious, or moral beliefs, can present challenges in aligning personal values with professional obligations, particularly in delivering patient-centred care. There is a paucity of information on pharmacists and CO. This scoping review aimed to explore and map published current literature investigating pharmacists' views on CO, including the types of services involved, prevailing attitudes, and influencing factors towards decision-making.

A comprehensive search was conducted across five databases (MEDLINE, EMBASE, APA PsycINFO, SCOPUS, and International Pharmaceutical Abstracts) to identify primary literature from the past 20 years that reported pharmacists' views on CO.

A total of 18 articles corresponding to 16 distinct studies were included. These comprised quantitative surveys and qualitative interview studies, and one modified Delphi study. Pharmacists commonly objected to the provision of hormonal contraception and supply of abortifacient medications based on several reasons, including perceived professional obligations, religious influences, work environment, and perception of autonomy. Decision-making also hinged on the type of service and the anticipated emotional distress, burden, or clinical consequences for patients. Pharmacists also expressed concerns about ensuring continuity of care.

Practising pharmacists navigate CO by balancing personal beliefs with professional responsibilities, which are influenced by intrapersonal and environmental factors. Referral can accommodate CO and help ensure continuity of care, but robust legal and ethical frameworks are essential. Strengthening these frameworks and conducting profession-specific research are critical to informing policy and continuity of care.