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Letter to the Editor International Journal of
Pharmacy Practice International Journal of Pharmacy Practice 2015, 23, pp. 92
The health professionals’ right to refuse: is it good, bad or ugly? Keivan Ahmadia,b, Syed S. Hasanb,c and Keihan Ahmadid a Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Selangor, bDepartment of Pharmacy Practice, School of Pharmacy, International Medical University (IMU), Kuala Lumpur, Malaysia, cSchool of Pharmacy, The University of Queensland, Brisbane, Qld, Australia and d
Faculty of Dentistry, Isfahan University of Medical Sciences and Health Services (IUMS), Isfahan, Iran
doi: 10.1111/ijpp.12121
The literature is replete with cases in which the health professionals have refused to provide care to their patients; where in some cases such professionals have received disciplinary actions against them for not fulfilling their professional duties.[1–4] However, the health professionals should have the right to refuse to provide care to their patients, for whatsoever reason, without being disparaged or disqualified. A health professional who fails to balance between personal partiality and professional impartiality, upon being compelled to provide care, might provide care with the quality, one could argue, that might not be the high-quality patient care. Our attention needs to be redirected to the basics of professionalism and its institutionalization within self,[5–7] where the pinnacle of professionalism ensues from the interest in provision of service to the patient, while ruminating about one’s own personal preferences.[6] The personal and the professional preferences are under constant change. For example, the professional preferences could be changed under the direct or indirect influence of the profession, professional bodies or the peers.[8,9] Professions favor some traits of professionalism such as tactic knowledge, certain routines and adaptabilities over the other because of
References 1. Lynch HF. Discrimination at the doctor’s office. N Engl J Med 2013; 368: 1668–1670. doi: 10.1056/ NEJMp1211375. 2. Nazir M et al. The provision of dental treatment for HIV positive patients in Manchester. Int J Health Promot Educ 2005; 43: 11–16. doi: 10.1080/ 14635240.2005.10708029. 3. Daily Mail. Dentists refuse NHS patients. Mail Online. http://www .dailymail.co.uk/news/article-75576/ Dentists-refuse-NHS-patients.html (accessed 2 October 2013). 4. Victory J. Pharmacists suspended for refusing to dispense “Morning-After © 2015 Royal Pharmaceutical Society
5.
6.
7.
8.
the economic profitability.[9] As a result of this, a sense of selectivity is imposed on the health professionals to render those favored services to their clients. Moreover, a health professional may make a decision that is influenced by the actions of a reputable peer, as the decisions made by the professionals are neither routinized nor predictable.[9] From a global view, a (wrong) decision making and its enactment by a health professional could be multidimensional and could be linked with (1) the profession; (2) the peers; (3) the clients; (4) the training; and (5) the health professional’s own morals.[10] Henceforth, if any action has to be taken to reinstitute professionalism, it should be multidimensional and should reasonably address all of the abovementioned contributing factors.
Declaration Conflict of interest The Author(s) declare(s) that they have no conflicts of interest to disclose.
Pill. ABC News 2005; 368: 1668–1670. http://abcnews.go.com/Health/story? id=1391310 (accessed 10 April 2014). Hafferty FW. Professionalism – the next wave. N Engl J Med 2006; 355: 2151–2152. doi: 10.1056/NEJMe 068217. Stern DT, Papadakis M. The developing physician – becoming a professional. N Engl J Med 2006; 355: 1794–1799. doi: 10.1056/NEJMra054783. Elvey R et al. Who do you think you are? Pharmacists’ perceptions of their professional identity. Int J Pharm Pract 2013; 21: 322–332. doi: 10.1111/ ijpp.12019. Gallagher CT et al. The fox and the grapes: an Anglo-Irish perspective on
conscientious objection to the supply of emergency hormonal contraception without prescription. J Med Ethics 2013; 39: 638–642. doi: 10.1136/ medethics-2012-100975. 9. Savage DA. The Professions in Theory and History: the Case of Pharmacy. Williamsburg: EconWPA, 1994. http:// ideas.repec.org/p/wpa/wuwpio/9406 001.html (accessed 17 June 2013). 10. Asher SL. Conflicts between patient requests and physician obligations. In: Jesus J et al. eds. Ethical Problems in Emergency Medicine. Chichester: John Wiley & Sons, Ltd, 2012; 37–46. http:// onlinelibrary.wiley.com/doi/10.1002/ 9781118292150.ch4/summary (accessed 10 April 2014).
International Journal of Pharmacy Practice 2015, 23, pp. 92
Letter to the Editor International Journal of
Pharmacy Practice International Journal of Pharmacy Practice 2015, 23, pp. 92
The health professionals’ right to refuse: is it good, bad or ugly? Keivan Ahmadia,b, Syed S. Hasanb,c and Keihan Ahmadid a Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Selangor, bDepartment of Pharmacy Practice, School of Pharmacy, International Medical University (IMU), Kuala Lumpur, Malaysia, cSchool of Pharmacy, The University of Queensland, Brisbane, Qld, Australia and d
Faculty of Dentistry, Isfahan University of Medical Sciences and Health Services (IUMS), Isfahan, Iran
doi: 10.1111/ijpp.12121
The literature is replete with cases in which the health professionals have refused to provide care to their patients; where in some cases such professionals have received disciplinary actions against them for not fulfilling their professional duties.[1–4] However, the health professionals should have the right to refuse to provide care to their patients, for whatsoever reason, without being disparaged or disqualified. A health professional who fails to balance between personal partiality and professional impartiality, upon being compelled to provide care, might provide care with the quality, one could argue, that might not be the high-quality patient care. Our attention needs to be redirected to the basics of professionalism and its institutionalization within self,[5–7] where the pinnacle of professionalism ensues from the interest in provision of service to the patient, while ruminating about one’s own personal preferences.[6] The personal and the professional preferences are under constant change. For example, the professional preferences could be changed under the direct or indirect influence of the profession, professional bodies or the peers.[8,9] Professions favor some traits of professionalism such as tactic knowledge, certain routines and adaptabilities over the other because of
References 1. Lynch HF. Discrimination at the doctor’s office. N Engl J Med 2013; 368: 1668–1670. doi: 10.1056/ NEJMp1211375. 2. Nazir M et al. The provision of dental treatment for HIV positive patients in Manchester. Int J Health Promot Educ 2005; 43: 11–16. doi: 10.1080/ 14635240.2005.10708029. 3. Daily Mail. Dentists refuse NHS patients. Mail Online. http://www .dailymail.co.uk/news/article-75576/ Dentists-refuse-NHS-patients.html (accessed 2 October 2013). 4. Victory J. Pharmacists suspended for refusing to dispense “Morning-After © 2015 Royal Pharmaceutical Society
5.
6.
7.
8.
the economic profitability.[9] As a result of this, a sense of selectivity is imposed on the health professionals to render those favored services to their clients. Moreover, a health professional may make a decision that is influenced by the actions of a reputable peer, as the decisions made by the professionals are neither routinized nor predictable.[9] From a global view, a (wrong) decision making and its enactment by a health professional could be multidimensional and could be linked with (1) the profession; (2) the peers; (3) the clients; (4) the training; and (5) the health professional’s own morals.[10] Henceforth, if any action has to be taken to reinstitute professionalism, it should be multidimensional and should reasonably address all of the abovementioned contributing factors.
Declaration Conflict of interest The Author(s) declare(s) that they have no conflicts of interest to disclose.
Pill. ABC News 2005; 368: 1668–1670. http://abcnews.go.com/Health/story? id=1391310 (accessed 10 April 2014). Hafferty FW. Professionalism – the next wave. N Engl J Med 2006; 355: 2151–2152. doi: 10.1056/NEJMe 068217. Stern DT, Papadakis M. The developing physician – becoming a professional. N Engl J Med 2006; 355: 1794–1799. doi: 10.1056/NEJMra054783. Elvey R et al. Who do you think you are? Pharmacists’ perceptions of their professional identity. Int J Pharm Pract 2013; 21: 322–332. doi: 10.1111/ ijpp.12019. Gallagher CT et al. The fox and the grapes: an Anglo-Irish perspective on
conscientious objection to the supply of emergency hormonal contraception without prescription. J Med Ethics 2013; 39: 638–642. doi: 10.1136/ medethics-2012-100975. 9. Savage DA. The Professions in Theory and History: the Case of Pharmacy. Williamsburg: EconWPA, 1994. http:// ideas.repec.org/p/wpa/wuwpio/9406 001.html (accessed 17 June 2013). 10. Asher SL. Conflicts between patient requests and physician obligations. In: Jesus J et al. eds. Ethical Problems in Emergency Medicine. Chichester: John Wiley & Sons, Ltd, 2012; 37–46. http:// onlinelibrary.wiley.com/doi/10.1002/ 9781118292150.ch4/summary (accessed 10 April 2014).
International Journal of Pharmacy Practice 2015, 23, pp. 92
