Monday, 30 September 2013

In co-operating with evil, where is the line between reality and paranoia?

Yesterday, my brother Andy* and his girlfriend sat down and filled out a mortgage application. Every so often I was asked my opinion about what I thought certain questions were getting at. I did my best to answer them but mostly, given my total ignorance of mortgages, credit cards and money in general, I pointed them in the direction of more reliable answers. I found myself wondering whether I should refuse outright, be rather more non-comittal or launch into a lecture on how co-habitation is not in God's Plan for them, despite the fact that my big-sisterly-omniscience apparently doesn't extend to morals. Andy and Gertrude** plan never to marry (G wouldn't mind if A insisted, I am told, but A is against it) or have children (A would secretly like to but G is vehemently against) and wish to buy a house together so that they can live happily ever after. My other brother, Chris, married Adele*** earlier this year, and prior to this they had been cohabiting for two years in the house they bought together. Now, when Chris told me the two of them were moving in together I expressed my concern and talked about it with him. He was unreceptive, but there was no animosity. Chris and Andy are extremely different in their openness to different ideas, and Chris at least has some basic appreciation for Christian morals. It was worth a try. With Andy there would be no point.

This issue of what counts as co-operation has been on my mind for some time, and I have a tentative plan to follow up my post on healthcare professionals and the law with one on conscience. Here's the deal: Pharmacists have a conscience clause in our Code of Ethics. We can refuse to do something if it is against our moral or religious beliefs. However we must "make sure that if your religious or moral beliefs prevent you from providing a service, you tell the relevant people or authorities and refer patients and the public to other providers". In general, among pharmacists, it is agreed that a conscience clause is a good idea because healthcare professionals constantly have to make difficult decisions about what the best course of action may be. However, the fact that we have to refer the patient to another provider rather makes a nonsense of it: I won't give you the morning after pill but my colleague here/over the road will.
I often have conversations with people about how we should handle these ethical dilemmas. For practical purposes I think it is virtually impossible for a Catholic pharmacist to work in community pharmacy (ie a shop) because although 'Emergency Hormonal Contraception' is not an essential service under the NHS community pharmacy contract, it is locally commissioned by PCTs and unless you have the luxury of owning your own pharmacy its unlikely that you would be in a position to say that the pharmacy won't have anything to do with it, and in any case you would still have to tell the person where to access said service. In hospital pharmacy it is a bit easier to pick and choose what field you work in. Most hospitals do not supply contraceptives to in-patients (for obvious reasons), but if a patient is usually takes hormonal contraceptives, you still need to clinically check that prescription. So then what? Is clinically checking when you aren't going to supply a problem? Even if you work in geriatric medicine there is still the dispensary slot, the on-call time when you can't hand over to a colleague. Leaving scripts to one side for other pharmacists to handle is practically a hanging offence. One friend and I were shocked to hear that a consultant simply passes over the ethically problematic patients. For us, that is not how it works. Some people would say they wouldn't dispense Viagra, in case the person was not married, or having an affair, or other immoral behaviour...but surely there comes a point when you have to give someone the benefit of the doubt. What if the person is married and erectile dysfunction is placing a huge strain on their relationship? How far can we go down this line of thought: should we even be working in the NHS?
What should we be doing as Catholic pharmacists or other healthcare professionals? Where should we go and work? I don't think the answer is for us to seek out fields of healthcare without ethical dilemmas, because that would also limit our opportunity to transform all of the temporal order which is in contrast to the Gospel (always supposing such fields exist). And I think we definitely need Catholic healthcare professionals. Must we just accept that our career options will be limited, our colleagues will mistrust or despise us and that we end up doing an unfulfilling job because we need to provide for a family?
Answers on postcard, please.
*Not his real name; if I use a psuedonym myself I'm hardly going to reveal his identity.
**Obviously not her real name, but follows a pleasing pattern known only to myself.


  1. I know that this is an old post now, but I just wanted to commend you for your blog.
    I have only just discovered it and I am throughly enjoying it.
    I used to be a community pharmacist and like you I came to the conclusion it would be impossible to continue in that field. I found Hospital Pharmacy to be much better, it does offer more scope but it still has it's problems.
    I was wondering if you ever managed to answer the question as to what a Catholic Pharmacist should do and where one should work?

    1. I know this is an old comment too, but I was very excited when I saw it. Short answer: no. Longer answer: I do think we need to work in all sectors, but I think that a lot of grace might be required, and not everyone is called to the same mission. Moment of excitement: oh wow, that makes 6 Catholic pharmacists I know of (of which one now in seminary, one retired)!


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