Imagine leaving a doctor's appointment with a freshly written prescription in hand. On your way home you decide to quickly pop into your local pharmacy and have the prescription filled right away. Now imagine your pharmacist hesitating as he or she reads the contents of your prescription. Just as you begin to wonder if they're having
difficulty reading your doctor's handwriting, the pharmacist suddenly hands back your prescription and says to you, "I cannot fill this prescription because to do so would be in direct violation of my personal beliefs and values".

You have just experienced your first encounter with a medical professional exercising a conscientious objection or as the practice is more commonly referred, 'conscience clause'.

A conscience clause is a provision in employment contracts that permit health-care providers including your pharmacist to refuse to give treatment on the basis of their religious or moral beliefs. The prescription you need filled is a birth control pill. Up until recently these contractual clauses required pharmacists to offer alternative solutions as well as a referral to a pharmacy that would fill the prescription. They are not required however to take into consideration the possible distance between them and the next pharmacy. This is especially troubling in smaller communities located in the more rural parts of the country where the distance between one pharmacy and the next could be a good 100 kilometres.

The practice of medical professionals declaring conscientious objection to certain medical procedures or services surfaced in the 1980s in the U.S. in the state of Washington when two pharmacists refused to dispense birth control pills to customers because they believed that the pills caused abortions. The pharmacists were subsequently fired and over the next several years more pharmacists were fired throughout the U.S. for similar refusals.

As more and more pharmacists continued to exercise their refusal to dispense on moral grounds, pharmaceutical associations across the United States and in Canada began to seriously examine the issue. They began to question whether an individual should be expected to ignore his or her personal moral values at their workplace. The majority
consensus emerged that medical professionals should not be expected to violate their moral beliefs and thus began the addition of conscience clause resolutions to existing employment contracts and to by-laws of various professional associations.

If a pharmacist or other health care worker including physicians and nurses have in their contracts a conscience clause, they are protected under law and personal belief to refuse certain procedures such as abortions and services such as birth control prescriptions, to their patients and clients. These conscientious objectors, to avoid leaving
the patient or client high and dry, would offer alternative solutions to abortion such as adoption and alternative solutions to birth control such as abstinence.

But with the recent increase of the very influential evangelical movement into mainstream politics in the United Sates in particular, those who claim conscience clauses are now refusing to offer alternative solutions and referrals to their patients and clients. Why, you may ask? These medical professionals now believe that to refer a patient to a facility that will follow through on a procedure or service that they find objectionable is continuing to condone the procedure or service.

According to an article in The New England Journal of Medicine, a bill has been recently introduced in Wisconsin that would permit health care professionals "to abstain from participating in any number of activities, with 'participating' defined broadly enough to include
counselling patients about their choices".

Efforts continue in Canada in provinces like Ontario and Alberta to allow conscience clauses but at a much smaller level than what is being seen in the United States. Nurses and doctors across Canada have had the right in most major institutions to exercise their objections to procedures like abortions by abstaining from participating without fear of sanction from their employers.

That is not to say however that the use of conscience clauses will not begin to infiltrate the Canadian health care system. As early as the mid 1990s, at least three bills dealing with conscience clause legislation were submitted by Maurice Vellacott, MP in the House of Commons, Senator Raymond Perrault re-submitted to the Senate and Julius
Yankowsky, MLA, submitted a bill to the Alberta Legislature in 2000. None were proceeded with.

Broad conscience clauses will affect the health of millions of people with the largest percentage being women. These clauses allow health-care providers to force their religious morals and personal beliefs on the world at large thus contributing to a generalized decline in women's reproductive health. Less information, services and referrals lead to poor choices for family planning, infertility, sterilization (for women and men), genetic counselling, rape treatment, abortion, and the prevention and treatment of sexually transmitted diseases including HIV/AIDS.

To allow and even encourage health care professionals to deny services, treatment and information to their patients because to do so would violate their own morals and belief system is a dangerous precedent. To be considered a 'professional' in the past, one must learn to leave their personal issues at the door as they entered their workplace. They were certainly entitled to pick them up at the end of the day but to refuse to fulfill their professional duties for personal beliefs should be considered a dereliction of duty, not something to condone and subsequently legislate.