Emergency hormonal contraception
Emergency hormonal contraception
There are many challenges when providing oral emergency hormonal contraception (EHC), in addition to determining its clinical suitability. These include assessing a patient’s capacity to consent, being alert to any possible safeguarding concerns, and managing cases where English is not a patient’s native language.
From the patient’s perspective, one complication is that some healthcare professionals might object to a supply of EHC on religious or moral grounds. This possibility has led to the introduction of a ‘conscience clause’ that allows such objections.
Conscientious objection
A conscientious objection is a refusal to perform either a legal or professional role because of personal beliefs. It is essential to recognise that this conscientious objection also applies to patients themselves.
Within healthcare, this conscience clause grants professionals the right to act in accordance with their personal beliefs and to opt out of a specific service – a right protected by law. However, this exemption does not apply in emergencies where treatment is necessary to save life or prevent serious harm.
Key facts
- Suitably qualified, competent pharmacy technicians can supply oral EHC under the NHS Pharmacy Contraception Service in England and equivalents in the devolved nations
- Conscientious objection is legally permitted, but you must ensure that oral EHC is available promptly
- GPhC guidance requires person-centred care and prohibits discrimination based on religion or personal beliefs when providing oral EHC
- Capacity must be assessed and consent obtained before supply
- The Mental Capacity Act 2005 applies to those aged 16 and older, while Gillick competence applies to under-16s
- Safeguarding checks are essential during consultations. Concerns should be reported to local safeguarding leads or the police
- Practical challenges include proxy consultations, repeat requests and accessibility for patients with sensory or language barriers.
Professional guidance
While you have a legal right to object to the supply of oral EHC, this could have a profound impact on the patient.
The refusal to supply might be interpreted as moral intimidation and could discourage a patient from seeking further help. What’s more, this refusal to provide EHC curtails the patient’s right to appropriate, time-sensitive treatment, simply because of the healthcare professional’s moral position.
While the right to conscientious objection is legally protected, pharmacy technicians remain bound to act in accordance with professional guidance from the General Pharmaceutical Council (GPhC).
The GPhC’s 2017 guidance on religion and personal values states that pharmacy professionals must not discriminate on the basis of religion, personal beliefs, or lack thereof.
The guidance, therefore, does not compel pharmacy technicians to provide a service such as EHC if doing so conflicts with their own beliefs.
However, pharmacy technicians should:
- Inform their employer of any beliefs that may affect service provision, and
- Ensure the patient can access the service promptly and without hindrance (e.g. by referral to a colleague).