Can Quebec pharmacists legally refuse to prescribe the morning-after pill?

Legal experts say a pharmacist in Saguenay, Que., who refused to prescribe the morning-after pill to a woman was within his rights, but he had an obligation to accommodate her through other means.

Radio-Canada reported Wednesday that a 24-year-old woman said a Jean Coutu pharmacist in the borough of Chicoutimi refused to sell her emergency oral contraception because doing so would not "align with his values." Ultimately, she went to another pharmacy to get the pill.

The woman wished to remain anonymous for fear of reprisal.

Asked whether the pharmacist was justified in his actions, human rights lawyer Julius Grey says a person cannot be forced to act against their beliefs.

"A person's conscience should be respected unless there is a completely compelling reason [for it not to be]," he said. "We consider all sorts of other things – equality, fairness, etc. – as more important than conscience. But conscience is a fundamental thing."

According to Section 3 of the Quebec Charter of Human Rights and Freedoms, "Every person is the possessor of the fundamental freedoms, including freedom of conscience, freedom of religion, freedom of opinion, freedom of expression, freedom of peaceful assembly and freedom of association."

Balancing rights

Grey says the importance of conscience shouldn't be understated. But like most freedoms, there may be limits.

For instance, Grey says if this pharmacy were the only one in the region where the pill could be obtained, then the pharmacist may be obligated to prescribe it.

"You're balancing the liberty and equality rights of one person with the liberty and equality rights of another," Grey said. "But if there is another pharmacy next door or another pharmacist even working with him, he can say, 'I don't want to do this.'"

To explain that the pharmacist acted within his rights, Grey also pointed to Section 7 and Section 15 of the Canadian Charter of Rights and Freedoms, which discuss liberty interests and equality rights.

Pearl Eliadis, a human rights lawyer and associate professor at the Max Bell School of Public Policy, notes the woman was entitled to receive the morning-after pill when she requested it and in a manner that respected the timeline to ensure a safe medical procedure.

The emergency oral contraception pill should be taken 12 to 24 hours after intercourse for maximum effectiveness, according to Familiprix, a Canadian group of independent pharmacists.

She says the pharmacist had an obligation to exercise diligence and make sure the woman received the needed medical service.

Both Eliadis and Grey say companies should screen pharmacists to understand whether they have convictions, religious or otherwise, that would prevent them from fulfilling their legal obligations. Having those conversations with staff would allow pharmacies to plan accordingly, they said.

Eliadis added that despite women's rights and secularism being integral parts of Quebec society, a patient can still be refused medical services because of a health-care provider's personal convictions.

"How is it that we have expended all this political energy to make sure that women who are seeking ... certain public positions are not able to wear religious garb when it's mandated by their religion, which does not affect anybody's rights in any way?" she said.

"It certainly would have been possible for the pharmacist not to express his view and simply to say, 'let me get you another colleague.'"

Processes in place

Radio-Canada reported that the Jean Coutu pharmacist acknowledged the incident wasn't the first time he had refused to prescribe emergency oral contraception.

But Marie-Claude Bacon, a spokesperson for Metro, which owns Jean Coutu, called the account "speculative" in an email to CBC.

She said most of the company's pharmacies already have mechanisms in place that allow clients to receive service from another professional on-site or, when the pharmacist is alone on duty, "as soon as possible at another one of its nearby pharmacies."

The company refused to comment on what processes are set up to accommodate clients and how employees would be reprimanded if they don't help them obtain the pill by other means after refusing to prescribe it themselves.

Gisèle Dallaire, the co-ordinator for the Table de concertation des groupes de femmes au Saguenay-Lac-Saint-Jean, says although pharmacies must take into account their employees' comfort levels, businesses should clearly indicate where and how women can receive the service to avoid wasting time.

"It says it in the name. It's an emergency," Dallaire said. "Once you take the decision and for a woman, it's not an easy decision .… you don't want to stay any longer."

"It should not be the customer who has to adapt. It should be the pharmacist [who should] adapt and be ready to serve."