Cooper Richard J, Bissell Paul, Wingfield Joy
Division of Social Research in Medicines and Health, The School of Pharmacy, University of Nottingham, Nottingham, UK.
J Fam Plann Reprod Health Care. 2008 Jan;34(1):47-50. doi: 10.1783/147118908783332122.
Community pharmacists' role in the sale and supply of emergency hormonal contraception (EHC) represents an opportunity to increase EHC availability and utilise pharmacists' expertise but little is known about pharmacists' attendant ethical concerns. Semi-structured qualitative interviews were undertaken with 23 UK pharmacists to explore their views and ethical concerns about EHC.
Dispensing EHC was ethically acceptable for almost all pharmacists but beliefs about selling EHC revealed three categories: pharmacists who sold EHC, respected women's autonomy and peers' conscientious objection but feared the consequences of limited EHC availability; contingently selling pharmacists who believed doctors should be first choice for EHC supply but who occasionally supplied and were influenced by women's ages, affluence and genuineness; non-selling pharmacists who believed EHC was abortion and who found selling EHC distressing and ethically problematic. Terminological/factual misunderstandings about EHC were common and discussing ethical issues was difficult for most pharmacists. Religion informed non-selling pharmacists' ethical decisions but other pharmacists prioritised professional responsibilities over their religion.
Pharmacists' ethical views on EHC and the influence of religion varied and, together with some pharmacists' reliance upon non-clinical factors, led to a potentially variable supply, which may threaten the prompt availability of EHC. Misunderstandings about EHC perpetuated lay beliefs and potentially threatened correct advice. The influence of subordination and non-selling pharmacists' dispensing EHC may also lead to variable supply and confusion amongst women. Training is needed to address both factual/terminological misunderstandings about EHC and to develop pharmacists' ethical understanding and responsibility.
社区药剂师在紧急激素避孕（EHC）销售与供应中的角色，为提高EHC的可及性及利用药剂师的专业知识提供了契机，但对于药剂师随之而来的伦理担忧却知之甚少。我们对23名英国药剂师进行了半结构化定性访谈，以探讨他们对EHC的看法和伦理担忧。
几乎所有药剂师都认为配发EHC在伦理上是可以接受的，但在销售EHC的观念上出现了三类情况：销售EHC的药剂师，尊重女性自主权和同行的良心反对意见，但担心EHC供应受限的后果；偶然销售的药剂师，认为医生应是EHC供应的首选，但偶尔也会供应，且受女性年龄、富裕程度和真诚程度的影响；不销售EHC的药剂师，认为EHC等同于堕胎，觉得销售EHC令人苦恼且存在伦理问题。对EHC的术语/事实误解很常见，且大多数药剂师很难讨论伦理问题。宗教影响着不销售EHC药剂师的伦理决策，但其他药剂师将职业责任置于宗教之上。
药剂师对EHC的伦理观点以及宗教的影响各不相同，再加上一些药剂师依赖非临床因素，导致供应可能存在变数，这可能会威胁到EHC的及时可得性。对EHC的误解延续了外行的观念，并可能威胁到正确的建议。从属关系以及不销售EHC药剂师配发EHC的影响，也可能导致供应变数和女性的困惑。需要开展培训，以解决对EHC的事实/术语误解，并培养药剂师的伦理理解和责任感。
