Abstract Background and methodology 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. Results 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 47 ©FSRH J Fam Plann Reprod Health Care 2008: 34(1) Introduction This article considers the role of community pharmacists in the sale and supply of emergency hormonal contraception (EHC) in the UK and, in particular, explores the ethical, religious and factual beliefs of pharmacists and their potential effect upon the availability of EHC in UK pharmacies. The findings of a qualitative study are presented and it is argued that although UK pharmacy sales and supplies of EHC represent opportunities for pharmacists to contribute to public health and also engage in new professional challenges, a range of ethical, religious and knowledge concerns identified in the study may affect the availability of EHC for UK female customers. In the UK, community pharmacists have been involved in the dispensing of EHC for more than 15 years, when it was originally a combined oestrogen and progestogen formulation. But with the introduction of a progestogen- only product in 2000, EHC became available for supply by pharmacists in the form of patient group directions (PGD). 1 This was soon followed by the reclassification of EHC to a ‘pharmacy’ medicine which, branded as Levonelle ® , could be sold from pharmacies without a prescription or the need for PGD, with the aim of Ethical, religious and factual beliefs about the supply of emergency hormonal contraception by UK community pharmacists Richard J Cooper, Paul Bissell, Joy Wingfield ARTICLE Division of Social Research in Medicines and Health, The School of Pharmacy, University of Nottingham, Nottingham, UK Richard J Cooper, PhD, MA, Research Fellow Joy Wingfield, MPhil, LLM, Professor Section of Public Health, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK Paul Bissell, PhD, MA, Senior Lecturer Correspondence to: Dr Richard J Cooper, Division of Social Research in Medicines and Health, The School of Pharmacy, University of Nottingham, University Park, Nottingham NG7 2RD, UK. E-mail: richard.cooper@nottingham.ac.uk 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. Discussion and conclusions 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. Keywords emergency contraception, ethics, pharmacists, religion J Fam Plann Reprod Health Care 2008; 34(1): 47–50 (Accepted 8 July 2007) improving timely access to EHC by women. Although the overall amount of EHC issued in the UK has remained relatively static, around 45% of EHC supplies now occur from pharmacies but almost 10% of women still report difficulty in obtaining EHC. 2 These statistics, coupled with several popular press reports of pharmacists refusing to sell EHC 3 and ongoing debates as to whether pharmacists may conscientiously object to EHC, 4–6 mean that research is needed to explore issues surrounding ethics, religion and the availability of EHC for sale and supply in pharmacies. Pharmacy supply of EHC has prompted research 1 and the experiences and attitudes of pharmacists have been explored 7–10 but no studies have specifically explored pharmacist EHC supplies in an ethical or religious context. Occasional ethical concerns have been identified and Blackwell et al., 11 for example, reported moral objection to EHC sales in 2.6% of pharmacists, D’Souza and Bounds 12 reported conscientious objection amongst one in five pharmacists whilst Wearn et al. 13 argued that “ethical reasons did not appear to be a major factor that would affect pharmacists’ ability to supply EHC”. The objective of this article is to gain a greater understanding of the ethical, religious and practical issues surrounding EHC Key message points ● Sales of emergency hormonal contraception (EHC) from UK community pharmacies may be influenced by ethical objection, religious beliefs and non-clinical factors but dispensing EHC was almost always ethically acceptable. ● Three categories of pharmacists emerged: a majority who found EHC sales unproblematic, those who sold contingently and a minority who were ethically and religiously opposed to selling EHC. ● Factual and terminological errors and a marked difficulty in discussing ethical issues were identified, necessitating further education. group.bmj.com on October 30, 2016 - Published by http://jfprhc.bmj.com/ Downloaded from