Conscience clause in emergency contraception: professional uncertainty, attitudes, and regulatory preferences among pharmacists and pharmacy students. A cross-sectional study.

内容摘要

Access to emergency contraception (EC) and pharmacists' professional autonomy remain subjects of legal and ethical debate in many healthcare systems. While pharmacists in Poland are increasingly involved in EC provision and pharmaceutical law emphasises the professional duty to dispense valid prescriptions, debate continues regarding pharmacists' right to conscientious objection. However, unlike physicians, nurses, and midwives, pharmacists are not granted a statutory conscience clause (CC) under Polish law, and the possibility of invoking CC remains a matter of ongoing legal and ethical debate. This study aimed to assess community pharmacists' and pharmacy students' attitudes toward the CC in the context of EC provision. A cross-sectional survey was conducted among 381 respondents, including community pharmacists and fourth- and fifth-year pharmacy students. Data were collected using an anonymous, structured questionnaire that assessed attitudes toward EC, concerns about conscientious refusal to dispense EC, and preferences regarding potential legal regulation of the CC. Multivariable logistic regression analyses were used to identify factors associated with support for the CC and regulatory preferences. More than half of respondents opposed allowing pharmacists to refuse EC dispensing on grounds of conscience clause (54.8%), while 33.8% supported such a right. Ethical concerns were reported more frequently when EC was intended for patients under 18 years of age. Legal concerns, particularly fear of civil liability, were reported more often than social or workplace consequences. Respondents strongly supported national-level ethical and legal regulations governing the use of the CC and generally opposed leaving such decisions to individual pharmacies. Higher religiosity was associated with greater support for the CC, whereas higher knowledge levels were associated with lower support. Attitudes toward the CC in the context of EC provision remain divided within the pharmacy community. The findings highlight the need for clear national regulatory frameworks and professional guidelines that reconcile pharmacists' freedom of conscience with ensuring consistent patient access to time-sensitive reproductive health services.