"The College will work to convince the provincial government to make legislative change concerning the sale of tobacco products from pharmacies including the following bylaw:
A licensed pharmacy must not be located in an establishment where tobacco products are sold from:
(1) the pharmacy, or
(2) any part of the establishment where goods or services are sold or offered fo r sale to the public, or
(3) any part of the establishment where goods or services are sold or offered for sale to the public and where customers of the pharmacy can pass into the establishment directly or by the use of a corridor or area used exclusively to connect the pharmacy and the establishment."
Clearly pharmacists are seeking to be taken seriously as competent and knowledgeable health care professionals. The College's Code of Ethics outlines the values to which pharmacists are expected to adhere, which include "honesty, integrity and compassion", supporting "the patient's right to receive competent and ethical health care", and ensuring that "the practice environment contributes to safe and effective pharmacy care". This latter code, "Value VII", confers the following obligations upon pharmacists:
"1. A pharmacist manager has a responsibility to foster an optimal practice environment and to ensure the provision of required resources.
2. If there is a conflict between professional activities and management policies, professional responsibilities will take precedence.
3. A pharmacist will challenge employment conditions that are inconsistent with professional practice as described in this code."
Pharmacists are expected to "assume[s] a professional commitment to the health and well-being of patients" and "not compromise pharmacy care".
The Code further states: "Adoption of the Code represents a conscious undertaking on the part of the members of the College of Pharmacists of British Columbia to be responsible for practicing in accordance with the expressed principles (values and obligations)." It "defines and seeks to clarify the obligations of pharmacists to use their knowledge and skills for the benefit of others, to minimize harm ...". The purpose of the Code of Ethics is described as "educational, guides behaviour, and expresses to the larger community the values and ideals that we espouse by reason of trust and commitment." Most importantly: "When a course of action is mandated by the Code, and there exists no opposing ethical principle, ethical conduct requires that course of action."
The British Columbia Pharmacy Association, designed to be an entity that represents rather than regulates pharmacists, lists among its purposes:
"To develop and maintain education, communication and information systems which
will respond to the needs of the members;
To foster good relations with the public and all other collegial groups and organisations;
To enhance the image and credibility of pharmacy; and To promote the ethical, responsible and competent professional activities of the members."
It also goes on at great length about promoting the economic well-being of its members, but does not address what should happen when economic and ethical interests are in obvious conflict.
So ... why do we still see pharmacies selling tobacco products, a practice that is clearly contrary to the ethics of any form of competent health care professional? Not only do these pharmacies sell the product, they make a point of stationing "power walls" of it by the cash register or customer service area, which amounts to not only selling, but actively promoting preventable disease and premature death. Before the practice was banned by law, certain pharmacies even posted actual tobacco advertising, tantamount to inviting porn video producers to set up booths on high school career days.
I have read and heard arguments defending the practice:
1. Pharmacies are consistent in not selling tobacco to minors. This is both untrue and irrelevant. Restricting tobacco sales on the same basis as alcohol, to licensed, adult-only venues, would have the same effect. Instead of fighting to prostitute their ethics, pharmacies should be lobbying for this solution.
2. Pharmacies need to sell tobacco in order to stay financially viable. The existence of numerous viable, surviving, and even thriving ethical pharmacies exposes this transparent and pathetic excuse for the blatant lie that it is. Those who feel that health care is insufficiently remunerative and feel they cannot survive without tobacco dollars can leave health care and open a licenced tobacco retail outlet.
3. Pharmacies are in a position to help smokers quit. If it is true that a particular pharmacy requires tobacco sales to stay viable, then helping smokers quit or discouraging people from starting puts them in a direct conflict of interest. Furthermore, it sends a message to smokers and those open to starting, which I hear/read often, that tobacco use "can't be all that bad if it is legal and even pharmacies sell it". Finally, it should be self-evident to anyone alleging competence in a health care profession that the last thing a smoker trying to stop needs is to be confronted with a power wall of tobacco while at the cash counter.
Who is to blame?
Why does the College, the regulatory body, not simply ban the practice, as it obviously wants to? Which is lacking, will, power, or both? If it is the power that is lacking, what can be done to change this?
What is the Association's role in this? When protecting the ethical reputation and maximizing the financial interests of its members, both of which it states as its goal, become mutually exclusive, which does it choose? Obviously tobacco is a convenient source of revenue; however, selling and even promoting it amounts to prostitution and an abandonment of the standard of care the public has a right to expect from those wishing to be acknowledged as credible health care professionals.
Finally, why does our provincial government not, as those in other provinces successfully have, simply make the practice illegal? Whose interests do our Premier, ministers, and MLAs serve at a time when we are all struggling with health care cuts and such a simple and obvious measure can be taken as restricting all tobacco sales to licenced, adult-only venues? Smoking is the primary cause of preventable:
- disease and premature death in both active and involuntary users;
- ubiquitous toxic litter; and
as well as all of the human and economic costs these entail. Even tobacco companies say that they are interested in marketing only to adults who choose to smoke. Such a measure would make history by being the first one that both health advocates and the tobacco industry can agree upon.
What are you going to do about it and which of you has the guts to do what you must know is right?
Vancouver, British Columbia