Original research article| Volume 91, ISSUE 1, P25-30, January 2015

Mifepristone (RU486) in Australian pharmacies: the ethical and practical challenges



      The recent legalization of mifepristone has given women in Australia a new option for termination of pregnancy. Pharmacists are well positioned to provide information and supply mifepristone for patients. However, there are ethical and legal concerns in Australia regarding the supply of mifepristone, as pharmacists may choose to conscientiously object to supplying mifepristone and are subject to differing abortion laws between states and territories in Australia. The objective of this study was to explore attitudes and knowledge of Australian pharmacists about mifepristone.

      Study design

      Semistructured interviews were conducted with 41 registered pharmacists working in a pharmacy or hospital in Sydney, Australia. When data saturation was achieved, audiotaped transcripts were deidentified and transcribed verbatim. Data were thematically analyzed using a framework approach for applied policy research and categorized into the following themes: contextual, diagnostic, evaluative and strategic.


      Analysis of the transcripts yielded four themes: (a) pharmacists' contextual view on pregnancy termination, the role of the pharmacist and impact on the pharmacy workplace; (b) diagnostic reasons for differing views; (c) evaluation of actual and perceived pharmacy practice in relation to the supply of mifepristone and (d) strategies to improve pharmacists' services, awareness and education.


      Australian pharmacists in this study perceived themselves to have a potentially important role as medicine experts in patient health care and safety in medical termination of pregnancy. However, there was a general lack of clinical, ethical and legal knowledge about medical termination of pregnancy and its legislation.


      To ensure patient safety, well-being and autonomy, there is an imperative need for pharmacist-specific training and guidelines to be made available and open discussion to be initiated within the profession to raise awareness, in particular regarding professional accountability for full patient care.


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        • Victorian Law Reform Commission
        Law of abortion: final report 15.
        Victorian Law Reform Commission, Melbourne2008 ([191 pp.])
        • Ashok P.W.
        • Penney G.
        • Flett G.M.
        • Templeton A.
        An effective regimen for early medical abortion: a report of 2000 consecutive cases.
        Hum Reprod. 1998; 13: 2962-2965
        • Petersen K.
        Early medical abortion: legal and medical developments in Australia.
        Med J Aust. 2010; 193: 26-29
        • DeHart R.M.
        • Morehead M.S.
        Ann Pharmacother. 2001; 35: 707-719
        • Therapeutic Goods Administration
        Registration of medicines for the medical termination of early pregnancy [Internet].
        Department of Health, TGA, Canberra2012 ([[updated 2012 Aug 30; cited 2013 Apr 25]. Available from:])
        • Gynuity
        Resources: list of mifepristone approvals [Internet].
        Gynuity Health Projects, New York2013 ([[cited 2013 May 12]. Available from:])
        • MS Health
        How to prescribe MS-2 Step: which patient is appropriate? [Internet].
        MS Health Pty Ltd, Carlton (Vic)2013 ([[updated 2013 July; cited 2013 Sept 30]. Available from:])
        • Center for Reproductive Rights
        The world's abortion laws [Internet].
        Center for Reproductive Rights, New York2013 ([[revised 2011 June 21; cited 2013 May 10]. Available from:])
        • MS Health
        MS Health: about us [Internet].
        MS Health Pty Ltd, Carlton (Vic)2013 ([[cited 2013 Oct 26]. Available from:])
        • MS Health
        Training and education: certification registration [Internet].
        MS Health Pty Ltd, Carlton (Vic)2013 ([[updated 2013 July; cited 2013 Sept 30]. Available from:])
        • Berlinger N.
        Birth to death and bench to clinic: The Hastings Center bioethics briefing book for journalists, policymakers, and campaigns.
        Chapter 8, conscience clauses, health care providers, and parents. 1st ed. The Hastings Center, New York2008: 35-40
        • Pharmaceutical Society of Australia
        Code of ethics [Internet].
        Pharmaceutical Society of Australia Ltd, Deakin (ACT)2011 ([Sept [revised 2011; cited 2013 May 3]. Available from:])
        • Chaar B.
        Rx: RU486 — will you dispense?.
        Aust Pharm. 2013; 32: 71-74
        • Pharmacy Council of New South Wales
        Pharmacy register [Internet].
        Health Professional Councils Authority, Sydney2010 ([[updated 2010 Dec 17; cited 2013 Sept 24]. Available from:])
        • Giannetti V.
        Pharmacists' beliefs about abortion and RU-486.
        J Am Pharm Assoc. 1996; 36: 698-703
        • Richman A.R.
        • Daley E.M.
        • Baldwin J.
        • Kromrey J.
        • O'Rourke K.
        • Perrin K.
        The role of pharmacists and emergency contraception: are pharmacists' perceptions of emergency contraception predictive of their dispensing practices?.
        Contraception. 2012; 86: 370-375
        • Ritchie J.
        • Spencer L.
        The qualitative researcher's companion.
        Chapter 9, qualitative data analysis for applied policy research. 1st ed. Sage Publications, London2002: 305-329
        • Davidson L.A.
        • Pettis C.T.
        • Joiner A.J.
        • Cook D.M.
        • Klugman C.M.
        Religion and conscientious objection: a survey of pharmacists' willingness to dispense medications.
        Soc Sci Med. 2010; 71: 161-165
        • American Pharmacists Association
        Code of ethics [Internet].
        American Pharmacists Association, Washington2013 ([[cited 2013 Oct 11]. Available from:])
        • Merrills J.
        • Fisher J.
        Pharmacy law and practice.
        Appendix 7, the code of ethics of the Royal Pharmaceutical Society of Great Britain. 3rd ed. Blackwell Science Ltd, Oxford2008: 361-378
        • Pharmacy Council of New Zealand
        Code of ethics 2011 [Internet].
        Pharmacy Council of New Zealand, Wellington2011 ([[cited 2013 Oct 20]. Available from:])
        • Ceva E.
        • Moratti S.
        Whose self-determination? Barriers to access to emergency hormonal contraception in Italy.
        Kennedy Inst Ethics J. 2013; 23: 139-167
        • Curlin F.
        Conscience and clinical practice: medical ethics in the face of moral controversy.
        Theor Med Bioeth. 2008; 29: 129
        • Wiedenmayer K.
        • Summers R.
        • Mackie C.
        • Gous A.
        • Everard M.
        • Tromp D.
        Developing pharmacy practice: a focus on patient care.
        World Health Organization, Geneva2006 ([87 pp.])
        • Downard S.L.
        The pharmacy manpower shortage: views from the academies.
        J Am Pharm Assoc. 2002; 42: 820-824
        • National Alternative Dispute Resolution Advisory Council
        Your guide to dispute resolution [Internet].
        Creative Commons Attribution, Australia2012 ([[cited 2013 Nov 6]. Available from:])
        • Sneeringer R.K.
        • Billings D.L.
        • Ganatra B.
        • Baird T.L.
        Roles of pharmacists in expanding access to safe and effective medical abortion in developing countries: a review of the literature.
        J Public Health Policy. 2012; 33: 218-229