A complex issue


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A majority of Australian pharmacists are in favour of pharmacy playing a dispensing role in physician-assisted suicide, providing there is a clear legislative framework 

The first study to specifically examined the perspectives of Australian pharmacists on physician-assisted suicide (PAS), found more than half of the participants in a series of interviews supported the role of pharmacists in the supply of medicines for PAS.

The remainder were either against or unsure of PAS legislation. Victoria became the first Australian state to introduce PAS earlier this year.

A team from the University of Sydney interviewed 40 pharmacists, of whom 65% were women, with varied experiences in community, hospital, industry, academia, government or other fields.

One of the respondents encapsulated the views identified across this study, saying: “pharmacists are a very diverse group with varied views when it comes to political voting, whether it’s left or right. But when scientific evidence comes into things, that’s where we rally around objective truths or as close to objective truths as we can get…

I think that the pharmacy perspective and the pharmacy industry as a whole, will be more or less supportive of this“.

Many of the interviewees perceived their role as a checkpoint necessary to ensure appropriate prescribing, in addition to working as part of an interdisciplinary healthcare team.

I’m not comfortable with the idea of the doctor giving out the drugs, as well as prescribing them. It is a real possibility they could get use to prescribing PAS as an easy way to kind of help the elderly and not look at other options. I guess that’s why the gatekeeper role of the pharmacist would be useful to help minimise that risk,” one respondent said.

It should be a multidisciplinary team. It shouldn’t really be based on one doctor’s opinion. It should be the oncologist, doctor, psychiatrist, pharmacist etc. It should be a team of palliative care staff who make the decision,” was the comment from another pharmacist. 

Meanwhile, there were some respondents who expressed ethical and/or religious concerns about their involvement with PAS medicine supply. Some also emphasised the emotional burden.

I don’t believe that it’s our place to decide when we die; God decides that,” one said.

Even though I support PAS, I can tell you if I was sitting at home right now knowing the drugs I supplied will be used to kill somebody, I would be an emotional wreck,” another pharmacist commented.

Some participants felt strongly against the notion of faith-based conscientious objection. They viewed it as an unnecessary obstacle and restriction to medical advancement, some more emotionally charged than others.

It’s always the religious zealots who think PAS is against the Bible. I think that’s the biggest challenge,” was one pharmacist’s view. 

A number of pharmacists expressed a lack of knowledge of the Victorian legislation, or of broader discussions regarding PAS.

I haven’t heard it being brought up in any topic and among not just pharmacists, but doctors and nurses and other health professionals. So maybe it is a topic that is not spoken about often,” one interviewee said. 

The majority of participants suggested the need for the development of new training courses and learning opportunities to ensure a greater understanding of PAS. They also reiterated a shared concern for ensuring that the medications successfully achieve the desired outcome after the first administration.

Will there need to be a new set of guidelines for doses? What is going to adequately kill you vs me is different. It would depend on weight, metabolism, tolerance all those types of things. And who is going to be monitoring and recommending all these values and doses?,” one pharmacist said.

It is going to be extremely intricate and the key would be to get it right the first time if they are going to implement it,“. 

The study authors said healthcare providers—including pharmacists—need to be actively involved in the development of PAS legislation, and legislators must be use international experiences and precedence to help establish boundaries and guidelines that protect all those involved in PAS.

“Some of the findings have implications for clinical educators in developing new guidelines and policy-makers in formulating policies that detail the role of pharmacists in PAS,” they said.

“We recommend that these views and strategies be considered, and an inclusive approach be adopted for all stakeholders involved in this process”.

The study was published in the BMJ Open

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