Pharmacist role in proposed voluntary assisted dying law

Pharmacists would dispense medicines used to end the lives of people eligible for voluntarily assisted dying, under a new Victorian bill

The Ministerial Advisory Panel on Voluntary Assisted Dying has released its final report, making a number of recommendations in what panel chair Dr Brian Owler calls a “conservative” framework.

People with terminal illnesses who wish to access voluntary assisted dying would need to self-initiate the process and comply with a set of strict criteria.

“The framework we are proposing provides a compassionate response for people who are dying and suffering to choose the timing and manner of their death,” Dr Owler said.

“It is a conservative framework that will ensure that only those who are at the end of their lives are able to access voluntary assisted dying.

“In order to access voluntary assisted dying, the person must be diagnosed with an incurable disease illness or medical condition that is advanced, progressive and will cause death.

“Their condition must be expected to cause death within weeks or months but no longer than 12 months, and it must be causing them suffering that can not be relieved in a manner that the person deems tolerable.

“In addition, only people who have decision-making capacity will be eligible. People must make the request and the decision for themselves and have capacity throughout the entire process. They also must be over the age of 18 and they must live in Victoria.”

The process would not be permitted to be initiated by a second party on the person’s behalf, and health professionals would not be able to suggest it to patients.

Patients would need to make three requests to initiate the process, including a written request signed by independent witnesses, over at least 10 days.

The lethal medication used would be dispensed by pharmacies.

“Before writing the prescription, the coordinating medical practitioner will be required to apply for a permit from the Department of Health and Human Services,” the report states.

“This process will be similar to the current authorisation process for other restricted drugs and provides an opportunity for an independent check that the process has been complied with before the person accesses the lethal dose of medication.

“The lethal dose of medication will be dispensed by a pharmacist, who will be required to appropriately label the medication and inform the person of their obligations to safely store the medication. The pharmacist will only dispense the medication if there is a valid permit issued by the Department of Health and Human Services.

“This provides another independent check to ensure compliance with the legal requirements. The person will be required to store the medication in a locked box until they decide to self-administer the medication.”

Dispensing pharmacists would be required to report to a Voluntary Assisted Dying Review Board, which would refer any improper conduct or potential criminal action to law enforcement, AHPRA or the Coroner.

The patient’s contact person must also agree to return any unused medication to the dispensing pharmacist to be destroyed after the person has died.

Recommendations include pharmacists attaching clear labelling about the use, safe handling, storage and return of the medication, as well as providing the person with counselling about the administration of the medicine and its likely outcome.

Earlier this year, AJP readers responded strongly to an article on a survey investigating pharmacist attitudes towards euthanasia and assisted dying.

Reader John Wilks cited research which he said “succinctly shows that despite the best intentions that may underpin euthanasia, the darkness of the human heart finds ways to circumvent said ‘safety provisions.’ Hence the only safeguard is to reject euthanasia – masquerading as it does under a variety of euphemisms such as ‘mercy killing’ or ‘death with dignity.’ – and adhere to the principled dictum ‘primum non nocere’.”

Reader Andrew said that “There’s strong evidence that the *availability* of euthanasia is of great comfort to patients and very effective at reducing anxiety at what is obviously a very stressful time.”

Jarrod McMaugh said that “We will be the profession dispensing the medication, so it’s important that we understand the processes and the professional ramifications.”

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  1. John Wilks

    I have been a community pharmacist for 30 + years, an accredited pharmacist for 20 years and more recently a hospital pharmacist in an orthopaedic rehab hospital.

    All my training and experience has been focused on aiding the ill, educating the less knowledgeable, and bringing comfort, be it moral or medical, to those in need. I am, we are, carers and protectors of the vulnerable. We are the keepers at the gate over which hangs the ancient sign ‘Primum non nocere.’

    Hence, in the very core of my being, in the privates rooms of my conscience, I cry out NO when I see advocacy for euthanasia pushing its ‘culture of death’ philosophy into my profession.

    Why? Because euthanasia is a lie that is built on a lie. It promotes death with dignity – lie number 1 – and offers the justifying excuse that deliberately hastening death is humane because the terminally ill cannot be treated successfully with modern medicines. This is lie number two.

    The following, from Dr Ian Haines, address most eloquently the fundamental issue of this debate.

    “As an oncologist with 35 years’ full-time experience, I have seen palliative care reach the point where the terminally ill can die with equal or more dignity than euthanasia will provide. It is now very effective and increasingly available for two of the three possible ways of dying, outside of sudden unexpected death, which are advanced cancer and chronic relapsing and remitting organ-specific disease such as heart or lung failure.

    Palliative care is also available for people with chronic progressive cognitive diseases such as dementia. This is the fourth way of dying and perhaps the most feared of all.

    Euthanasia is unlikely to become available for people in such circumstances because their condition prevents truly informed consent.

    Only a fully informed detailed advanced care plan done before any decline, where one can prohibit life-saving interventions such as antibiotics and intravenous fluids if certain conditions are met, can easily and safely produce the smooth outcome that many would desire if combined with palliative care.

    Like Andrew Denton and others who have observed unbearable suffering in loved ones and the terrible failures of modern medicine in the past, I had once believed that euthanasia was the only humane solution.

    I no longer believe that.

    The experiences of countless patients and families should be the inspiration for continuing to improve palliative care, for general introduction of advanced care plans and not for euthanasia with its openness to misuse.

    If the Victorian government legalises assisted dying for people suffering from serious and incurable conditions, it will be the wrong choice. It is not necessary and, as outlined in the minority report to government, it will inevitably increase the pressure, both stated and perceived, for some chronically ill patients to move on and stop being a burden.”

    ‘I believed that euthanasia was the only humane solution. I no longer believe that.’

    Sydney Morning Herald Nov 20 2016

  2. Cameron Walls

    Maybe I missed it, but I think it is odd that there is no accreditation for Pharmacists participating in this process. I would have expected it to work more like the MS2-step program where a Pharmacy must register to provide the service.

    Hopefully prescribers have the sense to partner with a local pharmacy who they know will dispense these prescriptions, since we know not all will.

  3. chris

    Mr Wilks, each to their own. On Friday at about 3.30pm, the life of a fellow first year student way back decades ago was professionally terminated. He got the boot and went on to become an engineer. Three years ago he was diagnosed with progressive and degenerative motor neurone disease. We all know the destructive story here. A week ago HE decided enough was enough and informed us all. His pain and suffering is over.
    Discussions with his family supported HIS view, and he made this decision HIMSELF and as I mentioned previoulsy, we all have an opinion. It is just that I don’t agree with yours.
    There is something eerie in planning your own funeral as he and his partner did before his last day, but there is also something special about going out in the way that YOU want to. I don’t mind an opinion but I hate a wanker.

    • John Wilks

      Thanks for your insight Chris. I am just disappointed that you decided to tarnish your poignant story with the last sentence. I did not sully anyone’s good name so i am disappointed you made an uncivilized comment against me.

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