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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