Pharmacists take on crucial new service

The Alfred Hospital’s pharmacy service will become the sole site for storing and dispensing voluntary assisted dying medications across Victoria

In late 2017 Victoria’s Parliament passed the Voluntary Assisted Dying bill, which will see pharmacists involved in the euthanasia process.

The legislation has been undergoing an 18-month implementation period before it comes into effect in June 2019.

On 5 January this year, the Victorian government announced that The Alfred hospital’s pharmacy service will become the sole service for dispensing voluntary assisted dying medications across the state.

Acting Minister for Health Martin Foley says that The Alfred Hospital’s pharmacy department would be responsible for importing, storing, preparing and dispensing medications for Victorians who make the choice to access voluntary assisted dying.

“The Alfred is one of Victoria’s leading hospitals. Having a single point of access for voluntary assisted dying is just one of the ways we’re making sure the model is the safest and most conservative in the world,” says Minister Foley.

A single point of access will ensure medicines are kept and dispensed securely, that patients are provided clear information regarding administration, and ensure unused medications are returned and destroyed if not used – in line with the stringent controls, he adds.

Professor Michael Dooley, as Director of Pharmacy at Alfred Health, will be overseeing the service.

“My perspective is that it’s imperative that the most appropriate care and high-quality care is provided to patients,” Professor Dooley tells AJP.

“This is a very specialised area and consequently the development of a specialised state-wide pharmacy service is something that will certainly make sure that it’s implemented in the best way possible.

“The Alfred is a major teaching hospital network that provides a range of state-wide services and has the capacity to provide such a specialised service.”

Several measures will be put in place to ensure the service is safely and appropriately rolled out, he says.

“Part of the Health Department approach has been to develop a structured formalised medication protocol,” Professor Dooley tells AJP.

“There will be a very defined protocol that’s put in place that the Health Department will approve.”

While the service will be located at The Alfred Hospital, it will be available to all Victorians, Professor Dooley emphasises.

“It’s a service that will be provided for Victorians wherever they are. Patients don’t come to us – we go to patients.”

The Victorian government has confirmed the following safeguards will be put in place to ensure the voluntary assisted dying model is safely implemented:

  • Only adults with decision making capacity, who are suffering and have an incurable, advanced and progressive disease, illness or medical condition that is likely to cause death within six months (or 12 months for people with neurodegenerative conditions) can access the scheme;
  • A person may only access voluntary assisted dying if they meet all of the strict eligibility criteria, make three clear requests and have two independent medical assessments that determine they are eligible;
  • The request must always be initiated by the person themselves, with health practitioners who are treating the person and raise the issue subject to unprofessional conduct investigations.

“All of the guidelines are now in place for voluntary assisted dying to begin in June – and ensure people with a terminal illness who wish to end their lives with dignity can do so,” says Minister Foley.

Professor Dooley highlights that the legislation that has been passed in Victoria has “clear support” for conscientious objection for those that don’t want to participate.

“If any pharmacist doesn’t want to participate, they don’t have to,” he says.

There will be a “dedicated” team of pharmacists that have volunteered to be a part of the service, he says.

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1 Comment

  1. John Wilks

    I am a pharmacist of 40 years and for the past 20 years have been an accredited consultant pharmacist. For the following reasons I consider that the much lauded approach by The Alfred is dangerously flawed.

    The indicated co-mixture of drugs is reported in The Age to ” … include the painkiller morphine, anxiety drug diazepam (valium) and prescription medications often used to treat heart conditions and epilepsy.”

    Here the intention is to heavily sedate, suppress respiration, and stop the patient’s heart.
    Inevitably some patients will survive this example of lethal polypharmacy. If brain injury occurs, the patient can no longer give informed consent. Is there a litigious issue for The Alfred secondary to a non-fatal but seriously debilitating outcome? Are the supplying pharmacist at legal risk? And who now pays for the added cost of care of a not dead yet dying patient?

    Further, who is responsible if the car driven by the pharmacist is accidentally left unlocked and drugs are stolen? Or worse, a car hijacking occurs?

    Finally it must be understood that what The Alfred is participating in is a betrayal of the soul of my profession. We have always been healers; now we are not.

    The ancient founding principle of primum non nocere – first do no harm – has been mortally violated. Our harvest will be that which we have now begun to sow. Sacred human ethics has been abandoned. People are now commodified and disposable. This New York Post is a warning that many have elected to ignore.

    “A year ago, I lost my 36-year-old husband to cancer. In the first few months after his death, I often felt lost without the heroic man I fell in love with 14 years earlier. But in our last few weeks together, I promised J.J. that I would keep sharing our story and carrying on his work advocating for better end-of-life care for terminal patients.

    J.J. was a volunteer fireman, a Marine Corps war veteran, and a New York public servant under Govs. Eliot Spitzer and David Paterson. Then, after he was diagnosed with terminal brain cancer in 2014, J.J. dedicated his final days to fighting the legalization and social acceptance of assisted suicide.

    This wasn’t an issue either of us would have become involved with prior to J.J.’s terminal diagnosis, but his illness gave us firsthand insights into how assisted suicide endangers those who are most vulnerable.

    When a seizure sent J.J. to the hospital in May 2014, he was told that he had glioblastoma multiforme, the deadliest form of brain cancer. The neurosurgeon said that it was inoperable and that he likely had only four months left to live. Three doctors told us there was nothing we could do. We were told to go home and enjoy the little time we had left together.

    Thankfully, we didn’t listen to those doctors, and J.J. had success with standard and experimental treatments. But he also realized that not everyone has the kind of support that he did, from family, friends and very good doctors. And even though J.J. was loved and supported, he suffered from periods of depression in his first few months of treatment.

    He later told us that if he had ­assisted-suicide pills with him in those darkest moments, he would have been very much tempted to take them.

    Then, in J.J.’s final weeks, we saw how the disabled are treated differently, how their lives are too easily dismissed as inconvenient, which is especially dangerous when ­assisted suicide becomes a legal medical treatment.

    Assisted suicide injects governmental pressure and profit-driven insurance decisions into everyone’s end-of-life care. When that happens, death becomes the cheapest form of “treatment.”

    Almost two dozen states considered assisted-suicide bills this past year. It’s already allowed in seven states and the District of Columbia, and various forms of assisted suicide and euthanasia are also legally available in Europe, as well.

    If he were still with us, J.J. would continue to tell us that assisted suicide is bad public policy. He would warn legislators and voters not to focus on the individual patient when considering this legislation. Instead, consider the many vulnerable people who will lose all hope and be put at risk when suicide ­becomes a medical treatment.


    California officials say 400 people used assisted death law in 2017
    Ultimately, legalizing assisted suicide results in less choice for patients through external pressures, coercion, mistakes and abuse. In Europe, for example, the expansion of assisted suicide has resulted in ever more groups of ­patients becoming eligible for the “treatment,” including youth and the non-terminally ill.

    Proponents insist that assisted suicide is only for last-resort scenarios, when there are only weeks or days left and unbearable pain. But physical pain isn’t among the top five reasons patients in Oregon — the first state to legalize assisted suicide, in 1997 — request death by doctor.

    In reality, assisted suicide is less about ending a patient’s suffering than it is about ending society’s care. There is a lot we can do to improve care at the end of life for terminal patients, and assisted suicide shouldn’t be one of them.

    That’s why, even as he took to the public square to speak out against death by doctor, J.J. also fought for better access to hospice and palliative care.

    I have no doubt that J.J. would have supported bills like the Palliative Care and Hospice Education and Training Act, which was introduced in Congress last year.

    This bipartisan measure helps Americans with advanced illness have better access to palliative care. It increases the number of health-care professionals trained in palliative care, expands national funding for research in palliative care and develops a ­national educational campaign to inform Americans, including physicians, many of whom are unaware of the benefits of palliative care.

    J.J. was convinced that the most vulnerable Americans need support, not poisonous pills and needles. A year after his death, it is vital that Americans continue to hear his message.
    Kristen Hanson is the community-relations advocate for the Patients Rights Action Fund.”

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