By Marjorie Weiss
The pharmacy profession should be engaging in active debate about the role of the pharmacist in physician-assisted suicide (PAS). The American Society of Health-System Pharmacists (ASHP) highlighted the need to identify the role of the pharmacist in PAS at its annual meeting in June, 1998,1 yet there has been little debate or clarification on this side of the Atlantic on an issue that has the potential for enormous impact on our profession.
What is PAS and why should it affect pharmacy?
Physician-assisted suicide, also known as “pharmaceutically assisted death”,
“aid in dying”, “death with dignity” and “choice in
dying” is defined by the ASHP as: “The practice by some health professionals
of providing a competent patient with pharmaceutical means for the patient to
use with the primary intention of ending his or her own life.”2
This describes a decision at the end of life that involves a patient, his or
her physician and the pharmacist. The doctor writes a prescription for the medicines
that the patient will take to end his or her life after being dispensed by a
pharmacist. A pharmacist is involved in the provision of the means to bring
about death. This involvement can be witting or unwitting depending upon the
communication between the doctor and pharmacist and the patient and pharmacist.
“No PAS please, we’re British!”
Perhaps it is unthinkable that PAS could happen in Britain? Euthanasia and PAS
only happen in the Netherlands and the United States, surely? PAS is legal in
the Oregon (US), tolerated in the Netherlands and was legal for some time in
the Northern Territories of Australia. A Private Member’s Bill, “Doctor-assisted
dying”, was debated in the House of Commons in December, 1997. Parliament
asked whether PAS should be legalised here. It was rejected by 234 votes to
89. Its defeat on that occasion does not mean that the debate is over. It will
be debated again — and perhaps the pro-PAS camp will be more successful.
The question remains, why is the profession of pharmacy in the United Kingdom
not engaging in debate on this topic so as to present an informed professional
opinion when the PAS debate reopens in the near future?
Follow the example of the BMA
Those who think that this subject is just too far-fetched to be taken seriously
or debated so far ahead of legislation, might ask why the British Medical Association
has just held a consensus conference on PAS. Could it be that the medical profession
is concerned that it should be part of the drive to shape future legislation
on issues that affect health, rather than waiting for the changes to occur and
then having to contemplate how those changes affect them?
The pharmacy profession in the Oregon did precisely that when PAS was legalised
in 1994. An article, which appeared shortly after legislation, raised several
logistical, legal and ethical issues that could arise from the pharmacist’s
participation in PAS under the new legislation:3
In January, 1995, the president of the Oregon Society of Hospital Pharmacists
reported the society’s concerns that, under the Act, no one is required
to inform the pharmacist about the purpose of the prescription, thus denying
the pharmacist the opportunity to decide whether or not to assist in suicide.4
Is this how we would like to see the process of change handled in the UK? For
no one to consider the role of the pharmacist until after legalisation has occurred
(if at all)? More worrying still are the findings of a UK study which surveyed
the opinions of 179 practising community pharmacists.5 The
results of this study indicated that a quarter of pharmacists would not want
to know the purpose of a prescription for use in PAS. Yet pharmacists wish to
demonstrate their competence in new areas of practice outside dispensing and
to be seen as drug experts by other health care professionals and the public
alike. This desire to bury our collective heads in the sand does not reflect
well on such professional aspirations.
Ignoring an issue never made it go away. We, as a profession, should be engaged
in well-thought-out debate on ethical issues. We should not be passive bystanders
on such issues of professional importance. We need to take part in the process
of change rather than being changed by the process.
The need for debate is now.
| Sale of chemicals to children | |
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Marjorie Weiss is a pharmacist and a lecturer in primary care at the University
of Bristol department of clinical medicine
| Correction This article was co-written by Tim Hanlon, a clinical pharmacist in Australia. |