Volume 24, Number 4, April 2023 Supplement - Section II: Opinions

  1. Home
  2. What we do
  3. IAHPC Publications
  4. Special issues
  5. IAHPC Special Issue on Assisted Dying Practices
  6. Volume 24, Number 4, April 2023 Supplement - Section II: Opinions
North America

A pharmacist’s point of view on physician-assisted suicide.

Ebtesam Ahmed
Clinical Professor, Department of Clinical Health Professions, St. John’s University College of Pharmacy and Health Sciences, New York City, New York, USA; Clinical Pharmacist, Supportive Oncology Clinic, Department of Geriatric and Palliative Care, Mount Sinai Medical Center, New York City, New York, USA

Physician-assisted suicide (PAS) or euthanasia is a complicated and contentious subject that has attracted substantial interest over the past few years. Researchers have found conflicting opinions on whether or not this practice violates the Hippocratic Oath’s “do no harm” tenet.1 As pharmacists are responsible for dispensing many of the medications used in assisted suicide, getting their thoughts on the matter is crucial. As a pharmacist, I think that looking at PAS from various angles, such as the legal and regulatory environment, ethical concerns, and possible effects on clinical outcomes, is vital.

From the patient care standpoint, physician-assisted suicide poses several issues that must be resolved. While some studies contend that it can give patients who are experiencing a terminal illness or excruciating pain a humane and empathetic end-of-life option, other studies express concern that it may erode patient confidence in health care professionals or that it may have unforeseen consequences, such as expediting killing without due consideration of palliative care or alternative treatments.2 

Given these contradictory results, a pharmacist must act per the laws that specify the procedures for physician-assisted suicide in their country. Pharmacists have a crucial role in ensuring that patients get the proper treatment, such as pain management and supportive measures, and that they are adequately educated about their choices and the possible risks and advantages of PAS. 

Moreover, the pharmacist is responsible for ensuring that the medications they dispense are appropriate for the patient's condition and are used properly.3,4 Pharmacists should monitor assisted dying cases to ensure medications are correctly administered and not diverted from their original use. Transparency in prescription procedures and identifying authorized pharmacists engaging in PAS are two common areas of concern, according to research by Isaac, McLachlan, and Chaar.5 That is creating much misunderstanding among pharmacists. I urge relevant parties to provide comprehensive PAS implementation guidelines and training procedures to close this gap. 

Concerns regarding health care personnel's complicity in patients' deaths and patients' ability to decide how they want to die are only two of the ethical issues that PAS brings up. Some claim that PAS goes against the Hippocratic Oath and the obligation of health care personnel to preserve life, while its proponents say it is compatible with the concepts of patient autonomy and beneficence.1 Hence, I muse that pharmacists, like other health care professionals, must think about these ethical ramifications and conduct themselves in a way consistent with their personal beliefs and the ideals of their profession.

Last but not least, from a legal and regulatory standpoint, PAS is presently permitted in only a handful nations, including Canada, Belgium, and the Netherlands, and is bound by strict standards and laws in those countries.2,3 Most states in the United States still prohibit assisted suicide, although many have legalized it via ballot initiatives or state laws. In my opinion, pharmacists have a professional and ethical obligation to familiarize themselves with their respective jurisdictions' legal and regulatory frameworks and act accordingly. 

In conclusion, in my opinion, as a pharmacist, physician-assisted suicide is a complicated and multidimensional topic that calls for a thorough study of the possible effects on patient care, ethical issues, and legal and regulatory frameworks. There are reasonable concerns on both sides of the issue, but I believe that a patient's welfare should always come first. Health care professionals, including pharmacists, should collaborate to ensure patients get the finest care and support toward the end of life.

References

  1. Fontalis A, Prousali E, Kulkarni K. Euthanasia and Assisted Dying: What is the current position, and what are the key arguments informing the debate? J Royal Society of Med 2018; 111(11): 407-413. 
  2. Gerson SM, Koksvik GH, Richards N, Materstvedt LJ, Clark D. Assisted Dying and Palliative Care in Three Jurisdictions: Flanders, Oregon, and Quebec. Annals Pall MeD 2021; 10(3):3528–3539. 
  3. Crumley ET, Kelly S, Young J, Phinney N, McCarthy J, Gubitz G. How Is The Medical Assistance in Dying (MAID) Process Carried Out in Nova Scotia, Canada? A qualitative process model flowchart study. BMJ Open 2021; 11(7): e048698. 
  4. Gallagher A, Gould O, LeBlanc M, Manuel L, Brideau-Laughlin D. Knowledge and Attitudes of Hospital Pharmacy Staff in Canada Regarding Medical Assistance in Dying (MAiD). Canadian J Hospital Pharmacy 2019; 72(1): 16-26.
  5. Isaac S, McLachlan A, Chaar B. Australian Pharmacists' Perspectives on Physician-Assisted Suicide (PAS): Thematic analysis of semistructured interviews. BMJ Open 2019; 9(10): e028868. 

Previous page | Back to the Table of Contents | Next page