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Assistance to die

A change in the law to allow assisted suicide would require stringent safeguards to be in place — informed by pharmaceutical expertise.

Hands holding patient, Assistance to die opinion piece, July 26 issue

Source: Callie Jones

How comfortable would you be to dispense a lethal dose for the purpose of ending the life of a dying patient? That is a dilemma pharmacists in the UK will need to consider if the assisted dying bill is passed by parliament. The private members’ bill, which had its second reading in the House of Lords last week, would offer the means for an adult in England or Wales who is terminally ill to be provided lawful assistance to end his or her life.

The shape of the bill was informed by a 2012 report from the Commission on Assisted Dying, chaired by Baron Falconer of Thoroton. Introducing the Bill’s second reading, Falconer said the legal framework is modelled closely on the law in the state of Oregon that has been in place for 17 years, as opposed to the voluntary euthanasia laws in some European countries.

Two doctors would need to verify independently that an individual is terminally ill, with less than six months to live, has the capacity to make the decision to end his or her own life and has reached the decision without coercion and with full information about the options for ongoing care.

Just over 750 terminally ill people in Oregon have ended their lives with medical assistance since 1997; around a third of patients who had the drugs dispensed chose not to take the lethal dose. Those numbers might seem small but, for the sake of comparison, the state of Oregon is not much more populous than Wales. It would be difficult to estimate what kind of demand for assisted suicide there might be in Britain as it is not currently an option for terminally ill patients to consider.

 The law, as proposed, would not obligate pharmacists to have any involvement in assisted suicide if they have a conscientious objection.

Among the views in objection to the bill is that the choice could be distressing for vulnerable people who believe they are a burden to their carers or who might be pressured to make the decision. Proponents say that those in the throes of agony would have the choice to die with greater dignity, without putting families and doctors in the position of having to intervene illegally or stand by and watch their suffering.

Pharmacists would need adequate guidance and support in the event of the bill being passed. Yet the law, as proposed, would not obligate them to have any involvement in assisted suicide if they have a conscientious objection.

The General Pharmaceutical Council’s standards of conduct, ethics and performance has a conscience clause which allows pharmacists not to offer a service on moral or religious grounds so long as they direct patients to alternative providers. The pharmacy regulator is due to review these standards over the coming year.

Falconer’s bill is unlikely to be passed in what remains of this parliamentary session. But the debate on assisted suicide will continue and pharmacists should consider their own views on the matter. If assisted suicide is ever legalised in Britain, pharmacists must be in a position to inform the finer details of the supporting legislation. And there are several issues — such as selecting and sourcing the barbiturates that might be used, determining lethal doses and having robust procedures and governance around their use. Any decision should not be made without pharmaceutical expertise.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.20065920

Readers' comments (2)

  • During my 16 years in England, I spent three years (1995-98) working as a caregiver – living with and caring for several elderly people suffering from advanced dementia. I saw first-hand how this disease leaves its victims trapped in a truly terrifying, living hell – with no way out except fading slowly and somewhat agonizingly into a merciful death. I often felt my charges were closer to anxious zombies than human beings – and did often wonder about the ethics of prolonging life as long as possible under those circumstances.

    My time as a carer left me decidedly unwilling to experience that kind of ‘life’ myself. As such, I can say hand on heart that the day I’m diagnosed with dementia is the day I start making moves to check out. When it comes that kind of illness, I’m going to quit while I’m ahead.

    In fact, maybe we should be a little more like Latin America – where people appear to embrace and celebrate death rather than attempting to ignore it and lock it away behind closed doors, as westerners seem inclined to do?

    Raising awareness

    This year, I self-published The Carer, a short e-novel based on my time as a live-in geriatric nurse. Described as a “gritty urban thriller with a social conscience”, The Carer offers a “Faustian tale of elder abuse, patricide by proxy and the corrosive effects of power.” You can buy The Carer for USD0.99 from Amazon and all other major ebook retailers.

    Scott Nelson
    Halifax, Nova Scotia

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  • I am a lawyer in Washington State USA where assisted suicide is legal. I am also President of Choice is an Illusion, a human rights organization opposed to assisted suicide and euthanasia. www.choiceillusion.org

    Below, please find three publications describing problems with legalization including new paths of elder abuse.

    The first two publications are short. Non-lawyers tell me that they especially like the first one. The third publication is an in-depth legal/policy memo.

    1. Margaret K. Dore, "'Death with Dignity': What Do We Advise Our Clients?," King County Bar Association, Bar Bulletin, May 2009, at https://www.kcba.org/newsevents/barbulletin/BView.aspx?Month=05&Year=2009&AID=article5.htm

    2. Margaret K. Dore, Preventing Abuse and Exploitation: A Personal Shift in Focus (An article about guardianship, elder abuse and assisted suicide), The Voice of Experience, American Bar Association, Volume 25, No. 4, Winter 2014, at http://www.choiceillusion.org/2014/02/preventing-abuse-and-exploitation.html

    3. Legal/policy memo regarding a recent assisted suicide law proposed in New Jersey USA. Attached documentation includes government reports from Oregon where assisted suicide is legal. See: http://choiceisanillusion.files.wordpress.com/2014/06/nj-a2270-legal-analysis_001.pdf

    You may also be interested in this short post regarding Lord Falconer's bill and its potentially broad application to people with chronic conditions such as diabetes: http://www.choiceillusion.org/2014/07/uk-falconer-assisted-suicide-bill.html

    Thank you for your interest,

    Margaret Dore, Esq., MBA
    Law Offices of Margaret K. Dore, P.S.
    Choice is an Illusion, an human rights organization
    www.margaretdore.com
    www.choiceillusion.org
    1001 4th Avenue, 44th Floor
    Seattle, WA 98154

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