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Why a 'conscience clause' is essential in assisted suicide legislation

Assisted suicide is a sensitive and emotional subject, and if it were legalised many pharmacists would play important roles in the process — including requests to dispense prescriptions that would end lives.

So when legislation to allow assisted suicide was proposed in both Scottish and Westminster Parliaments in 2012, the national pharmacy boards of the Royal Pharmaceutical Society (RPS) developed a policy to address the challenges and issues the profession might encounter.

RPS policy neither supports nor opposes the Bills. But we wanted to ensure politicians understood that the pharmacist’s role reaches far beyond supply, and that pharmacists would need to work in partnership with medical colleagues. Moreover, as healthcare professionals, the concept of dispensing a prescription that would end someone’s life is quite outside the realm of routine pharmacy practice and raises many ethical and practical questions.

We established a Great Britain-wide working group with representatives from across the profession, and invited members to contribute to a reference group. This process developed a suggested framework, which has proved a robust piece of policy and enabled the RPS to remain steadfastly neutral in opinion while engaging with policymakers and highlighting issues from a pharmacy perspective.

The requirement of a ‘conscience clause’, contained within legislation and not just in professional guidance, was the most important criterion identified. This would allow those opposed to the proposals to be absolved from dispensing the lethal prescription and accommodate any moral, ethical and religious beliefs. The working group felt strongly that the conscience clause should be explicit in legislation to give a clear message to policymakers that individuals must have freedom of choice.

Even members of the group who would be willing, if legislation changed, to dispense a prescription to end someone’s life were adamant that such a conscience clause was necessary. Parallels were drawn to emergency hormonal contraception and to the Abortion Act 1967. Explicit legal protection for anyone involved would also be a priority.

The principles behind the Westminster Parliament and Scottish Parliament Bills are similar, even if some details differ. Both attempt to give people the choice to die at a time of their choosing when they are suffering from a terminal or life-shortening illness, who find life no longer tolerable with no prospect of improvement.

The RPS policy suggests a framework within which pharmacists could work, exploring the issues any pharmacist dispensing for an assisted suicide procedure would have to address.

Under this framework, pharmacists would opt in and undertake necessary training alongside medical colleagues and facilitators (a role proposed in the Scottish Bill only). A doctor would then use a list of trained pharmacists to approach one willing to assist, helping to ensure patients and their families were not subjected to stress at a very difficult time in their lives.

We also stipulated for a multidisciplinary professional advisory panel to be written into statute that would produce best practice guidance to support prescribers. The need for palliative care to be adequately resourced and available for everyone was also highlighted.

Following the creation of the RPS policy, I gave evidence alongside medical colleagues at the first Health and Sport Committee session on the proposed legislation at the Scottish Parliament, and met the teams drafting the Bill in Westminster. It has been refreshing to see politicians recognising the importance of pharmacy’s role.

The Westminster Bill is likely to run out of time before the 2015 general election, although it may resume its passage afterwards. The fate of the Scottish Bill will be decided by a full vote of the Scottish Parliament after the Health and Sport Committee has presented its findings and recommendations. Public opinion in polls seems to be in favour of a change in legislation, but this might not be reflected in parliamentary support for what is still a highly contentious issue.

For the pharmacy profession, the conscience clause — the right to individual choice and to opt out — is a cornerstone to any proposals and must be firmly embedded in any new laws.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2015.20067807

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