Assisted Suicide: Where do we stand?

Lara SeymourOn the 30th April, Scottish Government published its Stage 1 Report on the Assisted Suicide Bill. RPS Scotland was asked to give evidence for this report and we worked hard to ensure that pharmacists’ opinions were heard. As our members hold a range of ethical views, we recommended specific measures that would protect both patients and health professionals. You can read the full details here.

Earlier this month, Scotland’s Practice and Policy Lead, Aileen Bryson, chaired a debate on Assisted Suicide at Robert Gordon University. Student debaters wrangled over the ethical concerns for pharmacists if the Bill were to pass.  Lara Seymour MRPharmS, Group Leader of RGU’s Pharmacy Law and Ethics Society, reveals the conclusions they came to.

My job is to get pharmacy students engaged with all things related to pharmacy law and ethics. The Assisted Suicide (Scotland) Bill was the perfect opportunity for a debate and to get students involved in the ethical issues surrounding the Bill. Our main considerations were: ‘What would we do as a profession if the Bill was passed?’ ‘What extra training and guidance would be given?’ ‘How would it be dispensed and prescribed?’

Assisted suicide is a sensitive and emotional subject. If passed, pharmacists would have an important role to play. However, aiding a patient on ending their life won’t sit comfortably with many pharmacists and it was not expected of them at the time they qualified. That is why it is important to have a ‘conscience clause’ which would give the pharmacist the right to ‘opt-in’ rather than ‘opt-out’.  Those opposed to the proposals due to ethical, moral or religious reasons would be automatically exempt from dispensing the lethal medication. It is important that the ‘conscience clause’ is embedded into legislation and not just professional guidance – the pharmacist would need legal protection that would protect them from prosecution if they participated in an assisted suicide procedure.

As suggested by RPS, by ‘opting in’ the pharmacist would declare their willingness to be trained in this scheme. Once trained, doctors would be able to access details of the pharmacist confidentially and start proceedings after a suitable patient’s request. This also means a pharmacist who is not willing to participate in the scheme would not be approached. The training is necessary to ensure the pharmacist has knowledge of the procedure, paperwork and legal requirements.

In an assisted dying request, we agreed that a regular prescription wouldn’t be enough. The pharmacist must also have full access to the patient’s diagnosis and assisted suicide care plan. With controlled drugs (which the lethal medication would fall under) it was noted that there would be a 28 day period. This window would provide the patient with the opportunity to stop going ahead with the plan at any point. If they chose to resume, they would require a new prescription.

The students ‘for’ the Bill stated that respecting a patient’s wishes and giving them the right to choose where and when they die was the main reason for their support. It was also raised that if a patient desperately wanted an assisted suicide procedure they could go to other countries. Why not save the patient and their families the unnecessary burden of going abroad?

Those in the ‘against’ camp stated the possibility of a ‘botched suicide’ – one that had no effect or one that caused the patient extreme pain was one reason why they were opposed. Another was instead of the Assisted Suicide Bill, we should have greater palliative care in place. By proposing improvements in this service, they felt it was a conflict of interest to then support the Bill. They also questioned how the suitability of a patient would be determined.

We rounded off the debate with a vote and then proposing a motion. The vote was for ‘those in favour of the Assisted Suicide Bill as it currently stands’. Interestingly, every student was against this, even those who were originally ‘for’ the Bill.  The following motion was proposed – ‘We believe in the principle (autonomy) of the Assisted Dying Bill, however it requires further adjustment and clarification.’ This motion was supported by all students.

Without a change in the law, those with terminal illnesses suffer at the end of their life. A change would give people control over their illness and allow them to choose where and when they die.