Australian pharmacists’ perspectives on physician-assisted suicide (PAS): thematic analysis of semistructured interviews

Abstract

ObjectivesThis study aimed to investigate Australian pharmacists’ views about their role in physician-assisted suicide (PAS), their ethical and legal concerns and overall thoughts about PAS in pharmacy.DesignSemistructured interviews of pharmacists incorporating a previously validated vignette and thematic analysis.SettingAustralia (face to face or phone call).Participants40 Australian Health Practitioner Regulation Agency registered pharmacists, majority women (65%) with varied experiences in community, hospital, industry, academia, government and other fields.ResultsEmergent themes from the interviews were: legal and logistical framework, ethical framework, training and guidance and healthcare budget. More than half the participants supported the role of pharmacists in the supply of medicines for PAS, while less than half were either against or unsure of the legislation of PAS in Australia. Shared concerns included transparency of prescribing practices and identification of authorised physicians involved in PAS, which were consistent with existing literature. Religious faith, emotion and professional autonomy were key indicators for the implementation of conscientious objection to the supply of medicines in PAS. Re-evaluation of current guidelines, pharmacist training and government reimbursement was also of significance from participants’ perspectives.ConclusionThis study revealed current concerns of practising pharmacists in Australia, including previously undocumented perspectives on the pharmacoeconomic impact of and barriers relating to PAS. The need for training of all healthcare professionals involved, the provision of clear guidelines, including regulation around storage, administration and disposal of medicines dispensed for PAS and the updating of current therapeutic guidelines around end-of-life care were all issues delineated by this study. These findings highlighted the need for current and future policies to account for all stakeholders involved in PAS, not solely prescribers.

Conscientious Objection and Other Motivations for Refusal to Treat in Hastened Death: A Systematic Review

“…We included in this category all those HCPs who claimed not to participate in hastened death procedures because they did not agree with the way the law concerning this was formulated or demonstrated fear of possible legal repercussions arising from the execution of this practice, e.g., in cases where someone close to the patient does not agree with the procedure, and for this reason ends up suing the HCP, putting his professional activity at risk. There were five articles that indicated this factor for refusal of treatment [33][34][35]38,39].…”

“…Several studies pointed to this factor as something that conditioned the decision of HCPs not to participate in hastened death procedures, either because they did not agree with the drug used in the procedure, because of the type of involvement they would have to have in the process, or because of their preference for other forms of end-of-life care. Six articles pointed to this as a motivating factor for treatment refusal [9,[33][34][35]39,43].…”

“…CO in health care is defined as the refusal to perform a certain medical procedure based on morality or conscience [1]. In this sense, throughout the various articles [8,[30][31][32][33][34][35][36][37][38][39]42], we found different motivations that would lead HCPs to choose to be conscientious objectors, including:…”

“…In this category, we include all those individuals who say they choose to object to hastened death, because this procedure is not compatible with the principles of their religion. There were 10 articles whose participants presented this type of justification for being conscientious objectors, and, in fact, there were only two articles that did not refer to this category as a motivation for CO [9,33,34,[36][37][38][39][40][41]43].…”

Hospital Pharmacists’ Experiences with Medical Assistance in Dying: A Qualitative Study

“…Since 2016, when Canada enacted legislation permitting medical assistance in dying (MAiD), other jurisdictions around the world have introduced similar laws. 1,2 For example, in Australia, numerous states have recently passed voluntary assisted dying laws or are at different stages of active parliamentary consideration. 3 This increased implementation of assisted dying practice by many nations or their subjurisdictions demonstrates the effects of changing societal views and needs over time.…”