Physician-assisted Suicide

Ethics Considerations

Physician- assisted suicide remains a very controversial topic throughout the country. Terminally ill patients, physicians, and pharmacists often have different beliefs about the practice. The Code of Ethics for Pharmacists, developed by the American Pharmacists Association (APhA) in 1994 and endorsed by ASHP, does not discuss physician-assisted suicide.^[16] The code describes the roles and responsibilities of the pharmacist with statements such as, "A pharmacist is dedicated to protecting the dignity of the patient," and "A pharmacist promises to help individuals achieve optimum benefit from their medications, to be committed to their welfare, and to maintain their trust." In the context of physician-assisted suicide, the code may be interpreted differently, depending on the individual pharmacist's perspective.

APhA does not endorse a specific moral position on the issue of physician-assisted suicide, according to APhA-adopted policies,^[17] but supports the use of pharmacists' professional judgment under such circumstances. ASHP issued a policy of neutrality on physician-assisted suicide in 1999;^[18] that document does not provide clear guidance for pharmacists regarding physician-assisted suicide and the pharmacist's role in dispensing lethal medications.^[18,19] Pharmacists' right to "conscientious objection," or the refusal to participate in activities they consider to be against their moral, ethical, or religious beliefs, comes to mind when faced with the personal decision of whether to dispense a medication dose that is intended for use in ending a patient's life.^[20] The "pharmacist conscience clause" supported by APhA recognizes the pharmacist's right to conscientious objection but expresses the importance of ensuring that patients have access to therapy.^[17] The conscience clause seems to be in keeping with state laws on physician-assisted suicide, which clearly state that pharmacists are not required to participate in the DWDA by dispensing medication or to refer patients to participating pharmacists.^[1,12] When Oregon's DWDA first became effective in 1997, physicians were not required to inform pharmacists of the purpose of a lethal medication dose; in 1999 the statute was amended to require that the pharmacist be notified of the intended use in advance.^[21]

Pharmacy owners in states with DWDA statutes must determine whether their establishment will participate in physician-assisted suicide so they may inform their employees and create written policies and procedures so that the staff is equipped to respond to physician requests. Staff meetings and continuing education may be beneficial to initiate discussion and provide an open forum for questions and concerns. A pharmacy might choose to issue a press release about its decision not to participate. The Washington State Hospital Association (WSHA) has developed draft guidance for issuing such press releases, as well as web page statements and model policy statements.^[22] A key point emphasized in the guidance is that nonparticipating facilities cannot prohibit their pharmacists from providing information on the DWDA and physician-assisted suicide to a patient upon the patient's request. Pharmacists may provide information but should refer a patient to the attending physician to discuss the request in detail, the WSHA guidance says. Also, pharmacists choosing not to dispense a lethal medication dose in a participating facility are permitted but not required to suggest a pharmacist willing to fill the prescription. Compassion & Choices, a nonprofit organization that advocates for more DWDA legislation and provides support and education,^[23] can be contacted to obtain contact information on participating pharmacists; a pharmacist may wish to have this information available for patients and physicians even if he or she has chosen not to participate in physician-assisted suicide or works at a nonparticipating facility.

Studies examining pharmacists' attitudes toward physician-assisted suicide demonstrate that a large number find it acceptable under certain conditions.^{[24,25,26,27]} However, only about one third would be willing to personally dispense lethal medication doses, survey findings suggest. The studies also indicated that younger pharmacists and those who describe themselves as more religious are more likely to oppose physician-assisted suicide. Pharmacists' attitudes on the practice may be influenced by personal experiences.^{[27,28,29,30]}

Am J Health Syst Pharm. 2011;68(9):846-849. © 2011 American Society of Health-System Pharmacists, Inc.

All rights reserved. Posted with permission.

Cite this: Physician-assisted Suicide - Medscape - May 01, 2011.