Ethical Decision-Making and Medical Assistance in Dying

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Ethical dilemmas have always been prevalent in practice. One could argue that the number and complexity of these dilemmas continue to increase as society evolves, political opinions become more polarized, professional organizations take political stances, and technology brings about possibilities not thought possible years ago, such as with cloning, genetically modified consumables, tests that might discover abnormalities in fetuses prior to birth, and so on. Another issue that pharmacists and other health care professionals might encounter deals with medical assistance in dying (MAiD), where patients who have been suffering seek medical assistance to end their lives. Ethical considerations of non-maleficence and patient autonomy seemingly clash.  

Fujuioka et al employed a scoping review to examine health care providers’ perspectives of their involvement with MAiD, specifically to address the roles of diverse health care professionals and the challenges that arise when confronted with MAiD requests. They evaluated 33 articles in their review, which included perspectives of nurses, physicians, mental health providers, pharmacists, social workers and medical examiners. Professional roles included consulting/supporting patients and/or other staff members with requests, assessing eligibility, administering/dispensing the lethal drugs, providing aftercare to bereaved relatives, and regulatory oversight. Challenges included lack of clear guidelines/protocols, role ambiguity, evaluating capacity/consent, conscientious objection (the practitioner refusing to participate on grounds the act offends their moral/religious beliefs), and lack of interprofessional collaboration. Evidence from various jurisdictions highlighted a need for clear guidelines and protocols that define each profession's role, scope of practice, and legal boundaries for MAiD. The review authors found that comprehensive models of care that incorporate multidisciplinary teams alongside improved clinician education may be effective to support MAiD implementation.

The aforementioned scoping review did not provide an “answer” to the question of authority, responsibility, obligations or proper judgment, and it was not meant to. Pharmacy managers should advocate for clear company/employer policy for guidance on pharmacist rights and responsibilities for MAiD, conscientious objection, and other dilemmas. Role ambiguity must be minimized. Pharmacy managers have to balance state laws/regulations with employee preferences, even though the latter might be entirely obviated by law and by company policy. Ethical judgment comes into play even more routinely during everyday practice, for example, when patients seek refills for important medications on weekends or after-hours when the prescriber might be unavailable. Ethical decision making is another learned set of behaviors pharmacists must seek to acquire.

Additional information about Ethical Decision-Making can be found in Pharmacy Management: Essentials for All Practice Settings, 5e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 5e. If your institution does not provide access, ask your medical librarian about subscribing.

1Fujioka JK, Mirza RM, McDonald PL, Klinger CA. Implementation of medical assistance in dying: A scoping review of health care providers’ perspectives. J Pain Symptom Manage. 2018;55:1564-1576.

Shane Desselle

Professor of Social and Behavioral Pharmacy, Touro University California

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Go to the profile of Shane Desselle
about 1 month ago

What are your thoughts regarding pharmacists’ roles here?