In Views

Follow this topic

Bookmark

Record learning outcomes

The debate over assisted suicide and voluntary euthanasia has been raging for years. It is a subject that, quite naturally, has given rise to heated arguments, both for and against, and hugely important questions concerning the sanctity of life and personal autonomy have been discussed at great length.

I don't intend to repeat the arguments here, other than to say that I find myself in the sanctity of autonomy camp. It was perhaps only a matter of time before a serious proposal to change the law was brought before Parliament, though it is, in fact, the Scottish Parliament where a draft bill €“ the Assisted Suicide (Scotland) Bill €“ was put forward by MSP Margo MacDonald in November last year. The Royal Pharmaceutical Society has been asked to give written evidence for scrutiny at the committee stage.

For the first time in my life I have read the full text of a parliamentary bill. It was an interesting exercise and revealed the care that is needed in drafting legislation. It is quite a remarkable piece of work which forces the issue in a way that all the media coverage and debate could never hope to do. It demands to be taken seriously.

Enabling assistance

As it stands, the bill would enable people to ask medical and other health practitioners for assistance in ending their lives painlessly at a time of their own choosing. The person asking for this assistance would have to be suffering from a progressive life-ending condition with a quality of life that was unacceptable and where there was no possibility of recovery.

As long as certain procedures and safeguards, which are described in detail in the bill, are followed, the health practitioners involved would be protected from both civil and criminal liability.

To qualify, the person must be 16 years old or over and be registered with a GP in Scotland. The procedure for requesting assisted suicide is in three stages: an initial declaration in principle that the person may at some stage decide to seek assisted suicide, then a first formal request for assistance followed by a second formal request with a gap of at least two weeks between them.

Each formal request must be endorsed by two medical practitioners. On receipt of the second request, drugs suitable to end the person's life may be prescribed for subsequent dispensing by a pharmacist.

The act of suicide must take place within 14 days of the second request being recorded in the person's medical record. The bill does not authorise the administration of any drugs by a second person; they must be self-administered. In the words of the bill: €The cause of death is the person's own deliberate act€.

Essential safeguards

By implication, this means that people who are physically incapacitated and who would not be capable of self-administration are not included; similarly, the bill specifically excludes any form of euthanasia €“ where one person kills another, but with their consent. On my reading, the safeguards are essential, measured, and achievable in practice: a good start.

Perhaps unsurprisingly, the RPS takes a neutral stance on this issue, citing the wide spectrum of members' views both for and against. This seems to be a convenient reason for sitting on the fence. Surely of much greater importance is the wellbeing of the people €“ patients, carers and other health professionals €“ that pharmacists serve.

There is clearly a need for better end of life care in the UK. This may or may not include assisted suicide, but it seems to me that the caring professions (if they really believe in that description) ought to be in the lead, offering objective information both for and against and canvassing the opinions of their members before embarking on a 'neutral' stance. It may be that a neutral stance would best serve the public interest, but to cite members' views as a reason is simply not good enough.

Pharmacists first

On the RPS website, the priorities seem wrong. In addition to stating their (our) 'neutral' stance on this issue, the RPS seems mostly concerned about ensuring that there is a conscience clause for pharmacists to opt out, that the legal protection is watertight, that pharmacists are included on any advisory groups, that the availability of lethal drugs in the community is minimised, etc.

Nowhere, I repeat, nowhere, is there any mention of the person who might be requesting assisted suicide, or of their family, or of their deep need for help and compassion at a time of extreme distress.

In 2013, the RPS published a policy statement on assisted suicide. It described the €approach to the issues and challenges which the pharmacy profession would be presented with should assisted suicide be legalised€.

For pharmacists, it attempted an 'everyman' approach, with a framework for those who might wish to be involved, while leaving an opt-out for pharmacists opposed to assisted suicide.

I am in full agreement with the suggestion that pharmacists who wish to be involved would opt in and complete an appropriate training course: far better to have one volunteer than 10 who have been press-ganged. I also agree that any policy statement should be written in an objective way, anticipating potential problems and offering the necessary safeguards.

But where is the patient? Somewhere in the midst of all the 'health-speak', the patient has been mislaid. I can't help but get the impression that the policy statement has been written by someone who has never seen a patient, who has never had to offer counselling to a distressed relative, who has never been in the position where they have had to wrestle with conscience issues in delivering healthcare on the high street or in a council estate or in a small village.

If I had been asked to contribute, I would have introduced it by saying that this policy is intended to ensure that the end-of-life needs of patients and their families are met in a professional manner that is consistent with the law and guided above all by compassion.