Pharmacists should be able to opt-in to participate in assisted dying by undertaking the necessary training, rather that having to opt-out of providing the service, the Royal Pharmaceutical Society (RPS) has told MPs.

And it stressed that there must be no obligation for any pharmacist to participate in any aspect of assisted dying if they feel this is against their personal beliefs.

Additionally, pharmacists must be protected from prosecution if they do choose to participate in the approved process for an assisted dying procedure, the RPS said in response to a call for evidence by a parliamentary committee.

Ensure pharmacists can opt-in to providing assisted dying

The RPS outlined several potential benefits of an opt-in model, including:

  • Pharmacists who did not want to provide the procedure would not be approached;
  • It would help identify where it may be more difficult to access health professionals who are willing to support assisted dying, such as in a specific care setting or in remote regions.

The RPS also stressed that while palliative care specialists may have specialist knowledge that would be useful, they may be unwilling to participate in the procedure or may experience a conflict of interest, and therefore should not be assumed to participate.

'Hospice pharmacists might not want to participate in case this raised anxieties, among patients and their families or carers around hastening a death. Established treatment pathways at the end of life should remain quite separate from a formal assisted dying procedure,' the RPS added.

Giving evidence to MPs on the issue in parliament this week (28 January), chief medical officer for England Professor Sir Chris Whitty said it was likely that 'a very large number' of healthcare professionals would be involved in 'the very earliest stages' of assisted dying training, 'because someone may raise an issue with their GP, with their nurse, with their consultant, and they need to have the basic understanding for that'.

‘When it comes to the more detailed later stages, that, in my view, will require some specific training,' he said.

‘And I think there will be a gradation, in my view, of doctors – ones that are happy to have the general initial conversation, ones who are happy to have the structured conversation that follows, and a minority of those who will be happy to go on to take part in the final stages.

‘It is very important that both the wishes of the patient are respected, and that is the central point of this, we must start with someone in their last six months of life and their immediate family, what’s good for them.

‘But we must also make sure that the wishes of healthcare professionals around this area are absolutely protected.'

Dispensing and supply of required drugs

Pharmacists that do choose to be involved in prescribing and/or dispensing medication for assisted dying must have full access to the patient’s diagnosis and assisted dying care plan, and be assured that procedure is suitable and that all legal requirements are in place.

And the prescriber should always be one of the assessors that determines whether the procedure should go ahead, the RPS said.

It also highlighted that time must be allowed to ensure that the prescription could be supplied on the due date, given that the appropriate medicinal products may not be routinely held in stock.

And it noted that drugs used in assisted dying 'will likely either not have a marketing authorisation in the UK for human use or will be used "off label" rather than for the licensed indication'.

Alternative options must be explored with patients

The RPS also said that counselling and advice on all the alternative options must be provided to anyone contemplating assisted dying,' the RPS said in its submission.

'It must not be assumed that when a person presents with a request for assistance to end their life that this is indeed their actual first choice.

'People may present with a request for assisted dying when they are not aware of all the alternative options available to them.

'It is imperative that the best possible standard of palliative care is provided and that all options have been fully explored in a multidisciplinary, holistic approach to care.'

Patients should also be given a medication review to discuss polypharmacy issues including minimising the risk of side effects towards the end of life, it added.

The RPS said it 'would both support and expect improvements in palliative care to allow equitable access for all patients diagnosed with a terminal illness'.

At the end of last year the Terminally Ill Adults (End of Life) Bill passed its second reading stage and will now be considered by MPs in several committee sessions.