Unfit for purpose
However, it is unclear whether Ireland will proceed with assisting-dying legislation, given that the Oireachtas Justice Committee declared that the proposed Dying with Dignity Bill 2020 was unfit for purpose.
In July 2021, Justice Committee Cathaoirleach James Lawless pointed to serious flaws in the proposed legislation that could lead to unintended policy consequences.
The bill will not progress to Committee Stage, but a Special Oireachtas Committee is expected to shortly give it detailed consideration.
No reference to the pharmacist’s role is made in the Dying with Dignity Bill 2020 and the individual pharmacist is excluded from the ‘conscientious objection’ section of the bill, Dr Flood has pointed out.
‘Controversial moral dilemmas’
This means pharmacists are not afforded legal protection if they take part in assisted dying, Dr Flood writes.
She warns that legalising assisted suicide or euthanasia will have a profound impact on pharmacists, since both practices require lethal medications dispensed by pharmacists.
“Pharmacists will be at the vortex of some of society’s most controversial moral dilemmas,” Dr Flood writes, adding that they are often written out of conscientious-objection legislative protections, unlike doctors and nurses.
“All three professions are part of the lethal-medication-use process. Euthanasia and assisted suicide cannot occur without the provision of lethal medications/lethal doses of medication.
“Many pharmacists may have a moral and/or ethical objection (for a number of reasons) to participation in a process that results in the intentional ending of a human life,” the article continues.
Unequal treatment of pharmacists is unjust and unfair and perpetuates the vulnerability of pharmacists and pharmacy, Dr Flood concludes.
Freedom of conscience
“Society desires pharmacists to be conscientious, but denies them legal protection of their human right to freedom of conscience, wants them to be conscientious but not to have a conscience,” she writes, warning that pharmacy is vulnerable to becoming a robotic profession.
She adds that modern medicine cannot guarantee a pain-free death (natural or intentional) for all.
“The difficulties and complications of medication administration during the assisted suicide/euthanasia lethal-medication process are rarely mentioned,” writes Dr Flood.
No drugs or devices have been approved by the US FDA for assisted suicide or euthanasia.
Failure to use the ‘correct’ medications may lead to traumatic situations, such as an extended time to death or awakening of the patient.
A 2013 study suggested that some physicians may overestimate the actual lethal effect of drugs, or use drugs that are not associated with euthanasia, but with ‘palliative sedation’, as a strategy to reduce cognitive dissonance from the emotional burden of performing euthanasia.
Dr Flood points to an international scarcity of lethal medications suitable for oral administration, with most intentional deaths having a doctor or nurse as the final actor administering lethal medication.
Low quality of evidence
“The quality of evidence for ‘optimal’ assisted suicide medications is low,” the pharmacist writes.
A number of medicines were previously used in executions. Use of medicines during executions has been described as ‘inhumane’, with reports of people feeling ‘burning’ sensations throughout their bodies prior to death.
A scoping review of 163 studies that included technical summaries, institutional policies, practice surveys, practice guidelines and clinical studies, identified prolonged duration of the dying process, difficulty in obtaining intravenous access, and difficulty in swallowing oral agents.
Concerns over ‘Oregon Death with Dignity’ reports
In the Oregon Death with Dignity programme (1998-2016), there are reports of one patient who required up to 104 hours to die; at least six patients awoke after ingesting drugs; and, for many patients, it is “unknown” whether complications occurred.
In the US, no medical association oversees assisted suicide or euthanasia, and no government committee funds research into the practice. In US states where the practice is legal, local governments provide guidance about which patients qualify, but are silent about which drugs to prescribe.