To the Editors:
We read the article by Buchbinder et al. entitled “Health Care Providers’ Experiences with Implementing Medical Aid-in-Dying in Vermont: a Qualitative Study,” published in the Journal of General Internal Medicine, with great interest.1 We agree with the authors; engagement in medical aid-in-dying (AID) is more complex than responding to patient requests and writing prescriptions. We wish to highlight this research is missing the important perspective of the pharmacist.
Due to drug availability and affordability challenges, there have been significant changes in the medication regimens used for medical AID.2 As an alternative to secobarbital or phenobarbital, patients are now frequently prescribed a compounded combination of diazepam, digoxin, morphine sulfate, and propranolol.3 While outcomes from drug distribution challenges are not well documented, this may translate to patient access issues as participation in medical AID may become limited to pharmacies and health-systems with compounding capabilities, infrastructure to navigate special distribution processes, and/or willingness to assume the financial risk of ordering high cost drugs.
It is also important to consider how widespread adoption of medical AID will impact pharmacy practice. Pharmacists frequently serve as the last interaction between a healthcare professional and patient and pharmacists are legally required to counsel patients on new prescriptions. This raises important issues on the protection of conscience, pharmacist corresponding responsibility, and educational needs for the dispensing of lethal medications.
Healthcare is moving towards an interdisciplinary approach. Pharmacists are completing residencies and obtaining credentials in specialty areas involving patients who may pursue medical AID.4, 5 They are well-positioned to assist in many clinical tasks outlined in this paper. We would encourage inclusion of pharmacists in these conversations.
Funding Information
The authors have received a small grant from the American Pharmacists Association (APhA) Foundation via the Incentive Grant Program for Residents and their Preceptors for research on this topic.
Footnotes
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References
- 1.Buchbinder M, Brassfield ER, Mishra M. Health care providers’ experiences with implementing medical aid-in-dying in Vermont: a qualitative study. J Gen Intern Med. 2019;34:636–41. doi: 10.1007/s11606-018-4811-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Riley S. Navigating the new era of assisted suicide and execution drugs. Journal of Law and the Biosciences. 2017;4:424–34. doi: 10.1093/jlb/lsx028. [DOI] [Google Scholar]
- 3.Public Health Division, Center for Health Statistics, Oregon Health Authority. Oregon Death with Dignity Act. 2018 Data Summary. Available at: https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf. Accessed May 11, 2019.
- 4.National Matching Services. American Society of Health-System Pharmacists. Summary of programs and positions offered and filled in the 2019 match combined Phase I and Phase II. Available at: https://natmatch.com/ashprmp/stats/2019summpos.pdf. Accessed May 12, 2019.
- 5.Board of Pharmacy Specialties. BPS Specialties. Available at: https://www.bpsweb.org/bps-specialties/. Accessed May 12, 2019.