"Death was a blessing"--should it ever be pharmaceutically hastened? British pharmacists' views

[Evaluation of the ethics of pharmaceutical practice: A literature review]

INTRODUCTION

Ethics are at the heart of pharmacy practice.

METHOD

This is a literature review. The main objective is to carry out a review of studies relating on the evaluation of ethics in pharmacy practice. Documentary research on Pubmed was carried out from 1990 to 2020. All studies relating to pharmaceutical ethics that may be applied to the pharmacy practice in pharmacies or in health establishments and that conducted a qualitative or quantitative evaluation of pharmaceutical ethics (e.g. surveying pharmacists or pharmacy students, using a measurement tool, quantifying or qualifying a perception or behaviour) were included.

RESULTS

The studies come mainly from Anglo-Saxon countries (29/38). Studies related to pharmacy practice, mainly target pharmacists (n=27) and pharmacy students (n=16), and more often have a quantitative component of (n=28). The main ethical dilemmas observed dealt with emergency oral contraception (EOC), voluntary termination of pregnancy with drugs, euthanasia, commercial practices of the pharmaceutical industry, refusal to dispense a prescription in a broader context and plagiarism or dishonesty in academic settings.

CONCLUSION

Few studies have been conducted on the review of ethics of pharmacy practices from 1990 to 2020. Pharmacy students and practicing pharmacists are regularly exposed to ethical dilemmas and respond to these dilemmas with due consideration, taking into account six principles, eight values and other factors. Exposure to these dilemmas creates inaction, stress and distress. A few possible solutions have been identified.

Australian pharmacists' perspectives on physician-assisted suicide (PAS): thematic analysis of semistructured interviews

OBJECTIVES

This study aimed to investigate Australian pharmacists' views about their role in physician-assisted suicide (PAS), their ethical and legal concerns and overall thoughts about PAS in pharmacy.

DESIGN

Semistructured interviews of pharmacists incorporating a previously validated vignette and thematic analysis.

SETTING

Australia (face to face or phone call).

PARTICIPANTS

40 Australian Health Practitioner Regulation Agency registered pharmacists, majority women (65%) with varied experiences in community, hospital, industry, academia, government and other fields.

RESULTS

Emergent themes from the interviews were: legal and logistical framework, ethical framework, training and guidance and healthcare budget. More than half the participants supported the role of pharmacists in the supply of medicines for PAS, while less than half were either against or unsure of the legislation of PAS in Australia. Shared concerns included transparency of prescribing practices and identification of authorised physicians involved in PAS, which were consistent with existing literature. Religious faith, emotion and professional autonomy were key indicators for the implementation of conscientious objection to the supply of medicines in PAS. Re-evaluation of current guidelines, pharmacist training and government reimbursement was also of significance from participants' perspectives.

CONCLUSION

This study revealed current concerns of practising pharmacists in Australia, including previously undocumented perspectives on the pharmacoeconomic impact of and barriers relating to PAS. The need for training of all healthcare professionals involved, the provision of clear guidelines, including regulation around storage, administration and disposal of medicines dispensed for PAS and the updating of current therapeutic guidelines around end-of-life care were all issues delineated by this study. These findings highlighted the need for current and future policies to account for all stakeholders involved in PAS, not solely prescribers.

Knowledge and Attitudes of Hospital Pharmacy Staff in Canada Regarding Medical Assistance in Dying (MAiD)

BACKGROUND

In February 2015, the Supreme Court of Canada ruled that it was unconstitutional to prohibit physicians from assisting in a patient's consensual death, thereby setting the groundwork for the legalization of medical assistance in dying (MAiD). Much of the research on this topic has focused on physicians, although other health care professionals will be involved in the process, including pharmacists, pharmacy technicians, and pharmacy assistants. In many provinces, the medications required for MAiD will be dispensed from hospital pharmacies, which will result in direct involvement of hospital pharmacy staff.

OBJECTIVES

The primary objective was to investigate the knowledge and attitudes of hospital pharmacy staff in Canada regarding MAiD. The secondary objective was to determine the factors that might influence those opinions.

METHODS

A 34-question web-based survey was available for 6 weeks during early 2017 to hospital pharmacy staff throughout Canada. For most questions, responses were based on a 5-point Likert scale, ranging from "strongly agree" to "strongly disagree". Descriptive and inferential statistics were used to analyze the data.

RESULTS

A total of 1040 valid survey responses were received: 607 from pharmacists, 273 from pharmacy technicians, and 160 from pharmacy assistants. Most respondents were supportive of MAiD; however, nearly all respondents (99% [601/607] of pharmacists, 73% [315/431] of technicians and assistants]) reported lacking comprehensive education on the topic. Despite high levels of overall support, pharmacists tended to be less supportive of MAiD than pharmacy technicians or assistants. Factors that influenced opinions included strong religious beliefs, region, and knowledge of provincial and federal legislation.

CONCLUSIONS

The majority of respondents, particularly technicians and assistants, were supportive of MAiD, but most respondents lacked education about the topic.

Medical assistance in dying: Examining Canadian pharmacy perspectives using a mixed-methods approach

Background:

Canada legalized assisted dying with the passing of Bill C-14, Medical Assistance in Dying (MAiD), in June 2016. This legislation has implications for health care professionals participating in MAiD. This research aims to understand the effect that MAiD has on pharmacists and pharmacy technicians in Canada.

Methods:

We conducted a thematic document analysis of pharmacy guidelines, position statements and standards of practice from pharmacy regulatory authorities across Canada. In addition, the Ontario Pharmacists Association surveyed its members (including pharmacists, pharmacy technicians and pharmacy students) about their perceptions of MAiD.

Results:

Our thematic analysis of the reviewed documents resulted in 3 major themes: pharmacists’ role in quality assurance, practice considerations when implementing MAiD and resources for pharmacy staff involved in MAiD. Survey responses illustrated that most (68%) pharmacy staff would dispense MAiD medications. Nonetheless, many respondents perceived that they lacked knowledge or comfort with different aspects of the MAiD process. Overall, 80% of participants reported a desire for professional development about MAiD.

Conclusion:

Despite the rapidly changing landscape surrounding medical assistance in dying within the past year, most pharmacy regulatory authorities have provided direction and resources to their pharmacists. Ontario pharmacists and pharmacy technicians are willing to dispense MAiD medications; however, additional support in the form of professional development may be necessary based on participants’ desire for education coupled with their perceived lack of knowledge. Future research may focus on the efficacy of provincial guidelines in supporting pharmacists’ participation in MAiD.

Factors Associated With Attitudes Toward Suicide

Background: Pharmacists could play a significant role in providing care for suicidal individuals. Previous studies reported that gatekeeper attitudes toward suicide could affect caregiving behaviors toward people at risk for suicide. Nevertheless, only few studies have examined the attitudes of pharmacists toward suicide. Aims: This study explores the factors associated with the attitudes of pharmacists toward suicide. Methods: A self-administered questionnaire and written explanation of the study were mailed to 541 pharmacists who had registered for the Board Certified Psychiatry Pharmacy Specialist Seminar in Tokyo, Japan. A Japanese version of the Attitudes Toward Suicide questionnaire was used to assess participant attitudes toward suicide. Multivariate analysis of covariance was used to assess relationships between participant attitudes toward suicide as well as demographics, occupational, and personal factors. Results: Participants who had previously received suicide-related education were more likely to have positive attitudes toward suicide prevention. Conversely, those with a lifetime history of suicidal thoughts had more permissive attitudes toward one’s right to commit suicide. Conclusions: Our findings suggest that pharmacist suicide prevention training programs should aim to alter permissiveness attitudes of trainees toward suicide.