PHYSICIAN-ASSISTED

DEATH
Preliminary Guidance to
Pharmacists & Pharmacy Technicians

FEBRUARY 5, 2016

The Ontario College of Pharmacists would like to thank the Alberta College of Pharmacists for their
collaboration in preparing this document, which was adapted from the Alberta College of Pharmacists
Physician-Assisted Death (PAD) Preliminary Guidance to the Professions.

Purpose
This document serves as interim guidance in the absence of federal and provincial legislation to
support the profession when serving patients who have qualified and consented to physician-assisted
death
The guidance is intended to help pharmacy professionals comply with the Code of Ethics and
Standards of Practice in a manner that is consistent with the decision of the Supreme Court of
Canada (SCC) in Carter v. Canada 1.
It is important for all pharmacy professionals to continually monitor information from the College about
physician-assisted death, as the following guidance is based on the information available to the
College at the time of publishing. Future development of policies, legislation or regulations may
impact this guidance, and will be communicated to the profession as it unfolds.

Relevance to Pharmacists and Pharmacy Technicians

Physician-assisted death, whether it occurs in a facility, or in another setting facilitated through a
prescription written by a physician, will likely include the services of a pharmacist and/or pharmacy
technician in preparing and dispensing drugs. As key members of the healthcare team pharmacy
professionals may be called upon to contribute to physician-assisted death as early as February 6,
2016.
Pharmacists and pharmacy technicians must understand how to comply with the Standards of
Practice and Code of Ethics when serving a patient who presents a physicians prescription for
physician-assisted death.
1

Carter v. Canada (Attorney General), 2015 SCC 5.

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Background
Assisted death has historically been considered a crime under the Criminal Code. However, on
February 6, 2015, in the Carter v. Canada 2 decision, the SCC found that this absolute prohibition
violated an individuals Charter right to life, liberty and security of person. Accordingly, the SCC
overturned the criminal prohibition to allow physician-assisted death where the individual requesting
access to physician-assisted death meets specific criteria. Both assisted suicide, where the patient is
provided assistance in ending his/her own life through self-administration of a lethal dose of
medication; and euthanasia, where a physician directly administers a lethal dose of medication are
forms of physician-assisted death allowed by the Carter decision.
The Carter decision requires that to be eligible for physician-assisted death an individual must:

Be a competent adult;

Clearly consent to the termination of life;

Have a grievous and irremediable medical condition (including an illness, disease or

disability); and

Experience enduring suffering that is intolerable to the individual in the circumstances of his or
her condition.

The SCC suspended its decision and granted federal and provincial governments one year to
develop federal and provincial legislation to accommodate its decision, with a deadline of February 6,
2016. With many provinces, including Ontario, requesting more time the Supreme Court extended the
deadline by four months, to June 6, 2016.
In its ruling the SCC included the provision that individuals may apply to a court of superior
jurisdiction (in Ontario that will be the Superior Court of Justice) for individual authorization to proceed
with physician-assisted death as of February 6, 2016 until June 6, 2016.
The College of Physicians and Surgeons of Ontario has released its Interim Guidance on PhysicianAssisted Death, to which this Ontario College of Pharmacists guidance document is aligned.
2

Carter v. Canada (Attorney General), 2015 SCC 5.

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Guiding Principles of Professionalism when Serving a

Patient who has Qualified and Consented to PhysicianAssisted Death 3
1. Pharmacists and pharmacy technicians must practice within their scope, and comply with the
Code of Ethics, Standards of Practice and in accordance with all relevant and applicable legal
and professional obligations to ensure they safely deliver quality health care.
2. Pharmacists and pharmacy technicians limit their practice to services they have the
knowledge, skills and judgement to perform.
3. Pharmacists and pharmacy technicians act in the best interest of their patients.
4. Pharmacists and pharmacy technicians communicate sensitively and effectively with patients
in a manner that provides patients with health information, referrals, and health services in an
unbiased and respectful manner to enable patients to make well-informed decisions.
5. Pharmacists and pharmacy technicians must not impede access to care or abandon patients
they care for.
6. Conscientious objection by a pharmacist or pharmacy technician must not be directly
conveyed to the patient and no personal moral judgements about the beliefs, lifestyle, identity
or characteristics of the patient should be expressed.
7. Conscientious objections by a pharmacist or pharmacy technician must not impede the right of
patients to receive unbiased information, including an effective referral made in good faith, to
a non-objecting and accessible alternative provider.

Adapted from the Guidance provided by the College of Physicians and Surgeons of Ontario to physicians.

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Guidance in the Absence of Federal and Provincial

Legislation
The Carter decision deals with the rights of individuals to request physician-assisted death under
specific conditions and does not explicitly address the involvement of the overall health team in this
process. At this time, the College advises that pharmacist and pharmacy technicians:

SHOULD NOT perform any activity that may imply that they are leading physicianassisted death. This includes assessing an individual to determine whether their condition is
grievous or irremediable. Additionally, a pharmacist should not adapt prescriptions for
physician-assisted death. Should he/she determine a need to adjust the treatment, he/she
should bring it to the attention of the prescriber and allow the prescriber to make the decision;

SHOULD NOT collect consent for physician-assisted death, but should exercise diligence
to ensure that protocols for collecting consent have been followed and are completed;

SHOULD NOT dispense drugs intended for physician-assisted death for Office Use
by the physician. While it is appropriate to provide the prescription directly to the prescribing
physician, the drugs MUST only be dispensed under that patients name and appropriately
recorded in the patients record of care.

Should ensure appropriate documentation according to the Colleges Documentation

Guidelines, such as indication and pertinent patient dialogue, on the patient record.

Ethical Considerations
The Code of Ethics must be considered holistically and in context with all principles and standards
within the Code. When providing services to support physician-assisted death pursuant to the
consent of a patient and the prescription of a physician, you should pay particular attention to these
principles and standards:

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Principle 1: Beneficence
Pharmacists and Pharmacy Technicians serve and benefit the patient and societys best interests.

Ensure the primary focus at all times is the well-being and best interests of the patient.

Apply therapeutic judgment in order to assess the appropriateness of current or proposed

medication therapy given individual patient circumstances.

Provide patients with the relevant and sufficient information they need in order to make more
informed decisions about their healthcare.

Participate in consultation, communication and documentation with colleagues or other

healthcare professionals to facilitate quality patient care.

Principle 2: Non-Maleficence
Pharmacists and Pharmacy Technicians refrain from participating in behaviours that may harm
patients or society and whenever possible prevent harm from occurring.

Practice only within their scope of practice, recognize their limitations and when necessary,
refer the patient to a colleague or other healthcare professional whose expertise can best
address the patients needs.

In circumstances where they are unwilling to provide a product or service to a patient on the
basis of moral or religious grounds, ensure the following:
o

that the member does not directly convey their conscientious objection to the patient;

that the member participates in a system designed to respect the patients right to
receive products and services requested;

that there is an alternative provider available to enable the patient to obtain the
requested product or service, which minimizes inconvenience or suffering to the
patient.

Assume responsibility for making reasonable efforts to ensure continuity of patient care when
they are unable or unwilling to provide requested pharmacy services.

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Principle 3: Respect for Persons

Pharmacists and Pharmacy Technicians respect their patients as self-governing decision-makers in
their healthcare and treat all patients fairly and equitably.

Respect and value the autonomy and dignity of patients.

Practice patient-centered care and treat patients with sensitivity, caring, consideration and
respect.

Listen to patients to seek understanding of their needs, values and desired health goals and
respect their right to be an active decision-maker in their healthcare.

Respect the patients values, customs and beliefs and their right to hold these as selfgoverning decision-makers.

Principle 4: Accountability
Pharmacists and Pharmacy Technicians maintain the public trust by ensuring that they act in the best
interest of their patients and society.

Assume responsibility for all decisions and actions they undertake in professional practice,
including failure to make a decision and take appropriate action when necessary.

Ensure that all professional documentation is accurately maintained in accordance with

practice standards.

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