On June 10, 2016, the Alberta government approved an Order in Council amending the standards of the College of Physicians and Surgeons of Alberta on Medical Assistance in Dying (MAID). Government also approved a directive, requiring that Alberta Health Services (AHS) establish a coordination service to facilitate MAID. Our college encourages you to review each of these documents to further familiarize yourself with new requirements about the provision of MAID in Alberta.
Earlier this year, ACP surveyed pharmacy licensees to determine their pharmacy’s readiness and willingness to provide pharmacy services to support MAID; primarily for the purpose of facilitating registrants wishing to exercise conscientious objection. The information collected through this survey has been kept strictly confidential; and has served its purpose. It will be destroyed to ensure confidentiality.
Now that Alberta Justice has issued a directive protecting pharmacists and pharmacy technicians who compound and dispense drugs to support MAID – and with the advent of the amended standards and the requirement for AHS to establish a coordinating service – our college will again survey pharmacy licensees to determine their pharmacy’s readiness and willingness to provide compounding and dispensing services to support MAID. Our intention will be to share this information with AHS to support their role in coordinating MAID when individuals qualify for this service and wish that it be provided outside of AHS facilities.
Next steps and important considerations
Consistent with the most recent Message from the Registrar on MAID (June 6), ACP will be reviewing its previous guidance documents, with the intent of merging them into a single current version to reflect the current regulatory environment. Again, this guidance will be based on information available to ACP at the time of publication, and will be subject to change should federal or provincial legislation be passed. In the interim, we encourage you to:
- familiarize yourself with the MAID protocols (June 3 version), the standards of practice for physicians approved by Alberta Health, and the guidance provided by ACP with respect to compliance with the Standards of Practice for Pharmacists and Pharmacy Technicians and ACP’s Code of Ethics when supporting MAID;
- familiarize yourself with the sources of drugs, excipients, and other products that you may require to compound and dispense a MAID protocol;
- discuss your readiness and willingness to provide services to support MAID with your pharmacy team;
- understand any limitations about your ability to provide services that support MAID, and be prepared to respond appropriately to individuals and family members;
- should you intend to exercise conscientious objection, review the Code of Ethics for guidance about how to do this properly,
- familiarize yourself with the AHS Coordinating Service, and prepare to forward individuals to that service if they are seeking information about MAID and if your pharmacy is unable to provide compounding or dispensing services to support MAID.
- Should you receive a prescription for MAID requesting the euthanasia protocol, clarify with the prescribing physician whether they wish the drugs to be dispensed in the manufacturer’s package, or whether they wish the drugs to be dispensed in pre-loaded syringes.
All licensed pharmacies may dispense drugs in the manufacturer’s original packaging. However, the pre-loading of syringes must only be performed in a sterile environment, and therefore, only a limited number of licensed pharmacies with the necessary infrastructure and environment to perform sterile compounding are able to provide this service.
- Prescriptions for MAID protocols should only be dispensed through a direct relationship between the prescribing physician and the pharmacy providing the compounding and dispensing services. MAID protocols should not be facilitated and dispensed through a relationship between a licensed pharmacy and a secondary compounding and repackaging pharmacy. The protocols require the dispensing of controlled substances which are not accommodated through compounding and repackaging agreements. Secondly, the 1:1 relationship should be preserved, to respect patient confidentiality.