June 17/16 was a historic day in Canada. It was the day that bill C-14, legislation on medical assistance in dying (MAiD) received royal assent.

Picking the title for this post was tough. The pun idea was what initiated the post in the first place, but reading it may imply a lack of respect which is unintentional. My feeling is that Canada took the bold step to acknowledge that dying with dignity belongs in our consciousness and in how we care for those suffering the unimaginable. Now that this step was taken, and the discussions have occurred, there is no putting the toothpaste back in the tube. Providing patient care in this setting is a marked departure from anything most of us have been involved with in our careers. We are trained to be exacting in our standards and level of detail to prevent patient harm from dosing errors or drug interactions. Recognizing what was always viewed as the most extreme degree of harm as holistic patient care is not an easy feat.

It’s no surprise the debate was prolonged. The subject of death in any form is an extremely sensitive topic. It’s never supposed to be a planned event, and when it is, it’s associated with tragedy and unanswered questions. There is now a provision in the criminal code for an individual to seek assistance in ending their personal suffering on their terms without penalty to themselves or the healthcare providers involved in carrying out those final wishes.

In Nova Scotia, the regulations make clear the pharmacist’s involvement. In my opinion, the document is transparent, and is well-written. Should our team be approached with a request, we’ve discussed our comfort with the sourcing and dispensing of the medications (some of which we’ve never actually dispensed in retail). We understand our role in the process, and those of the physicians and the nursing staff. Still, when the request is actually made, it’s difficult to predict the emotions we will feel…and that’s perfectly okay. I’ve spoken with colleagues that have been approached and they describe the process as extremely collaborative and supportive. In the lead-up, it’s all about following the protocol: receiving the orders, collecting the medications and associated supplies, labeling the kits, and arranging dispensing to the responsible physician. It’s usually only after the required notification is received that the gravity tugs a little stronger.

The CBC published an article in May of this year with a province by province snapshot of the developing guidelines based heavily on the Supreme Court ruling in the case of Carter v. Canada in Feb 2015. All had defined criteria for eligible candidates, and all outline ‘effective referral’, a clause requiring any health professional unable to provide service themselves to ensure that it is received. Not everyone will be comfortable with medically-assisted dying and we respect those who decide not to participate. Since that point, there have been additional provisions and court challenges that deem the laws too restrictive, so the conversation is far from settled.

In closing, I don’t usually like to provide opinions on controversial topics. We are a community of mostly pharmacists and complementary health care providers, meaning one opinion is one voice, and no more or less important than that of a fellow pharmacist, nurse, or physician. I have been asked, and to me it really comes down to the individual making the request. If they were my loved one; a spouse, a sibling, a parent and they were suffering helplessly, would I wish for them to have that choice? Would I wish to have that choice should my health decline to the point where comfort measures are the only form of therapy available? As many times I’ve replayed the arguments, I seem to always settle on ‘Yes’.

If you have not already done so, please read the decision and the MAiD materials before you are called on to respond. Whether you participate is a deeply personal decision that can not be made lightly. History will never be undone, so we all need to be at peace with how we move forward and evolve with this change.

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.