Less than a month before doctor-assisted suicide is legal in Quebec, and there is confusion over the role pharmacists will play in the contentious practice, with some voicing concern over the level of preparation they have received.
VICE News spoke with more than half a dozen pharmacists across the province working in both private pharmacies and hospitals, none of whom wanted to identify themselves publicly.
While hospital pharmacists said they had received information and some training, private pharmacists painted a different picture.
"I wasn't even aware the law was coming into effect, and that's a bit worrisome," said one pharmacist-owner, who added that his four employees are in the dark.
"It's something that's going to require a lot of follow up, and I don't even know what medications we'll be working with," said another practitioner.
A Supreme Court of Canada ruling overturned the ban on doctor assisted suicide earlier this year, and by February 2016 doctors across Canada will be able to help terminally ill patients die. Quebec is ahead of the curve, though, having approved its law already, which takes effect on December 10.
To be eligible, patients will have to meet a very strict set of criteria and demonstrate intolerable and incurable pain. The treatment plan will be devised by a group of healthcare professionals, including pharmacists and at least two physicians, and will typically consist of three injections: one to sedate the patient, another to induce a coma and a third to stop the patient's breathing and heart.
Evidently, there are still kinks to iron out. For one, healthcare professionals have yet to formally establish where the service will be administered. So far, only one palliative care center has agreed to offer assisted suicide — most have refused — and while hospitals will be legally obligated to give patients this option, there is still debate as to which department will host the service. There is also significant opposition to the law, with one group of doctors now contesting it in court.
And among some pharmacists, there is a sense the legislative changes will have little to no impact on the day-to-day job.
"I don't think it will happen immediately that we'll have to fill these prescriptions," one private pharmacist said. "For now I'm not too concerned, for the simple reason that these cases are pretty rare and because the health care workers involved will ensure it's well managed," another said. "At the pharmacist level, it's more a matter of approving the treatment, not selecting it."
But that's not the way the Quebec Order of Pharmacists sees it.
President Manon Lambert stressed the pharmacist's role is much more than simply filling a prescription.
"In the context of medically assisted suicide, the pharmacist is the specialist on the medication that will be used," she said. "The pharmacist could often be the first point of contact, families might question the pharmacist to find out how to access [this service] and to know how it works."
She said practitioners would have to remain available while the life-ending medication is being administered. "If there is an issue with the prescription, the pharmacist has to be reachable to help," she said. "And they have to later discuss how it went." Pharmacists will also have to answer questions on the treatment, from both families and patients.
Despite the opposition and outstanding questions, Lambert said medical professionals are preparing for a December start date. The Quebec Order of Pharmacists has published a manual to help pharmacists handle the new responsibility. "We've informed the members, and we have a complete file on this coming out in the December issue of our magazine," said Lambert. She said all of the province's pharmacists have received two emails on the subject.
In many cases, however, the information seems to have gone unnoticed. The hospital pharmacists that VICE News spoke to seemed more prepared, saying the manual had been reviewed in both meetings and in training sessions. Of the five private pharmacists contacted for this story, only one had read the guide, which he said he sought out after the initial interview request.
Another pharmacist said he'd simply been too busy keeping up with other legislative changes to notice. "The [provincial] government has made a lot of cuts in pharmacy, so we have other challenges," he said.
Lambert said she's not surprised pharmacists missed her association's emails, given their heavy workload. She said it's up to pharmacists to seek out the manual and ensure they're up to speed, something she believes will happen as the deadline inches closer.
"People will read [the information] when they feel that it will be important to their practice tomorrow."
But private pharmacists say more outreach would be appreciated. "It would be nice to get training, not to be thrown into that," one pharmacist said. "We see patients more than others, since we're often the most accessible health care professionals, and now we have nothing to tell them," another said. "With something this touchy, it's even more abhorrent."
Follow Brigitte Noel on Twitter: @Brige_Noel