A Vermont Pharmacist’s Analysis of the State’s Assisted Suicide Law

A Pharmacist analyzes Vermont Law

A Pharmacist analyzes Vermont’s Physician-Assisted Suicide statute

•  Vermont Pharmacists have the right to refuse to fill lethal prescriptions.
•  Vermont Physicians have immunity under the law
•  Oregon and Washington Pharmacists have immunity under their law.
•  Vermont Pharmacists have no immunity under our law!

The Physician-Assisted Suicide law that was passed by the Vermont Legislature went into effect immediately upon the Governor’s signature, thus allowing almost no time for pharmacists and other health care workers to digest the words of the law and to evaluate what it meant as it related to how they practiced their profession.  The pharmacists I have spoken to have little or no knowledge of the details of the law, now known as Act 39, so I thought I would put my understanding into words in the hope that it would encourage other pharmacists to do their homework on this.  I want to make clear that what I say here is my opinion only.  Each professional pharmacist must make their own decision and choices and if they need special counsel they should seek it.  For me, I feel comfortable looking at the entirety of the matter and making my own decision and these are some of my thoughts.

Governor Shumlin signed the bill on May 20, 2013, so it is in effect today.   A pharmacist could at any time be called on to fill a prescription that a prescriber has written for a patient who has requested the prescription for the purpose of ending their own life.   That being the case, it seems necessary to me that I, as a pharmacist, should not only understand the law but to know ahead of time what my decision will be if asked by a physician to fill such a lethal prescription.  It was important for me to speak to others, including my pastor so I could more completely understand the decision I might have to make and the impact it would have on me as a pharmacist and as a fellow human being.

I have read the law for myself and was able to draw some conclusions.   I believe the statute clearly gives me the right to refuse to fill a lethal prescription and says nothing about any requirement to refer the patient to a pharmacy that can fill the prescription.   Act 39 can be accessed on the State Legislative website.  http://www.leg.state.vt.us/docs/2014/Acts/ACT039.pdf

Through my review of Act 39, I learned that it provides immunity to physicians from civil and criminal penalties for those who participate. It raised the question in my mind: why does the law not grant the same immunity for the pharmacist and other health care workers?  Maybe they did not think of it or felt it was unnecessary or that they could get us to participate without such immunity.  I only needed to ask myself the question of why immunity is needed and was given to a physician who writes the prescription that kills the patient, but not for the pharmacist who actually fills that same prescription that kills the patient.  I learned that civil and criminal immunity is provided pharmacists in the other two states (Oregon and Washington) that passed voter referendum laws permitting physician assisted suicide, but Vermont law does not provide the same civil and criminal immunity to a Vermont pharmacist or any other Vermont health care worker.  That makes me vulnerable if I chose to fill such prescriptions.

I have bought an insurance policy yearly that hopefully provides me with adequate malpractice insurance if something goes wrong in my practice.    I have never felt certain that I had sufficient coverage but was always assured by the knowledge that pharmacists are seldom sued.  This law raises new concerns, and I think it would be wise for me if I was to consider filling these prescriptions to discuss the matter with the insurance carrier.    I feel that filling these prescriptions would open the door to more vulnerability and legal exposure if I did.  When a litigious-minded person realizes that the physician is off limits for a lawsuit, they just might well look to the next person down the line to sue and that would be me, the pharmacist.

I know so many people who have expressed concerns to me that they do not want their health care provider, any physician, pharmacist or other who would knowingly participate in the taking of a human life.  I have decided that I will never participate in such a filling.

Over the many years that I have served as a retail pharmacist, I recall the reporting in the drug magazines of surveys that the profession of Pharmacy was the most respected of professions even topping the clergy and doctors. It is not unusual that pharmacy customers tell us they believe we know more than doctors. While not necessarily so, it was nice to hear people speak so highly of us. This trust will be lost when pharmacists start doing things like assisting in the death of vulnerable individuals. People trust pharmacists who work to cure people, not to kill them.

A pharmacist with the knowledge of drug actions and reactions is in a unique position to understand the dangers created by this law. A law that allows a physician to write a prescription for an oral drug to kill a patient who they might have rightfully or wrongfully diagnosed as terminal with six months or less to live creates dangers. This is a law that requires this compromised patient to self-administer this lethal dose that could and will, in many cases, cause the patient horrific pain and suffering.  It is likely that some of these patients will botch their suicide attempt and not die as has happened in Oregon, and some could experience increased and prolonged suffering as a result. These are side effects that I believe an ethical pharmacist must consider before deciding to participate in dispensing of a drug that could do these very things.

I hope that the trust the public has put in pharmacists will not be violated by our acceptance of a law that turns our profession upside down.  I hope that pharmacists and pharmacies carry on their practice in the traditional and caring way that pharmacists have done over the centuries and, as a result, they will still command the respect of those they serve, will not jeopardize their license, livelihood, personal positions and welfare of their family, and they will be able to sleep soundly at night with a clear conscience that they did no harm to vulnerable, valuable human life.

Bob Orleck, Randolph, Vermont