Medical Assistance in Dying Medication Protocol Updated

The Medical Assistance in Dying Medication Protocol has been enhanced by:

  • Clarifying the role of pharmacists when verifying that the necessary assessments have been completed;
  • Changing the oral protocol drug formulation; and,
  • Adding additional information to support pharmacists, pharmacy technicians, and other team members in coordinating access to consumables used to support assisted dying interventions.

Two additional documents have been posted in the password-protected (for registrants only) area of our website to support pharmacy team members involved in interventions:

  • Medication Administration Record – to be completed by health professionals attending an intervention; and,
  • Medication Inventory Tracking Sheet – to be completed by pharmacy team at time of dispensing and when unused medications are returned to the pharmacy.
Background

In June of 2016, the federal government approved legislation legalizing Medical Assistance in Dying. As of June 30, 2017, there were 164 assisted dying interventions conducted in Alberta; 115 in AHS facilities and 49 in the community. The injectable protocol has been used in all Alberta-based interventions. In all instances, pharmacists and pharmacy technicians who have taken the initiative to prepare themselves (and their teams) to support the wishes of individuals suffering at the end stages of life, are commended for doing so in a professional and dignified manner.

Alberta continues to lead Canada in our approach to assisted dying. This is largely due to strong leadership from within AHS, and its commitment to partnering with ACP, CARNA, CPSA, and Alberta Health, amongst others. Every experience is documented and evaluated, and that has allowed continuous learning and improvement to occur.

When receiving a prescription protocol for assisted dying, pharmacists are to verify with the providing practitioner that all assessments have been completed and that the patient has been deemed to satisfy all of the qualifying criteria identified in the June 30, 2017, Medical Assistance in Dying Medication Protocol. Review of documentation is not required by the pharmacist. Verification occurs when the pharmacist asks the providing practitioner whether each criterion has been met and an affirmative response is received for each criterion. The pharmacist shall document verification by initialing beside each criterion.

Chloral hydrate was a significant ingredient in the original oral protocol. It has toxic properties that presented potential risk to individuals compounding it, and was very unpalatable due to its potential to burn. Medical Assistance in Dying partners have identified a new protocol from Washington State that does not include chloral hydrate.

Please review the new Medical Assistance in Dying Medication Protocol to familiarize yourself with these changes and the new information provided.