MEDICAL ASSISTANCE IN DYING
Unique collaboration necessary for medical assistance in dying By Dr. Ellen Wiebe Doctors and pharmacists work together in many ways, but perhaps even more closely when providing medical assistance in dying (MAID). Read below to examine how this unique medical situation both aligns with and differs from other similar collaborative efforts. Please note: this table is not comprehensive and is only intended to highlight some of the differences when dispensing medications for MAID. Like other prescriptions, the pharmacy must retain the entire MAID prescription for a minimum of four years. To see an example of the
BC MAID prescription template (for both pharmacy regulatory and PharmaCare purposes) visit the College of Pharmacists of BC's eServices website (member login required). This article was written by Dr. Ellen Wiebe, a Vancouver family physician who provides medical assistance in dying. Dr. Wiebe spoke at a webinar in March for BCPhA members and this webinar is also now available online at bcpharmacy.ca/physician-assisted-dying.
The doctor diagnoses a condition and chooses medications based on that diagnosis.
The prescribing physician must inform the pharmacist that the medications are intended for MAID.
The doctor writes the prescription.
The prescribing physician completes a pre-printed order form that is six pages long and accompanied by a one-page special authority (SA) form for payment. The pharmacist should confirm that the SA form is faxed to PharmaCare for coverage. This SA is usually done within 24 hours. A backup set of medication is also usually ordered.
The pharmacist checks that the prescription is valid, is therapeutically appropriate and is not contraindicated due to other medications or allergies.
The pharmacist also initials the prescription to document that they have confirmed with the prescriber that it is for the purpose of MAID and that the prescriber has obtained patient consent and determined that the patient meets eligibility criteria for MAID.
The pharmacist dispenses the medication with appropriate packaging and instructions.
Drugs for MAID must be dispensed directly to the prescribing physician and both the physician and the pharmacist must sign off on the handover. The MAID drugs must be provided in a sealed, tamper-proof container.
The pharmacy disposes of any medication that has been returned.
Unused MAID drugs are returned by the prescribing physician within 48 hours of the patient's death. The pharmacist documents what was returned and disposes of the returned unused drugs.
The doctor and pharmacist maintain their respective records.
A medical administration record (MAR) for MAID must be completed by the prescribing physician and a copy provided to the dispensing pharmacist. The prescribing physician also sends relevant provincial forms and the BC Coroners Service Report of MAID Death form to the appropriate agencies.