By Jesse Hogue, Pharm.D., pharmacy education coordinator, Bronson Methodist Hospital, Kalamazoo, MSHP immediate past-president
The American Society of Health-System Pharmacists (ASHP) convened its 69th Annual Session of the House of Delegates in Minneapolis in June to consider 28 policy recommendations and a resolution, receive board and committee reports and consider a variety of other society business items. Your elected delegates this year were Gary Blake, Mike Ruffing, Paul Walker, and myself. In addition to attending the two official House sessions, the other Michigan delegates and I participated in Regional Delegate Conferences as well as during other forums and caucuses during the Summer Meeting to fully understand all the issues voted upon to consider possible language amendments, new business items and recommendations of other delegates. While a full discussion of each policy recommendation is beyond the scope of this article, I would like to highlight a few that I felt were of greatest interest to Michigan Society of Health-System Pharmacists (MSHP) members.
Any Willing Provider Status for Pharmacists and Pharmacies. This policy was of particular interest considering MSHP’s focus this year is on “Gearing Up” for advanced practice. I can’t summarize it any better than the stated rationale in the ASHP Board of Directors report, so I have copied it here: “Historically, any willing provider statutes have primarily been a concern for pharmacists in the traditional retail or community pharmacy practice settings, but as hospitals and healthcare organizations have become more engaged in developing ambulatory care service lines, pharmacists working in those settings increasingly find themselves excluded from payer networks. As pharmacists obtain provider status in a number of states, they recognize the infrastructure required to implement direct, independent patient care and billing for provider-based services. Including pharmacists and pharmacies as providers in any willing provider statutes will improve patient access to pharmacists’ care by allowing pharmacists to access payer networks, assuming those pharmacists can fulfill the terms and conditions required by payers.”
Ready-to-Administer Packaging for Hazardous Drug Products Intended for Home Use. Although at first glance you might not think it, I believed this policy was also of acute interest to MSHP members as we increasingly see these medications brought into the hospital as “patient supplied” medications and because we are becoming more actively involved in transitions of care. This policy urges ASHP to advocate that pharmaceutical manufacturers be required to provide hazardous drug products intended for home use in ready-to-administer packaging whenever feasible, and that pharmacists be involved in providing education regarding safe handling of the products. This would be expected to minimize patient, caregiver (including pharmacy staff and nurses while the patient is hospitalized), and family exposure to hazardous drugs, promote patient adherence and enhance safe medication use.
Collaborative Drug Therapy Management. This was a policy amending the existing ASHP policy 1217 of the same name. I highlighted this policy for a couple reasons. First, I think this policy closely relates to our MSHP theme for this year because it pushes for federal and state laws that recognize our advanced practice roles. Second, it recognizes that pharmacists practicing in advanced roles must be responsible and accountable for medication-related outcomes. The main amendment to the existing policy was to add a clause advocating for laws and regulations that would also allow pharmacists to transmit prescriptions electronically, which I think is very important. However, the proposed language dictates that this be done under collaborative drug therapy management protocols, which is something MSHP successfully opposed in the MPA House of Delegates policy recommendations in February because restricting us to protocols actually narrows the scope of our practice in Michigan. I have volunteered to work on amending language to address this, with broad support from many other delegates, and there is also a push to amend the policy to use the broader “collaborative practice agreement” phrase rather than the narrow “collaborate drug therapy management” phrase.
Pharmacist Participation in Medical Aid in Dying. I expected this policy to be the most controversial one we considered this year. Two years ago, the ASHP House of Delegates approved a policy opposing pharmacists’ participation in capital punishment, affirming that we, as healthcare providers dedicated to achieving optimal health outcomes and preserving life, should not participate in capital punishment. A recommendation was made after that to evaluate the ASHP position of neutrality on health professional participation in assisted suicide, and subsequently the ASHP Committee on Resolutions proposed a policy amendment strengthening that policy to one of opposition for consideration at the 2016 House. The House voted to refer the motion for further study, and the ASHP Board convened the Council of Pharmacy Management, Council on Pharmacy Practice, and the Council on Public Policy as a Joint Council Task Force to study and consider the issue. The Task Force noted in their rationale that many healthcare professionals and organizations, including the American Medical Association, the American College of Physicians, and the American Nurses Association, hold that death is not an acceptable therapeutic goal. Others, however, such as the American Academy of Hospice and Palliative Medicine and the American Psychological Association, have a neutral position, with the view that medical aid in dying has as its goal the relief of suffering through a compassionately hastened death while recognizing the risks of such a practice. They also noted that “medical aid in dying” is the currently accepted terminology, rather than “assisted suicide.” After researching and discussing the issue, the Task Force proposed a position of studied neutrality on whether pharmacists should participate in medical aid in dying. They define studied neutrality as “the careful or premeditated practice of being neutral in a dispute … to foster a respectful culture among people of diverse views and to guide action that does not afford material advantage to a [particular] group.”1 The Task Force cited a desire to promote patient autonomy and access to care and to protect pharmacists’ professional integrity and comity as the rationale for this stance. The recommended policy also reaffirmed that a pharmacist’s decision to participate is one of individual conscience, and that participation or refusal to participate should not result in retribution, which is similar to the existing ASHP policy. There appears to be significant disagreement among delegates whether to approve the Task Force’s policy recommendation, or to amend it to delete the third clause and add a first clause expressly opposing pharmacist participation in medical aid in dying. This may come down to individual delegate conscience when the vote is taken, but I would welcome input from ASHP members in Michigan on this debate. I have included the Task Force’s proposed amendment to ASHP policy 9915, ASHP Position on Assisted Suicide, below for your review (underscore indicates new text;
strikethrough indicates deletions).
To affirm that
the a pharmacist’s decision to participate or decline to participate in the use of medications in assisted suicide medical aid in dying for competent, terminally ill patients, where legal, is one of individual conscience; further,
To reaffirm that pharmacists have a right to participate or decline to participate in medical aid in dying without retribution; further,
remain take a stance of studied neutrality on the issue of health professional participation in assisted suicide of patients who are terminally ill legislation that would permit medical aid in dying for competent, terminally ill patients ; further,
To offer guidance to health-system pharmacists who practice in states in which assisted suicide is legal.
Since this discussion merely scratches the surface and all of the Policy Recommendations, I would encourage all of you to review the actions taken at the House Session which can be found here. If you have additional questions or comments, please contact one of your Michigan delegates: Jesse Hogue: firstname.lastname@example.org; Paul Walker: email@example.com; Mike Ruffing: MRuffing@dmc.org; Gary Blake: Gary.Blake@ascension.org). For more information about policy recommendations considered at the 2017 Session, click here.
1. Johnstone M-J. Organization Position Statements and the Stance of “Studied Neutrality” on Euthanasia in Palliative Care. J Pain Symp Manag. 2012;44:896-907.