Oral medical assistance in dying (MAiD): informing practice to enhance utilization in Canada.

The legislation Bill C-14 legalized medical assistance in dying (MAiD) in Canada. After thorough assessments of eligibility by two clinicians, Bill C-14 allows for both intravenous-assisted death by a clinician (euthanasia) and prescription of oral medication for self-administration (assisted suicide). Nevertheless, since inception in June 2016, intravenous euthanasia is the main form of delivery of assisted death in Canada. The reasons why oral MAiD is underutilized in Canada are multifactorial. Currently, there is no consensus on either the medications or the protocols for oral administration, nor a comprehensive understanding of the potential side effects and complications associated with different regimens. The quality of evidence for optimal MAiD medications is low, so any suggested recommendations can only be informed by the global but generally anecdotal experience. The challenges for implementing oral MAiD in Canada include a need to enhance clinician comfort in prescribing oral medications as an alternative to intravenous administration. The goals for ideal oral MAiD medications are 100% effectiveness and minimal side effects, while ensuring that the needed dose is both palatable and deliverable in a tolerable oral volume. The Netherlands has the most experience worldwide and barbiturates have emerged as the most common, efficacious, and tolerable agents by patients. Based on this global experience and the over-arching goals for oral MAiD, we recommend the use of a secobarbital suspension combined with antiemetic prophylaxis.

Survey of graduates of the british columbia pharmacy practice residency programs, 1973-2009.

BACKGROUND: The Canadian Hospital Pharmacy Residency Board (CHPRB) first introduced accreditation standards to guide the development and maintenance of pharmacy residency programs in the 1970s. These standards have evolved over the years, including a comprehensive revision in 1998. Ongoing quality assessment of residency training is necessary to identify areas for improvement and to ensure that residency training keeps pace with continual changes in pharmacists' roles. OBJECTIVE: To characterize the practices of graduates of the British Columbia Pharmacy Practice Residency Programs (BCPPRPs), to review the effect of residency training on their careers, and to assess whether the BCPPRPs achieved their educational goals with respect to the 2010 CHPRB accreditation standards. METHODS: An 18-question electronic survey was sent by e-mail to all graduates of the BCPPRPs from inception in 1973 to 2009. Both quantitative and qualitative data were collected, so descriptive, narrative, and formal mixed-methods approaches were used for the analysis. RESULTS: Of the estimated 490 graduates, 144 (29%) completed the survey. About 95% of respondents (125 of 131) agreed that the BCPPRPs had adequately prepared them for a career in hospital pharmacy practice. A majority strongly or somewhat agreed that their respective programs had allowed them to aquire all core competencies. There was less agreement about the achievement of project management and leadership skills. Analysis of these results by eras (specifically, before and after the 1998 revision of the CHPRB accreditation standards) showed statistically significant improvements in achievement for 2 of the educational outcomes, "providing evidence-based direct patient care as a member of an inter-professional team" (p = 0.001) and "adequate training in literature appraisal" (p = 0.005). CONCLUSIONS: A majority of respondents recognized that their residency program had a substantial impact on their hospital pharmacy careers, especially in terms of developing direct patient care skills. The 2010 standards have introduced a specific outcome related to leadership skills. These results indicate that both the CHPRB and specific residency programs would benefit from discussions clarifying outcomes related to project management skills.