Justice committee  We think that is a very important question. The provincial regulatory bodies are in the process of drafting guidelines for their members, and this is a very important consideration. They have to drill down on some of these specifics because they need to take the need of their populations into consideration.

Justice committee  It would be a concern, and we're definitely working with the pharmacy regulators in Canada to take this discussion further. If that were indeed the case, there would be much conversation that would definitely be necessary.

Justice committee  Absolutely.

Justice committee  Thank you for the question. There are concerns. These medications have not been used therapeutically for quite some time. We're talking about barbiturate drugs that in the past were used in therapeutic doses to help people sleep. We understand that the companies that used to make these medications are no longer doing so.

Justice committee  Well, I think it's important that Health Canada would make the necessary provisions to allow manufacturers to import these drugs from other countries where they are being produced.

Justice committee  Well, first, we feel that there are a number of unanswered questions that the pharmacy profession needs to address. What we will say, though, is that we do not believe it's within the scope of practice for pharmacists to make a judgment on capacity. We feel it's important for pharmacists to know that a patient has met the criteria for assisted death, but we do not feel that pharmacists are in a position to make that determination of capacity.

Justice committee  Yes, that's the kind of structure that we had anticipated. It would be an independent third party agency that could be engaged in such a way. Exactly.

Justice committee  Thank you very much, Mr. Chair, and also the committee, for inviting us to speak today. First I'd like to acknowledge the difficult task you have before you. The final legislation must strike a balance between the needs of patients, the right to access, and ensuring that health care providers are fully equipped to deliver quality care regardless of the setting.

Physician-Assisted Dying committee  It's quite likely that some of the precedents that have been set in other jurisdictions, such as Oregon and the Netherlands, would be used here in Canada as well. Typically, patients who consume these drugs in the home setting use long-acting barbiturate drugs, which is a class of drugs that hasn't been used very much in Canada in the last 20 years.

Physician-Assisted Dying committee  There is a process within Health Canada to provide increased access to drugs that are available internationally and to make them available in Canada through, for example, the special access program. However, if those drugs are deemed to be the most appropriate ones in this setting, there is a role for the federal government to make those drugs available.

Physician-Assisted Dying committee  Thank you for the question. We did not specifically ask the question that the CMA mentioned earlier. We did ask the following questions, which I think are relevant to this discussion. When we asked respondents to express their level of agreement with the statement “Pharmacists should be obligated to participate in assisted dying”, 70% of pharmacists either disagreed or strongly disagreed that pharmacists should be obligated, so there's fairly strong disagreement with that statement.

Health committee  Again, there is a high degree of judgment involved in this. It has to be within the pharmacist's level of expertise. I would say most pharmacists are not going to be in a position to prescribe Remicade. This is something that a specialist is going to be prescribing. A pharmacist may be able to detect if a patient is perhaps failing on the Remicade and that maybe it is not the best medication for them.

Health committee  I believe provincial governments are able to track the prescribing habits of pharmacists, yes.

Health committee  If I could just add to that, the Controlled Drugs and Substances Act regulates the controlled drugs in Canada, but it doesn't have a monitoring and surveillance side to it. I think maybe it's time to look at that. I think we need a national monitoring vehicle because people do move from province to province as well.

Health committee  This was actually put into place a couple of years ago. What we typically see is someone running out of their medication on a late evening or weekend, and it's a medication they've been taking routinely. It could be something for their blood pressure, or their cholesterol. Rather than get in touch with a doctor and perhaps have to wait a little bit, we're able to continue that therapy.