According to a recent poll conducted by C+D, 74% of 188 respondents were supportive of legalising assisted dying.

Over a third (36%) would be happy for assisted dying to be legalised without a ‘conscience clause’, allowing pharmacists and other professionals to opt out of being involved.

The poll is timely in light of the Assisted Dying for Terminally Ill Adults (Scotland) Bill.

If you are unclear on exactly how pharmacy professionals might be expected to be involved in assisted dying under the Bill’s proposals, you are not alone.

Careful examination of the Bill indicates that even those proposing the new law have not fully considered the role of pharmacists and pharmacy technicians.

Read more: C+D Snap Poll: 74% of pharmacists in favour of assisted dying

In practice, pharmacy professionals would be very involved in the process: procuring, preparing and dispensing the unlicensed product; clinical screening and accuracy checking the prescription; providing counselling to patients; and contributing to the development of clinical guidance and protocols.

Community Pharmacy Scotland and 38% of poll respondents declared themselves satisfied with the existing conscience clause in the Bill (section 18). However, that clause is deeply flawed, and thoroughly ill-suited to protecting the minority of pharmacy professionals who might seek to opt out.

The main issue with the clause is that – as things stand – it may well not become law along with the rest of the Bill.

While the Scottish Parliament has the power to legislate for assisted dying, it lacks the power to legislate about conscientious objection.

Unless it is granted such power by Westminster, section 18 will simply be ineffective, and health professionals will have no right to opt out at all.

Read more: The assisted dying debate

But even if the power is granted and the clause does take effect, it would still be inadequate. The clause is modelled on section 4 of the Abortion Act 1967. In 2014, when the UK Supreme Court decided the case of Greater Glasgow Health Board v Doogan, it ruled that section 4 only protected professionals from ‘direct’ or ‘hands-on’ involvement in abortion.

The wording of section 18 in the current Bill means that the same would be true of assisted dying. Whether pharmacy professionals were protected from having to fulfil certain tasks in relation to assisted dying would depend, therefore, on whether those tasks were considered sufficiently ‘direct’ or ‘hands on’ to be covered.

In our view, there is a risk that the ways in which pharmacy professionals would be expected to support the process would be regarded as indirect, and therefore not protected by the conscience clause. This ought to be a cause for real concern.

Even if all of the tasks of pharmacy professionals were covered by section 18, the Bill envisages that those objecting to a particular task will have a duty to ‘refer’, i.e. to arrange for the task to be taken over by another professional who has no such objection.

This duty is already familiar in the context of, for example, a pharmacist conscientiously objecting to emergency hormonal contraception, or a GP objecting to arranging an abortion.

The nature of the two contexts is quite different, however. In contrast with the context of emergency contraception, or unplanned pregnancy, assisted dying is never an unplanned event or emergency, and people seeking assisted dying are not up against clinical deadlines (as is the case with emergency contraception) or statutory time limits (as with abortion).

Read more: CPS ‘partially supports’ assisted dying with pharmacist ‘opt-out’ clause

It is not clear, therefore, why a duty to refer – which still entails complicity in the practice being objected to – is felt to be necessary in relation to the current Bill.

A small number of hubs could support a nationwide assisted dying service, minimising the number of pharmacy professionals involved. Those who chose to work in the hubs would not be objectors (just as a pharmacist who objected to abortion would not seek employment at BPAS).

A healthy, functioning profession requires reflective, analytical professionals, who do not provide services uncritically simply because they are lawful. ‘Lawful’ is not synonymous with ‘ethical’, and it is legitimate to disagree about the ethical status of lawful services. The bare fact of assisted dying becoming lawful would not mean that it would somehow become an objective moral good that all professionals should accept, or be willing to provide.

RPS Scotland’s published policy position on assisted dying supports conscientious objection, and (like other professional bodies) it advocates for an ‘opt in’ system. We welcome this suggestion.

However, it should not be supposed that an opt-in system would remove the need for a meaningful conscience clause in the Bill, because while an opt-in system with dedicated hubs might be enough to fully protect pharmacists and pharmacy technicians, members of other health professions might still find themselves working in proximity to the assisted dying process despite having objections.

Conscientious objection is key to safeguarding not only the integrity of individual professionals, but also the rich diversity of the profession, avoiding excluding those with particular viewpoints or faith backgrounds.

Protection for conscience is not a luxury, but an essential feature of any assisted dying legislation, and pharmacy professionals and organisations should be far from satisfied with what is currently on offer in the Scottish Bill.

Isaac Moore is a pharmacist and a funded Doctoral researcher at the University of Strathclyde.

Dr Mary Neal is a Reader in Law at the University of Strathclyde and has published widely on both assisted dying and conscientious objection.