Earlier this month, a Coroner issued a Prevention of Future Deaths Report, following the death by suicide of John Ellis MRCVS, a veterinary surgeon. In it, Simon Burge, the Coroner for Hampshire, Portsmouth and Southampton, raised concerns about the ease of access to euthanasia drugs by veterinary staff. So what does this mean for the veterinary profession?
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It’s well recognised that mental health burdens are statistically high in the veterinary profession. And that veterinary surgeons are 3-4 times more likely to take their own lives than the general population. While we know that suicide is multi-factorial, and can almost never be blamed on a single cause (despite media attempts to do so), the Coroner focused on the ease with which Mr Ellis obtained a euthanasia drug, which he used to take his own life.
The sad train of events
For whatever reason, apparently relating to both his personal and professional life, Mr Ellis felt that he needed to end his life. He obtained a quantity of a Schedule 3 Controlled Drug (more on that later) that is commonly used to euthanase dogs by telling a colleague that he needed to euthanase a large dog. He then used it to end his life.
Leaving aside the tragic waste of his own life, the impact this has had on his colleagues has to have been profound.
How easy is it for vets to get access to euthanasia drugs?
To some extent this depends on the practice. The issue is that in many situations euthanasia is an emergency, and animal welfare needs to be prioritised. Against that, barriers are generally set up to prevent unauthorised access to these drugs (e.g. theft as these are all potentially drugs of abuse). So there is a tension here; however, the law is not as strict as most people think.
What does the law say?
This is complicated. Schedule 2 Controlled Drugs such as morphine or ketamine have very strict requirements, including being kept locked in a secure Controlled Drugs Cabinet. And a register must be maintained detailing who withdrew any quantity of drugs from stock.
On the other hand, for Schedule 3 Controlled Drugs there is no legal requirement for a Register or for Safe Custody in this sense. (Although the RCVS strongly recommends they should always be kept under lock and key, and almost all practices do anyway).
The relevant laws are quite venerable now; the Misuse of Drugs Act 1971, the Misuse of Drugs (Safe Custody) Regulation 1973, and the Misuse of Drugs Regulations 2001. However, these laws are primarily aimed at preventing theft for “recreational” abuse from human medical facilities, rather than access to drugs licensed for euthanasia in a veterinary context, for suicide. Given that vets need these drugs to euthanase animals, often in an emergency, and therefore need access to them, the law doesn’t really reflect the reality in a veterinary practice.
Who could make any changes?
The RCVS could introduce specific requirements for a “2 man rule” in veterinary practices. However, this would only be binding on veterinary surgeons and veterinary nurses, and cannot be enforced on a practice (the RCVS has no authority over practices, just the professionals employed in them).
The VMD, on the other hand, as the regulator for veterinary medicines, could add a binding requirement for additional controls on Schedule 3 Controlled Drugs. However, whether they would want to, since this would involve amending Home Office derived legislation, is unclear.
Ultimately, I suspect this needs to go through the Home Office, who enforce the Misuse of Drugs Regulations. Again, though, it’s unclear whether there would be an appetite for major reform at this time; despite the fact that misuse of drugs for suicide seems to be a major issue in the veterinary (and maybe even the medical) world.
As I write this, the debate on assisted dying is actively ongoing in Parliament. I wonder, if the bill goes through on Friday, whether the law will have to be amended once euthanasia becomes an option in the UK for humans, and these drugs start being used in medical contexts?
However, right now, I suspect it will be up to the RCVS to act.
What changes could be put in place?
The most logical change would be to require that Schedule 3 drugs are kept in the Controlled Drugs cabinet; require a register to be kept of all drug withdrawals, even of Schedule 3 drugs; and also to add a mandatory “2 man rule”, whereby two registered professionals (vets or vet nurses) are required to authorise a withdrawal.
While more stringent requirements are possible, they would have to be balanced against the requirement to be able to access these drugs in an emergency.
Will this make a difference?
Sadly, no change in procedure or protocol is ever going to prevent every person in crisis from taking their life. But anything that adds a “speed bump” and encourages professionals to talk to each other will help. Anything that adds another layer of consideration will reduce the number of impulsive or reflexive suicides; and every professional checking in on their colleagues and querying how they’re doing will help reduce the chances of people getting into that situation in the first place.
Remember…
If you’re a veterinary professional reading this, and are struggling with any problems – please, please, please talk to someone about it! A friend, a family member, or the great people at VetLife on 0303 040 2551. Vetlife is there for you 24/7 – anytime. You do not need to be at crisis point to reach out.
Even if you’re not, then there are people who can help if you, a friend or family member is in crisis. Contact the emergency services on 999 or 112; call the Samaritans on 116123; or Papyrus if you’re under 35 on 0800 684141.
And if you can – think about donating to Vetlife, the support charity for the veterinary industry.
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