Abstract
BACKGROUND: Assisted suicide is discussed in many countries to permit terminal-ill patients to die in dignity. Pharmacists often have the last interaction with the patients. This study aimed to explore Austrian pharmacists' perspectives on assisted suicide and to identify challenges and strategies for improving this service. METHODS: The study was a cross-sectional convergent parallel mixed-methods study. The quantitative component involved digital surveys distributed by the Austrian Board of Pharmacists. The qualitative phase included semi-structured interviews with pharmacists who had experience dispensing lethal drugs. Quantitative data were analysed using SPSS and qualitative data through Mayring's content analysis with MAXQDA. Findings were integrated through mixed-methods matrices for comparison and strategy development. The study was registered in the German Clinical Trials Register (DRKS00034077). RESULTS: A total of 324 pharmacists participated (193 enrolled and 131 non-enrolled) yielding a 5.11% total response rate. Over half of the enrolled pharmacists (52.8%) had dispensed the lethal drug, viewing their involvement as a responsibility (55.6%) and feeling mentally capable (44%). Nearly half of non-enrolled pharmacists (42%) opposed participation, citing safety concerns and fear of mental burden. In-depth interviews (n = 5) highlighted the emotional strain on patients and pharmacists. Older pharmacists felt more prepared than younger ones (ρ = -0.295, p = 0.001). Enrolled pharmacists viewed training as helpful, while non-enrolled saw it as a barrier, emphasising the need for better communication and support. CONCLUSION: The study identified key issues and areas for improving care and pharmacist enrolment. Frameworks can assist pharmacists supporting patients facing their last destination, while also providing room for their own reflection.Trial registration: German Clinical Trials Register identifier: DRKS00034077.