The American Medical Association recently voted to request further clarification of a report on physician-assisted suicide published by its Council on Ethical and Judicial Affairs. That may sound dull and procedural, but it has an unmistakable significance for the doctors’ group, which has always opposed turning its members into life-enders instead of health-givers.
We all must keep an eye on what the AMA is considering regarding this dangerous public policy. The ramifications to the safety of our patients and the practice of medicine are profound.
The CEJA report, a product of two years of work by that group, began by stressing the importance of accurate terminology. After careful consideration, the authors wisely recommended use of the term “physician-assisted suicide” rather than “death with dignity” or “aid in dying.” They explained that, although “physician-assisted suicide” connotes opposition to the practice, it also provides the greatest precision, and that precision facilitates a more robust debate. Plain language is crucial for a productive discussion between parties who are of goodwill but who disagree.
I couldn’t agree more — the euphemisms touted by proponents only shroud the intent to give physicians the ability to help patients die by suicide.
The CEJA report concluded that there are irreducible differences in moral perspectives on physician-assisted suicide, with those pro and con both holding deeply held beliefs and values. CEJA noted that a policy position of neutrality could be read as “little more than acquiescence with the contested practice.” I agree — for on an issue of such fundamental importance, the AMA does us all a disservice if it takes no position.
Speaking of the risk of the unintended consequences of legalizing physician-assisted suicide, the CEJA report found that current evidence from Europe “tells a cautionary tale.” The report authors noted that European countries legalizing physician-assisted suicide have expanded the practice to include people with psychological suffering and to also include the practice of euthanasia — that is, doctors actually killing people, as opposed to helping them end their own lives.
Noting great doubts about the oversight and procedural safeguards in Europe, CEJA concluded that “medicine must learn from this experience.” Yet in jurisdictions of the U.S. where assisted suicide is legal, experience has shown that the supposed safeguards are hollow and easily circumvented. Data from the Centers for Disease Control tragically show that suicide rates continue to rise. If we come to a point where our end-of-life patients prefer suicide over medical care, then physicians need to ask ourselves some very tough questions.
CEJA noted that there are too few conversations between physicians and their patients regarding end-of-life issues and options. This highly esteemed ethics council was concerned that “many patients may be led to request assisted suicide because they don’t understand the degree of relief of suffering state-of-the-art palliative care can offer.” I would add that high-level multidisciplinary palliative care is also not available in many places in America, especially rural and poor communities. As Canada has discovered, lack of access to the best palliative care can drive patients to choose assisted suicide and euthanasia.
CEJA made it clear that physicians have a particular responsibility to protect vulnerable and disadvantaged patients from adverse influences in end-of-life decision-making. Physicians must rise to that challenge.
CEJA concluded its report by recommending no changes to existing AMA policy on physician-assisted suicide, which holds that “permitting physicians to engage in assisted suicide would ultimately cause more harm than good” and that “physician-assisted suicide is fundamentally incompatible with the physician’s role as healer.”
The day following its vote for further clarification of the CEJA report, the AMA then voted to keep in force policy that the AMA “strongly opposes any bill to legalize physician-assisted suicide or euthanasia, as these practices are fundamentally inconsistent with the physician’s role as healer.” In other words, while the AMA wants to think more about physician-assisted suicide and to give its members and the entire medical community the utmost clarity regarding this practice, the AMA remains opposed to its legalization. And pending the new CEJA review, all existing AMA policy against physician-assisted suicide remains unchanged and in full force.
While the AMA passed up an opportunity to accept a remarkably cogent and courageous report of its Council on Ethical and Judicial Affairs on the complex issues surrounding physician-assisted suicide, I trust that upon further reflection the AMA will not bend with the winds of political interests, but rather maintain the perennial wisdom of “Do no harm.”
Frederick J. White, M.D., serves as chair of the Board of Councilors of the Louisiana State Medical Society.
