AMA Says ‘No’ to Physician-Assisted Suicide
About a year ago, the Washington Post reported on the debate at the American Medical Association regarding physician assisted suicide, and asked whether its longstanding opposition might change. The answer is now in, and the answer is a resounding NO. We are not simply reaffirming opposition to an unethical practice. The AMA has reasserted the fundamental role of the physician as healer, and a commitment to principles of the ancient oath to Do No Harm.
This summer, after 2 years of in-depth study by our Council on Ethical and Judicial Affairs (CEJA) and another year of formal debate, we at the AMA House of Delegates voted at the annual meeting by a 71% majority to reaffirm our opposition to physician assisted suicide, again noting that it is “fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.”
We are the largest medical association in the country. With our recent vote reaffirming opposition we join the 2nd largest physician association, the American College of Physicians, which reaffirmed its opposition in 2017, as well as the World Medical Association, which reaffirmed its opposition in 2015.
The AMA-adopted report retains use of the term “physician-assisted suicide” rather than the sanitized “death with dignity” or “aid in dying.” Ethics requires clarity of expression. We owe our patients, the media, and politicians straight-forward language that betokens honest, productive discussion between divergent parties of goodwill.
There are unintended consequences of legalizing physician-assisted suicide, as have been seen both in the European experience and in the small handful of states that have legalized. Recently, there have been cases coming from Europe where persons experiencing acute clinical depression were either abandoned to, or assisted with, suicide by medicine. This is unconscionable.
But the European issues are not isolated to the old world. Here in the United States, cases have been reported of patients with psychiatric conditions being given the lethal drugs, even though not technically qualified to do so. In Oregon this year, we also saw several legislative bills attempting to expand the practice, eroding what little safeguards there are. In this context, the AMA again saw physician assisted suicide as impossible to control and posing serious societal risks.
People with disabilities rightfully join in opposition to the practice. Physician-assisted suicide may be an affront to the physician’s role as healer, but it is also an assault on the lives of people with disabilities, putting them and other vulnerable groups at risk of deadly harm through abuse, mistakes, and outright coercion toward ending life.
The AMA fully embraces and supports patient autonomy. It is not, however, ethically incumbent upon physicians to be party to all of the decisions a patient may make for themselves. Further, the AMA has policy affirming the highest quality care at the end of life, especially quality hospice and palliative care that, without intentionally delaying or hastening death, can alleviate nearly all physical suffering and much existential suffering at the end of life. As the approved ethics report states, the AMA heard physician concerns 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.” When the top five reasons people are requesting lethal drugs in Oregon have nothing to do with physical pain, we in medicine need to ask ourselves whether we are doing enough to navigate the complex existential and psychological sufferings our patients are enduring as they face their mortality.
Are physicians receiving adequate training in end of life care? Do our patients with economic disadvantage have equal access to end of life care? These questions challenge medicine and public servants to actionable discussion on doing all in our power to end suffering without ending the lives of those who suffer. As we have again concluded at the AMA, “permitting physicians to engage in assisted suicide would ultimately cause more harm than good.”
Frederick J. White, MD is a Louisiana Delegate to the American Medical Association