The American Medical Association (AMA) House of Delegatestoday voted 53 to 47 percent to reject a report by its Council on Ethical and Judicial Affairs (CEJA)that recommended the AMA maintain its Code of Medical Ethics’ opposition tomedical aid in dying. Instead, the House of Delegates referred the report backto CEJA for further work.
TheAMA Code of Medical Ethics Opinion 5.7 adopted 25 years ago in 1993 beforemedical aid in dying was authorized anywhere in the United States says:“…permitting physicians to engage in assisted suicide would ultimately causemore harm than good. Physician-assisted suicide is fundamentally incompatiblewith the physician’s role as healer…”
Incontrast, the CEJA report implicitly acknowledges that medicalaid-in-laws improve end-of-life care, by spurring conversations betweenphysicians and terminally ill patients about all end-of-life care options, suchas hospice and palliative care:
“Patientrequests for [medical aid in dying] invite physicians to have the kind ofdifficult conversations that are too often avoided. They open opportunities toexplore the patient’s goals and concerns, to learn what about the situation theindividual finds intolerable and to respond creatively to the patient’sneeds…” said the report. “Medicine as a profession must ensure thatphysicians are skillful in engaging in these difficult conversations andknowledgeable about the options available to terminally ill patients.” (Seelines 38-45).
TheCEJA report also acknowledges: “Where one physicianunderstands providing the means to hasten death to be an abrogation of thephysician’s fundamental role as healer that forecloses any possibility ofoffering care that respects dignity…. another in equally good faith understandssupporting a patient’s request for aid in hastening a foreseen death to be anexpression of care and compassion.” (See lines 10–14).
Themajority of AMA delegates felt that the AMA Code of Medical Ethics should bemodified to better reflect the sentiment of the report.
“Wefeel that the AMA abandons all of the physicians who, through their consciousbeliefs, are allowed to support patients who are in the states where it islegal and feel that that does need to be addressed regardless of how we feel,”said neurologist Lynn Parry, an AMA delegate from Colorado, just before thevote. “We don’t care how long it takes you.”
“Clearly,the AMA’s position is evolving as delegates hear from more and more colleagueswho practice medical aid in dying or believe the option should be available totheir patients,” said Dr. Roger Kligler, an AMA member and retired internist inFalmouth, Mass., living with stage 4 metastatic prostate cancer who supportsmedical aid in dying.
Medicalaid in dying has been authorized in Washington, D.C. and seven states —Colorado, Hawai‘i, Montana, Oregon, Vermont, Washington, and California —although the California law currently is under legal challengebased on a technicality. Collectively, these eight jurisdictions representnearly one out of five Americans (19%) and have 40 years of combined experiencesafely using this end-of-life care option.
“Manyof the AMA’s constituent societies favor neutrality in order to respect andprotect doctors and patients whether they decide to participate in this medicalpractice or not,” said Dr. David Grube, who wrote 30 prescriptions for medicalaid in dying in Oregonbetween 1998 and 2012 and currently is the national medical director forCompassion & Choices. “I’m heartened that the AMA House of Delegates isopen to continuing to study and learn about this issue when there is no clearconsensus among AMA members.”
Numerous professional associations have dropped theiropposition to medical aid in dying and adopted a neutral position. Theyinclude: the American Academy of Hospice andPalliative Medicine, Washington Academy of Family Physicians, American Pharmacists Association, Oncology Nursing Association, California Medical Association, California Hospice and Palliative CareAssociation, Colorado Medical Society, Maine Medical Association, Maryland State Medical Society, Massachusetts Medical Society, Medical Society of the District ofColumbia, Minnesota Medical Association, Missouri Hospice & Palliative CareAssociation, Nevada State Medical Association, Oregon Medical Association, Vermont Medical Society, Hospice and Palliative Care Council ofVermont, Washington Academy of Family Physicians, and Washington State Psychological Association.
In addition, medical groups increasinglyendorse medical aid in dying, including: the American College of Legal Medicine, American Medical Student Association, American Medical Women’s Association, American Nurses Association ofCalifornia, American Public Health Association, GLMA: Healthcare Professionals AdvancingLGBT Equality, and New York State Academy of FamilyPhysicians.
Accordingto a 2016 Medscape online survey, more than 7,500 doctors from more than25 specialties agreed by nearly a 2-1 margin (57% vs. 29%) that“physician-assisted dying [should] be allowed for terminally ill patients.”
In fact, Oregon’s medical aid-in-dying law has helped spurthe state to lead the nation in hospice enrollment, according to the reportpublished in the New England Journal of Medicine. More than 40 percent ofterminally ill patients in Oregon were enrolled in home hospice in 2013,compared with less than 20 percent in the rest of the United States. Nearly two-thirds ofOregonians who died in 2013 did so at home, compared to less than 40percent of people elsewhere in the nation. Research shows over 85percent of Americans say they want to die at home.
Accordingto a May Gallup poll, 72 percent of U.S. adults agreed that“When a person has a disease that cannot be cured…doctors should be allowed bylaw to end the patient’s life by some painless means if the patient and his orher family request it.”